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Primary Submission Category: Social/relational factors

Social Norms Change and Tobacco Use: A Systematic Review and Meta-Analysis of Interventions

Authors:  Shaon Lahiri,

Presenting Author: Shaon Lahiri*

Background: Effective approaches to reduce tobacco use include taxes and smoke-free policies. However, these approaches falter in countries with relatively weak tobacco regulatory environments, such as several low- and middle-income countries where the tobacco industry has shifted operations. Social norms represent a potent lever of change to reduce tobacco use, as tobacco use spreads through social networks, influencing social norms around tobacco use in turn. But do interventions leveraging social norms or social influence actually reduce tobacco use, and if so, how do their underlying mechanisms work?

Methods: To answer this question, we conducted a systematic review and meta-analysis of the experimental and quasi-experimental intervention literature written in English in which social norms or social influence are used in some way to reduce any type of tobacco use. We searched Scopus, PubMed, PsycInfo, Clinicaltrials.gov, ProQuest Dissertations, the Cochrane Trial Registry, as well as the websites of the Society for Research on Nicotine and Tobacco, the Open Science Framework, medrXiv, and the Truth Initiative from inception to May 30, 2024.

Results: Ninety-five studies met inclusion criteria. Two hundred effect sizes from 86 studies were included in the tobacco outcomes meta-analysis, and 66 effect sizes from 29 studies were included in the social norms outcomes meta-analysis. Social norms change interventions had a statistically significant effect on reducing tobacco use and pro-tobacco social normative perceptions (g = 0.233, 95% Confidence Interval (CI) = 0.166, 0.301, p<.001 and g = 0.292, 95% CI = 0.090, 0.494, p=0.007, respectively). Interventions were commonly conducted through multi-component education sessions, often coupled with regular ‘booster’ sessions over time.

Conclusion: Social norms interventions can be used effectively to reduce individual tobacco use, as well as pro-tobacco normative perceptions.