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National Cancer Institute

Nonsmokers and Tobacco Control Norms: Population Surveys and Intervention Studies

Project Title: Nonsmokers and Tobacco Control Norms: Population Surveys and Intervention Studies

Organization: University of California, San Diego

Grant Number: 1U01CA154280

Principal Investigator: Shu-Hong Zhu

Note: The descriptions in this section were provided by the principal investigator and are not maintained or updated by NCI.

Sharon Cummins, University of California San Diego
Anthony Gamst, University of California San Diego
Laura Beebe, University of Oklahoma

Study Summary
Dr. Zhu and his research team conduct population surveys and randomized trials to examine intervention strategies that affect the smoking cessation rate at the population-level.  Special focus of this project is on the effect of social norms on smoking cessation.  Nonsmokers play a significant role in defining social norms regarding smoking.  Mobilizing nonsmokers to help smokers quit represents a new line of research.  Moreover, emerging and new tobacco products also affect the social norms on smoking and their effects on smoking cessation are examined in this project as well.

Research Aims and Methods                                                                     

  • Conduct surveys of a nationally representative sample to examine the attitudes of smokers and nonsmokers toward tobacco use and tobacco control measures.
  • Conduct a randomized trial that compares an intervention targeting nonsmokers with an intervention targeting smokers.
  • Examine the population trend for smoking cessation through analysis of multiple national surveys to identify factors that affect the smoking cessation rate in the U.S.

Key Findings

  • Nonsmokers support restrictions on smoking and stronger tobacco control norms, and their attitude is positively correlated with smokers’ success in quitting smoking.
  • Targeting nonsmokers is an effective way to help smokers quit.
  • There are disparities in quitting with low-income smokers being the least likely to make a quit attempt and least likely to succeed.
  • E-cigarettes can affect the social norms on smoking and can play a role in helping smokers quit.
  • Increasing the quit attempt rate of smokers is key to increasing the population cessation rate.

Key Implications

  • State anti-tobacco media campaigns should mobilize nonsmokers because they represent an untapped resource. Not only do nonsmokers hold the key to social norms, they can assist in increasing the quit attempt rate for smokers.
  • Changing smoking policies is an important way to increase the population quit attempt rate.
  • Interventions need to address disparities in social norms because the norms affect quit attempt rates and, ultimately, population cessation rates and smoking prevalence.
  • It is importantly to carefully weigh the positive and negative impacts of e-cigarettes on the social norms of smoking so as to make the most effective regulatory policies about them.

Original Abstract
This proposal focuses on testing a new idea to increase smoking cessation on the population level. We propose to conduct population surveys and intervention studies to demonstrate that nonsmokers hold the key to increasing population cessation. This large project is grouped by three overlapping phases: Phase 1: Surveys: We will conduct surveys of nationally representative samples to test the hypothesis that the attitudinal gaps between nonsmokers and smokers on tobacco control measures are significantly larger among those living in states with a high tobacco control index than among those in low index states, and that the attitudinal gap (grouped by state) predicts the smoking cessation rate. The survey of 3,500 smokers and 3,500 nonsmokers will be conducted with Knowledge Networks Inc. Phase 2. A Randomized Trial: We will recruit 2,960 smoking households (with an adult non-smoker) from the general community (half from California and half from Oklahoma) and randomly assign them into a 2 x 2 factorial design: one factor is whether the intervention targets smokers or nonsmokers and the other is the intensity of the intervention. They will be followed up for 12 months. Two primary hypotheses to test are: Messages targeting nonsmokers produce significantly higher quit rates among smokers in the household than messages targeting smokers and that higher intervention intensity produce a higher quit rate. Phase 3. A Comparative Media Study and Dissemination: We will create a new cessation media spot and compare it with the existing media campaign in California and Oklahoma. The health departments of these two states (who are co-investigators) have committed to coordinate their ongoing media campaign with this study. In a selected in market in each state, we will use an ABAB design (A= targeting smokers and B=targeting nonsmokers) to test the effects of the new media spots. Using the number of calls to each state quitline as a proxy measure, we will test the that hypothesis that media spots targeting nonsmokers produce significantly higher rates of quitline calls than media spots targeting smokers. We incorporate dissemination into the project through collaboration with multiple state health departments.