Social Acceptability of Smoking: the missing link

Transcription

1 Social Acceptability of Smoking: the missing link Robert Schwartz, David Ip, Michael Chaiton, Shawn O Connor Tobacco Control Research Forum Tel Aviv University December 18 th, 2013

2 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.

3 Denormalizing what? Tobacco Industry? Smokers? Smoking?

4 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.

5 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?

6 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

7 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 nongovernmental organizations (see for example CDPAC (2008

8 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 Infrastructure Interventions Expected Contribution Known Contribution Paths Lt Outcomes Youth Action Alliances Lungs are for Life Leadership, Coordination, Collaboration High School Grants Availability Leave the Pack Behind Visibility / Marketing Reduce Initiation of tobacco use among children, youth & young adults Capacity Building Youth Access Restrictions Price Stupid.ca Technical Assistance Public Education/Media Campaigns Youth Vortal Social Climate Reduce tobacco use prevalence among children, youth, and young adults Research, Evaluation, Monitoring, Knowledge Exchange Taxes Knowledge / Awareness Ontario Tobacco-free Network Advocates Advertising & POS Restrictions Advertising Bans

9 Evidence There is evidence to suggest that shifting social norms or altering the social climate of smoking by promoting a sentiment of antismoking and pro-restriction of smoking among the public can be an effective mechanism for tobacco control policies.

10 Social Climate and Cessation In one study, most former smokers identified social unacceptability of smoking as their main motivation for quitting,

11 Social Climate & Cessation ii an unfavorable social climate towards tobacco use has been associated with higher cessation rates and lower smoking prevalence

12 HOW CAN IT BE MEASURED

13 Two ways to measure SOCIETAL NORMS VS FAMILIAL NORMS

14 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

15 Familial Norms Approach focuses on close social network members.[14] more closely reflects people s actionable attitudes.

16 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)

17 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?

18 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?

19 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.

20 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.

21 HOW SOCIALLY ACCEPTABLE IS SMOKING TODAY (IN ONTARIO)?

22 Findings Smokers reported higher mean scores on all eight SASS components than non-smokers counterparts.

23 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).

24 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.

25 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 nonsmoking 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.

26 Predicted SAS Index Sco Male Fem ale Age Groups (Years)

27 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.

28 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