The Relation Between Number of Smoking Friends and Adult Smoking Cessation Outcomes

Background: It is a basic principle of life that behaviour is guided by the social context. It matters to us whether significant others share with us the same likes and dislikes, and when they do not, that discrepancy is a source of potential for change in our individual beliefs, attitudes, and ultimately our behaviour. It is the importance of the social context that is the foundation for the research presented in this dissertation, which focuses on the relation between friends' smoking behaviour and individual smoking behaviour. Objectives: The objectives of this dissertation are to: (1) examine whether smokers report a greater number of smoking friends than chance would predict, (2) examine whether smokers’ number of smoking friends and changes in their number of smoking friends over time are related to demographic characteristics and variables that predict smoking cessation outcomes, (3) examine whether smokers’ number of smoking friends and changes in their number of smoking friends over time are related to smoking cessation outcomes, and (4) examine whether any relation between changes in number of smoking friends over time and smoking cessation outcomes is explained by changes in smokers’ social and subjective norms towards smoking. Respondents: Data were drawn from the International Tobacco Control Policy Evaluation Project Four Country Survey, a random-digit dial parallel prospective longitudinal cohort survey of nationally representative samples of adult smokers in Australia, Canada, the United Kingdom, and the United States. Samples included a Wave 1 cross-sectional sample (N=8,812), and a Wave 1-Wave 2 longitudinal sample (N=6,321). Methods: Number of smoking friends was measured by asking smokers how many of their five closest friends smoke. Change in number of smoking friends over time was the difference between smokers’ number of smoking friends at Wave 1 and Wave 2. Smoking cessation outcomes tested included: (1) intentions to quit at Wave 1 and Wave 2, (2) quit attempts between Wave 1 and Wave 2, (3) abstinence for at least one month at Wave 2 among everyone, and (4) abstinence for at least one month at Wave 2 among smokers who attempted to quit (successful quit attempts). Changes in respondents’ subjective and social norms towards smoking between Wave 1 and Wave 2 were also measured. Results: Smokers reported a significantly higher number of smoking friends than would have been expected by chance at Wave 1. There were also significant differences in smokers’ number of smoking friends. Notably, smokers who were male, younger, had low education, and lower incomes had more smoking friends. These groups were also more likely gain and less likely to lose smoking friends over time. Smokers with characteristics that made them unlikely to quit smoking, i.e., higher nicotine dependence, also had more smoking friends. Smokers with fewer smoking friends at Wave 1 were more likely to intend to quit at Wave 1 and more likely to succeed in their attempts to quit. Smokers who lost smoking friends over time compared to smokers who experienced no change in their number of smoking friends were more likely to intend to quit at Wave 2, attempt to quit, be abstinent at Wave 2, and succeed in their attempts to quit. There was some evidence that change in subjective norms partially mediated the relation between changes in number of smoking friends and attempts to quit. Conclusions: These findings suggest that the majority of smokers live in social contexts where smoking is heavily concentrated, and that there are demographic differences in smokers’ number of smoking friends and changes in their number of smoking friends over time. Overall, changes in number of smoking friends over time was a more significant and consistent predictor of smoking cessation outcomes than number of smoking friends at Wave 1. This finding agrees with theories of behaviour change that suggest that changes in the context are important when predicting behavioural change. Future studies of the predictors of quitting should consider how factors that change over time are related to quitting, particularly the number of people who smoke in smokers’ social contexts. Smoking cessation interventions should consider the challenges faced by smokers who live in contexts where smoking is heavily concentrated when attempting to quit. These challenges may include a higher number of smoking friends, difficulties avoiding smokers during their quit attempts, and making social contacts with non-smokers to support their desired non-smoking status

Dynamic norms for dynamic times? An experiment on the effects of dynamic and static norms messages on COVID-19 vaccination intention

Social norms messages may motivate COVID-19 preventive behaviors, such as getting vaccinated. To date, however, the research has mainly focused on the established concept of static norms and widely ignored the potential of dynamic norms. Dynamic norms convey information about how norms are developing over time and have been shown to promote change when the behavior is not yet the majority norm. The present study investigated the potential of dynamic norms in the context of the COVID-19 vaccination campaign. It examined (a) the effects of static and dynamic norms messages on vaccination intention, (b) the mechanisms through which dynamic norms may influence vaccination intention, and (c) the potential of dynamic norms to increase vaccination intention of vaccine-hesitant people. We conducted a preregistered online experiment with three conditions (static norm, dynamic norm, control message) among people who were not yet vaccinated (N = 2,289, 16-60 years) in May 2021, during the early vaccine roll-out period for the general population in Switzerland. We found no effects of exposure to the static or dynamic norms messages on vaccination intention and no specific influence mechanisms of dynamic norms (e.g., via perceived future norm) - neither for participants who were willing to get vaccinated nor for the vaccine-hesitant group. However, further analyses showed that, among vaccine-hesitant participants, the normative perception that formerly vaccine-critical people were changing their minds was correlated with a stronger vaccination intention. We discuss potential reasons why social norms messages did not show an effect in our study and derive theoretical and practical implications

Reasons for not getting vaccinated against COVID-19 in German-speaking Switzerland: An online survey among vaccine hesitant 16-60 year olds

Background: Several research studies have examined the reasons why people are hesitant to be vaccinated against COVID-19. However, there is no published data to date on Switzerland. Identifying these reasons among the Swiss population who are vaccine hesitant may help inform campaigns to encourage vaccine confidence. Aims: The primary aim of this study is to identify the reasons for not getting vaccinated against COVID-19 among Swiss residents who are vaccine hesitant. The secondary aim is to examine whether reasons differ by age, gender, education, and likelihood of accepting a vaccination to better target campaigns and design interventions. Design: An online survey asked participants to indicate the reasons why they were hesitant to be vaccinated against COVID-19. Setting: German-speaking Swiss Cantons, the survey was administered online between 5 May 2021 and 16 May 2021. Participants: The participants in this analysis were a sample of (N=1191) Swiss residents age 16-60 years old from German-speaking Cantons, who could answer an online survey in German, who had yet not been vaccinated, who had not yet registered for a vaccination appointment, and who did not indicate that they would definitely be vaccinated if offered the chance. Findings: Among people who are vaccine hesitant in Switzerland, the most common reasons forbeing hesitant were side-effect, safety, and effectiveness concerns. It was also common for people to indicate that they were healthy/at low risk, would decide later, and that they wanted to build immunity naturally. Less common, but still prevalent concerns included wanting more information, thinking COVID-19 was not a real threat, and concerns that the vaccine may serve another purpose. Differences in reasons for being vaccine hesitant were found by age, gender, education, and likelihood of accepting a vaccination if offered. Conclusions: To increase the likelihood of accepting a vaccination, vaccination campaigns should address side-effect, safety, and effectiveness concerns. Campaigns could also consider informing people why it is necessary for people in lower risk groups to be vaccinated, and why vaccination is preferable to infection for building immunity. While campaigns may be effective in reaching some of the population, alternative strategies might be necessary to strengthen the trust relationship with vaccines and vaccine providers in some groups. Less prevalent concerns, such as not liking needles, could be addressed through individual level interventions

COVID-19 vaccination and changes in preventive behaviours: findings from the 2021 vaccine roll-out in Switzerland

Background: Behavioural, environmental, social and systems interventions (BESSIs) remain important for controlling the COVID-19 pandemic in addition to vaccination. However, people’s adoption of BESSIs may decrease as vaccination rates increase due to reductions in the perceived threat of disease, and changes in risk perceptions of behaviours that increase the chance of infection. Thus, we examined predictors of and changes over time in reports of mask wearing and physical distancing and whether changes in mask wearing and physical distancing differed by vaccination status during the main 2021 COVID-19 vaccine roll-out period in Switzerland. Methods: Weekly online cross-sectional surveys (26 April 2021 to 1 August 2021) among people 18–79 years old in Switzerland, N = 6308 observations and 5511 cases. Logistic regression models using generalized estimating equations. Results: Reports of being vaccinated increased, while mask wearing and physical distancing decreased over time. This decrease was similar regardless of vaccination status. However, the level of reported mask wearing and physical distancing remained higher among vaccinated people. Older, female, and Italian language region respondents also had higher odds of reporting mask wearing and physical distancing. Conclusions: Adoption of COVID-19 preventive behaviours is associated with demographics and vaccination status. Further research is needed to understand the reasons why people who are not vaccinated are less likely to adopt preventive behaviours, including that they may have fewer social and environmental opportunities to do so

Use of cigarettes with flavor-changing capsules among smokers in the United Kingdom: An online survey

Introduction Cigarettes with flavour-changing capsules in the filter have experienced phenomenal global growth in the last decade. We explore socio-demographic and smoking-related factors associated with using capsule cigarettes, how frequently users burst the capsule, and reasons for using them. Methods An online survey was conducted in the United Kingdom between April-May 2016 with 6234 factory-made and/or hand-rolled cigarette smokers. This analysis focuses on 3620 factory-made cigarette smokers, aged 18 years and over, who had smoked in the past month. Results Thirteen percent smoked capsule cigarettes, with younger smokers more likely than older smokers to do so. Capsule use was significantly more common among white non-British than white British, and among those planning to quit in the next six months than those not planning to quit. Most capsule users who crushed the capsule did so always (51%) or most of the time (18%), with more frequent crushing of capsules more common among females, younger and middle-aged participants, white-British and those with a lower score on the Heaviness of Smoking Index. The most common reasons for using capsule cigarettes were that they taste better (52%), are smoother (41%), provide a choice of flavours (32%) and the enjoyment of clicking the capsule (25%). Capsule and non-capsule smokers did not differ significantly in their perceptions of the harmfulness of their brand relative to other brands. Conclusions Our study provides an insight into how and why smokers of capsule cigarettes use these products, with the key drivers of use being taste, flavour choice and interactivity

Is the use of electronic cigarettes while smoking associated with smoking cessation attempts, cessation and reduced cigarette consumption? A survey with a 1-year follow-up

To use a unique longitudinal data set to assess the association between e-cigarette use while smoking with smoking cessation attempts, cessation and substantial reduction, taking into account frequency of use and key potential confounders

Tobacco packaging design for reducing tobacco use

Background  Tobacco use is the largest single preventable cause of death and disease worldwide. Standardised tobacco packaging is an intervention intended to reduce the promotional appeal of packs and can be defined as packaging with a uniform colour (and in some cases shape and size) with no logos or branding, apart from health warnings and other government-mandated information, and the brand name in a prescribed uniform font, colour and size. Australia was the first country to implement standardised tobacco packaging between October and December 2012, France implemented standardised tobacco packaging on 1 January 2017 and several other countries are implementing, or intending to implement, standardised tobacco packaging.  Objectives  To assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction.  Search methods  We searched MEDLINE, Embase, PsycINFO and six other databases from 1980 to January 2016. We checked bibliographies and contacted study authors to identify additional peer-reviewed studies.  Selection criteria  Primary outcomes included changes in tobacco use prevalence incorporating tobacco use uptake, cessation, consumption and relapse prevention. Secondary outcomes covered intermediate outcomes that can be measured and are relevant to tobacco use uptake, cessation or reduction. We considered multiple study designs: randomised controlled trials, quasi-experimental and experimental studies, observational cross-sectional and cohort studies. The review focused on all populations and people of any age; to be included, studies had to be published in peer-reviewed journals. We examined studies that assessed the impact of changes in tobacco packaging such as colour, design, size and type of health warnings on the packs in relation to branded packaging. In experiments, the control condition was branded tobacco packaging but could include variations of standardised packaging.  Data collection and analysis  Screening and data extraction followed standard Cochrane methods. We used different 'Risk of bias' domains for different study types. We have summarised findings narratively.  Main results  Fifty-one studies met our inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between- and within-participant experimental studies, cohort and cross-sectional studies, and time-series analyses. Few studies assessed behavioural outcomes in youth and non-smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross-sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non-behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall we judged most studies to be at high or unclear risk of bias in at least one domain. The one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 percentage point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. Findings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. One national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post-implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. Studies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye-tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non-behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. We found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse-tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack.  Authors' conclusions  The available evidence suggests that standardised packaging may reduce smoking prevalence. Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect. A reduction in smoking behaviour is supported by routinely collected data by the Australian government. Data on the effects of standardised packaging on non-behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence. As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake. We did not find any evidence suggesting standardised packaging may increase tobacco use