Adolescent smoking and social norms

: An appraisal of theory and application of social norms to understand risk factors for smoking and sensitivity to normative influence

Abstract

Background: As a developmental period, adolescence is critical for the formation of health behaviours that are carried into adulthood. The social reorientation that occurs during adolescence marks an important stage in development when normative influences become more salient, and social pressures to conform to the behaviours of peers increase in their magnitude and regularity. One behavioural outcome that is examined consistently in the literature is smoking, the social antecedents of which are well-documented and have been explored using a range of different theoretical models which are explored in Chapter 2.

While social norms are important determinants of smoking behaviour, they are not universal across all contexts. For example, in low-middle-income countries tobacco advertising is more prominent and smoke-free regulatory frameworks are not consistently implemented. As a result, the global burden of tobacco-related disease has shifted to low-middle-income settings where the tobacco industry can circumvent local tobacco legislation with relatively little resistance. By comparison, smoking rates in high-income countries are significantly lower and Chapter 3 investigated how the factors that contribute to smoking differ across these contexts.

Despite a large body of research delineating the normative and psychosocial antecedents of adolescent behaviour, there are few studies that have attempted to expound upon the specific personality and cognitive traits that make adolescents more susceptible to normative influence. Therefore, the objective of Chapter 4 was to explore the psychosocial and cognitive traits associated with sensitivity to social norms using a novel experimental tool designed to gauge adolescent’s norms sensitivity using a modified version of a rule-following task.

Method: Chapter 2 is a theory landscaping review (supported by systematic methodological elements) of studies that utilise theoretical models to examine the role of social influence in adolescent smoking. The analytical framework was grounded in a meta-narrative framework that utilised a model of theory synthesis proposed by Pound and Campbell. This facilitated the identification of key themes and commonalities within the literature and presents a narrative overview of how theoretical models have been applied to understand the contribution of social influence to adolescent smoking. To visually illustrate the overlap in measures of social influence used in the studies, a hierarchical edge bundling diagram was rendered using Vega data visualisation software.

Chapters 3 and 4 employed baseline data collected during the Mechanisms of Networks and Norms Influence on Smoking in Schools (MECHANISMS) study. The MECHANISMS study was a school-based proof of concept study designed to further understanding of social norms based mechanisms of action related to smoking in high- and low-middle-income settings. Students in Northern Ireland and Bogotá, Colombia completed self-administered questionnaires measuring various normative, socio-environmental and psychosocial constructs related to smoking, as well as a series of Game Theory experiments designed to elicit individual sensitivity to norms.

Chapter 3 is a cross-cultural comparison of the socio-environmental and psychosocial factors associated with smoking susceptibility among adolescents from two settings with contrasting sociocultural characteristics. Logistic regression analysis was used to examine how these predictors of smoking susceptibility compared across the two countries.
Chapter 4 investigated the association between norms sensitivity and a number of personality and cognitive traits, and to understand if these associations varied according to gender. A series of multilevel linear mixed effects models and ordered logistic regression models were employed to assess the association between sensitivity to norms and the personality and cognitive traits. The data were disaggregated by gender and the analyses performed separately for each group.

Results: The results of Chapter 2 highlighted three theories that featured prominently in the studies reviewed: the Theory of Planned Behaviour; Social Cognitive / Social Learning Theory; and Ecological Systems Theory. The studies primarily used descriptive norms and sociocultural factors to gauge social influence. Other factors such as injunctive norms, parental monitoring and perceived pressure to smoke were also investigated with relative consistency.

The results of Chapter 3 showed that the correlates of smoking susceptibility differed in their magnitude and distribution across the two settings.

The results of Chapter 4 were consistent with the findings of an earlier study, identifying gender as the only factor that consistently demonstrated a significant association with sensitivity to norms.

Conclusions: In Chapter 2, it was evident that a broad range of instruments, scales, and variables were used to capture ostensibly similar theoretical constructs that relate to social influence. Thus, a formal framework that unifies the multiple theoretical perspectives is needed to advance the scientific discourse around social influence and adolescent smoking.

By comparing the risk factors for smoking susceptibility in settings with generally dissonant cultural and social properties, Chapter 3 highlighted the need for interventions targeting adolescent smoking to be sensitive to the unique sociocultural characteristics of the context within which they are implemented.

The results of Chapter 4 suggested that sensitivity to norms is an independent, and stable, personality dimension. However, sensitivity to norms is still a relatively underexplored construct within the literature. As such, future research should attempt to capture sensitivity to different types of norms (i.e., injunctive norms, subjective norms, descriptive norms) and expand upon these findings to better understand the interaction between gender and norms sensitivity in adolescent decision-making.

Chapter 5 expands upon some of the implications for future research, drawing attention to the role of social norms in designing effective smoking prevention interventions, and the implications associated with the emergence of e-cigarettes as an alternative to conventional cigarette smoking.

Date of Award	Jul 2022
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Northern Ireland Department for the Economy
Supervisor	Ruth Hunter (Supervisor), Rajnish Kumar (Supervisor) & Frank Kee (Supervisor)