Equity impact of interventions and policies to reduce smoking in youth: systematic review

Abstract

Objective: A systematic review to assess the equity impact of interventions/policies on youth smoking. Data sources: Biosis, Cinahl, Cochrane Library, Conference Proceedings Citation Index, Embase, Eric, Medline, Psycinfo, Science Citation Index Expanded, Social Sciences Citation Index and tobacco control experts. Published January 1995 to October 2013. Study selection: Primary studies of interventions/policies reporting smoking-related outcomes in youth (11-25 years) of lower compared to higher socioeconomic status (SES). Data extraction: References were screened and independently checked. Studies were quality assessed; characteristics and outcomes were extracted. Data synthesis:A narrative synthesis by intervention/ policy type. Equity impact was assessed as: positive (reduced inequity), neutral (no difference by SES), negative (increased inequity), mixed (equity impact varied) or unclear. Thirty-eight studies of 40 interventions/policies were included: smokefree (12); price/tax (7); mass media campaigns (1); advertising controls (4); access controls (5); school-based programmes (5); multiple policies (3), individual-level cessation support (2), individual-level support for smokefree homes (1). The distribution of equity effects was: 7 positive, 16 neutral, 12 negative, 4 mixed, 1 unclear. All 7 positive equity studies were US-based: price/tax (4), age-of-sales laws (2) and text-messaging cessation support (1). A British school-based intervention (A Stop Smoking in Schools Trial (ASSIST)) showed mixed equity effects (neutral and positive). Most neutral equity studies benefited all SES groups. Conclusions: Very few studies have assessed the equity impact of tobacco control interventions/policies on young people. Price/tax increases had the most consistent positive equity impact. There is a need to strengthen the evidence base for the equity impact of youth tobacco control interventions.