Normative processes and adolescents’ smoking behaviour in Norway: A multilevel analysis

Investigating the rationale for low-carbon production techniques in agriculture for climate change mitigation and fostering sustainable development via achieving lowcarbon targets

In China, agricultural activities are a major source of greenhouse gas emissions, ranking second only to another significant source. This presents a significant obstacle to reducing emissions and jeopardizes both the availability of food and the sustainable growth of agriculture. It is primarily the farmers who utilize cultivated land and are thus accountable for the initiation of these emissions. Farmers' role is significant in adopting green and low-carbon (LC) agricultural production practices, and their actions are directly tied to the achievement of the dual goals of carbon reduction. Understanding their motivations for engaging in LC production and the factors that influence their willingness to do so is important for both theory and practice. In this study, data was collected from 260 questionnaires in 13 counties across five major cities in Shaanxi Province. The purpose was to identify factors that impact farmers' motivation and willingness to engage in LC agriculture using linear regression analysis. A structural equation model was constructed to better understand the underlying mechanisms that influence farmers' actions towards LC farming practices. The study's findings indicate that (1) farmers' behavior towards LC production practices is notably impacted by internal motivation based on joy and internal motivation based on responsibility (IMR); (2) IMR has the most pronounced effect on farmers' adoption of LC production practices; (3) the internal motivation based on joy, IMR, behavior attitude, subjective norm, and perceived behavior control are related to each other; and (4) the multi-group analysis of the data indicates that the impact of internal motivation based on joy and IMR on adopting sustainable farming practices may vary among different groups. It is essential to support farmers who have strong intrinsic motivation to engage in sustainable agriculture. Additionally, policymakers must promote positive attitudes towards sustainable farming to achieve the desired environmental (LC) objectives.

The State of Norm-Based Antismoking Research: Conceptual Frameworks, Research Designs, and Implications for Interventions

This synthesis review examined 189 qualified studies on norms and smoking in terms of conceptual frameworks, types of social norms, research designs, dependent variables, independent variables and covariates, and findings related to norms. Results show that 7.9% were experimental, and the remaining were cross-sectional. By far, the reasoned action approach (RAA) was the most-cited theory, but RAA was not used to guide experimental designs. The social norms approach, norm focus theory, social cognitive theory guided the intervention experiments. Harmful norms were more frequently examined than healthful norms. Pro-smoking norms positively predicted smoking intentions and behaviors, whereas antismoking norms positively predicted antismoking intentions and behaviors. The over-application of RAA in cross-sectional antismoking research has yielded repetitive findings. Norm-based experiments can adopt other theoretical perspectives to offer insights into antismoking interventions. The RAA constructs are still applicable and can be integrated into intervention designs.

Determinants of smokeless tobacco use and prevalence among Sudanese adolescents

BACKGROUND

Smokeless tobacco is a part of social and cultural life in Sudan. The affordability and availability of this kind of tobacco make it a fundamental issue in adolescents. The aim of this study is to investigate the extent of the use of smokeless tobacco in adolescents and its determinants.

METHODS

A school-based cross-sectional study was conducted in Khartoum state in Sudan. The study targeted male and female adolescents in secondary schools. A total of 3387 students from public and private schools participated in the study. Multistage random sampling was used to select the participants. The Arabic version questionnaire from the Global Youth Tobacco Survey (GYTS) was utilised to collect the data from the participants.

RESULTS

Among the participants, 57.3% were females and 42.7% were males. Students from private and public schools were 48.4 and 51.6%, respectively. The overall prevalence of those who had ever used smokeless tobacco was 7.6%, in which the prevalence among male students was 11.0% while among females was 5.0%. The determinant factors were male gender (OR 1.53 CI 95% 1.03-2.28), family structure (OR 1.52 CI 95% 1.03-2.23), exposure to second-hand smoke at home (OR 1.60 CI 95% 1.11-2.31), friends smoking cigarettes (OR 1.78 CI 95% 1.22-2.60), lack of restriction of selling tobacco to minors (OR 1.73 CI 95% 1.25-2.39), promotion of smokeless tobacco (OR 2.12 CI 95% 1.20-3.72) and low self-efficacy (OR 7.47 CI 95% 4.45-12.52).

CONCLUSION

A comprehensive prevention programme that enforces the prohibition of the promotion of smokeless tobacco and the selling of smokeless tobacco to minors is crucial. Moreover, the prevention programme should enhance adolescents' self-efficacy.

Adolescents' support for an outdoor smoke-free policy at sports clubs in the Netherlands

INTRODUCTION

Outdoor smoke-free policies (SFPs) at sports clubs may contribute to the prevention of smoking among adolescents. Adolescents' support for such policy is important to its success. The aim of this study is to explore adolescents' perceptions with regard to an outdoor SFP at sports clubs in the Netherlands.

METHODS

Focus group discussions (n=27) were held with 180 participants (aged 13-18 years) at 16 sports clubs. Thematic analysis was used to analyze the data.

RESULTS

Participants generally supported an outdoor SFP at sports clubs. Five reasons for this support were reported: 1) children should not be exposed to smoking, 2) smoking and sports (clubs) do not fit together, 3) secondhand smoke is undesirable, 4) an outdoor SFP may enhance a sports club's image, and 5) an outdoor SFP contributes to the prevention of smoking. Some participants voiced considerations against an outdoor SFP, arguing amongst others, that smokers need to be taken into account, and that problems may occur with compliance and enforcement. Support for an outdoor SFP was stronger among participants at clubs with an outdoor SFP than among those without such policy.

CONCLUSIONS

This study shows that adolescents generally support an outdoor smoke-free policy at sports clubs. After implementation, the outdoor SFP was generally experienced as a normal practice. These results could encourage sports clubs without an outdoor SFP to become smoke-free as well.

Individual and contextual determinants of perceived peer smoking prevalence among adolescents in six European cities

BACKGROUND

Young people perceiving a high peer smoking prevalence are more likely to initiate smoking. It is unclear which factors contribute to perceived peer smoking prevalence and if these factors vary according to education. This study aimed to assess the determinants of perceived smoking prevalence and assessed its variation at school and country-level.

METHODS

Data of 10,283 14-17-year-old students in 50 secondary schools in six European cities were derived from the 2013 SILNE survey. The outcome was the perceived smoking prevalence score among peers at school (0-10 scale, 10 represented 100% smoking prevalence). Multilevel linear regression models estimated the associations of factors with perceived prevalence score and variance at school and country-levels. Analyses were also stratified by academic achievement of the adolescent and parental education.

RESULTS

Determinants of a higher perceived prevalence score were female sex, ever smoking, having friends who smoke, low academic achievement, low parental educational level, and higher actual prevalence of smoking in the school. The perceived prevalence score was not associated with school policies or with the availability of cigarettes near the school. Determinants were very similar across levels of academic achievement and parental education. Perceived prevalence scores substantially varied between schools and countries: 10% and 11% of total variance was related to schools and countries respectively.

CONCLUSION

Across educational levels, perceptions of peer smoking are strongly determined by both individual characteristics and school and national contexts. Future studies should assess why perceived smoking prevalence varies between schools and countries and identify modifiable factors.

Secular versus religious norms against smoking: which is more important as a driver of quitting behaviour among Muslim Malaysian and Buddhist Thai smokers?

BACKGROUND

This paper prospectively examined two kinds of social normative beliefs about smoking, secular versus religious norms.

PURPOSE

The purpose of this paper is to determine the relative importance of these beliefs in influencing quitting behaviour among Muslim Malaysian and Buddhist Thai smokers.

METHODS

Data come from 2,166 Muslim Malaysian and 2,463 Buddhist Thai adult smokers who participated in the first three waves of the International Tobacco Control Southeast Asia project. Respondents were followed up about 18 months later with replenishment. Respondents were asked at baseline about whether their society disapproved of smoking and whether their religion discouraged smoking, and those recontacted at follow-up were asked about their quitting activity.

RESULTS

Majority of both religious groups perceived that their religion discouraged smoking (78% Muslim Malaysians and 86% Buddhist Thais) but considerably more Buddhist Thais than Muslim Malaysians perceived that their society disapproved of smoking (80% versus 25%). Among Muslim Malaysians, religious, but not societal, norms had an independent effect on quit attempts. By contrast, among the Buddhist Thais, while both normative beliefs had an independent positive effect on quit attempts, the effect was greater for societal norms. The two kinds of normative beliefs, however, were unrelated to quit success among those who tried.

CONCLUSIONS

The findings suggest that religious norms about smoking may play a greater role than secular norms in driving behaviour change in an environment, like Malaysia where tobacco control has been relatively weak until more recently, but, in the context of a strong tobacco control environment like Thailand, secular norms about smoking become the dominant force.

Normative influences on intentions to smoke among Greek adolescents: the moderating role of smoking status

Background

Social norms influence adolescent smoking intentions, but this effect may differentiate depending on current smoking experiences. The presented study assessed the moderation effects of smoking status on the relationship between social norms and smoking intentions among Greek adolescents.

Methods

A cross-section survey-based design was used. Overall, 251 Greek secondary school students (M age = 16.1 years, 61.2% females) completed structured and anonymous questionnaires including demographic characteristics (age, gender), subjective and descriptive social norms towards smoking, self-reported tobacco use, and intentions to smoke in the next 12 months.

Results

Linear regression analysis showed that social norms overall predicted 36.4% (Adjusted R²) of the variance in intentions. Perceived prevalence of smoking in same age peers and adults, having more close friends who smoke and perceived social approval of smoking predicted intentions to smoke in one year. Moderated regression analysis showed that the effects of social norms on smoking intentions were significantly moderated by smoking status.

Conclusions

Social norms predict smoking intentions, but this effect is stronger among ever (than never) smoker adolescents. Adolescents with smoking experiences may selectively attend to pro-smoking social cues and this perpetuates into their motivation to keep up the habit. School-based interventions should target normative beliefs and related cognitive processes, especially among adolescents who have already initiated tobacco use.

Association between social network communities and health behavior: an observational sociocentric network study of latrine ownership in rural India

OBJECTIVES

We identified communities of interconnected people that might serve as normative reference groups for individual-level behavior related to latrine adoption.

METHODS

We applied an algorithmic social network method to determine the network community from respondent-reported social ties of 16 403 individuals in 75 villages in rural Karnataka, India; data were collected from 2006 to 2008. We used multilevel modeling to test the association between latrine ownership and community-level and village-level latrine ownership. We also investigated the degree to which network cohesion affected individual latrine ownership.

RESULTS

Three levels of social contacts (direct friends, social network community, and village) significantly predicted individual latrine ownership, but the strongest effect was found at the level of social network communities. In communities with high levels of network cohesion, the likelihood was decreased that any individual would own a latrine; this effect was significant only at lower levels of latrine ownership, suggesting a role for network cohesion in facilitating the nonownership norm.

CONCLUSIONS

Although many international health and development interventions target village units, these results raise the possibility that the optimal target for public health interventions may not be determined through geography but through social network interactions.

Community-level adult daily smoking prevalence moderates the association between adolescents' cigarette smoking and perceived smoking by friends

Few studies have investigated the complex interactions among the individual- and community-level social risk factors that underlie adolescents' smoking behaviors. This study investigated whether community-level adult daily smoking prevalence is associated with adolescents' smoking and whether it moderates the associations between perceived friends' smoking approval and smoking behavior and adolescents' own smoking. Self-reported data from 1,190 youths (50.3% female; 13-18 years old) in 50 midsized Californian cities were obtained through telephone interviews. Community characteristics were obtained from 2010 GeoLytics data. Community adult daily smoking prevalence was ascertained from telephone interviews with 8,918 adults conducted in the same 50 cities. Multilevel analyses, controlling for individual and city characteristics, were used to predict adolescents' past 12-month smoking from perceived friends' smoking approval and smoking behavior and from community adult daily smoking prevalence. Results showed that perceived friends' smoking approval and behavior were associated positively with adolescents' smoking, as was the community-level prevalence of adult daily smoking. Furthermore, the association between perceived friends' smoking behavior and adolescents' own smoking was moderated by the prevalence of adult daily smokers in the community. Specifically, the association was stronger in cities with higher prevalence of adult smokers. These results suggest that adult community norms that are more supportive of smoking may enhance the influence of friends' smoking behavior. Therefore, interventions designed to prevent or reduce youths' smoking should also focus on reducing smoking by adults.

School and community predictors of smoking: a longitudinal study of Canadian high schools

OBJECTIVES

We identified the most effective mix of school-based policies, programs, and regional environments associated with low school smoking rates in a cohort of Canadian high schools over time.

METHODS

We collected a comprehensive set of student, school, and community data from a national cohort of 51 high schools in 2004 and 2007. Hierarchical linear modeling was used to predict school and community characteristics associated with school smoking prevalence.

RESULTS

Between 2004 and 2007, smoking prevalence decreased from 13.3% to 10.7% in cohort schools. Predictors of lower school smoking prevalence included both school characteristics related to prevention programming and community characteristics, including higher cigarette prices, a greater proportion of immigrants, higher education levels, and lower median household income.

CONCLUSIONS

Effective approaches to reduce adolescent smoking will require interventions that focus on multiple factors. In particular, prevention programming and high pricing for cigarettes sold near schools may contribute to lower school smoking rates, and these factors are amenable to change. A sustained focus on smoking prevention is needed to maintain low levels of adolescent smoking.

Multi-level influence of school norms on tobacco use in South Africa: an ecometric consideration of group differences

OBJECTIVES

Tobacco use has been found to be related to contextual-environmental characteristics. This study focuses on the influence of contextual norms on adolescent smoking behavior with consideration of racial differences.

METHODS

Data for this study were derived from the South African Community Epidemiology Network on Drug Use survey. Students (n = 1,277) completed a self-administered questionnaire (available in Afrikaans, Xhosa, and English). School-level aggregate measures were developed from the items: whether they thought smoking was wrong, whether they thought they would be seen as "cool" if they smoked, how many of their closest friends smoked, and whether they had repeated a grade level in school.

RESULTS

The results of this analysis revealed that after controlling for demographic characteristics, aggregate measures of importance for ever smoking were whether there were school norms of perceiving that smoking was not wrong, perceiving that smoking was cool, and high prevalence of having friends who smoke. Recent smoking was only predicted by attendance at schools with increased levels of academic failure. Black South Africans were less likely to ever smoke than Coloured or White.

CONCLUSIONS

This study highlights the saliency of both compositional (academic failure) and ecological (collective perceptions about smoking) characteristics in predicting ever and recent smoking. Collective perceptions of smoking in a predominantly Black school were largely negative. These findings can be used to target school norms regarding tobacco use in Cape Town.

Setting a good example? Changes in smoking prevalence among key occupational groups in New Zealand: evidence from the 1981 and 2006 censuses

INTRODUCTION

Role modeling by smokers may influence smoking among children and young adults. Most work on smoking by occupation has focused on health workers. A unique opportunity to explore smoking by occupation is presented in New Zealand (NZ) due to inclusion of a smoking status question in most national censuses since 1976. Our aim was to assess trends in smoking prevalence among potential role model occupational groups in NZ.

METHODS

Adult smoking status by occupation was obtained from the 1981 census (N = 1,321,323) and 2006 census (N = 1,744,479). Subjects were aggregated into 5 broad groups of potential role-model occupations: teachers, uniformed services, health-related occupations, public figures, and sportspeople/entertainers. Age and sex-standardized current smoking prevalences were calculated using the 2006 NZ employed population as the reference standard.

RESULTS

Standardized smoking prevalence among the employed population was 34.5% in 1981 and had declined 37% in relative terms and 12.8% in absolute terms to 21.7% in 2006. Relative declines in smoking prevalence between 1981 and 2006 ranged from 35% to 60% among the role model occupational groups and absolute declines from 8.3% to 19.9%. Māori had higher smoking prevalence and lower relative declines in prevalence in each occupational group from 1981 to 2006, compared with non-Māori. Specific occupations mostly had low smoking prevalences--particularly doctors and teachers. But some role model occupations had high crude smoking prevalences in 2006 (up to 47%).

CONCLUSIONS

Persisting high smoking prevalence among some occupational groups suggest that additional targeted smoking cessation support for role model occupational groups may be justified.

Socioeconomic patterning in changes in child exposure to secondhand smoke after implementation of smoke-free legislation in Wales

Introduction:

Secondhand smoke (SHS) exposure is higher among children from lower socioeconomic status (SES) households. Legislation banning smoking in public places has been linked with reduced SHS exposure in children. However, socioeconomic patterning in responses to legislation has been little explored.

Methods:

A total of 3,083 children aged 10–11 years, within 75 Welsh primary schools, completed questionnaires either before legislation or 1 year later. Saliva samples were provided by 2,787 of these children for cotinine assay. Regression analyses assessed socioeconomic differences in SHS exposure, and associations of legislation with exposure among children from low, medium, and high SES households. Changes in parental smoking in the home, car-based exposure, and perceived norms were assessed.

Results:

SHS exposure was highest among children from lower SES households. The likelihood of providing a sample containing an undetectable level of cotinine increased significantly after legislation among children from high [relative risk ratio (RRR) = 1.44, 95% CI = 1.04–2.00] and medium SES households (RRR = 1.66, 95% CI = 1.20–2.30), while exposure among children from lower SES households remained unchanged. Parental smoking in the home, car-based SHS exposure, and perceived smoking prevalence were highest among children from low SES households. Parental smoking in the home and children’s estimates of adult smoking prevalence declined only among children from higher SES households.

Conclusions:

Post-legislation reductions in SHS exposure were limited to children from higher SES households. Children from lower SES households continue to have high levels of exposure, particularly in homes and cars, and to perceive that smoking is the norm among adults.

Theory of planned behavior and smoking: meta-analysis and SEM model

To examine if the theory of planned behavior (TPB) predicts smoking behavior, 35 data sets (N = 267,977) have been synthesized, containing 219 effect sizes between the model variables, using a meta-analytic structural equation modeling approach (MASEM). Consistent with the TPB's predictions, 1) smoking behavior was related to smoking intentions (weighted mean r = 0.30), 2) intentions were based on attitudes (weighted mean r = 0.16), and subjective norms (weighted mean r = 0.20). Consistent with TPB's hypotheses, perceived behavioral control was related to smoking intentions (weighted mean r = -0.24) and behaviors (weighted mean r = -0.20) and it contributes significantly to cigarette consumption. The strength of the associations, however, was influenced by the characteristics of the studies and participants.

The effects of smoking norms and attitudes on quitting intentions in Malaysia, Thailand and four Western nations: a cross-cultural comparison

This research investigated the influence of smoking attitudes and norms on quitting intentions in two predominantly collectivistic countries (Malaysia and Thailand) and four predominantly individualistic Western countries (Canada, USA, UK and Australia). Data from the International Tobacco Control Project (N = 13,062) revealed that higher odds of intending to quit were associated with negative personal attitudes in Thailand and the Western countries, but not in Malaysia; with norms against smoking from significant others in Malaysia and the Western countries, but not in Thailand; and with societal norms against smoking in all countries. Our findings indicate that normative factors are important determinants of intentions, but they play a different role in different cultural and/or tobacco control contexts. Interventions may be more effective if they are designed with these different patterns of social influence in mind.

Mental health problems during puberty: Tanner stage-related differences in specific symptoms. The TRAILS study

The aim of this study was to investigate associations between specific mental health problems and pubertal stage in (pre)adolescents participating in the Dutch prospective cohort study TRAILS (first assessment: N=2230, age 11.09±0.56, 50.8% girls; second assessment: N=2149, age 13.56±0.53, 51.0% girls). Mental health was assessed by the Youth Self-Report, pubertal (Tanner) stage by parent-rated drawings of secondary sex characteristics. Overall, higher Tanner stages were related to more reported tiredness, irritability, rule-breaking behaviors, and substance use; and fewer fears and somatic complaints. Girls showed increases in social uncertainty, depressed mood, and worries; boys a decrease in self-criticism. Increasing problems during puberty were mostly related to the process of physical maturation, whereas decreasing problems were rather related to general age-related developments. Pubertal timing was associated with different symptoms than pubertal status or age. Puberty seems to affect girls more negatively than boys.

Social-cognitive and school factors in initiation of smoking among adolescents: a prospective cohort study

AIMS

The aim of the present study was to examine the association between social-cognitive factors, school factors, and smoking initiation among adolescents who had never smoked.

METHODS

The study was based on longitudinal data on Danish adolescents attending randomly selected public schools. Adolescents enrolled in grade 7 (mean age, 13 years) who had never smoked (n = 912) were followed up for 6 months after baseline. Those who had still never smoked were followed up again 18 months after baseline, in grade 8 (n = 442). Social-cognitive factors were examined with five measures: self-efficacy, social influence (norms), social influence (behavior), social influence (pressure), and attitude. We used multilevel analyses to estimate the associations between social-cognitive factors at baseline and smoking initiation as well as the random effects of school, school class, and gender group in the school class.

RESULTS

At the first follow-up, we found significant associations between attitude, father's smoking, best friend's smoking, and smoking initiation. At the second follow-up, we found a significant association with pressure to smoke from friends. Of the school factors, gender group in the school class showed an effect at both first and second follow-up.

CONCLUSION

Our results suggest that father's smoking, best friend's smoking, attitude, and pressure to smoke from friends affect smoking initiation. The results for school factors suggest an effect of classmates of the same gender, which has not previously been examined longitudinally.

Subjective attractiveness and perceived trendiness in smoking and snus use: a study among young Norwegians

In Norway, there has been a decline in smoking among adults and young people, but there has also been an increase in the use of snus, particularly among young males. Among females, snus use is less common. This study examines to what extent subjective attractiveness (SA) (the individual's personal opinion regarding how attractive a person who smokes/uses snus is) and perceived trendiness (PT) (the individual's impressions of how popular smoking/use of snus is) may contribute to explaining current trends in smoking and snus use among young people in Norway. Data were collected from a national representative sample of 2400 young people (age 16-20) by telephone interviews. Among males, regular smokers were also likely to be regular snus users and vice versa. SA and PT were significant predictors of their respective behaviours (smoking and snus use) and in some cases of the other behaviour. Smoking and snus use were perceived as unattractive, while snus use was perceived to be trendier than smoking. Males, more than females, perceived snus use to be attractive and trendy. This pattern is partly consistent with current changes in tobacco use in the Norwegian population.

Social differences in smoking and snuff use among Norwegian adolescents: a population based survey

BACKGROUND

A change in pattern of tobacco use has been observed in the last decade in Norway. Snuff use and occasional smoking have to some degree replaced daily smoking among adolescents and young adults. Daily smoking is known to be negatively associated with social background factors, but little is known about these associations for other types of tobacco use. Our aim was to study different types of tobacco use among adolescents according to gender, educational ambitions, family background factors, and urbanization.

METHODS

Cross-sectional, school-based study with 15 931 participants and response-rate 87%, conducted among 15 and 16 year olds during 2000-2004.

RESULTS

More girls (33.8%) than boys (26.4%) were daily or occasional smokers, while more boys (21.4%) than girls (3.5%) were daily or occasional snuff users. Daily smoking was more common among adolescents planning vocational education, with single parents or poor family economy. Occasional smoking and snuff use (daily or occasionally) showed a similar, but less pronounced pattern regarding education and single parent families. Adolescents with parents from foreign countries were less likely to use tobacco. One exception was boys with parents from Muslim majority countries who had an increased risk of daily smoking. A typical combination user of both tobacco types was a Norwegian boy with divorced parents and ambitions to complete vocational studies or only one year of upper secondary school.

CONCLUSION

Tobacco use in adolescents is mainly associated with low educational ambitions and less affluent self-reported family economy. Adolescents with divorced parents use more tobacco than those living with both parents. Public health initiatives to avoid or reduce tobacco use should mainly target adolescents in vocational studies and those leaving school early.

Do local tobacco regulations influence perceived smoking norms? Evidence from adult and youth surveys in Massachusetts

Smoking behavior has been shown to be influenced by individuals' perceptions of social norms about smoking. This study examines whether local regulations regarding clean indoor air and youth access to tobacco are associated with residents' subsequent perceptions of smoking norms. Data came from Massachusetts surveys of adults and youths and from records of local tobacco control policies. Indices of perceived smoking norms were based on perceived smoking prevalence and perceived community acceptance of smoking. Multilevel models tested the association between perceived norms and the presence of strong local regulations in four policy domains (restaurant smoking bans, smoking restrictions in other venues, enforcement of laws prohibiting sales to youths and youth-oriented marketing restrictions). The model controlled for town voting results on a tobacco tax referendum, which served as a measure of antismoking sentiment pre-dating the regulations. Results showed that youths perceived community norms to be significantly more 'antismoking' if they lived in a town that had strong regulations in at least three of the four domains. For adults, having strong regulations in as few as one to two domains was associated with perceiving community norms to be significantly more antismoking. Implementing and publicizing local regulations may help shape perceptions of community smoking norms.

Implications of the normative fallacy in young adult smokers aged 19-24 years

We used a random-digit-dialed survey of 434 smokers to demonstrate that approximately three quarters of young adult (aged 19-24 years) smokers overestimated by 20% or more the proportion of their peers who smoked. The effect of this normative fallacy was significantly greater in young adult smokers than in smokers aged 25 years or older. Because of the strength of this false consensus effect in young adult smokers, normative feedback interventions might be especially effective in this age group.