Primary Submission Category: Health behaviors
Social Norms and Tobacco Use in China: Change under Pressure
Authors: Shaon Lahiri,
Presenting Author: Shaon Lahiri*
Introduction: Tobacco use is a global epidemic that depletes the human capital of nations, particularly in China, the world’s largest manufacturer and consumer of tobacco. While the most effective tobacco control approaches are price-based, they falter in settings with weak implementation and enforcement of tobacco control policies. Social norms are a promising avenue of tobacco reduction through the development and maintenance of anti-tobacco norms, which can exert social influence in the absence of strong regulatory conditions. However, the evidence for the influence of social norms change on tobacco use in China is severely lacking. This is further complicated by the infiltration of tobacco industry into social norms around gifting in China, and the state’s monopoly on tobacco manufacturing and sale. How social norms around tobacco use related to actual tobacco use over time in this setting?
Methods: We fit several Bayesian latent growth curve models to understand how social norms and tobacco use unfold over time in China, using longitudinal data from adult smokers, collected by the International Tobacco Control Policy Evaluation Project. The data cover nine years across four cities in Mainland China. We also conducted moderation and exploratory mediation analyses to understand how contextual factors influence the norms-tobacco use relationship.
Results: Change in social norms significantly predicts change in tobacco use over time, even after controlling for several known confounders such as addiction level. Descriptive norms exert a particularly strong and stable influence on tobacco use. This relationship was robust to missing data in sensitivity analyses.
Conclusions: The perceived frequency of others’ behavior is a potent influence on tobacco use, and group-based approaches for tobacco control should be considered for hardened adult smokers, focusing on reducing actual smoking behavior within local networks, as opposed to approval of smoking.