Impact Of Social Reference Norms On Smoking And Secondhand Smoke Exposure

ObjectiveThe objective of this research is to find out the status and the impact factors of smoking and secondhand smoke exposure of health professional students by analyzing the influence of tobacco control attitude and social reference norms in order to lay a good foundation for smoke-free campus policy advocacy in China.MethodsThe questionnaire surveys were conducted to the health professional students in the10medical universities/colleges in Jiangsu Province, Zhejiang Province and Shanghai, which included tobacco use prevalence, exposure to secondhand smoke, tobacco control attitude, organizational norms and subjective norms. Statistical analyses were carried out using SPSS20.0for Windows. Analysis methods contained general statistical description, chi-square test (Pearson chi-square test, contingency coefficient and linear trend test), multiple factor logistic regression model and ordinal logistic regression model. ResultsA total of1735health professional students were approached to participate in the study. The number of effective questionnaire returned was1620.A total of93smokers were approached and the smoking rate in all was5.7%;672non-smokers (n=1527) reported to be exposed to secondhand smoke and the exposure rate in all was44.0%.Smoking rate of male students (11.8%) was higher than female’s (1.6%)(P<0.01);60.8%of the students had active attitude toward public tobacco control. It came out to be that the more positive attitude towards public tobacco control was, the lower smoking rate was (P<0.01).59.0%of students reported that their school had a policy prohibiting smoking indoors, while60.6%of the students approved of the execution of the policy; smoking rates of students who recognized the school tobacco control policy implementation was far below the smoking rate of the students who didn’t (P<0.01);10.2%of the students had negative friend norms and the result of analysis showed that difference between the smoking rates with negative friend norms and positive friend norms had statistical significance (P<0.01). With analysis of logistic regression, it is indicated that positive attitude towards public tobacco control was a protective factor while negative friend norms and exhaustive campus tobacco restrictions without policy execution (compared with no campus tobacco restrictions) were risk factors.Secondhand smoke exposure rate in male (47.5%) was higher than female (41.9%)(P<0.01). Besides, grade (P<0.05), policy execution (P<0.01), friend norms (P<0.01) and family norms (P<0.05) significantly affect students’secondhand smoke exposure. With analysis of logistic regression, it is indicated that partial campus tobacco restrictions without policy execution (compared with no campus tobacco restrictions) and negative family norms were risk factors. ConclusionSocial reference norms were closely related to smoking behavior and secondhand smoke exposure, which suggested that improving positive attitude towards public tobacco control among students, strengthening policy implementation and supervision, focusing on students with negative family norms or negative friend norms would be effective when performing tobacco-free campus policy advocacy. Strengthening social reference norms targetedly could be in favor of tobacco control, which should be taken into consideration when culturally appropriate tobacco control strategy was to be developed.