Introduction
Methods
Search strategy
Inclusion and exclusion criteria
Quality assessment
Data extraction (selection and coding)
Translating interpretations and synthesis
Results
Paper No. | Authors (date of publication), country, reference | Research aims | Population, age, gender, cultural identification, smoking status | Qualitative data collection methods | Qualitative analysis |
---|---|---|---|---|---|
1 | Aho et al. (2019), Finland [49] | To assess how practical nursing students perceive themselves as smokers and future healthcare workers | N = 29 / Ages 16–25 / Gender identification: not reported / Racial and cultural identification: not reported / current smokers | 6 focus groups | Critical discourse analysis |
2 | Amos et al. (2006), Scotland, UK [47] | To explore Scottish 16–19 year olds’ understanding of their smoking and attitudes towards quitting and cessation support | N = 99 / Ages 16–19 / Female: 52 / Male: 47 / Racial and cultural identification: not reported / current smokers | Mostly paired interviews, 4 three-person group interviews and 1 one-to-one interview | A modified grounded theory approach |
3 | Antin et al. (2017), USA [50] | To investigate the lived experience of smoking stigma for black women who smoke and understand the potential unintended consequences of tobacco denormalisation policies for low-income black women | N = 15 / Ages 18–25 / Female: 14 / Not identifying with any particular gender: 1 / Black American: 15 / current smokers | 10 one-to-one interviews and 1 group interview | Thematic analysis |
4 | Antin et al. (2018), USA [51] | To examine the meanings of tobacco in the lives of sexual and gender minority youth in San Francisco Bay Area | N = 58 / Ages 19–25 / Sexual and gender minority (SGM): 58 / “Ethnic minority”: 78% / current smokers | 58 one-to-one interviews | Narrative analysis |
5 | Berg et al. (2010), USA [52] | To examine how college students define the term ‘smoker’ and how this definition impacts their behaviour and attitudes | N = 73 / Ages 18–25 / Female: 41 / Male: 32 / Non-Hispanic white: 65 / Other racial identity: 8 / current smokers | 12 focus groups | Focus group analysis |
6 | Breslin et al. (2018), Ireland [53] | To explore and understand the factors associated with young people’s use of roll-your-own tobacco | N = 62 / Ages 16–22 / Female: 29 / Male: 33 / Racial and cultural identification: not reported / current smokers | 22 one-to-one interviews and 8 focus groups | Categoric and thematic data analysis |
7 | Brown et al. (2011), USA [54] | To examine the motivations behind occasional smoking within college students who often do not define themselves as smokers | N = 53 / Ages 18–25 / Female: 30 / Male or not specified: 22 / Caucasian: 27 / Other racial identity: 8 / occasional smokers | 8 focus groups | Thematic analysis |
8 | Cheney et al. (2017), USA [55] | To understand how the Greek fraternity and sorority university social networks influence smoking attitudes, beliefs and behaviours among their members | N = 33 / Ages 18–25 / Sorority members: 16 / Fraternity members: 17 / White: 32 / White Hispanic: 1 / current smokers | 33 one-to-one interviews | Thematic analysis |
9 | Delaney et al. (2018), Scotland, UK [56] | To explore young adults’ perceptions and experiences of smoking and their smoking trajectories in the context of their social and occupational histories and transitions in Scotland | N = 15 / Ages 20–24 / Female: 6 / Male: 9 / Racial and cultural identification: not reported / ever-smokers | 15 one-to-one interviews | Thematic analysis |
10 | Dono et al. (2020), Australia [57] | To explore how social relationships and normative group behaviours can be barriers to transitioning from a smoker to non-smoker identity | N = 30 / Ages 18–25 / Female: 13 / Male: 17 / Racial and cultural identification: not reported / daily smokers, occasional smokers and former smokers | 6 focus groups | Thematic analysis |
11 | Foraker et al. (2005), USA [58] | To assess the beliefs and attitudes regarding tobacco use interventions among young adult Latinos | N = 19 / Ages 18–24 / Female: 12 / Male: 7 / Latino: 19 / current smokers, former smokers and never smokers | Individual and group interviews | Content analysis |
12 | Fry et al. (2008), England, UK [6] | To explore the reasons why smokers and non-smokers believe young people smoke, focusing on how and why they believe that they start, continue, and problems perceived with stopping smoking | N = 87 / Ages 16–24 / Female: 46 / Male: 39 / Racial and cultural identification: not reported / current smokers and non-smokers | 22 focus groups | Framework analysis |
13 | Gilbert (2007), Australia [59] | To explore what cigarette smoking means to young women in their adolescent years and to see if the decision to begin smoking is related to identify formation | N = 20 / Ages 18–24 / Female: 20 / Racial and cultural identification: not reported / current smokers | 20 one-to-one interviews | Grounded theory |
14 | Glenn et al. (2017), Canada [60] | To consider how smoking among young adults relates to their local neighbourhood contexts to better understand place-based inequalities in smoking | N = 39 / Ages 18–25 / Gender identification: not reported / Racial and cultural identification: not reported / current smokers | 9 focus groups | Thematic analysis |
15 | Grogan et al. (2009), England, UK [61] | To explore accounts of the impact of smoking on appearance in order to make suggestions for targeted appearance related anti-smoking campaigns aimed at young people | N = 87 / Ages 16–24 / Female: 48 / Male: 39 / Racial and cultural identification: not reported / current smokers and non-smokers | Focus groups | Thematic analysis and grounded theory |
16 | Haines et al. (2009), Canada [62] | To understand why young women smoke, using Bourdieu’s theory of cultural capital | N = 25 / Ages 16–18 / Female: 25 / White: 23 / Asian: 1 / Multiracial: 1 / current smokers | 25 one-to-one interviews and participants asked to take photographs to discuss how smoking fits within their lives | Coding guided by a Bourdiesian theoretical framework |
17 | Hefler & Carter (2017), Australia [63] | To explore the intersection between stigmatised identity and smoking among young people who attended social services for at-risk youth in an inner city area of Australia | N = 18 / Ages 16–25 / Gender identification: not reported / Racial and cultural identification: not reported / current smokers, social smokers, ever-smokers, former smokers and never smokers | One-to-one interviews and follow-up interviews for respondent validation and to gather information about changes over time | Grounded theory |
18 | Hoek et al. (2011), New Zealand [64] | To explore how young adult social smokers view their smoking identities and the influences on social smoking | N = 13 / Ages 19–25 / Female: 4 / Male: 9 / New Zealand European: 10 / Maori: 2 / Australian: 1 / social smokers | 13 one-to-one interviews | Thematic analysis |
19 | Hsia & Spruijt-Metz (2003), USA [65] | To identify what smoking means to Chinese American and Taiwanese American college students, and how those meanings may influence smoking behaviours in the context of acculturation | N = 30 / Ages 18–26 / Female: 16 / Male: 14 / Taiwanese American: 15 / Chinese American: 15 / current smokers, ever-smokers and never smokers | 6 focus groups | Content analysis followed by data reduction and clustering |
20 | Jones et al. (2013), USA [66] | To identify factors influencing decisions to start smoking among young black African Americans in a US midwestern state | N = 22 / Ages 19–25 / Female: 16 / Male: 6 / Non-hispanic black: 22 / smokers, former smokers and non smokers | One-to-one interviews and follow-up interviews to verify the accuracy of data analysis | Thematic analysis |
21 | Kulbock et al. (2008), USA [67] | To discover potentially modifiable protective attitudes, beliefs and norms associated with decisions of non-smoking adolescents in the US | N = 39 / Ages 16–17 / Female: 22 / Male: 17 / African Americans: 22 / Caucasian Americans: 17 / non-smokers | Group interviews | Content analysis |
22 | McCool et al. (2013), New Zealand [68] | To understand how young adults perceive smokers and smoking in an environment non-accepting of smoking, and examine how this environment stigmatises smokers. The focus was on identity and stigma within a context of denormalising smoking policies in New Zealand | N = 86 / Ages 18–24 / Female: 49 / Male: 27 / New Zealand European: 43% / Maori: 37% / Pasifika: 28% / Asian: 5% / Other racial identity: 7% / smokers and non-smokers | 14 group discussions and 4 one-to-one interviews | Thematic analysis |
23 | McQuoid et al. (2019), USA [69] | To explore the everyday smoking contexts and practices of bisexual young adults to reveal unique mechanisms driving tobacco use | N = 17 / Ages 18–26 / Cisgender female: 12 / Cisgender male: 2 / Gender queer (born female): 3 / White, Non-Hispanic: 7 / Hispanic/Latino: 6 / Asian American: 3 / African American: 1 / Native American: 1 / Southeast Asian/Pacific Islander: 1 / current smokers | Baseline survey, 30-day geographically explicit ecological momentary assessment (GEMA) integrated with follow-on one-to-one interviews | Thematic analysis |
24 | Nichter et al. (2006), USA [70] | To explore the gender dimensions of smoking among college students; specifically: acceptability of smoking, the monitoring of self and friends and norms of sharing and communicating | N = 35 / Ages 18–19 / Female: 17 / Male: 18 / Caucasian: 35 / current smokers: social smokers and casual smokers | 2 ethnographic studies, including interviews, focus groups and observations of smoking on campus | Inductive and deductive analysis |
25 | Rosa & Aloise-Young (2015), USA [71] | To explore the smoker identity among US college student smokers, beyond the smoker/non-smoker dichotomy | N = 41 / Ages 18–21 / Female: 27 / Male or not specified: 14 / White: 80.5% / Hispanic: 9.7% / Other: 9.7% / daily smokers, social smokers and occasional smokers | 6 focus groups | Thematic analysis |
26 | Scheffels (2009), Norway [45] | To explore young smokers’ construction of identity through their smoking experience in Norway | N = 21 / Ages 18–23 / Female: 10 / Male: 11 / Racial and cultural identification: not specified / current smokers | One-to-one interviews | Grounded theory and discourse analysis |
27 | Scheffels & Schou (2007), Norway [46] | To explore how young adult smokers in Norway talk about continuing to smoke in an increasing negative climate towards smoking, how they construct their identities, and the meaning they attribute to smoking as a choice | N = 21 / Ages 18–23 / Female: 10 / Male: 11 / Racial and cultural identification: not specified / current smokers | One-to-one interviews | Thematic and discourse analysis |
28 | Seguire & Chalmers (2000), Canada [72] | To explore the smoking patterns of late adolescent female smokers in Canada and factors which may/not be helpful in assisting them with quitting | N = 25 / Ages 17–19 / Female: 25 / Racial and cultural identification: not specified / current smokers and former smokers | One-to-one interviews | Codes and categories developed with reference to grounded theory |
29 | Wiltshire et al. (2005), Scotland, UK [48] | To explore experiences and attitudes towards smoking among mid to late adolescents, the role of smoking in their lives and the impact of their life transitions on their smoking | N = 99 / Ages 16–19 / Female: 52 / Male: 47 / Racial and cultural identification: not reported / daily smokers and social smokers | Mostly paired interviews, 4 three-person group interviews, 1 one-to-one interview | Thematic analysis |
30 | Youatt et al. (2015), USA [73] | To understand and explore specific factors influencing smoking among the young adult LBGTQ community | N = 30 / Ages 18–24 / Female: 30 / White: 24 / African American/Black: 4 / White/Latino/Other: 2 / Lesbian: 15 / Bisexual: 13 / Queer/Pansexual: 2 / current smokers, former smokers and never smokers | Telephone interviews | Thematic analysis |
Conceptual category | Meta-theme |
---|---|
1. Reasons for taking up smoking | 1.1 Alleviating stress 1.2 Influence of family and friends 1.3 Transition to further study, employment or leaving home 1.4 Experimenting with other risk-taking behaviours |
2. Adopting a smoker identity | 2.1 Transforming identity: a mature image 2.2 Transforming identity: a rebellious image 2.3 Sense of belonging 2.4 Smoking in groups to prevent negative reactions 2.5 Smoking to facilitate new relationships 2.6 Alcohol and social smoking |
3. Stigma of smoking | 3.1 Sensing social disapproval 3.2 Women stigmatised for smoking |
4. Barriers to quitting | 4.1 Pleasure of smoking 4.2 Minimising the health risk of smoking 4.3 Not identifying with addiction 4.4 Not identifying as a smoker |
5. Factors facilitating quit attempts | 5.1 Health concerns 5.2 Self-motivation and self-confidence 5.3 Pregnancy 5.4 Recognising own addiction to smoking 5.5 Non-smoking peers |
Reasons for taking up smoking
Alleviating stress
“We’re in college, that’s kind of stressful, you know we have jobs, we have social lives and we have school to worry about.” [73]
“Being queer in a heterosexist society is very stressful […] a lot of substance abuse within the queer community is directly tied to that stress” [51]
Influence of family and friends
“My whole family smoked, I was brought up with it. I had to almost.” [72]
“My culture [Latin American] doesn’t acknowledge that [smoking] is bad for them. It’s like, I’m going to die anyway.” [58]
Transition to further study, employment or leaving home
“At school you were always getting watched but at college you’re not […] you’ve got the freedom to smoke.” [48]
Experimenting with other risk-taking behaviours
“I don’t know if smoking led to drugs, but I think that’s what happened.” [72]
“It was really just a gradual kind of increase, it wasn’t any kind of event that said I’m going to smoke more today. I think going out and going to clubs and having a drink and everything does kind of make you smoke more.” [56]
Adopting a smoker identity
Transforming identity: A mature image
“I remember feeling like an adult when smoking […] we always wanted to look older than we were.” [45]
“I can’t quit, we start young and we are hooked. One day you wake up in the morning and it’s too late.” [72]
Transforming identity: A rebellious image
“It’s like you smoke a cigarette… you do something you’re not supposed to be doing, you know. It’s like bad for you, but it’s also like a simple little rebellion.” [70]
“It was cool you know. We gained status, and the girls thought it was tough […] It was fashion. It was a good investment.” [46]
Sense of belonging
“Rejection or alienation is a huge fear for adolescent girls […] that’s why I started, ‘cause everybody around me was smoking in my group, and I think that’s why I continued.” [59].
“At the hotel you weren’t allowed a break unless you were a smoker” [56]
Smoking in groups to prevent negative reactions
“When properly all your mates smoke and when we sit around at ours and play cards, they’re like, send them out for a fag. We can’t really stay alone with those cards.” [49]
2.5 Smoking to facilitate new relationships
“You can hang out with people, smoke, and not be drinking as a social smoker.” [71]
Alcohol and social smoking
“After I’ve had a drink I just don’t care.” [64]
Stigma of smoking
Sensing social disapproval
“I don’t smoke at work ‘cause I work in a posh, posh shop and don’t want clients thinking ‘oh there’s another wee girl smoking’” [48]
Women stigmatised for smoking
“Smoking women look like sluts. They are wild and undisciplined.” [65]
“I feel that women that smoke cigarettes are looked down upon… like you can’t control yourself, you have a problem… you’re not really a woman if you smoke cigarettes.” [50]
Barriers to quitting
“If what I have gone through hasn’t killed me so far… the cigarette is probably not going to kill me” [49]
Pleasure of smoking
“Often when I get stressed or annoyed I just go and sort of calm down with a smoke” [49]
Minimising the health risk of smoking
“I can still take care of my health even if I smoke, because I just exercise and bother to be active” [46]
“I have sort of imagined that I will quit. Maybe it will help me that my brother is quitting now. He’s in his 30s, and that’s OK because then the risk is not so high, kind of. But if you’re 40 the risk of getting ill is a bit higher. Like, not many 30 year olds get lung cancer.” [46]
“I don’t want to smoke my whole life. I want to quit by the time I’m 22 or something” [60]
“Working class people, folks of colour and queers and, God forbid, if you are all three of those things you are going to be smoking. You are stressed out. There are not a lot of things that are accessible to you in terms of relief. Like […] Who can afford mental health care? Sometimes smoking a cigarette is the difference between cutting myself or not” [51]
Not identifying with addiction
“Because I’ve never had an urge [to smoke]” [71]
Not identifying as a smoker
“I see a social smoker as someone who only wants a cigarette when they are having a few drinks and don’t smoke by themselves or have cravings during the day. Could go without.” [64]
“The people I know that have quit know about patches and gum and stuff, but they don’t want to use them. It’s a pride issue.” [58]
Factors facilitating quit attempts
Health concerns
“Probably I‘d completely stop if I had cancer or anything like that.” [70]
“I am trying to quit smoking because I find that my health and physique are not as good as they were.” [65]
Self-motivation and self-confidence
“I want to be a role model […] Like I’m well known and everything and I don’t smoke” [63]
Pregnancy
“When I’m pregnant I will quit.” [72]
“I’ve never understood that when you’re in the last stage of pregnancy, why you have to smoke in a public place. Can’t you do it somewhere out of sight?!” [49]
Recognising own addiction to smoking
“I never used to see myself as a smoker, it was just as someone who smoked. One day I couldn’t be bothered smoking and I wanted to stop but I couldn’t stop. And I didn’t even know I was addicted.” [48]
Non-smoking peers
“When I bought the e-cigarette thing I bought him one for his birthday at the same time and he quit too” [57]