Associations between school-based peer networks and smoking according to socioeconomic status and tobacco control context: Preliminary results from a mixed method systematic review
Hannah Littlecott, Jemma Hawkins, Mala Mann, G.J. Melendez-Torres, Fiona Dobbie, Graham MooreBackground: Smoking remains a major public health concern. School-based social networks influence uptake of smoking among peers. During the past two decades the UK context within which schools are nested and interact with has changed, with anti-smoking norms having become set at a more macro-systemic level. Whilst the overall prevalence of smoking in the UK has decreased, inequality has prevailed. It is plausible that the influence of school-based social networks on smoking uptake may vary according to socioeconomic status and may have changed over time. Therefore, this review aims to understand how social influence on smoking among adolescents has changed in line with variance within and between contexts according to time and geography.
Methods: The following databases were searched; Medline, PsycINFO, Embase, Applied Social Sciences Index and Abstracts (ASSIA), British Education Index, Sociological abstracts, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC) and Scopus. Additional searches included reference checking of key papers, citation tracking, word of mouth and grey literature searches. The search strategies incorporated terms relating to smoking, adolescents, schools, peers, network analysis and qualitative research. Papers using data from 1997 onwards with abstracts written in English, focused on school students (aged 11-18 years), school staff or parents will be considered. Quantitative studies must conduct social network analysis and employ either a cross-sectional or longitudinal cohort design to study participants’ exposure to network characteristics. Qualitative studies will report data on participants’ perceptions of friendship and peers and how they may, or may not, influence smoking behaviour and attitudes. Titles and abstracts and full texts were independently screened and assessed for quality by at least two researchers. Included studies were assessed for quality and data was extracted for synthesis, including participant characteristics, setting and tobacco control context, study design and methods, analysis and results and conclusions. Quantitative findings will be narratively synthesised, whilst a lines of argument synthesis combined with refutational analysis will be employed to synthesise qualitative data. Both sets of findings will be charted on a timeline to add context to network findings and obtain an enhanced understanding of changes over time.
Discussion: This mixed methods synthesis will synthesise changes in school-based friendship network structures and the context of social influence on adolescent smoking over time and geographically. As context is increasingly recognised as a key source of complexity, this enhanced understanding will help to inform future interventions targeting smoking through social influence. This will help to enhance their relevance to context, subsequent effectiveness and targeting of inequalities. Preliminary results will be presented and discussed.