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Table 1 Characteristics of included studies

From: Tobacco use, smoking identities and pathways into and out of smoking among young adults: a meta-ethnography

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