Improving measurement of normative beliefs involving smoking among adolescents

Abstract

Objectives: To identify different components of smoking normative beliefs and determine if each component is independently associated with 2 clinically relevant measures of smoking in adolescents.

Design: Cross-sectional survey.

Setting: One large suburban high school.

Participants: A total of 1211 high school students aged 14 to 18 years.

Outcome measures: Current smoking and susceptibility to smoking.

Results: Of the 1138 students with data on current smoking, 216 (19.0%) reported current smoking, and 342 (38.3%) of the 893 nonsmoking students with susceptibility data were susceptible to future smoking. Factor analysis identified 3 normative belief constructs, labeled "perceived prevalence of smoking," "perceived popularity of smoking among elite/successful elements of society," and "disapproval of smoking by parents/peers." On average, students believed that 56% of people in the United States smoke cigarettes; 27.7% believed that wealthy people smoke more than poor people. Multiple logistic regression showed that each of the 3 constructs was independently associated with current smoking (adjusted odds ratios, 1.05 [95% confidence interval {CI}, 1.02-1.08], 1.12 [95% CI, 1.02-1.23], and 0.66 [95% CI, 0.59-0.75], respectively), even after controlling for covariates. Students' perceptions of smoking among the successful/elite and disapproval by parents/peers were independently associated with susceptibility to future smoking (adjusted odds ratios, 1.20 [95% CI, 1.11-1.29] and 0.87 [95% CI, 0.79-0.96], respectively).

Conclusions: Adolescents' normative beliefs about smoking are multidimensional and include at least 3 distinct components, each of which was independently related to smoking outcomes. These distinct components should be considered in the design and evaluation of programs related to prevention and cessation of adolescent smoking.

Figures

Figure 1. Histogram of subjects’ impression of the percent of high school seniors who smoke

The black line indicates the actual percentage of seniors who are current smokers at the high school where the study was conducted (21.9%).

Figure 2. Histogram of subjects’ impression of the percent of all Americans who smoke

The black line indicates the actual percentage of adult Americans who are current smokers (22.3%).