BMJ public health · 2026
Social norms and the decline in US cigarette smoking: evidence from 30 years of US representative surveys.
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Strong David R, Pierce John P, Messer Karen, Dang Brian, McMenamin Sara, Stone Matthew D, Trinidad Dennis R
Аннотация
INTRODUCTION: Changing social norms on cigarette smoking are proposed as a primary strategy to reduce smoking behaviour.
METHODS: Using core questions in 30 years of tobacco use supplements (TUS) to the Current Population Survey (CPS), we develop a state-specific, injunctive social norm scale of Willingness to Restrict Smoking (WTRS) and test its association with smoking behaviours. Respondents (n=1 462 050) to US national and state representative TUS-CPS conducted at nine regular intervals from 1992 to 2022.
RESULTS: Respondents were queried on their WTRS in 10 different settings, which varied somewhat over time. Psychometric analyses of 10 items supported a single primary dimension that accounted for 74% (SD: 7.3%) of estimated common variance. Using item response theory methods, we calibrated scores across different years and demonstrated consistency of measurement over time (differential test functioning (DTF) across adjacent years = <1% difference in scores). The resulting WTRS scale had good reliability (omega-h mean = 0.75, SD=0.04 and alphamean=0.81, SD=0.03). Construct and concurrent validity of the scale were shown with regression analyses with outcomes of current cigarette smoking (p<0.001) and presence of home smoking restrictions (p<0.001). An 87% correlation between state-averaged smoking prevalence and WTRS score was observed over the 30-year period. The adjusted OR (AOR) of being a person who smokes for people in states with the lowest versus highest quartiles of states for the WTRS score was 0.74 (95% CI 0.69 to 0.76) which can be compared with the same OR between the lowest and highest quartiles of cigarette prices. (AOR=0.84, 95% CI 0.84 to 0.92).
CONCLUSIONS: This WTRS social norm scale was likely influenced by state tobacco control programmes targeting social norms and appears to be a strong indicator of declining smoking prevalence across 30 years of US data.
METHODS: Using core questions in 30 years of tobacco use supplements (TUS) to the Current Population Survey (CPS), we develop a state-specific, injunctive social norm scale of Willingness to Restrict Smoking (WTRS) and test its association with smoking behaviours. Respondents (n=1 462 050) to US national and state representative TUS-CPS conducted at nine regular intervals from 1992 to 2022.
RESULTS: Respondents were queried on their WTRS in 10 different settings, which varied somewhat over time. Psychometric analyses of 10 items supported a single primary dimension that accounted for 74% (SD: 7.3%) of estimated common variance. Using item response theory methods, we calibrated scores across different years and demonstrated consistency of measurement over time (differential test functioning (DTF) across adjacent years = <1% difference in scores). The resulting WTRS scale had good reliability (omega-h mean = 0.75, SD=0.04 and alphamean=0.81, SD=0.03). Construct and concurrent validity of the scale were shown with regression analyses with outcomes of current cigarette smoking (p<0.001) and presence of home smoking restrictions (p<0.001). An 87% correlation between state-averaged smoking prevalence and WTRS score was observed over the 30-year period. The adjusted OR (AOR) of being a person who smokes for people in states with the lowest versus highest quartiles of states for the WTRS score was 0.74 (95% CI 0.69 to 0.76) which can be compared with the same OR between the lowest and highest quartiles of cigarette prices. (AOR=0.84, 95% CI 0.84 to 0.92).
CONCLUSIONS: This WTRS social norm scale was likely influenced by state tobacco control programmes targeting social norms and appears to be a strong indicator of declining smoking prevalence across 30 years of US data.