Evidence from qualitative studies of youth about the impacts of tobacco control policy on young people in Europe: a systematic review.

Introduction: A range of tobacco control policies endeavour to prevent smoking uptake in young people, yet relatively little is known about how such interventions impact young people's engagement with smoking. We reviewed existing qualitative evidence on young people and smoking in Europe in order to assess whether, in what ways and why young people comply with, adapt to, resist or circumvent tobacco control policies in their respective countries. Methods: We undertook a systematic review of academic literature presenting qualitative research from Europe on smoking and young people (11-18 years), published from 2000 - 2015. Bibliographic searches (PubMed, PsycInfo, SSCI) produced 1357 records, from which 43 relevant papers were assessed for quality and 39 included in the review. Results: Most studies were from the UK (27), with a small number (one or two each) from other European countries (Denmark, Sweden, Switzerland, Belgium, Cyprus, Greece, Hungary, Ireland and Spain). Only 16 articles (11 from UK) provided any evidence about the impacts of tobacco control policies on young people's smoking. These focussed on smoke-free legislation (four), age of sale laws (four), plain packaging (three), and black market tobacco (one). Conclusions: There is very little qualitative evidence exploring the impacts of tobacco control on youth smoking in Europe. To develop more effective smoking prevention policies that take account of local political, social and cultural contexts, more qualitative research from a wider range of European countries is needed in order to understand how tobacco control impacts on young people's social worlds and smoking behaviours. Implications: Smoking is the leading cause of premature mortality in Europe. However, there is little qualitative evidence exploring the impact of tobacco control policies on young people in Europe. Most comes from the UK and focuses on a narrow range of policies. Thus we have a limited understanding of how and in what ways tobacco control policies reach young people, their engagement with these, and how local context affects their impact. More qualitative research is needed, from a wider range of countries and on a broader range of tobacco control policies, in order to strengthen the evidence-base for reducing youth smoking