Abstract
ObjectiveTo assess trends in daily smokers' social norms and opinions of smoking between 2002 and 2015 in Canada, the United States, the United Kingdom, and Australia.MethodData were from wave 1 (2002) to wave 9 (2013–2015) of the longitudinal International Tobacco Control Four Country Survey (Canada, the United States, the United Kingdom, Australia), involving 23 831 adult daily smokers. Generalized estimating equation logistic regression models, adjusted for demographics and survey design effects, assessed associations of wave and country with outcomes: (A) over half of five closest friends smoke, (B) agreeing that people important to you believe you should not smoke, (C) agreeing that society disapproves of smoking, and (D) negative opinion of smoking.ResultsBetween 2002 and 2015, adjusting for covariates, (A) over half of five closest friends smoke did not change (56% vs. 55%; adjusted odds ratio [AOR] = 0.95 [95% Confidence Interval = 0.85–1.07]), (B) agreeing that people important to you believe you should not smoke generally decreased (89% vs. 82%; AOR = 0.54 [0.46–0.64]) despite an increase around 2006–2007, (C) agreeing that society disapproves of smoking increased between 2002 and 2006–2007 (83% vs. 87%; AOR = 1.38 [1.24–1.54]) then decreased until 2013–2015 (78%; AOR = 0.74 [0.63–0.88]), and (D) negative opinion of smoking decreased between 2002 and 2010–2011 (54% vs. 49%; AOR = 0.83 [0.75–0.91]) despite an increase around 2005–2006 and at the final wave (2013–2015). Except friend smoking, Canada had the greatest, and the United Kingdom the lowest, antismoking social norms and opinions.ConclusionsExcept friend smoking and opinion of smoking, daily smokers' social norms became less antismoking between 2002 and 2015 despite increases around 2006–2007. Several potential explanations are discussed yet remain undetermined.ImplicationsIncreasingly comprehensive tobacco control policies alongside decreasing smoking prevalence in Canada, the United States, the United Kingdom, and Australia have led to the assumption that smoking has become denormalized in these countries. Absent from the literature is any formal assessment of social norms towards smoking over time. Contrary to our hypotheses, this study found that the injunctive social norms of daily smokers became less antismoking between 2002 and 2015, despite increases around 2006–2007. There was no change over time in the proportion of daily smokers who report that over half of their five closest friends smoke.
Highlights
Social norms have an important impact on human behavior,[1,2,3,4] and can be categorized into two distinct domains
Data were from wave 1 (2002) to wave 9 (2013–2015) of the longitudinal International Tobacco Control Four Country Survey (Canada, the United States, the United Kingdom, Australia), involving 23 831 adult daily smokers
Contrary to our hypotheses: the descriptive norm (A) reporting that over half of five closest friends smoke did not change after adjusting for covariates; the two injunctive norms, agreeing that (B) people important to you believe you should not smoke, and (C) society disapproves of smoking, generally decreased between 2002 and 2013– 2015 despite increases around 2006–2007; (D) negative opinion of smoking generally decreased between 2002 and 2010–2011 despite an increase around 2005–2006 and some recovery at the final wave (2013–2015)
Summary
Social norms have an important impact on human behavior,[1,2,3,4] and can be categorized into two distinct domains. Social norms towards tobacco smoking can be important sources of influence for smoking intentions, uptake, and cessation.[5,6,7,8,9] Several tobacco control efforts focus on the denormalization of smoking and, in conceptual models, normalization beliefs are often placed on the causal pathway between tobacco control policies and behavioral outcomes.[10,11] Many efforts have been found to reduce smoking prevalence and promote cessation,[12,13,14,15] and smoking prevalence has decreased alongside increasingly comprehensive tobacco control policies.[16] Smoking is theorized to have become increasingly denormalized in many Western countries. A recent study among British youth found that both prevalence of smoking and prevalence of perceiving that smoking is OK have decreased between 1998 and 2015.17 there is no research of which we are aware assessing both descriptive and injunctive norms towards smoking over time
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call