social acceptability of smoking: the missing link · social norms or altering the social climate of...
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Social Acceptability of
Smoking: the missing link Robert Schwartz, David Ip, Michael Chaiton, Shawn
O’Connor
Tobacco Control Research Forum
Tel Aviv University
December 18th, 2013
Ever since the 1970s, it has been proposed
that:
“the solution of the smoking problem requires a
change from an accepting social climate to one
rejecting smoking behavior”.
Denormalizing what?
Tobacco Industry?
Smokers?
Smoking?
Chapman & Freeman (2008)
decry the lack of scholarship and monitoring
related to the social acceptability of smoking,
smokers and tobacco industry reputation,
noting that an increasingly hostile social
climate towards tobacco use can be observed
in society, but is rarely studied empirically.
Outline
1. What is social acceptability of smoking?
2. Why is it important?
3. How can it be measured?
4. How did we measure it?
5. How socially acceptable is smoking in
Ontario today?
What is social acceptability / social
climate?
‘societal norms, practices, and beliefs’ [2]
patterns of ‘human actions and interactions
which include meanings, traditions, rules,
values, norms and forms of discourse’
Social Climate & Ecological
Approaches
the importance of ecological approaches to
health protection and promotion, including
focusing interventions on social climate
change. Social climate change has been
central to active public health policy agendas
in Canadian governmental and non-
governmental organizations (see for example
CDPAC (2008
Reduce Initiation of
tobacco use among
children, youth &
young adults
PREVENTION LOGIC MODEL
Strategy goal: To prevent smoking initiation and regular use among Ontario’s children, youth, & young adults in order to
eliminate tobacco-related illness and death
Reduce tobacco use
prevalence among
children, youth, and
young adults
Infrastructure Interventions Expected Contribution Known Contribution Paths Lt Outcomes
Youth Action Alliances
Lungs are for Life
High School Grants
Leave the Pack Behind
Youth Access Restrictions
Stupid.ca
Public Education/Media
Campaigns
Youth Vortal
Taxes
Ontario Tobacco-free
Network
Advocates
Visibility / Marketing
Price
Social Climate
Knowledge /
Awareness
Availability
Advertising & POS
Restrictions
Advertising Bans
Leadership,
Coordination,
Collaboration
Capacity Building
Technical Assistance
Research,
Evaluation,
Monitoring,
Knowledge
Exchange
Evidence
There is evidence to suggest that shifting
social norms or altering the social climate of
smoking by promoting a sentiment of anti-
smoking and pro-restriction of smoking among
the public can be an effective mechanism for
tobacco control policies.
Social Climate and Cessation
In one study, most former smokers identified
social unacceptability of smoking as their main
motivation for quitting,
Social Climate & Cessation ii
an unfavorable social climate towards tobacco
use has been associated with higher cessation
rates and lower smoking prevalence
HOW CAN IT BE MEASURED
Two ways to measure
SOCIETAL NORMS
VS
FAMILIAL NORMS
Societal Norms Approach
“more distal, abstract referent of society”
uses questions inquiring about the extent of
agreement to the following statements:
“[xx] society disapproves of smoking”;
“People who smoke are more and more
marginalized”
Cigarettes should not be sold at every corner
store
Familial Norms Approach
focuses on “close social network
members”.[14]
more closely reflects people’s actionable
attitudes.
How did we measure it?
CAMH Monitor (2010)
786 respondents
112 smokers, 674 non-smokers
Developed reliable 8 question Social
Acceptability of Smoking Scale (SASS)
SASS (a) 1. For you, would having friends who smoke be completely
acceptable, somewhat acceptable, somewhat unacceptable,
or completely unacceptable?
2. What do you think about people smoking cigarettes at
outdoor celebrations, parties, or other social gatherings in
which you participate?
3. What do you think about cigarette smoking among adults?
4. What do most of your friends think about cigarette
smoking among adults?
SASS (b)
5. What do most of your family members think about cigarette
smoking among adults?
6. If you started smoking cigarettes, what would most of your
family members think? / What do most of your family
members think about your cigarette smoking?
7. What do you think about people smoking cigarettes at
indoor celebrations, parties, or other social gatherings in
which you participate?
8. What do you think about cigarette smoking among
teenagers?
Scoring
For each question, scores range from 1
(completely unacceptable) to 4 (completely
acceptable).
By summing up the scores for all 8
questions, aggregate scores range from 8 to
32.
Confirmatory Factor Analysis
Based on maximum likelihood factor, we
carried out confirmatory factor analysis to
confirm our findings that the SASS is reliable
and that it is measuring one underlying
factor.
HOW SOCIALLY ACCEPTABLE
IS SMOKING TODAY
(IN ONTARIO)?
Findings
Smokers reported higher mean scores on all
eight SASS components than non-smokers
counterparts.
On average, adult smokers in Ontario found
only one of the eight items to be completely or
somewhat unacceptable - teenage smoking
with a mean score of 1.68 (out of 4).
In contrast, adult non-smokers in Ontario, as a
group, found five of the eight items completely
unacceptable or somewhat unacceptable (mean
scores < 2).
Smokers’ views on smoking at outdoor parties
and having friends who smoke appeared to be
leaning towards completely acceptable (3.46
and 3.47, respectively)
Non-smokers’ views on having friends who
smoke (2.36) and smoking at outdoor parties
(2.35) were leaning towards somewhat
unacceptable.
Cigarette smoking is more socially acceptable
for males than females; however this difference
narrows with age.
Although younger non-smoking men tend to find
smoking more socially acceptable than non-
smoking women, their perceived social
acceptability of smoking seems to decrease
with older age.
By age 65, perceived social acceptability of
smoking is virtually equal across gender.
0
4
8
12
16
20
24
28
32
18-29 30-39 40-49 50-64 65+
Age Groups (Years)
Pre
dic
ted
SA
S In
de
x S
co
res
Male Female
Implications 1
It is feasibile to include familial norms
measures in assessments of social climate
SASS is a reliable tool
SASS proved useful in discriminating
differences amongst sub-populations defined
by smoking status, sex, age and immigrant
status.
Implications 2
Although previous research has shown that
social norms, specifically family and friends’
expressed disapproval of smoking, contribute
to the formation of smoker-related stigma,[20]
this may not be the case as current smokers in
Ontario seem not to think that their families
and friends disapprove of their smoking