Approaches of Social Norms in Antismoking Research: A Meta-synthesis and a Meta-analysis

The tobacco epidemic is an enormous worldwide public health threat. Not only do smokers harm their own health and sustain financial burden, they subject nonsmokers to secondary inhalation and impose health consequences on nonsmokers. Of the many causes of tobacco use, social influences, such as offering cigarettes to nonsmokers and reciprocating cigarette offers, are a key reason for smoking onset and maintenance of smoking behavior. Researchers have traced sources of social influence to people/groups with whom an individual interacts. The normative attitudes and behaviors regarding smoking among these people/groups exert a significant impact on whether an individual takes up smoking. Three theories – theory of reasoned action/planned behavior, social learning theory, and the social norms approach – have played an important role in guiding norm-based research on smoking. These three theories explain how subjective norm, descriptive norm, and/or injunctive norm predict risky behavior. Research guided by these three theoretical frameworks has received empirical support to varying degrees. However, a proliferation of research on smoking utilizing the norm construct(s) has exhibited several problems. These problems include some studies’ reliance on intuition rather than theory, inconsistent labeling of norms, subsequent inconsistent operationalization of norms, and little research comparing the relative impacts of norms. The absence of meta-reviews of norm-based research on smoking necessitates our current project that consists of a meta-synthesis and a meta-analysis.

Our meta-synthesis systematically reviews norm-based empirical research (from 2000 -present) and compares the existing theoretical frameworks of social norms; evaluates the state of norm-based research in terms of strengths and weaknesses; synthesizes significant patterns of findings; and, offers suggestions for integrating theories of social norms, applying theories to antismoking research, and enacting norms communication interventions for preventing smoking onset and progression. Moreover, the meta-synthesis identifies frequently examined norms, smoking dependent variables, and covariates to provide a solid empirical basis for the types of variables to be included in our follow-up meta-analysis. Our meta-analysis assesses the extent to which the frequently examined norms exert an impact on smoking-related attitudes, behavior intentions, and behaviors, gauges the effect sizes of the most relevant moderators, and provides suggestions for designing and conducting future norm-based antismoking studies.

In our project, we will make every effort to gather relevant studies using samples in China. When we have enough such studies, we will analyze the effects of social norms on smoking and antismoking interventions in China. In the end, we hope that our findings will provide cumulative empirical evidence for prioritizing antismoking intervention efforts via targeting the most influential norms.