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Are anti-smoking social norms associated with tobacco control mass media campaigns, tax and policy changes? Findings from an Australian serial cross-sectional population study of smokers
  1. Sarah J Durkin1,
  2. Danielle Schoenaker1,2,
  3. Emily Brennan1,
  4. Megan Bayly1,
  5. Melanie A Wakefield1
  1. 1Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
  2. 2School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
  1. Correspondence to Dr Sarah J Durkin, Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC 3004, Australia; sarah.durkin{at}


Background Anti-smoking social norms are associated with subsequent quitting behaviours. We examined if exposure to tobacco control advertisements and policy changes predict subjective (perceived disapproval of smoking among close family and friends) and internalised injunctive norms (embarrassed about telling others you are a smoker).

Methods A serial cross-sectional population survey of Australian adult smokers (n=6649; 2012 to 2015). Logistic regression analyses examined associations of social norms with exposure to different types of tobacco control advertisements, tax increases and other tobacco control policies, adjusting for key demographic, smoking and media exposure covariates. Interaction analyses examined differences by age and socioeconomic status (SES).

Results Greater past month exposure to predominantly fear-evoking advertisements was associated with increased odds of perceiving disapproval (per 1000 gross rating points: adjusted OR (AOR) 2.69, 95% CI: 1.34 to 5.39), while exposure to advertisements evoking multiple negative emotions (fear, guilt, sadness) reduced perceived disapproval (AOR 0.61, 95% CI: 0.42 to 0.87). Increased perceived disapproval was also associated with anticipation (AOR 1.38, 95% CI: 1.02 to 1.88), and implementation of a series of annual 12.5% tobacco tax rises (AOR 1.41, 95% CI: 1.03 to 1.94). Associations were consistent across age and SES. There were no associations nor subgroup interactions between advertisement exposure or policy changes and feeling embarrassed about telling others you are a smoker.

Conclusion Smokers’ perceptions of family and friends’ disapproval of their smoking was more common after exposure to fear-evoking tobacco control campaigns and after large tobacco tax increases were announced and implemented.

  • tobacco control advertisements
  • tobacco control policy changes
  • tax
  • social norms
  • population survey
  • socio-economic status
  • age groups

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  • Contributors SJD, DS, EB and MAW designed the analysis; SD and DS performed the statistical analysis; SD and DS interpreted the results and wrote the manuscript; EB, MB and MAW contributed to interpretation of the results and critical revision of the manuscript. MB and SD led the study design and contributed to questionnaire development for the Victorian Tracking Survey.

  • Funding The study was funded by an Australian National Health and Medical Research Council Partnership Project grant (#1016419) with VicHealth. The Victorian Tracking Survey was auspiced by Quit Victoria, with funding from VicHealth, the Victorian Department of Health and Human Services and Cancer Council Victoria.

  • Competing interests All authors are employed by a non-profit organisation that conducts public health interventions and advocacy aimed at reducing the harms of tobacco in the community, especially those pertaining to cancer.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Human Research Ethics Committee of Cancer Council Victoria (HREC 1104). The data were analysed anonymously.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.