Social norms regarding smoking

Lars M. RamströmInstitute for Tobacco studies, Stockholm, Sweden

WEDNESDAY 5.11.2008 at 14.00 hoursMajor session on

Social and Cultural Norms and Acceptability of Certain Behaviours

51st International ICAA Conference on DependenciesLimassol, Cyprus, 2 to 6 November 2008

SOCIAL NORMS have been described as values, beliefs, attitudes and behaviors that are generally approved in a certain social environment.

• SOCIAL NORMS REGARDING SMOKING are affected by various phenomena in the social environment (such as tobacco advertising) and influences from opinion leaders (such as celebrities and experts).

• These conditions can differ a lot from time to time and between different groups/countries.

According to a recent Nationwide survey:

More Doctors smoke Camels than any other cigarette

Quoted from the text: "Doctors in every branch of medicine - 113,597 in all - were queried in this nationwide study of cigarette preference”

US advertisement in 1951

US advertisement in 1951

US advertisement in 1951

4 %21 % FallingAustralia

12 %39 % FallingLuxembourg

52 %38 % RisingBulgaria

61 %53 % RisingChina

PhysiciansMen at large

Smoking prevalence Trend for smokingCountry

Smoking by physicians vs men at large

Examples of patterns in different countries according to the stage of the smoking epidemic

Source: Tobacco Control Country Profiles, Second Edition 2003

(American Cancer Society Inc, World Health Organization, International Union Against Cancer)

One of 14 pictorial health warnings on cigarette packs in Australia.

To cover 90% of the back side. To cover 30 % of the front side.

50 years ago…

Smoking was accepted as a ”normal” behaviour in most Western communities

Later… Denormalization of smoking has increasingly

been recognized as a key komponent of tobacco control programmes

Denormalization beliefs among ITC Four-Country* Survey respondents (n = 8991)

9%3%88%People who are important to me believe I should not smoke

16%3%81%There are fewer and fewer places I feel comfortable smoking

12%7%81%Society disapproves of smoking

DisagreeNeutralAgreeStatement

Source: Hammond D et al. Tobacco Denormalization and Industry Beliefs Among Smokers from Four Countries. Am J Prev Med 2006;31(3)

*Canada, United States, United Kingdom, Australia

Perception of acceptability of smoking and of snus use.Swedish men, age 18 – 79.

Source: Ramström L, Wikmans T. Changing tobacco habits in Sweden: Influence of environmental and psycohological factors related to smoking and use or smokeless tobacco (”snus”). Poster presentation at the SRNT 14th Annual meeting, Portland 2008.

Perception of acceptability of smokingSwedish men, age 18 – 79.

Source: Ramström L, Wikmans T. Changing tobacco habits in Sweden: Influence of environmental and psycohological factors related to smoking and use or smokeless tobacco (”snus”). Poster presentation at the SRNT 14th Annual meeting, Portland 2008.

“Does it occur that you feel uncomfortable in your role as smoker/snus user?”Swedish men, age 18 – 79.

Source: Ramström L, Wikmans T. Changing tobacco habits in Sweden: Influence of environmental and psycohological factors related to smoking and use or smokeless tobacco (”snus”). Poster presentation at the SRNT 14th Annual meeting, Portland 2008.

Desire to quit smoking vs. Feeling uncomfortable as smoker.Swedish men, age 18 – 79.

Source: Ramström L, Wikmans T. Changing tobacco habits in Sweden: Influence of environmental and psycohological factors related to smoking and use or smokeless tobacco (”snus”). Poster presentation at the SRNT 14th Annual meeting, Portland 2008.

How do most adults that you know feel about other adults smoking?

Strength of smoke-free Proportions answeringregulations ”disapprove a lot”

Weak 15%

Medium 16%Strong 20%

Source: Hamilton W. et al. Do local tobacco regulations influence perceived smoking norms?

Health Education Research Advance, Accessed October 18, 2007.

Making workplaces totally smoke-free

Reduction of smoking prevalence 4%

Reduction of number of cigarettesper day per continuing smoker 25%

Total reductionof cigarette consumption 29%

Derived from: Fichtenberg C, Glanz S, Effect of smoke-free workplaces on smoking behaviour. Systematic review. British Medical Journal Vol. 325, 27 July 2002.

Health Effects of Smoke-Free Workplaces

(Examples from Scottish Bar Staff, two months after introduction of smoking ban)

- Number of those showing smoke-related symptoms fell from 80% to 50%.

- Improvement in lung function by as much as 10%.

Source: BBC News 2006.10.11

Summary and conclusions

Acceptability of smoking is now substantially lower than in the mid-1950s.

Decreasing acceptability of smoking is strongly linked to decreasing cigarette consumption.

Non-smoking environments favour smoking cessation and improve health.

Continued denormalization of smoking should be an integral part of tobacco-control policies.