Confirming the importance of social norms in smoking cessation behavior

Background: Smokers continually face the decision of whether to continue to smoke or to take measures to stop smoking. The Theory of Planned Behavior suggests that intention to engage in such behaviors is determined by one's attitude toward the behavior, perceived norms about the behavior, and self-efficacy for engaging in the behavior. However, the relative importance of each determinant varies based on the specific behavior. We explored whether meaningful differences existed in the determinants of continuing to smoke versus taking measures to stop smoking. Methods: This study included 395 adult smokers from seven Texas cities who were contacted by random digit dialing and interviewed by telephone. We conducted multiple regression analyses to test the association between attitude, subjective norm, and self-efficacy and intention to engage in two behaviors – continuing to smoke and taking measures to stop smoking. Results: For the behavior of continuing to smoke, attitude (Beta=.240, p<.001) and self-efficacy (Beta=.444, p<.001) significantly predicted intention (R2=.386). For the behavior of taking measures to stop smoking, attitude (Beta=.340, p<.001), self-efficacy (Beta=.165, p<.001), and perceived norms (Beta=.341, p<.001) significantly predicted intention (R2=.365). Conclusions: The results from this study suggest that smokers' perceptions of what others think they should do are important for taking steps toward cessation but do not influence their decision to keep smoking. This provides further evidence that delivering messages designed to encourage smokers to listen to their family, friends, and other people in their lives is likely to lead to quit attempts.