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

Abstract for Preformed Panel Presentation from the 2022 International SBCC Summit in Morocco:

"Tobacco use kills over eight million individuals annually, and results in substantial economic and human capital loss across nations. While effective policy solutions to tobacco control exist, these approaches are less effective at promoting cessation among heavy smokers and smokers living in weaker tobacco control policy environments. Thus, effective demand-side tobacco control approaches such as shifting social norms around tobacco use are needed. However, the scholarship on the conceptualization, measurement, and intervention applications of social norms is diverse and occasionally conflicting. This study synthesizes this vast terrain by focusing on the effectiveness, measurement, modality, and underlying mechanisms of NSIs [non-smoking initiatives] around and actual tobacco use.

A systematic review and meta-analysis of social norms intervention studies aimed at shifting tobacco use was conducted. Social norms change interventions had a small but significant effect on both tobacco and social norms outcomes (g = 0.229, SE = 0.04, p<.001 and g = 0.282, SE = 0.101, p=0.011). The studies were characterized by an extremely high level of heterogeneity, explained to some degree by a priori specified covariates. Resistance skills training emerged as a social norms change mechanism not previously described as such in the literature. Descriptive norms were the most common type of measured social norm, followed by injunctive norms.

Social norms change interventions are an effective approach to changing normative perceptions of tobacco use and actual tobacco use. Future research and programs should adopt a consistent approach to reporting and implementing these mechanisms to shift tobacco use, as well as other modifiable health risk behaviors."