Neighborhood smoking norms modify the relation between collective efficacy and smoking behavior

Abstract

Background: Although neighborhoods with more collective efficacy have better health in general, recent work suggests that social norms and collective efficacy may in combination influence health behaviors such as smoking.

Methods: Using data from the New York Social Environment Study (conducted in 2005; n=4000), we examined the separate and combined associations of neighborhood collective efficacy and anti-smoking norms with individual smoking. The outcome was current smoking, assessed using the World Mental Health Comprehensive International Diagnostic Interview (WMH-CIDI) tobacco module. Exposures of interest were neighborhood collective efficacy, measured as the average neighborhood response on a well-established scale, and neighborhood anti-smoking norms, measured as the proportion of residents who believed regular smoking was unacceptable. All analyses adjusted for demographic and socioeconomic characteristics, as well as history of smoking prior to residence in the current neighborhood, individual perception of smoking level in the neighborhood, individual perception of collective efficacy, and individual smoking norms.

Results: In separate generalized estimating equation logistic regression models, neighborhood collective efficacy was not associated with smoking (OR 1.06, 95% CI 0.84-1.34) but permissive neighborhood smoking norms were associated with more smoking (OR 1.34, 95% CI 1.03-1.74), particularly among residents with no prior history of smoking (OR 2.88, 95% CI 1.92-4.30). When considered in combination, where smoking norms were permissive, higher collective efficacy was associated with more smoking; in contrast, where norms were strongly anti-smoking, higher collective efficacy was associated with less smoking.

Conclusions: Features of the neighborhood social environment may need to be considered in combinations to understand their role in shaping health and health behavior.

Figure 1

Odds ratios for the association between neighborhood collective efficacy and smoking, at different levels of neighborhood smoking norms, for the group with no history of smoking prior to living in the current neighborhood (interaction p-value < 0.001)^{a a} Neighborhoods with low collective efficacy are 1 SD below the mean, indicating they have less social cohesion and informal social control. Neighborhoods with high collective efficacy are 1 SD above the mean, indicating they have more social cohesion and informal social control. Neighborhoods with weak norms are 1 SD below the mean of the percentage who believe it is unacceptable for adults to smoke regularly, meaning norms are more permissive around smoking. Neighborhoods with strong norms are 1 SD above the mean of the percentage who believe it is unacceptable for adults to smoke regularly, meaning norms are more anti-smoking.