Social norms towards smoking and vaping

: are they associated with smoking and vaping behaviours and policies across countries?

Abstract

Background: Tobacco control policies have been implemented in many countries to reduce the prevalence of smoking. Social norms have been theorised to be on the pathway between tobacco control policies and reductions in smoking prevalence. However, there has been little assessment of this pathway. There are also concerns that the increase in e-cigarette use (vaping) might renormalise smoking, particularly among youth, and undermine declines in smoking prevalence. Research is therefore needed to explore the associations between smoking and vaping norms, behaviours, and policies. 
Aims: To assess, among youth, the associations between: A1: smoking norms and smoking behaviours, A2: vaping norms and vaping behaviours, A3: vaping norms and smoking behaviours, and smoking norms and vaping behaviours, A4: vaping initiation and smoking initiation, A5: smoking and vaping norms and harm perceptions of vaping and nicotine. To assess, among youth, and adult smokers, whether: A6: smoking norms correspond with tobacco control policies and smoking prevalence rates, A7: vaping norms correspond with vaping policies and vaping prevalence rates. 
Methods: Six studies were used. A1: Systematic review [41 articles] and meta-analysis [17 articles]. A1-4: Longitudinal survey of British youth [N=1,152]. A5: Cross-sectional survey of British youth [N=2,103]. A1-3&6-7: Cross-sectional survey of youth in England, Canada, US [N=10,280]. A6-7: Cross-sectional survey of adult smokers in seven European countries [N=7,779]. A6: Longitudinal survey (2002-2015) of adult daily smokers in UK, Canada, US, Australia [N=23,831]. Norms were measured by assessing perceptions of how common (descriptive norms) and approved of (injunctive norms) smoking and vaping were among different social groups (family, close friends, peers, society). 
Results: A1: Descriptive norms of close others (family, close friends) were strong, reliable predictors of youth smoking initiation, more so than the descriptive norms of wider social groups (peers, society) and injunctive norms. A2: Similar results were also found for associations between vaping norms and youth vaping behaviour. A3: There were also some associations between smoking norms and v aping behaviour, and vaping norms and smoking behaviour: in Britain, friend vaping was protective against smoking, while in the US, friend vaping was positively associated with smoking. A4: Among British youth, vaping was also found to predict smoking initiation, while smoking was found to predict vaping initiation. A6: Among youth, and adult smokers, smoking norms did not always correspond with tobacco control policies or smoking prevalence rates. Smoking was also not found to have become denormalised from 2002-2015 among adult daily smokers. A7: Vaping norms similarly did not always correspond with vaping policies or vaping prevalence rates. 
Conclusions: The smoking and vaping behaviours of close others influenced youth smoking and vaping behaviours, respectively, more so than the behaviours of wider social groups and injunctive norms. Contrary to theorised, smoking and vaping norms often did not correspond with policies and prevalence rates. Denormalisation of smoking over time also did not occur among adult daily smokers. However, findings do suggest that vaping could have the potential to change norms towards smoking, and also smoking behaviour, among youth.

Date of Award	1 Jan 2020
Original language	English
Awarding Institution	King's College London
Supervisor	Ann McNeill (Supervisor) & Sara Hitchman (Supervisor)