Examining the Impact of Smoking Social Norms on Commercial Tobacco Dependence Among Spanish Speaking Mexican American Smokers

Background and Purpose: Research has consistently demonstrated that cigarette smoking rates increase with greater acculturation among Mexican American women but not men. It has been speculated that US-perceived smoking norms that are less restrictive for women than Mexican-perceived smoking norms may account for the observed association. However, the research examining smoking social norms is limited within this population. This study examined the association of smoking social norms with acculturation and commercial tobacco dependence among Spanish-speaking women and men.

Methods: The current study examined Mexican and US descriptive and injunctive smoking norms for women and men among 290 Mexican American smokers. Primary outcomes were four tobacco dependence subscales: Continuity, Drive + Tolerance, Priority, and Stereotypy from the Nicotine Dependence Syndrome Scale. Primary predictors were female and male descriptive and injunctive norms in Mexico and the US. Four items measured descriptive norms, where participants reported their perceptions of smoking prevalence among women and men in Mexico and US. Four additional items measured injunctive norms where participants self-reported their perceptions of how acceptable smoking was among women and men in Mexico and the US. Acculturation was assessed through Mexican Cultural Identity and American Cultural Identity subscales as measured by the Multidimensional Acculturation Scale II. A structural equation modeling was used to examine the relationship between acculturation and social norms. Path analysis was used to examine the relationship between social norms and tobacco dependence. All models were adjusted for age, partner status, nativity status, educational attainment, employment status, and smoking initiation age. Analyses were conducted among women and men separately.

Results: Among women, American Cultural Identity and Mexican Cultural Identity were not significantly associated with Mexican or US descriptive or injunctive norms. Among men, greater Mexican Cultural Identity was associated with higher perceived smoking prevalence among men in Mexico. Among women, greater perceived acceptability of smoking among women in the US and Mexico were significantly associated with Continuity, Priority, and Stereotypy. Additionally, all four smoking social norms were positively associated with Priority among women. Among men, higher perceived smoking prevalence among men in the US and Mexico were significantly associated with Continuity, Priority, and Stereotypy.

Conclusion and Implications: Findings suggest that among Spanish speaking Mexican origin women, addressing injunctive norms may be more impactful in helping minimize their tobacco dependence. Interventions that include discussion of injunctive norms in individual and/or group setting counseling may increase women’s smoking cessation success. Among men, addressing descriptive norms may help reduce their tobacco dependence. Furthermore, interventions that correct misperceptions about smoking prevalence rates may help promote smoking cessation. Study findings contribute to the limited literature surrounding smoking social norms among Latin/x smokers and may pave the way for future research to examine different factors that can make smoking social norms salient to the individual.