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Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: A systematic review and meta-ethnography of qualitative research

Littlecott, H. J., Moore, G. ORCID:, Evans, Rhiannon ORCID:, Melendez-Torres, G. J., McCann, M., Reed, Hayley ORCID:, Mann, Mala, Dobbie, F., Jennings, S., Donaldson, Caitlyn and Hawkins, Jemma ORCID: 2023. Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: A systematic review and meta-ethnography of qualitative research. BMC Public Health 23 , 424. 10.1186/s12889-022-14727-z

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Background A relationship between smoking and interpersonal influences has been well established within the literature. There have been cultural shifts in denormalisation and a reduction in tobacco smoking in many countries. Hence there is a need to understand social influences on adolescents’ smoking across smoking normalisation contexts. Methods The search was conducted in July 2019 and updated in March 2022 within 11 databases and secondary sources. Search terms included schools, adolescents, smoking, peers, social norms and qualitative research. Screening was conducted by two researchers independently and in duplicate. Study quality was assessed using the eight-item Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-centre) tool for the appraisal of qualitative studies. Results were synthesised using a meta-narrative lens for meta-ethnography and compared across smoking normalisation contexts. Results Forty one studies were included and five themes were developed, mapping onto the socio ecological model. The social processes by which adolescents take up smoking differed according to a mixture of school type, peer group structure and the smoking culture within the school, as well as the wider cultural context. Data available from smoking denormalised contexts, described changes in social interactions around smoking to cope with its stigmatisation. This was manifested through i) direct peer influence, whereby subtle techniques were employed, ii) group belonging whereby smoking was less likely to be seen as a key determinant of group membership and smoking was less commonly reported to be used as a social tool, and iii) popularity and identity construction, whereby smoking was perceived more negatively in a denormalised context, compared with a normalised context. Conclusions This meta-ethnography is the first study to demonstrate, drawing on international data, that peer processes in adolescent smoking may undergo changes as smoking norms within society change. Future research should focus on understanding differences across socioeconomic contexts, to inform the adaptation of interventions.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Social Sciences (Includes Criminology and Education)
Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Publisher: BioMed Central
ISSN: 1471-2458
Funders: Cancer Research UK
Date of First Compliant Deposit: 20 January 2023
Date of Acceptance: 25 November 2022
Last Modified: 09 Sep 2023 11:37

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