Social Norms and Tobacco Use: Studies of Change
Open AccessTobacco use is a modifiable health behavior that results in substantial morbidity and mortality across populations. Effective approaches to reducing the prevalence of tobacco use include taxation, legal reforms, and efforts to reduce the supply of tobacco. However, these approaches falter for heavy smokers, and for smokers residing in countries with relatively weaker tobacco control policy environments. Thus, demand-side approaches are required. Shifting social norms around tobacco use may be a potent avenue to curtailing the spread of tobacco use. The influence of others on tobacco use has been studied in diverse settings, but there is comparatively little research on the association between social normative change and tobacco use change. Lingering knowledge gaps remain concerning to what degree are social norms change interventions for tobacco use effective, and if so, under what conditions are they effective?Social norms research on tobacco use in China, the world’s largest producer and consumer of cigarettes, is under-explored. This dissertation explores these issues through two original empirical studies. The first study examines the relationship between social norms change and tobacco use change over nine years among urban, middle-aged, mostly male smokers in Mainland China. The dynamics of tobacco use and normative change are modeled using Bayesian parallel process latent growth modeling, allowing for within- and between-person variation in latent constructs. Model-implied trajectories for smokers with different levels of descriptive and injunctive norms provide a more granularexploration of the norms-tobacco change relationship.The second study is a sweeping systematic review and meta-analysis of interventions to change tobacco use that have a social norms or social influence component. Casting a broader conceptual net than previous approaches to synthesize the evidence on “social norms interventions,” this study is anchored by a focus on underlying social norms change mechanisms, or the “active ingredients” of normative change, gleanedfrom previous meta-synthetic efforts. Using a novel meta-analytic approach to model the correlated and hierarchical nature of multiple effect sizes obtained from individual studies, this study estimates the effectiveness of such interventions on actual tobacco use as well as on social normative perceptions around tobacco use. Meta-regressions are conducted to explore determinants of the heterogeneity between studies. The results from both studies suggest that social norms change and tobacco use change move together, and that changing social norms is an effective approach for changing tobacco use.
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