Interaction and effect modification in the association between socioeconomic status and adolescent smoking: a systematic review
Bibliographic record
Abstract
This systematic review was conducted to identify effect modification and interaction factors that moderate the association between socioeconomic status (SES) and smoking behavior among adolescents. We searched the PubMed, Embase, PsycINFO, and Web of Science databases using keywords including "adolescents," "smoking," "inequality," "effect modification," and "interaction." Peer-reviewed articles published in English or French between January 1, 2011, and December 31, 2021, were included, as were relevant studies identified from reference lists. Of 3485 articles, 23 met the eligibility criteria. All reported quantitative observational study designs to identify factors that modify the SES-smoking behavior association. Two independent reviewers extracted data from each article, using a standardized form. Reporting quality was assessed using the Strengthening the Reporting of Observational Articles in Epidemiology guidelines. Of 23 studies, 13 reported statistically significant moderation associations. The most frequently studied moderators were race/ethnicity (n = 5; significant in 4) and sex (n = 5; no significant associations). Contextual factors, including school-level SES (n = 2; significant in 1), neighborhood SES (n = 2; significant in both), and peer influence (n = 2; significant in both), were also examined. Time trends (n = 2), country-level factors (n = 2), and social capital (n = 1) were significant moderators in the few studies that investigated them. Methodologically, adherence to best practices was limited. This review highlights the need for use of a wider range of SES measures, exploration of understudied potential moderators, and consistent adherence to standardized methodologies to better inform public health interventions addressing adolescent smoking inequalities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.098 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.014 |
| Bibliometrics | 0.009 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".