Social Acceptability of

Smoking: the missing link Robert Schwartz, David Ip, Michael Chaiton, Shawn

O’Connor

Tobacco Control Research Forum

Tel Aviv University

December 18th, 2013

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”.

Denormalizing what?

Tobacco Industry?

Smokers?

Smoking?

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.

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?

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’

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 non-

governmental organizations (see for example

CDPAC (2008

Reduce Initiation of

tobacco use among

children, youth &

young adults

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

Reduce tobacco use

prevalence among

children, youth, and

young adults

Infrastructure Interventions Expected Contribution Known Contribution Paths Lt Outcomes

Youth Action Alliances

Lungs are for Life

High School Grants

Leave the Pack Behind

Youth Access Restrictions

Stupid.ca

Public Education/Media

Campaigns

Youth Vortal

Taxes

Ontario Tobacco-free

Network

Advocates

Visibility / Marketing

Price

Social Climate

Knowledge /

Awareness

Availability

Advertising & POS

Restrictions

Advertising Bans

Leadership,

Coordination,

Collaboration

Capacity Building

Technical Assistance

Research,

Evaluation,

Monitoring,

Knowledge

Exchange

Evidence

There is evidence to suggest that shifting

social norms or altering the social climate of

smoking by promoting a sentiment of anti-

smoking and pro-restriction of smoking among

the public can be an effective mechanism for

tobacco control policies.

Social Climate and Cessation

In one study, most former smokers identified

social unacceptability of smoking as their main

motivation for quitting,

Social Climate & Cessation ii

an unfavorable social climate towards tobacco

use has been associated with higher cessation

rates and lower smoking prevalence

HOW CAN IT BE MEASURED

Two ways to measure

SOCIETAL NORMS

VS

FAMILIAL NORMS

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

Familial Norms Approach

focuses on “close social network

members”.[14]

more closely reflects people’s actionable

attitudes.

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)

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?

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?

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.

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.

HOW SOCIALLY ACCEPTABLE

IS SMOKING TODAY

(IN ONTARIO)?

Findings

Smokers reported higher mean scores on all

eight SASS components than non-smokers

counterparts.

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).

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.

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 non-

smoking 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.

0

4

8

12

16

20

24

28

32

18-29 30-39 40-49 50-64 65+

Age Groups (Years)

Pre

dic

ted

SA

S In

de

x S

co

res

Male Female

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.

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