Exploring the perceived socio-cultural factors in the initiation of smokeless tobacco among adolescents: A systematic review of qualitative findings

Poster
2024 Prague [Global Evidence Summit]
Karuveettil V1, Ramanarayanan V1, Green H2, Fernandez R3, Sanjeevan V4, Janakiram C1
1Amrita Center For Evidence Based Oral Health: A Jbi Affiliated Group, Ernakulam, Kerala, India; Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
2School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia; Centre for tranformative Nursing, Midwifery and Health Research: A JBI Centre of Excellence, University of Newcastle, Gosford, New South Wales, Australia
3Centre for tranformative Nursing, Midwifery and Health Research: A JBI Centre of Excellence, University of Newcastle, Gosford, New South Wales, Australia; University of New Castle, New Castle, New South Wales, Australia
4Department of Public Health Dentistry, Goa Dental College, Goa, India

Objective:

This systematic review aims to identify and explore the perceived socio-cultural factors leading to smokeless tobacco initiation among the adolescent population.

Introduction: Adolescent population is at risk for initiation of addictive habits like smokeless tobacco use. Multiple socio-cultural factors are reported to be linked with using these products among this risk group. Implementing interventions during the early stages of initiation can deter adolescents from adopting this habit. To execute such interventions, an in-depth understanding of the socio-cultural factors responsible for the initiation of this habit need to be explored.

Methods:

Electronic searches were performed in MEDLINE (Ovid), Scopus, Embase, CINAHL, Psych INFO, and Cochrane CENTRAL databases. ProQuest Dissertations, OAIster, and Google Scholar were searched. Studies published from January 2002 until July 2023 and in the English language were considered for the review. Study screening, extraction, and critical appraisal were performed by two independent reviewers using the standardized JBI tools. Data synthesis involved the aggregation of categories, findings, and synthesized findings supported by illustrations. The review was reported under PRISMA reporting guidelines for systematic reviews.

Results:

Thirteen studies satisfied the inclusion and exclusion criteria and were included in the review. From the aggregation of 42 findings, eight categories were generated that were again grouped into three synthesised findings. Perceived socio-cultural factors for smokeless tobacco initiation were i) Curiosity, the experience of pleasure in combination with availability at a low cost and the perception that Smokeless tobacco products are harmless trigger smokeless tobacco experimentation for adolescents ii) Kith and kin role modelling and intergenerational transfer of the smoking habit motivates adolescents initiation of smokeless tobacco iii) Socio-Cultural identity, peer pressure and the normalization of smokeless tobacco leads to initiation for adolescents. Based on the ConQual scores, the confidence level in the synthesised findings were graded as low to moderate.

Conclusion:

Multiple socio-cultural factors trigger adolescents to experiment with smokeless tobacco. The presence of intergenerational transfer and normalization of smokeless tobacco highlights the role of society in influencing adolescents. The study results will enable policymakers and tobacco-control units establish global policies and implement control strategies to prevent SLT initiation.