Disadvantaged youth and smoking in mature tobacco control contexts: a systematic review and synthesis of qualitative research

Abstract

Objective: To review qualitative research and synthesise findings about socioeconomically disadvantaged and socially marginalised adolescents and young adults in mature tobacco control contexts.

Data sources: Searches of PubMed and MEDLINE, additional purposive searches in Google Scholar, PsycINFO, grey literature, specialist journals and reference lists for English language articles published after 2000. Search terms were qualitative, youth or adolescent or young adult, smoking/tobacco and vulnerable populations or disadvantage or socioeconomic inequality. The most recent update of the search was undertaken in January 2014.

Study selection: Twenty articles, reporting on 17 studies, from 902 initial records were included. Inclusion criteria were: qualitative study undertaken in a country in the final stage of the tobacco epidemic and with comprehensive tobacco control measures in place, participants were youth who were socioeconomically disadvantaged or members of an identified subgroup with higher smoking prevalence and/or resided in a geographical area of low socioeconomic status. The target age range was 10-24.

Data extraction: Data were independently extracted by one author, summarised and reviewed, compared and re-reviewed at multiple time points.

Data synthesis: The majority of studies were from the UK, with the remainder from the USA, Australia and New Zealand. The review used a thematic analysis approach, and started with an open question: 'what does qualitative research tell us about disadvantaged young people and smoking?' The synthesis provides insights into the social context of smoking for marginalised and disadvantaged young people, group affiliation and identity, the role of smoking in social capital and sources of cigarettes.

Conclusions: Surprisingly few qualitative studies focused exclusively on smoking and disadvantaged young people were found. Future qualitative studies on the intersection between specific psychosocial characteristics associated with disadvantage and increased smoking risk would be of use to inform approaches to reduce socioeconomic differentials in smoking prevalence.

Keywords: Denormalization; Disparities; Primary Health Care; Priority/special populations; Socioeconomic status.