Exploring the perceived socio-cultural factors in the initiation of smokeless tobacco among adolescents: a qualitative systematic review
Abstract
BACKGROUND: Smokeless tobacco use remains highly prevalent among adolescents in many regions, driven by complex socio-cultural influences that extend beyond individual choice. Understanding the perceived social, cultural, and familial factors that contribute to initiation is essential for informing effective prevention strategies. METHODS: A qualitative systematic review was conducted following JBI Methodology to identify and explore socio-cultural factors influencing smokeless tobacco initiation among adolescents. Electronic searches were performed in MEDLINE (Ovid), Scopus, Embase, CINAHL, PsycINFO, and Cochrane CENTRAL. Grey literature was identified through ProQuest Dissertations, OAIster, and Google Scholar. Studies published in English between January 2002 and March 2026 were eligible. Qualitative studies examining socio-cultural determinants of smokeless tobacco initiation were included, while studies focusing on cigarette smoking, alternative tobacco products, or cessation interventions were excluded. Two independent reviewers undertook study selection, data extraction, and critical appraisal using standardized JBI qualitative appraisal and data extraction tools. Data were synthesized through meta-aggregation of findings and categories, with interpretation informed by a socio-ecological framework, and the review was reported in accordance with PRISMA guidelines. RESULTS: Fourteen studies met the inclusion criteria, yielding 42 findings that were grouped into eight…
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