Abstract
Tobacco use kills more than eight million individuals each year, and results in substantial economic and human capital loss across nations. While effective supply-side solutions to tobacco control exist, these approaches are less effective at promoting cessation among heavy smokers, and less feasible to implement in countries with weaker tobacco control policy environments. Thus, effective demand-side solutions are needed. Shifting social norms around tobacco use is one such promising approach. To this end, a systematic review and meta-analysis of social norms intervention studies to influence tobacco use will be conducted following PRISMA 2020 guidance. Tobacco intervention studies with at least two time points that explicitly mention social norms or social influence as part of an intervention or set of measured variables will be included. Literature sources will comprise PubMed, Scopus, PsycInfo, and the Cochrane Trial Registry, as well as several grey literature sources. Two reviewers will independently screen studies, and risk of bias will be assessed using the Cochrane Risk of Bias 2 and ROBINS-I tools. The primary outcomes will be change in tobacco use and change in social norms. A random-effects meta-analysis will be conducted for both outcomes. Sources of heterogeneity will be explored using meta-regression with key covariates. Non-reporting biases will be explored using funnel plots. PROSPERO: CRD42021251535.
Highlights
IntroductionIt kills more than eight million individuals per year, and is practiced by approximately 1.3 billion users, over 80% of whom reside in low- and middleincome countries [1]
This review aims to synthesize the literature on social norms interventions, defined as studies in which social norms or social influence changes are measured as an outcome, predictor, or mediator, or in which social norms or social influence are an explicit part of an intervention even if they are unmeasured
This review focuses on social norms intervention studies, defined as an intervention study in which social norms or social influence are measured as an outcome, predictor, or mediator, or have an explicit role in the intervention or policy being evaluated but are unmeasured
Summary
It kills more than eight million individuals per year, and is practiced by approximately 1.3 billion users, over 80% of whom reside in low- and middleincome countries [1]. Estimates from 2018 suggest that 82% of smokers are male, and. 1.2 million non-smokers are exposed to second-hand smoke [2]. Tobacco-related illnesses include eight of the leading causes for premature mortality, including ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, tuberculosis, lower respiratory infections, and cancers of the trachea, bronchi, and lungs [2]. An estimate of the total economic costs related to tobacco smoking in 2012 was $1.436 trillion, with nearly 40% of this figure occurring in developing countries [3]
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