Social Norms Change and Cigarette Smoking: A Longitudinal Study in Mainland China

Authors

• Shaon Lahiri, Department of Public Health Sciences and Administration, School of Health Sciences, College of Charleston, 30 George St, Charleston, SC, 29401, USA.
• Jeffrey B. Bingenheimer, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20037, USA.
• Yan Wang, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20037, USA.
• W D. Evans, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20037, USA.
• Ben Cislaghi, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda.

Document Type

Journal Article

Publication Date

3-11-2026

Journal

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco

DOI

10.1093/ntr/ntag052

Keywords

Bayesian statistics; Mainland China; Social norms; cigarette smoking; latent growth curve models; longitudinal analysis; tobacco control

Abstract

INTRODUCTION: Cigarette smoking is a global epidemic, and is particularly pronounced in China, the world's largest manufacturer and consumer of cigarettes. Price-based approaches are effective for tobacco control, but can falter in settings with weak policy enforcement. Changing social norms around cigarette smoking may reduce smoking through the exertion of anti-smoking social influence even in the absence of strong regulatory conditions. However, evidence of the social norms-smoking relationship over time at a population level in China is severely lacking. METHODS: We fit Bayesian latent growth curve models to understand how smoking-related descriptive norms (perceptions of others' smoking), injunctive norms (perceptions of others' approval of smoking), and cigarette smoking unfold over time. We used longitudinal data from adults who smoke in four cities over nine years (N = 5,400 observations), provided by the International Tobacco Control Policy Evaluation Project in Mainland China. Self-reported smoking status was defined as smoking ≥100 cigarettes in one's lifetime and currently smoking at least one cigarette per week. RESULTS: Higher pro-smoking descriptive and injunctive norms were associated with increases in cigarette smoking over time, even after controlling for known confounders such as addiction level, exposure to household smoking, and exposure to pro-smoking media. Higher pro-smoking descriptive norms were associated with both higher initial level of cigarette smoking and slower rates of smoking reduction over time. CONCLUSIONS: Social norms impact smoking over time among middle-aged people who smoke in China. Tobacco control efforts should support anti-smoking descriptive norms through group-based interventions and creating social networks of those who do not smoke.

APA Citation

Lahiri, Shaon; Bingenheimer, Jeffrey B.; Wang, Yan; Evans, W D.; and Cislaghi, Ben, "Social Norms Change and Cigarette Smoking: A Longitudinal Study in Mainland China" (2026). GW Authored Works. Paper 8900.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8900

Department

Prevention and Community Health