Systematic Literature Review using Social-Ecological Approach in Adolescent Polytobacco use
Student?s name
Objective: This paper offers a systematic literature review of the existing studies covering polytobacco use among adolescents by using a socio-ecological framework.
Data Sources: an electronic literature search of studies published (strictly English articles) between 2015 and 2019 was conducted using MEDLINE, EMBASE, PubMed and Google Scholar. The search phrases used included smoking, polytobacco, adolescents, socio-ecological approach,
Inclusion and exclusion criteria: the inclusion criteria were peer-reviewed and published articles, drafted in English, pertinent to polytobacco use among adolescents. The criterion for age bracket was between 12 and 30 years.
Extraction of data: two reviewers independently extracted the sample and results
An assessment was done to estimate the number of articles that met the inclusion criteria, with the initial list narrowing down to 24 articles. The overall outcome indicates that users have preference for flavored multiple tobacco products and this has increased the likelihood of tobacco products use among adolescents and young adults.
The likelihood of multiple tobacco products use among adolescents has been significantly influenced by flavor factor. Young adults have been shown to, generally, be influenced into MTP use by menthol and sweet flavors. In addition, the results indicated how flavors led to minimized harm perceptions by users (such as fruit flavor), while on the other hand, users believed that tobacco flavor was harmful. The overall outcome indicates that consumers have preference for flavored multiple tobacco products, and this has increased the likelihood of tobacco products use among adolescents and young adults.
Keywords: Adolescents, Young Adults, Multiple Tobacco Products (hereafter MTP), Nicotine
Research has it that more than 37% of tobacco users (adults only) tend to use more than a single tobacco product [1]. While there has been a decrement in the level of tobacco use in the USA recently, the levels of multiple tobacco products (MTP) have escalated among adolescents and young adults. Tobacco has been clinically verified as the main factor resulting in disabilities and deaths in the USA. Users of MTP signify a considerable minority of tobacco users, with the major combinations of tobacco products being electronic cigarettes (e-cigars) and combusted cigarettes (CCs); hookah and CCs; traditional cigars and CCs, and; smokeless tobacco and CC [1]. The increment in MTP prevalence among adolescent users is probably as a result of increment in the marketing strategies, diversity and delivery of non-combusted cigarettes tobacco products []. For instance, the use of MTP among adolescents is considered as having increased exposure rates in comparison to a single tobacco product (STP) [].[.Erin L. Mead, Sarah Lindstrom Johnson, Junaed Siddiqui, James Butler III, Thomas Kirchner & Robert H. Feldman (2018) Beyond blunts: reasons for cigarette and cigar use among African American young adult dual users, Addiction Research & Theory, 26:5, 349-360, DOI: 10.1080/16066359.2017.1366456] [.Kowitt , S.D., Tanha, P,. Ranney , L.M., Huang, L., Sutfin, E.L., and Goldstein, A. O., 2015). Poly-Tobacco Use among High School Students. Int. J. Environ. Res. Public Health 2015, 12(11), 14477-14489;]
MTP prevalence among adolescent users in the USA is substantial due to the fact that it is affiliated with higher nicotine exposure and addictions as well as challenges with tobacco cessation in comparison to STP use [3]. While findings regularly differ with reference to the type of MTP-use combinations (cigars vs. CCs or hookah vs. CCs or; smokeless tobacco vs. CC) and the total products (poly-tobacco vs. dual product use) under study, the current literature indicates that users of MTP normally smoke a significant number of CC on daily basis in comparison to users of CC only. For instance, Huang et al. indicated a greater likelihood of CC/ENDS and dual CC/cigar to quit compared with CC-only users []. Studies have associated MTP use with increased probability of nicotine reliance as contrasted with CC-only dependence. In addition, in adolescents, MTP use is associated with increased nicotine reliance and reduced probability of cessation plans in comparison to STP users [2]. Since this paper offers a systematic literature review of the existing studies covering MTP use among adolescents by using a socio-ecological framework, the subsequent section offers a brief description of the socio-ecological framework.[. Huang, L., Kowitt, S.D., Sutfin, E.L., Patel, T., Ranney, L.M,, and Goldstein, A.O., (2016). Electronic Cigarette Use Among High School Students and Its Association With Cigarette Use And Smoking Cessation, North Carolina Youth Tobacco Surveys, 2011 and 2013. Prev Chronic Dis 2016;13:150564. DOI:]
Socio-ecological model
In accordance with centers for disease control the social-ecological framework is a model founded on theory to comprehend the multidimensional and interactive impacts of personal and ecological aspects that define behaviors, in addition to determining organizational and behavioral control points and intermediaries to promote a healthy culture among populace []. The model was initially proposed by McLeroy and colleagues in 1988 and portrays how behaviors are influenced at a 5-level approach: intrapersonal, interpersonal, organizational, community and public policy. Figure 1 below portrays the social-ecological framework based on CDC [4].[. Centers for Disease Control and Prevention (CDC) (2014). The Social Ecological Model: A Framework for Prevention, ecologicalmodel.html (retrieved April 21, 2014)]
Fig 1: social-ecological framework. Source CDC (2014).
At the individual level, the framework entails the individual aspects that impact behaviors like attitudes, beliefs, skills and knowledge. The interpersonal level entails the groups and processes offering support and identity, inclusive of peers, friends, and family. For instance, adolescents with parents or guardians who are users of MTP will be highly compelled to use as well []. In view of the organizational level, as explained by King and colleagues, the key components include organizations that promote or limit behaviors inclusive of stores, schools or churches [5]. Impacts at this level may comprise of school health programs that offer nicotine therapies aimed at helping adolescents and young adults stop quit tobacco products? use. Community level entails the larger social networks and cultural or community norms, for instance advertisements targeting the campaign of stopping usage of tobacco products among young adults and adolescents.[. King, J., Merten, J., Wong, T.J., and Pomeranz, J.L., (2018). Applying a Social Ecological Framework to Factors Related to Nicotine Replacement Therapy for Adolescent Smoking Cessation. American Journal of Health Promotion 2018, Vol. 32(5) 1291-1303. DOI: 10.1177/089011711771842]
Last but not the least, the enabling environment or the public policy include national, state, local and universal laws that govern or endorse healthy practices and procedures. The social-ecological model equally highlights the association between, and interdependence of, dynamics within and across various levels of a health predicament [5]. Users of social-ecological frameworks argue that engaging in risky deeds like tobacco use is due to an intricate social system [5] []. Given the numerous levels impact defining individual behavior as well as the environmental impacts, it is imperative to ascertain and comprehend the factors within each level. This study sought to conduct a systematic review of literature on the use of polytobacco among adolescents within the socio-ecological framework. The inclusion criteria were search of peer-reviewed and published articles, drafted in English, pertinent to polytobacco use among adolescents. The age consideration was between 12 and 30 years. Gender and ethnicity factors were equally considered in the inclusion criteria. Based on the above criteria, articles wherein participants exceeded 30 years or were below 12 years were not eligible. The other exclusion criterion was avoiding news articles, letters and editorial comments, as well as working papers.[. Collins, L. K., Villanti, A. C., Pearson, J. L., Glasser, A. M., Johnson, A. L., Niaura, R. S., & Abrams, D. B. (2017). Frequency of Youth E-Cigarette, Tobacco, and Poly-Use in the United States, 2015: Update to Villanti et al., “Frequency of Youth E-Cigarette and Tobacco Use Patterns in the United States: Measurement Precision Is Critical to Inform Public Health”. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 19(10), 1253?1254. doi:10.1093/ntr/ntx073]
Sources of data and extraction
The initial phase of the search procedure commenced on 20th August 2018, and repeated again in February 2019, for the purposes of identifying any further published articles. The key databases considered during the search process included MEDLINE, EMBASE, PubMed and Google Scholar. The search keywords used included smoking, polytobacco, adolescents, young adults, socio-ecological approach. The initial phase of the search procedure led to a total of 10,000 articles, and these were narrowed down to English peer-reviewed, thereby resulting in a total of 2000 artic…