Beliefs regarding cigarette use, motivations to quit, and perceptions on cessation programs among minority adolescent cigarette smokers

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

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.

"It's really addictive and I'm trapped:" A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people

BACKGROUND

Debate continues over how e-cigarettes have impacted the health of young people, and what regulatory policies should be enacted. The debate has appropriately been informed by quantitative studies, often focused on initiation, prevalence, and product transition among the general population and demographic segments. Factors driving cessation and subjective experiences that motivate young users to quit have been largely absent from the debate. This qualitative study highlights the range of motivating experiences among a population of treatment-seeking young e-cigarette users.

METHODS

Three researchers coded reasons for quitting provided by a sample of n = 1000 youth (13-17) and n = 1000 young adults (18-24) enrolled in a text message cessation program. Data spanned January 18 - February 22, 2019. Codes were adapted from previous literature.

RESULTS

The most common reasons were health (50.9%; "I want my lungs back"), financial cost (21.7%; "I don't have enough money to feed my addiction"), freedom from addiction (16.0%; "i hate juuling. it's taking over my life"), and social influence (10.1%; "it's affecting my friendships"). Selected quotes highlight a broad range of additional ways in which e-cigarette use negatively impacted young people, including decreased academic performance and mental health.

CONCLUSIONS

Young people trying to quit e-cigarettes are motivated by a diversity of reasons including health, financial, social, and academic. The range of impacts should be considered in discussions of policies intended to protect young people, and incorporated into cessation programs designed to serve them.

Revealing users' experience and social interaction outcomes following a web-based smoking prevention intervention for adolescents: A qualitative study

BACKGROUND

Tobacco smoking remains a public health problem among adolescents in the United States. While Web-based interventions for smoking prevention have been successful at the individual level, there is still an urgent need to understand their engagement capabilities and their effects at the social level. In the current study, we aimed to (1) learn about adolescents' subjective experience with a Web-based program called a smoking prevention interactive experience (ASPIRE), (2) obtain suggestions for improvement in ASPIRE content, (3) identify psychological outcomes of ASPIRE, and (4) explore outcomes of social interaction.

MATERIALS AND METHODS

After a randomized controlled trial with 110 adolescents, 20 adolescent users of ASPIRE, aged 11-18, were randomly selected to participate in one-on-one interviews at four after-school programs in Houston, Texas. Interviews involved questions concerning adolescents' experience with the intervention. Qualitative data were coded and analyzed using a constant comparison approach for the generation of themes.

RESULTS

Describing their experience with ASPIRE, participants expressed comfort in material that is tailored to their demographic and preferred interactive activities over entertaining videos. Presenting suggestions for improvement, participants mainly reported the need to include gaming features into ASPIRE. Presenting psychological outcomes, they expressed emotional engagement in the program, shifts in attitudes and beliefs, and unwillingness to smoke. Finally, as outcomes of social interaction, participants reported engagement with others in discussions about tobacco and their need to hold smokers accountable for their actions.

CONCLUSIONS

Adolescents' reports moved from their individual experience with ASPIRE to their active interactions with family members and friends and their attempt to persuade others to quit smoking. Future Web-based programs for adolescents may be designed with tailoring and game play in mind, in order to provide mobilization skills and foster social interactions against smoking.

Examination of a Process Model of Adolescent Smoking Self-Change Efforts in Relation to Gender

Little information describes how adolescents change their smoking behavior. This study investigated the role of gender in the relationship of motivation and cognitive variables with adolescent smoking self-change efforts. Self-report and semi-structured interview data from a prospective study of smoking self-change efforts were examined among 98 adolescent smokers ages 14-18 (55% female). Social disapproval motives and short-term consequence reasons for quitting, quit self-efficacy and intentions to quit were modeled in relation to prospective self-quit attempts assessed at a 6-month follow-up, separately by gender. Hypothesized mediating relationships were not supported although gender differences were noted. Social influence motives related to intention to quit and prospective self-quit attempts among girls. For boys, intention to quit predicted making a self-quit attempt. Findings emphasize the importance of examining adolescent models separately by gender and contribute to understanding of mechanisms involved in adolescent smoking change efforts.

Smoking cessation recruitment among African American youth: what youth think will help them attend

Data on the perceived sources of cessation information and the reasons why alternative school students would attend a smoking cessation program were collected from 302 students at an alternative high school who were surveyed through the Safer Decisions Program in Houston, Texas. Data collection took place between September 2006 and January 2007. Logistic regression identified that non-smokers were more likely to believe it was important to receive cessation information from doctors (4.93 adjusted odds ratio 95% confidence interval CI=1.96; 12.40), health educators (4.70 AOR; 95% CI=1.46; 15.10), people who have been affected by smoking (3.20 AOR; 95% CI=1.04; 9.80), teachers (2.73 AOR; 95% CI=1.3; 5.60), and celebrities (2.44 AOR; 95% CI=1.21; 4.92) compared to smokers. In addition, persons who had smoked in the past 30 days were twice as likely to report embarrassment (1.86 AOR; 95% CI=1.00; 3.44) and feel that it was not right to smoke (2.24 AOR; 95% CI=1.00; 5.00) compared to respondents who had not smoked during the past 30 days. While the relationships tested in this study are exploratory, they provide initial evidence for understanding the importance of smoking cessation recruitment strategies that may impact minority alternative school youth.