National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
UK Centre for Tobacco and Alcohol Studies, Nottingham, UK.
Nicotine Tob Res. 2021 Jan 7;23(1):203-211. doi: 10.1093/ntr/ntz179.
To assess trends in daily smokers' social norms and opinions of smoking between 2002 and 2015 in Canada, the United States, the United Kingdom, and Australia.
Data were from wave 1 (2002) to wave 9 (2013-2015) of the longitudinal International Tobacco Control Four Country Survey (Canada, the United States, the United Kingdom, Australia), involving 23 831 adult daily smokers. Generalized estimating equation logistic regression models, adjusted for demographics and survey design effects, assessed associations of wave and country with outcomes: (A) over half of five closest friends smoke, (B) agreeing that people important to you believe you should not smoke, (C) agreeing that society disapproves of smoking, and (D) negative opinion of smoking.
Between 2002 and 2015, adjusting for covariates, (A) over half of five closest friends smoke did not change (56% vs. 55%; adjusted odds ratio [AOR] = 0.95 [95% Confidence Interval = 0.85-1.07]), (B) agreeing that people important to you believe you should not smoke generally decreased (89% vs. 82%; AOR = 0.54 [0.46-0.64]) despite an increase around 2006-2007, (C) agreeing that society disapproves of smoking increased between 2002 and 2006-2007 (83% vs. 87%; AOR = 1.38 [1.24-1.54]) then decreased until 2013-2015 (78%; AOR = 0.74 [0.63-0.88]), and (D) negative opinion of smoking decreased between 2002 and 2010-2011 (54% vs. 49%; AOR = 0.83 [0.75-0.91]) despite an increase around 2005-2006 and at the final wave (2013-2015). Except friend smoking, Canada had the greatest, and the United Kingdom the lowest, antismoking social norms and opinions.
Except friend smoking and opinion of smoking, daily smokers' social norms became less antismoking between 2002 and 2015 despite increases around 2006-2007. Several potential explanations are discussed yet remain undetermined.
Increasingly comprehensive tobacco control policies alongside decreasing smoking prevalence in Canada, the United States, the United Kingdom, and Australia have led to the assumption that smoking has become denormalized in these countries. Absent from the literature is any formal assessment of social norms towards smoking over time. Contrary to our hypotheses, this study found that the injunctive social norms of daily smokers became less antismoking between 2002 and 2015, despite increases around 2006-2007. There was no change over time in the proportion of daily smokers who report that over half of their five closest friends smoke.
评估 2002 年至 2015 年期间加拿大、美国、英国和澳大利亚的每日吸烟者的社会规范和对吸烟的看法趋势。
数据来自于国际烟草控制四国调查（加拿大、美国、英国、澳大利亚）的 1 波（2002 年）至 9 波（2013-2015 年）的纵向研究，涉及 23831 名成年每日吸烟者。采用广义估计方程逻辑回归模型，调整了人口统计学和调查设计效果，评估了波次和国家与以下结果的相关性：（A）近 5 个朋友中超过一半吸烟，（B）同意对你重要的人认为你不应吸烟，（C）同意社会不赞成吸烟，和（D）对吸烟的负面看法。
在调整了协变量后，（A）近 5 个朋友中超过一半吸烟的比例在 2002 年至 2015 年间没有变化（56%对 55%；调整后的优势比 [AOR] = 0.95 [95%置信区间 = 0.85-1.07]），（B）同意对你重要的人认为你不应吸烟的比例普遍下降（89%对 82%；AOR = 0.54 [0.46-0.64]），尽管在 2006-2007 年左右有所上升，（C）同意社会不赞成吸烟的比例在 2002 年至 2006-2007 年间增加（83%对 87%；AOR = 1.38 [1.24-1.54]），然后在 2013-2015 年下降（78%；AOR = 0.74 [0.63-0.88]），（D）对吸烟的负面看法在 2002 年至 2010-2011 年间下降（54%对 49%；AOR = 0.83 [0.75-0.91]），尽管在 2005-2006 年和最后一波（2013-2015 年）有所上升。除了朋友吸烟外，加拿大的反吸烟社会规范和看法最强，而英国的则最低。
除了朋友吸烟和对吸烟的看法外，2002 年至 2015 年间，每日吸烟者的社会规范变得不那么反吸烟，尽管在 2006-2007 年左右有所上升。讨论了几种潜在的解释，但仍未确定。
加拿大、美国、英国和澳大利亚日益全面的控烟政策以及吸烟率的下降，使得人们认为这些国家的吸烟行为已经变得不那么正常。文献中没有对吸烟的社会规范随时间变化的正式评估。与我们的假设相反，这项研究发现，2002 年至 2015 年间，尽管在 2006-2007 年左右有所上升，但每日吸烟者的规范性社会规范变得不那么反吸烟。每日吸烟者中报告近 5 个朋友中有超过一半吸烟的比例在这段时间内没有变化。
