A Systematic Review of Qualitative Studies on Factors Associated With Smoking Cessation Among Adolescents and Young Adults

Abstract

Objective To summarize findings from qualitative studies on factors associated with smoking cessation among adolescents and young adults. Data sources We searched Pubmed, Psychinfo, CINAHL, Embase, Web of Science, and SCOPUS databases, as well as reference lists, for peer-reviewed articles published in English or French between January 1, 2000, and November 18, 2020. We used keywords such as adolescents, determinants, cessation, smoking, and qualitative methods. Study selection Of 1724 records identified, we included 39 articles that used qualitative or mixed methods, targeted adolescents and young adults aged 10–24, and aimed to identify factors associated with smoking cessation or smoking reduction. Data extraction Two authors independently extracted the data using a standardized form. We assessed study quality using the National Institute for Health and Care Excellence checklist for qualitative studies. Data synthesis We used an aggregative meta-synthesis approach and identified 39 conceptually distinct factors associated with smoking cessation. We grouped them into two categories: (1) environmental factors [tobacco control policies, pro-smoking norms, smoking cessation services and interventions, influence of friends and family], and (2) individual attributes (psychological characteristics, attitudes, pre-quitting smoking behavior, nicotine dependence symptoms, and other substances use). We developed a synthetic framework that captured the factors identified, the links that connect them, and their associations with smoking cessation. Conclusions This qualitative synthesis offers new insights on factors related to smoking cessation services, interventions, and attitudes about cessation (embarrassment when using cessation services) not reported in quantitative reviews, supplementing limited evidence for developing cessation programs for young persons who smoke. Implications Using an aggregative meta-synthesis approach, this study identified 39 conceptually distinct factors grouped into two categories: Environmental factors and individual attributes. These findings highlight the importance of considering both environmental and individual factors when developing smoking cessation programs for young persons who smoke. The study also sheds light on self-conscious emotions towards cessation, such as embarrassment when using cessation services, which are often overlooked in quantitative reviews. Overall, this study has important implications for developing effective smoking cessation interventions and policies that address the complex factors influencing smoking behavior among young persons.

An overview of systematic reviews on predictors of smoking cessation among young people

“…The highest number of studies included in one review [ 12 ] was 51 studies, however, only 18 of them were retrievable. The second highest number of studies included in one review [ 38 ] was 39. Five reviews [ 13 , 34 – 37 ] detected <20 predictors, while 4 reviews [ 11 , 12 , 33 , 38 ] detected 21–50 predictors and 2 reviews [ 14 , 39 ] detected >51 predictors.…”

“…Tables 3 – 5 and S2 Appendix presents the distribution of 119 predictors of smoking abstinence/quit attempts by 3 overlapping age groups- ~12–21 years, ~16–34 years, and ~10–29 years. While the predictors for the first two age groups were very small in number, the four reviews [ 14 , 33 , 38 , 39 ] conducted on the ~10–29 years age group identified on an average of 46.5 predictors. No ‘probable’ and ‘probably unrelated’ predictors were found for ~12–21 years age group, while 22 ‘possible’ predictors, 3 predictors of ‘insufficient evidence’, and 1 predictor of ‘inconsistent direction’ were identified.…”

“…The summary statistics of the included studies and general characteristics of individual reviews are presented in Tables 1 and 2 respectively. Out of 11 final systematic reviews [11][12][13][14][33][34][35][36][37][38][39], only 2 [12,33] were published before 2010, the remaining 9 were published between 2011 and 2022. Only 2 reviews [35,37] assessed predictors of intention to quit smoking, while all reviews [11][12][13][14][33][34][35][36][37][38][39] identified predictors of smoking abstinence/quit attempts.…”

“…Finally, a total of 24 articles were selected for full-text screening. After removing 13 articles for various reasons (Fig 1 ), we included total 11 articles [11][12][13][14][33][34][35][36][37][38][39] in the final review. The detailed selection process of the articles is presented in the PRISMA flow diagram (Fig 1).…”

The association between cultural and social occasions and smoking cessation: The case of Saudi Arabia

“…Intention to quit is one factor responsible for 12% of the variance in successful quit rate 11 . Other factors that contribute to successful quitting are nicotine dependence, history of quit attempts, health consciousness, cultural norms, social support, clinician assistance, belief in smoking cessation's benefit, availability of cessation treatment, and implementation of tobacco control measures including increased tobacco prices and prevention of secondhand smoking 12,13 . Due to social stigma related to smoking among women in several Arab countries, factors that influence cessation among women were investigated.…”