Social Pressure May Be More Effective in Encouraging Life-long Smokers to Quit
Sun. Sand. Surf. And no smoking. California’s attitude toward smoking may be the best recipe for success when trying to quit. New research shows that social pressure plays a key role in getting smokers to quit.
By analyzing the smoking patterns of Asian immigrants from countries where smoking is socially acceptable, researchers at the University of California, San Diego School of Medicine have shown that smokers are far more likely to try to quit when living where smoking is not socially acceptable. And the more these smokers try to quit, the more they succeed.
“People say they don’t want to conform but in reality, the desire to conform is strong,” said principal investigator Shu-Hong Zhu, Ph.D., of the Cancer Prevention and Control Program at UCSD Moores Cancer Center, and Department of Family and Preventive Medicine at UCSD School of Medicine. “For a study like this, you have to create a different social norm and then allow people to experience it, so immigrants are an ideal group to study.”
Using data from three previous tobacco studies conducted in California, Zhu’s team looked at smokers who are recent immigrants to California from China and Korea, where smoking is still widely accepted. They found that the California immigrants have a smoking cessation rate much higher than their counterparts in their native countries, where about two thirds of all men smoke, and smoking is a common and expected social interaction.
California provides a radically different setting. The most recent data from the Centers for Disease Control (CDC) shows that only about 14 percent of California’s adults smoke. With a strong state tobacco control program in place since 1989, most Californians see smoking as socially unacceptable. Smoking has been banned in restaurants and bars statewide for nearly a decade, and more than half the Californians who have ever smoked have now successfully quit, one of the highest quit rates in the nation.
In their study, published in Nicotine and Tobacco Research (November 2007: Volume 9, Supplement 3) researchers note that more than half of all Chinese and Korean immigrants in California who ever smoked have quit. Chinese immigrant smokers in California stop smoking at roughly seven times the rate of their counterparts in China. In Korea, a recent, aggressive tobacco control campaign is starting to boost the quit rate, but Korean immigrants in California still stop smoking at more than three times the rate of their counterparts in Korea.
Anti-smoking Campaigns Work
The researchers attribute this marked difference to the difference in social norms. According to the UC San Diego study, over 82 percent of Chinese and Korean immigrant smokers in California reported that they were familiar with the state’s anti-smoking campaigns through print, television, or radio. This familiarity shows an awareness of the new social norm.
Changing the social norm not only makes more smokers try to quit, it also makes them more likely to keep on trying, even if earlier tries ended in relapse. Repeated tries will ultimately lead to success.
Zhu points out, “The large difference in annual quit rates is almost completely explained by the difference in proportions of smokers trying to quit. In China, for example, the quit rate is low because a very low proportion of smokers try to quit each year. In California, by contrast, a very high proportion of Chinese smokers try to quit each year. More tries means more success. Cessation aids like nicotine patches, gum, and so on, contribute only in a minor way to these smokers' dramatically higher quit rate because few of these immigrants use them.”
What does the UCSD study mean for tobacco control? Social norm change is more powerful than people may have realized, said Zhu. Passing new laws and mounting media campaigns is not only a cost effective plan, but will also have dramatic, population-wide impact, the report concludes.
The study, supported by the National Cancer Institute, was conducted by a team of California healthcare professionals, including: lead investigator Shu-Hong Zhu, Ph.D., UCSD; research fellow Shiushing Wong, Ph.D., UCSD; Chih-Wen Shi, M.D. assistant adjunct professor, Department of Family and Preventive Medicine, UCSD; Hao Tang, M.D., Ph.D., California Department of Health Services; and Moon Chen, Ph.D., M.P.H, University of California, Davis.
Data for the study came from three tobacco surveys conducted in California. Two focused specifically on Asian populations:
The 2003 California Chinese American Tobacco Use Survey (Carr et al., 2005a) and The 2003 California Korean American Tobacco Use Survey (Carr et al., 2005b).
Both surveys recruited respondents by randomly telephoning numbers from purchased lists of households with Chinese and Korean surnames. A professional survey research service, Strategic Research Group, Inc. used a computer assisted telephone interviewing (CATI) system and trained telephone interviewers to screen people at random from the telephone lists.
The third source of data for this present study was the 2002 California Tobacco Survey (CTS), a population-based, random-digit-dialed survey conducted in English and Spanish, every 3 years, for evaluation of the California Tobacco Control Program (Gilpin et al., 2003).
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