Modeling the relationship between descriptive norms and behaviors: a test and extension of the theory of normative social behavior (TNSB)

Proenvironmental self identity as a moderator of psychosocial predictors in the purchase of sustainable clothing

Previous research investigated the impact of psychosocial predictors (e.g. attitude, social and moral norm, perceived behavioral control, intention) on sustainable clothing purchasing. To date, no studies considered whether proenvironmental self-identity moderates the effects of these predictors on behavior. In this study, we adopted an intrapersonal approach and a longitudinal design to assess the moderating role of proenvironmental self-identity in predicting intentions and behaviors, considering gender differences. 250 participants completed an initial questionnaire on the predictors of three sustainable clothing purchasing. A month later, they filled out a second questionnaire to self-assess these behaviors. The results showed that social and internalized norms (moral norms) were notably influential of participants' intentions. Affective attitude influenced behavior positively, while cognitive attitude had a negative influence. When considering the moderating role of proenvironmental self-identity, significant gender differences emerged. Women with a weak proenvironmental self-identity expressed a higher intention to purchase sustainable clothing when they had high affective attitudes and descriptive norm but low cognitive attitudes. Women with a strong proenvironmental self-identity intended to purchase sustainable clothing when they had high moral norms and cognitive attitudes but low descriptive norm. Man with a weak proenvironmental self-identity and high positive affective attitude increased their future SCP.

Social norms, vaccine confidence, and interpersonal communication as predictors of vaccination intentions: Findings from slum areas in Varanasi, India

In recent years, India has seen significant improvements in childhood immunization, but rates among the urban poor remain stagnant. Disruptions during COVID-19 pandemic have created further challenges. This paper focuses on how social norms, vaccine confidence, and interpersonal communication independently and jointly affect vaccine intentions among caregivers of infants living in six slum areas in Varanasi, India. Data for this study come from the baseline assessments conducted before implementing the Happy Baby Program, an intervention to improve vaccination attitudes and intentions. In-person interviews (N = 2,058) were conducted with caretakers of children up to two years old. Analyses showed that interpersonal communication about vaccines, descriptive norms, injunctive norms, and vaccine confidence were each associated with intentions to vaccinate in both a bivariate and, except for injunctive norms, a multivariate model. In addition, we found significant interactions among these variables, suggesting that the roles of interpersonal communication and vaccine confidence attenuated the relationship between social norms and vaccination intention. Overall, our model explained 46.2 % of the variance in vaccine intention. Given the strengths of the relationships observed in this study, intervention strategies should focus on enhancing social norms and vaccine confidence to promote vaccination.

Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis

BACKGROUND

Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes.

OBJECTIVE

This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities.

METHODS

We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis.

RESULTS

Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective.

CONCLUSIONS

High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions.

TRIAL REGISTRATION

PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.

Not all norm information is the same: Effects of normative content in the media on young people's perceptions of e-cigarette and tobacco use norms

Norm information in media can predict individuals' norm perceptions and, ultimately, their behavior. Little research has examined how descriptive norm information manifests in media and impacts beliefs in the real world. Previously, using automated content analysis, we measured and examined longitudinal trends in two types of descriptive norm information, individual use depictions and population norms, pertaining to tobacco and e-cigarette use across six media sources from 2014-2017. Here, we assess how this norm information affected norm perceptions over time by pairing these data with a rolling cross-sectional survey of young people's beliefs and intentions related to these behaviors. We found that individual use depictions predicted some norm perceptions, although the direction of effects varied depending on the source, behavior, and type of perceptions considered. Population norm content did not affect perceptions. These findings highlight that real-world media norm information has real-world effects, and moderators of these effects should be studied.

Measurement of social norms for entertainment-education

BACKGROUND

While there has been a marked increase in measurement and scholarship surrounding social norms in recent years, there is little evidence related to social norms measurement in the context of health campaigns utilizing entertainment-education. Entertainment-education goals and objectives have shifted over time to include social norms and an update is needed to merge contemporary practice with the most recent measures from the literature. The aim of the present study was to analyze commonly used quantitative measures and their properties for social norms and entertainment-education, specifically on the topic of family planning, to bolster ongoing research and practice efforts by validating items for social norms measurement in entertainment-education programs.

METHODS

The study used data from a survey conducted with 438 married women aged 19-34 in the Central Province of Zambia in 2019 who were exposed to the entertainment-education initiative Kwishilya (Over the Horizon), a Bemba-language, 156-episode radio program designed to shift social norms on family planning. Multiple items were included to measure descriptive norms, injunctive norms, and outcome expectations. Exploratory factor analysis and estimates of scale reliability were conducted to understand the properties and structure of the social norms items.

RESULTS

Results showed a five-factor solution best fit the data, which accounted for 45.7% of the variance, exhibited fair reliability, and loaded largely as expected.

CONCLUSIONS

This study provides a useful tool for practitioners and scholars to use globally to measure important social norms constructs in entertainment-education.

Reconsidering the Effectiveness of Fear Appeals: An Experimental Study of Interactive Fear Messaging to Promote Positive Actions on Climate Change

Masspersonal communication has emerged as a compelling alternative persuasive approach in response to the widespread use of social media. It is crucial to comprehend how observing online interpersonal interactions regarding the fear appeal of climate change can foster pro-environmental behaviors among users. This study examines the effects of vicarious message interactivity in promoting actions against climate change and the underlying mechanisms behind this effect. The results of an online experiment conducted in China (N = 236) revealed that psychological reactance and message elaboration mediated the effects of vicarious message interactivity on behavioral intention in a serial indirect effect. In comparison to static fear appeal, interactive fear appeal proves effective in reducing psychological reactance, promoting message elaboration, and ultimately increasing intention to take actions against climate change. Our findings not only contribute to the literature on interactive communication but also provide insights for environmental-health campaigns on social media.

Leveraging Dynamic Norms to Reduce College Student Alcohol Use: A Test of Four Mediators

Social norms are common in persuasive messaging. For norms trending in a positive direction, it may be beneficial to emphasize change (i.e. dynamic norm) rather than the status quo (i.e. static norm). To test this proposition, we examined college students' responses to social norm messages encouraging moderate alcohol use. Undergraduates (N = 842) were randomly assigned to view a dynamic norm ("More college students drinking in moderation"), a static descriptive norm ("Most college students drink in moderation"), or a no message control. Four mechanisms were examined as potential mediators, three of which have been examined in previous work (preconformity, perceived importance, self-efficacy) and one of which was novel (psychological reactance). Results revealed that exposure to either social norm message (dynamic or static descriptive) was associated with more favorable attitude relative to a no message control. Attitude did not differ between the dynamic norm and static descriptive norm conditions. Only psychological reactance mediated the relationship between message condition (dynamic vs. static descriptive norm) and favorable attitude. Implications and future directions are discussed.

Where Do Perceived Norms Supporting Child Corporal Punishment Come From? A Study of Low-Income Parents

Although the influence of perceived norms on health behavior has been well researched, the sources of normative perceptions remain understudied. Drawing on the theory of normative social behavior, this study investigated factors shaping descriptive norms associated with child corporal punishment among a sample of low-income Black, Hispanic, and White parents (N = 260). Hierarchical regression results showed that childhood experiences of corporal punishment, direct observation, and interpersonal communication valence were significantly associated with descriptive norms. Path analysis confirmed the direct association between descriptive norms and behavioral intentions, as well as the mediating role of descriptive norms in linking the norm sources and behavioral intentions. Results also revealed that interpersonal network size and interpersonal communication valence jointly affected descriptive norms among parents who talked to others in their proximal networks about applying this disciplinary measure. Theoretical and practical implications were discussed.

The model of norm-regulated responsibility for proenvironmental behavior in the context of littering prevention

Previous research suggests that descriptive norms positively influence proenvironmental behavior, including littering prevention. However, in some behavioral contexts, a weak descriptive norm may increase individuals' feelings of responsibility by signaling a need for action. We examined this effect in the context of litter prevention by conducting structural equation modeling of survey data from 1400 Singapore residents. The results showed that descriptive norms negatively predicted ascription of responsibility and were negatively related to littering prevention behavior via ascription of responsibility and personal norms. It also showed that strong injunctive norms can reduce the inhibitory effect of descriptive norms on ascription of responsibility. These findings were consistent with several hypotheses constituting the model of norm-regulated responsibility, a novel explanatory framework offering new insights and a more nuanced and comprehensive understanding of social norms' influence on proenvironmental behavior.

Modeling the Relationship Between Perceived Descriptive Norms and Willingness to Practice COVID-19 Preventative Behaviors: A Test of the Mediation and Moderation Mechanisms in the Theory of Normative Social Behavior

Social norm has been found to impact compliance with COVID-19 preventative behaviors, including handwashing, wearing a face mask, social distancing, and cleaning and disinfecting frequently touched surfaces. There is, however, a limited understanding of the social norm influence mechanisms and its boundary condition in the context of COVID-19. Guided by the theory of normative social behaviors (TNSB), this study conducted an online survey (N = 336) to examine whether perceived injunctive norms (PIN), outcome expectation (OE), group identity (GID), group orientation (GO), and cultural tightness-looseness (CTL) can moderate and/or mediate the relationship between perceived descriptive norms (PDN) and behavioral intentions (BI) to perform COVID-19 preventative behaviors in the United States. Results showed that whereas OE mediated the PDN-BI relationship to enact all four focal behaviors, PIN mediated the PDN-BI relationship for social distancing, wearing a face mask, and cleaning and disinfecting. However, inconsistent with the predictions, all five moderators (i.e. PIN, OE, GO, GID, and CTL) attenuated, instead of strengthening, the PDN-BI relationships for particular preventative behaviors. Theoretical and practical implications were discussed.

The Roles of Trust in Government and Sense of Community in the COVID-19 Contact Tracing Privacy Calculus: Mixed Method Study Using a 2-Wave Survey and In-Depth Interviews

BACKGROUND

Contact tracing technology has been adopted in many countries to aid in identifying, evaluating, and handling individuals who have had contact with those infected with COVID-19. Singapore was among the countries that actively implemented the government-led contact tracing program known as TraceTogether. Despite the benefits the contact tracing program could provide to individuals and the community, privacy issues were a significant barrier to individuals' acceptance of the program.

OBJECTIVE

Building on the privacy calculus model, this study investigates how the perceptions of the 2 key groups (ie, government and community members) involved in the digital contact tracing factor into individuals' privacy calculus of digital contact tracing.

METHODS

Using a mixed method approach, we conducted (1) a 2-wave survey (n=674) and (2) in-depth interviews (n=12) with TraceTogether users in Singapore. Using structural equation modeling, this study investigated how trust in the government and the sense of community exhibited by individuals during the early stage of implementation (time 1) predicted privacy concerns, perceived benefits, and future use intentions, measured after the program was fully implemented (time 2). Expanding on the survey results, this study conducted one-on-one interviews to gain in-depth insights into the privacy considerations involved in digital contact tracing.

RESULTS

The results from the survey showed that trust in the government increased perceived benefits while decreasing privacy concerns regarding the use of TraceTogether. Furthermore, individuals who felt a connection to community members by participating in the program (ie, the sense of community) were more inclined to believe in its benefits. The sense of community also played a moderating role in the influence of government trust on perceived benefits. Follow-up in-depth interviews highlighted that having a sense of control over information and transparency in the government's data management were crucial factors in privacy considerations. The interviews also highlighted surveillance as the most prevalent aspect of privacy concerns regarding TraceTogether use. In addition, our findings revealed that trust in the government, particularly the perceived transparency of government actions, was most strongly associated with concerns regarding the secondary use of data.

CONCLUSIONS

Using a mixed method approach involving a 2-wave survey and in-depth interview data, we expanded our understanding of privacy decisions and the privacy calculus in the context of digital contact tracing. The opposite influences of privacy concerns and perceived benefit on use intention suggest that the privacy calculus in TraceTogether might be viewed as a rational process of weighing between privacy risks and use benefits to make an uptake decision. However, our study demonstrated that existing perceptions toward the provider and the government in the contact tracing context, as well as the perception of the community triggered by TraceTogether use, may bias user appraisals of privacy risks and the benefits of contact tracing.

Injunctive social norms and perceived message tailoring are associated with health information seeking

Social norms messages may promote information seeking, especially when the norms refer to a group with which a person identifies. We hypothesized that tailored social norms messages would increase COVID-19 testing willingness and intentions. College students (n = 203, 75% female, 87% White) were randomly assigned to one of four conditions in a 2 (Descriptive norms: Relevant vs. Irrelevant to COVID-19 testing) x 2 (Tailoring: Specific vs. General group information) experimental design. Participants reported COVID-19 testing willingness and intentions, perceived injunctive norms, and identification and connectedness with the group in the message. Although neither the norm nor tailoring manipulation worked as intended, participants who perceived greater message tailoring and injunctive norms reported greater willingness and intentions, with no effect of perceived descriptive norms on either outcome. Tailored messages as well as messages promoting injunctive norms may promote information seeking across health contexts, thereby enabling more informed decisions.

Political Party Collective Norms, Perceived Norms, and Mask Wearing Behavior: A Test of the Theory of Normative Social Behavior

The theory of normative social behavior (TNSB) postulates that people are influenced by others' behaviors, which they observe from messages and experience. In addition to focusing on perceived (i.e., descriptive and injunctive) norms, the TNSB was expanded to include collective norms, which represent what people actually do. Testing this expanded theoretical model, the current study examined whether two types of collective norms - collective political norms and collective regional norms - interacted with descriptive norms to influence pandemic mask wearing behavior expectations among U.S. adults (N = 444). The interaction was statistically significant for collective political norms (β = -.74, p = .009) but not collective regional norms (β = -.16, p = .85). Specifically, descriptive norms were related to increased mask wearing expectation for all values of political party collective norms, but the effects were stronger when political party collective norms were low (i.e., low mask wearing behavior was normative). The findings support the inclusion of collective norms in the TNSB, clarify the relationships among different types of norms, and provide insights for norms-based interventions.

The Role of Collective Group Orientation and Social Norms on Physical Distancing Behaviors for Disease Prevention

To reduce the impact of communicable diseases like COVID-19, collective action is required and likely to be susceptible to normative influence as well as whether people are more or less collectively oriented. We extend the theory of normative social behavior (TNSB) to account for group orientation and predict the relationships between social norms and physical distancing behaviors. Using a rolling cross-sectional design during 17 weeks of the pandemic, a national sample of US residents from 20 states (N = 8,778) participated in the study. The findings show that perceived descriptive norms, injunctive norms, and group orientation are significantly associated with physical distancing. The descriptive norm-behavior relationship and injunctive norm-behavior relationship are moderated by group orientation and the other predicted moderators in the TNSB. The findings extend the TNSB and highlight the need to understand social norms and group orientation in formative research for health communication campaigns designed to promote prevention behaviors.

Descriptive Norms and eHealth Use Among Older Adults: A Cross-Country Comparative Study

eHealth use enables older adults to access and manage healthcare resources, and benefits their health; however, older adults' uptake of eHealth remains low across societies. Social influences such as descriptive norms may be of critical importance in promoting the elderly's usage of eHealth. Based on the Integrative Model of Behavioral Prediction, this study investigates how descriptive norms relate to eHealth use among the elderly in China and the United States. Analysis of the combined sample (N = 1,070) showed that descriptive norms were positively related to eHealth use. Also, descriptive norms were indirectly associated with eHealth use via injunctive norms, attitudes and self-efficacy. Moderated mediation analysis indicated that these direct and indirect relationships differed across the two countries. This study highlights the important role of descriptive norms in promoting older adults' eHealth use behavior and addresses potential country differences in how the elderly respond to descriptive norms. Several important theoretical and practical implications are also discussed.

Drinking Buddies: The Importance of Proximal Norms in Emerging Adults' Alcohol-Related Private and Public Social Media Use

Exposure to alcohol posts on social media has been found to be associated with emerging adults' alcohol use. An important mechanism through which this association seems to occur are social norms. Thus far, however, research has not differentiated between proximal and distal norms and has not accounted for the private (e.g. Instagram private features, Snapchat) and public media outlets (e.g. Instagram public features) through which these norms might have been constructed. The results of our online survey among emerging adults (N = 789, Mage = 21.46, SDage = 1.88, 56.4% female), therefore, showed that exposure to alcohol posts on private SNS features in combination with descriptive proximal norms, instead of more public SNS features and distal norms, played an important role in emerging adults' alcohol use. As such, future research should focus more thoroughly on the interrelations between SNS private features and proximal normative perceptions and try to better understand on which social cues normative perceptions of proximal other's alcohol consumption are based.

Whose Norms to Follow? Effects of Social Norm Specificity on Black Americans' Intention to Receive COVID-19 Vaccines

COVID-19 has caused tremendous disruptions to public health and social stability. While the record-breaking speed of vaccine development brings a beam of light to put this global pandemic under control, public health professionals struggle to motivate certain population segments to be vaccinated. This research examined how social norms varying in reference group specificity influenced the intention to be vaccinated against COVID-19 among unvaccinated Black Americans. This report documented findings yielded from the first wave of data collection of a longitudinal study conducted in June 2021, with a total of 1,278 Black Americans who had not received COVID-19 vaccines. The results showed that participants' perceived norms among important others, Black Americans, and all Americans differed in their effects on vaccination intention. Moreover, perceived norms among Black Americans strengthened the effect of perceived norms in important others on vaccination intention, whereas perceived norms among all Americans attenuated the relationship between perceived norms among Black Americans and vaccination intention. The findings suggest the importance of considering norm specificity in future theoretical advancements and practical applications of social norms.

Mass behaviour change amid COVID-19: How public health information and social norms explain the transformation

COVID-19 is a severe and ongoing threat globally, with the spread disrupting lives and society. Despite the developments of vaccines, the key measure to reduce the transmission of variants has stemmed from mass changes to personal behaviours. COVID-19 pandemic offers a unique context, where the protection behaviours enacted by an individual are necessary to keep the community safe. A social psychological perspective can be used to understand the reasons for adherence to policies and determine what other factors can shape preventive behaviours. To resolve this, in partnership with health consumers we use an online survey, with the findings substantiating preventive behaviours are positively related to COVID-19 information access and descriptive norms. Additionally, findings demonstrate the mediating role of injunctive norms on preventive behaviour suggesting that policy makers can influence decision-making by promoting health information that provides guidance on acceptable behaviours, but also demonstrates subsequent success. The integrity of the model is substantiated by partial least squares (PLS) testing.

How Czech Adolescents Perceive Their Physical Activity

Adolescence is a critical stage in the development of an individual's physical activity (PA) habits and preferences. Adolescents' perceptions of PA can influence their motivation to engage in PA and, consequently, their overall level of PA. Thus, our primary aim was to investigate whether Czech adolescents misperceive their peers' PA. Our dataset comprised cross-sectional data on 1289 adolescents aged 11-15 years. PA was measured using self-reported items used in the HBSC study. To describe the gender and school grade differences in VPA, independent samples T, ANOVA, Mann-Whitney U, and Kruskal-Wallis H tests were performed. To analyze the effect of gender, school grade, school, and participants' own PA on the underestimation of PA, binomial regression models were used. Our study points out that there is a discrepancy between self-perceived levels of PA and the perceived descriptive norms of peers' PA. Adolescents underestimate the prevalence of sufficient PA, and thus perceived descriptive norms in PA as being worse than levels of own PA. These findings indicate room for targeted interventions based on social-norms-based approaches to increase the PA of adolescents or at least strengthen their actual positive behavior.

Leveraging Dynamic Norm Messages to Promote Counter-Normative Health Behaviors: The Moderating Role of Current and Future Injunctive Norms, Attitude and Self-Efficacy

Describing that many people perform a certain behavior has been known to increase people's behavioral intentions. However, the underlying premise is that the behavior must be high in prevalence. The present study examined whether describing low-prevalence behaviors (static norm) and framing low-prevalence behaviors as increasing in popularity across time (dynamic norm) may increase behavioral intentions in the context of getting the flu shot and eating less red meat. In addition, the study aimed to examine whether other behavioral antecedents could moderate the effect of viewing these normative messages. An experiment that randomly assigned participants to view either dynamic norm messages, static norm messages, and no messages (control) was conducted. Results indicated that for the behavior of eating less red meat, viewing a static norm message backfired while viewing a dynamic norm message did not. Moreover, the effect of viewing low-prevalence norm messages was moderated by other behavioral antecedents such as, current and future injunctive norm perceptions and attitude. These findings contribute to the theoretical and practical understanding of utilizing low-prevalence norms for persuasion.

"Can I Hit Our JUUL?": The Norms of Vaping and Dating among Emerging Adults

The growing popularity of vaping devices is of major concern for public health practitioners, and personal relationships have the potential to either increase or decrease the use of vaping devices. The escalation of romantic relationships, in particular, can have implications for the use of vaping devices. The current study seeks to understand how emerging adults negotiate communication about the use of vaping devices while initiating and escalating romantic relationships. Five focus groups were conducted with groups of participants who either did or did not use vaping devices. Results reveal the various reasons participants were reluctant to date individuals who vaped and illustrated the role of vaping norms in the stages of relational escalation. Practical and theoretical implications are discussed.

Brain Systems Underlying Fundamental Motivations of Human Social Conformity

From birth to adulthood, we often align our behaviors, attitudes, and opinions with a majority, a phenomenon known as social conformity. A seminal framework has proposed that conformity behaviors are mainly driven by three fundamental motives: a desire to gain more information to be accurate, to obtain social approval from others, and to maintain a favorable self-concept. Despite extensive interest in neuroimaging investigation of social conformity, the relationship between brain systems and these fundamental motivations has yet to be established. Here, we reviewed brain imaging findings of social conformity with a componential framework, aiming to reveal the neuropsychological substrates underlying different conformity motivations. First, information-seeking engages the evaluation of social information, information integration, and modification of task-related activity, corresponding to brain networks implicated in reward, cognitive control, and tasks at hand. Second, social acceptance involves the anticipation of social acceptance or rejection and mental state attribution, mediated by networks of reward, punishment, and mentalizing. Third, self-enhancement entails the excessive representation of positive self-related information and suppression of negative self-related information, ingroup favoritism and/or outgroup derogation, and elaborated mentalizing processes to the ingroup, supported by brain systems of reward, punishment, and mentalizing. Therefore, recent brain imaging studies have provided important insights into the fundamental motivations of social conformity in terms of component processes and brain mechanisms.

Normative influences on young drivers' illegal smartphone use: Applying an extended Theory of Normative Social Behaviour

In the 12 months to November 2021, 19 % of the people killed on Australian roads were aged between 17 and 25 years, despite this age group making up just 12 % of the driving population. A substantial number of these crashes resulted from smartphone use. It is widely accepted that norms influence young drivers' smartphone use; however, there is a dearth of research investigating how different norms interact to influence this behaviour. The current survey study (N = 137) applied an extended Theory of Normative Social Behaviour (TNSB) to investigate illegal smartphone use among young drivers. The original TNSB model proposes that injunctive norm (i.e., perceived societal approval), outcome expectancies, and group identity each moderate the relationship between descriptive norm and behavioural intention. The current study added subjective norm (i.e., perceived approval from important others) to the model. Moderation analyses found that only subjective norm moderated the relationship between descriptive norm and behavioural intention, whereas subjective norm, injunctive norm, and outcome expectancies each partially mediated this relationship. These findings provided partial support for the TNSB. They highlighted the influence of a range of norms on young drivers' smartphone use (i.e., descriptive norm, subjective norm, and injunctive norm) and, in particular, the influence of subjective norm in this context. It also highlights the importance of investigating how norms interact with each other to influence the relationship between descriptive norm and behavioural intention. In accordance with these findings, future public education messages should challenge normative influences, and subjective norm in particular, on young drivers' smartphone use.

Predicting Breastfeeding Intentions: A Test and Extension of the Theory of Normative Social Behavior with African American Social Identity

Breastfeeding is a health promoting social behavior but statistics suggest a persistent disparity of lower rates among African American mothers. The Theory of Normative Social Behavior (TNSB) explains when and how norms influence behaviors, but has produced inconsistent results with respect to proposed moderators group identity and injunctive norms (IN), limiting its predictive value in diverse cultural groups. Cultural norms are one of many influences on breastfeeding behaviors, yet little is known about their mechanisms of influence. The TNSB has not been tested in the breastfeeding context or within an exclusively African American cultural group. Given this knowledge gap, a survey of 528 African American mothers in the Washington, D.C. area was conducted to test the moderating effects of IN and subjective norms (SN) and social identity on the descriptive norms (DN) to intentions relationship as predicted by the TNSB. Structural equation modeling was used to show that when controlling for education and breastfeeding history, norms significantly predicted 26.4% of the variance in breastfeeding intentions. SN and DN interacted negatively to enhance breastfeeding intentions. Latent profile analysis using ethnic pride, collectivism, and religiosity scales detected four profiles of African American social identity. Social identity profile membership was a significant moderator on the DN to intentions pathway in the structural equation model. Profiles with the highest ethnic pride were significantly influenced by DN to intend to breastfeed. Implications from this study for public health intervention and communication messaging are discussed.

An explorative study of psychological and social factors impacting littering behavior in Vietnam

Littering is a worldwide problem and Vietnam is one of the most affected countries. To enact change, not only individual cognitive determinants but also social and natural-, or environment-related variables should be taken into consideration. Although there is a large body of literature researching littering, most researchers do not distinguish the level of these factors. Thus, this research aims to investigate the interactive mechanism of these different level factors influencing the intention of the Vietnamese to stop littering, with the multi-level social-ecological model used to guide model building. The data were collected through a self-reported online questionnaire and the Partial Least Squares Structural Equation Modelling (PLS-SEM) method was employed to examine the proposed conceptual framework. The results indicated that perceived behavioral control and connectedness to nature are the two main factors influencing the Vietnamese people's intention to stop littering. Multi-group analysis results suggested the moderating effects of injunctive and descriptive norms. This research proposed a new conceptual framework and achieved unique insights into littering behavior in Vietnam, which could benefit and guide behavioral change experts, academics, and practitioners to design appropriate marketing strategies/campaigns to reduce littering.

Follow or not? Descriptive norms and public health compliance: Mediating role of risk perception and moderating effect of behavioral visibility

In a pandemic context, public health events are receiving unprecedented attention, and identifying ways to enhance individual public health compliance behaviors has become an urgent practical problem. Considering that individual decisions are susceptible to group members' behaviors and that descriptive norms provide social information about the typical behaviors of others, we focused on the effects of the properties and reference groups of descriptive norms on public health compliance behaviors. We also investigated the mechanism with risk perception as a mediator and the applicable condition with behavioral visibility as a moderator. Through a 2 × 2 × 2 between-subject survey experiment with 529 subjects, we demonstrated that (1) compared with the negative norm, the positive norm was more effective in promoting public health compliance behaviors; (2) compared with the distal group norm, the proximal group norm more significantly promoted public health compliance behaviors; (3) the effect of the property of descriptive norms on public health compliance behaviors was weakened in the treatment of the proximal group norm; (4) risk perception partially mediated the association between the property of descriptive norms and public health compliance behaviors and fully mediated the effect of the interaction of the property and the reference group of descriptive norms on public health compliance behaviors; in the treatment of the negative-proximal group norm, individuals perceived more risk, thus effectively nudging their public health compliance behaviors; (5) compared with low-visibility behaviors, public health compliance behaviors were significantly stronger for high-visibility behaviors; (6) the property of descriptive norms had a weaker effect on public health compliance behaviors for low-visibility behaviors. In terms of theoretical significance, we refined the study of descriptive norms to promote the application of behavioral public policy. Moreover, the new model of public health compliance behaviors constructed in this study explains the mechanism and applicable conditions of public health compliance behaviors. In practical terms, this study has implications for designing intervention programs to nudge public health compliance behaviors.

Descriptive, Injunctive, and Collective Norms: An Expansion of the Theory of Normative Social Behavior (TNSB)

We propose and test several hypotheses derived from the expanded theory of normative social behavior (TNSB) that also includes collective norms (with descriptive and injunctive norms). Data come from a quasi-experiment intervention to promote safer driving among adolescents in Serbia. The intervention was administered among high school students, most of whom were on the verge of receiving their driver's licenses. Longitudinal data were collected from treatment and control schools at baseline (N = 1,449) and four months later at end line (N = 1,072). Descriptive norms at baseline predicted six-month changes in safer-driving intentions among women (β = .010 p < .05) but not among men. Main-effects of injunctive and collective norms were not significant. However, a significant interaction between descriptive norms and collective norms emerged among men (though not among women) and injunctive norms interacted with both collective norms and descriptive norms among women (but not among men). Initial evidence adds credence to the idea of enhancing the TNSB by adding both injunctive and collective (together with descriptive) norms as drivers of behaviors.

Strategic communication as planned behavior for science and risk communication: A theory-based approach to studying communicator choice

This essay argues that we should treat science and risk communicators' choices about tactics, objectives, and goals as behaviors to advance both research and practice. Doing so allows for a discussion about how to use theories about behavior change and trust-building to help foster more strategic communication choices. The essay also seeks to anticipate and respond to potential arguments against using behavior change theories to encourage more strategic communication choices. We argue that it is possible to use behavior change tactics ethically if those tactics are aimed at increasing the likelihood that all participants in communication-including decisions makers like risk scientists-meaningfully engage with true, relevant information. Under the right conditions, such engagement is what should allow for the development of new knowledge, as well as a range of evidence-based evaluative beliefs, feelings, and frames. Being strategic when making choices about communication should also help with identifying situations in which justice, equity, diversity, or inclusion issues require additional attention. The essay concludes by noting that the difficulty of efficient and effective science and risk communication may require increased emphasis on getting experts such as scientists to collaborate with expert communication advisors. It may also be necessary to increase the capacity of science- and risk-focused communication practitioners.

Predicting intentions to practice COVID-19 preventative behaviors in the United States: A test of the risk perception attitude framework and the theory of normative social behavior

This study examined risk perceptions, efficacy beliefs, social norms, and their interactions as predictors of people's intention to practice four COVID-19 preventative behaviors among a U.S. sample with quotas on age, sex, ethnicity, and region (N = 336). This online survey found that perceived injunctive norms predicted intentions to clean and disinfect (β = 0.20), practice social distancing (β = 0.14), and wear a face mask (β = 0.24). Additionally, efficacy beliefs were found to attenuate the association between descriptive norm perceptions and intention to wash hands (B = -0.15) and wear a face mask(B = -0.12). The results revealed the importance of considering both psychological and social factors to promote COVID-19 preventative behaviors.

The Influence of Normative Perceptions on the Uptake of the COVID-19 TraceTogether Digital Contact Tracing System: Cross-sectional Study

BACKGROUND

In 2020, the Singapore government rolled out the TraceTogether program, a digital system to facilitate contact tracing efforts in response to the COVID-19 pandemic. This system is available as a smartphone app and Bluetooth-enabled token to help identify close contacts. As of February 1, 2021, more than 80% of the population has either downloaded the mobile app or received the token in Singapore. Despite the high adoption rate of the TraceTogether mobile app and token (ie, device), it is crucial to understand the role of social and normative perceptions in uptake and usage by the public, given the collective efforts for contact tracing.

OBJECTIVE

This study aimed to examine normative influences (descriptive and injunctive norms) on TraceTogether device use for contact tracing purposes, informed by the theory of normative social behavior, a theoretical framework to explain how perceived social norms are related to behaviors.

METHODS

From January to February 2021, cross-sectional data were collected by a local research company through emailing their panel members who were (1) Singapore citizens or permanent residents aged 21 years or above; (2) able to read English; and (3) internet users with access to a personal email account. The study sample (n=1137) was restricted to those who had either downloaded the TraceTogether mobile app or received the token.

RESULTS

Multivariate (linear and ordinal logistic) regression analyses were carried out to assess the relationships of the behavioral outcome variables (TraceTogether device usage and intention of TraceTogether device usage) with potential correlates, including perceived social norms, perceived community, and interpersonal communication. Multivariate regression analyses indicated that descriptive norms (unstandardized regression coefficient β=0.31, SE=0.05; P<.001) and injunctive norms (unstandardized regression coefficient β=0.16, SE=0.04; P<.001) were significantly positively associated with the intention to use the TraceTogether device. It was also found that descriptive norms were a significant correlate of TraceTogether device use frequency (adjusted odds ratio [aOR] 2.08, 95% CI 1.66-2.61; P<.001). Though not significantly related to TraceTogether device use frequency, injunctive norms moderated the relationship between descriptive norms and the outcome variable (aOR 1.12, 95% CI 1.03-1.21; P=.005).

CONCLUSIONS

This study provides useful implications for the design of effective intervention strategies to promote the uptake and usage of digital methods for contact tracing in a multiethnic Asian population. Our findings highlight that influence from social networks plays an important role in developing normative perceptions in relation to TraceTogether device use for contact tracing. To promote the uptake of the TraceTogether device and other preventive behaviors for COVID-19, it would be useful to devise norm-based interventions that address these normative perceptions by presenting high prevalence and approval of important social referents, such as family and close friends.

Family Communicative Environment's Effects on Young Adults' Social Norms about Limiting Alcohol: Examining the Mediating Effects of Implicit Privacy Rules

Alcohol usage among young adults remains a prominent public health concern. Communicating with family members about alcohol can positively influence young adults' perceptions of social norms, yet the stigmatized nature of alcohol-related conversations in the family create a barrier to occurrence of these conversations. This study examines how young adults' familial communication patterns relate to their descriptive and injunctive social norms about limiting alcohol, using Communication Privacy Management Theory as the theoretical framework. Specifically, this study seeks to understand how conversation orientation, conformity orientation, warm conformity orientation, and cold conformity orientation associates with two sets of social norms (descriptive and injunctive), and to investigate how implicit privacy rules mediates each of these relationships. The current study examines 444 college students' responses to several quantitative measures. Implicit privacy rules did fully mediate the relationships between conversation orientation and injunctive social norms about limiting alcohol as well as warm conformity orientation and injunctive social norms about limiting alcohol.

Whistleblowing Against Doping Misconduct in Sport: A Reasoned Action Perspective With a Focus on Affective and Normative Processes

Whistleblowing against doping misconduct represents an effective deterrent of doping use in elite competitive sport. The present study assessed the effects of social cognitive variables on competitive athletes' intentions to report doping misconduct. A second objective was to assess whether the effects of social norms on whistleblowing intentions were mediated by actor prototype evaluations and group identification and orientation. In total, 1,163 competitive athletes from Greece, Russia, and the United Kingdom completed a questionnaire on demographics, past behavior, social cognitive variables, and intentions toward whistleblowing. Regression analyses showed that whistleblowing intentions were associated with different social cognitive variables in each country. Multiple mediation modeling showed that attitudes and subjective norms were associated with whistleblowing intentions indirectly, via the effects of anticipated negative affect and group identification and orientation, respectively. The findings of this study are novel and have important implications about the social, cognitive, and normative processes underlying decision making toward reporting doping misconduct.

The indirect effect of family communication patterns on young adults' health self-disclosure: Understanding the role of descriptive and injunctive norms in a test of the integrative model of behavioral prediction

Family communication patterns (FCP) are relational schema theorized to influence behaviors indirectly via cognitive processes, including perceived norms. However, relatively little is known about the indirect effect of FCP on health self-disclosure via perceived norms. We examine FCP's associations with young adults' health self-disclosure to their parents, assessing the theory of normative social behavior and the integrative model of behavioral prediction. Young adults (N = 504) completed a cross-sectional survey. Mediation analysis showed the effect of conversation orientation on health self-disclosure via communication efficacy and descriptive norms. Injunctive norms moderated the indirect effect of descriptive norms on self-disclosure. Results suggest conversation, but not conformity orientation, influenced young adults' self-disclosure, while norms and efficacy act as predominant drivers of disclosure behavior.

Caught in the Crossfire: How Contradictory Information and Norms on Social Media Influence Young Women's Intentions to Receive HPV Vaccination in the United States and China

This study uses online survey data from the United States and China to examine how contradictory information and social norms regarding HPV vaccines obtained through social media are related to young women’s attitudes and intentions surrounding HPV vaccination. The results show that exposure to contradictory information on social media had a greater negative association with intentions to receive HPV vaccination among the United States participants than among the Chinese participants, while social norms supporting HPV vaccines had a stronger positive association with intentions to receive HPV vaccination among the Chinese participants than among the United States participants. These findings extend the literature on social media communication regarding HPV vaccination and contribute to our knowledge of cultural contexts that influence intentions to receive HPV vaccination.

Influence of Presumed Media Influence for Health Prevention: How Mass Media Indirectly Promote Health Prevention Behaviors through Descriptive Norms

According to the influence of presumed influence (IPI) hypothesis, people's presumption of media effects tend to impact their willingness to engage in unhealthy behaviors (e.g., smoking) by shaping the normative perception of such behaviors. By applying the IPI hypothesis to media content for health promotion, this study explores how presumed media influence promotes health prevention behaviors in college students. Moreover, this study adopts three health behaviors to test the IPI processing mechanisms across different types of prevention behaviors (i.e., ambiguity and privacy). The results show that one's perceived influence of health promotion media content on others promotes one's own intentions to engage in healthy behaviors of safe sex, diet and nutrition, and skin cancer prevention. The findings also indicate that descriptive norms play various roles depending on the types of behavior. We discuss the IPI hypothesis as a persuasive strategy for health campaigns using mass media.

Understanding alcohol-specific antecedents among Chinese vocational school adolescents

BACKGROUND

Alcohol use among Chinese vocational school students is widespread and associated with many negative consequences. However, alcohol-specific antecedents for this population are understudied.

OBJECTIVES

The current study explored: (a) which alcohol-specific antecedents are the most salient predictors for alcohol use intentions, (b) whether any mediational relationships exist among these alcohol-specific antecedents, and (c) whether gender-based differences exist among these relationships.

METHODS

This study analyzed data from 1,230 vocational school adolescents in three Chinese cities. Survey data were analyzed using dominance analysis and structural equation modeling.

RESULTS

Personal norms were the most salient antecedents for alcohol use intentions, followed by injunctive norms from friends and parents, descriptive norms from friends and classmates, and positive belief about drinking. We observed a statistically significant mediational chain from descriptive norms to injunctive norms, and in turn to personal norms and positive beliefs, and finally to alcohol use intentions. Gender moderated some of the paths.

CONCLUSIONS

Alcohol use norms and beliefs among Chinese vocational school students have distinct predictive relationships with alcohol use intentions. Alcohol use prevention programs designed for this population need to address normative beliefs (descriptive, injunctive, and personal norms) and the perceived benefit of alcohol use.

Exploring How Media Influence Preventive Behavior and Excessive Preventive Intention during the COVID-19 Pandemic in China

In the context of global fighting against the unexpected COVID-19 pandemic, how to promote the public implementation of preventive behavior is the top priority of pandemic prevention and control. This study aimed at probing how the media would affect the public’s preventive behavior and excessive preventive intention accordingly. Data were collected from 653 respondents in the Chinese mainland through online questionnaires and further analyzed by using partial least squares structural equation modeling (PLS-SEM). Taking risk perception, negative emotions, and subjective norms as mediators, this study explored the impact of mass media exposure and social networking services involvement on preventive behavior and excessive preventive intention. Based on differences in the severity of the pandemic, the samples were divided into the Wuhan group and other regions group for multi-group comparison. The results showed that mass media exposure had a significant positive impact on subjective norms; moreover, mass media exposure could significantly enhance preventive behavior through subjective norms, and social networking services involvement had a significant positive impact on negative emotions; meanwhile, social networking services involvement promoted excessive preventive intention through negative emotions.

Rejoice architecture meets social norms to accelerate vaccination in Nepal: Protocol for a mixed-method quasi-experimental study

Background: Each year, 600,000 children under 5 years old die from vaccine-preventable diseases globally. Immunization is an effective way to prevent many diseases, saving two to three million lives per year. The Nepal National Government recommends vaccinations for all children for 11 diseases by 15 months of age. However, only 78% of children between 1-2 years of age have received all recommended vaccines and only 43% receive them at the age-appropriate times for which they are scheduled. Objectives: This protocol describes the development of an intervention - called "Rejoice Architecture" - that is informed by three theoretical perspectives: choice architecture, the broken windows theory, and the theory of normative social behavior. We also describe a mixed-methods approach to develop the intervention, which will improve the physical and social environments of health facilities in Makwanpur, Nepal. We hypothesize this intervention will improve immunization behaviors and intentions among mothers of children younger than 2 years, pregnant women, and prospective mothers. Methods: We describe the qualitative formative assessment to understand existing attitudes, norms, and behaviors among caregivers, healthcare workers, and government representatives. The formative assessment will include in-depth interviews, key informant interviews, and focus group discussions. We also describe the overall quasi-experimental study design, used to assess intervention impact. Impact: This study will contribute to the social and behavioral change communication intervention research by offering a novel strategy for increasing immunization. This study will also illustrate to policymakers the value of structural change for health service delivery.

How social norms are often a barrier to addressing climate change but can be part of the solution

We argue that the behavioral challenges posed by climate change are fundamentally problems of social influence. Behaviors that perpetuate climate change are often opaque in their consequences; thus, we look to others to infer how to act. Yet unsustainable behaviors, like driving and eating meat, are often the norm; conformity to such norms is a major hurdle to a more sustainable world. Nonetheless, we argue that social norms can also be a powerful lever for positive change. Drawing on two streams of recent research, we show that well-implemented social norm strategies can motivate positive steps even in the face of a negative current norm and even in individuals’ private behavior absent the judgment of others. First, appeals to dynamic norms – information about change in others or trends in norms over time – can lead people to conform to the change itself, even if this change violates current norms. Second, framing normative appeals in terms of an invitation to work with others toward a common goal can increase the motivation to join in. Despite ubiquitous unsustainable norms, careful theory-based representations of social norms can help us make progress on climate change.

Gender-norms, violence and adolescence: Exploring how gender norms are associated with experiences of childhood violence among young adolescents in Ethiopia

Adolescence is a time of particular risk for violence perpetrated by parents, teachers, peers and intimate partners. Social norms that condone violent discipline, promote masculinities focused on violence, and support gender inequality play an important role in perpetuating violence. However, little is known about the relationship between inequitable gender norms and children's experiences of violence from parents or other adults in the household. Utilising data from the Gender and Adolescence: Global Evidence (GAGE) study, this paper explores how adolescent and household attitudes and community-level gender norms influence experiences of violence among young adolescents (aged 10-12) in Ethiopia. Our results show that community norms, rather than adolescent and household attitudes, are significantly associated with experiences of household violence. This result holds for boys and girls, and in rural areas. In urban areas, however, adolescent attitudes were more influential than community norms, perhaps indicating less cohesive communities. Overall, these findings suggest that violence prevention programming should prioritise shifting community norms, particularly in rural areas, in order to promote adolescent girls' and boys' right to bodily integrity.

Narrative Persuasion and Social Norms in Entertainment-Education: Results from a Radio Drama in Mozambique

Narrative persuasion and social norms are part of the most recent theorizing behind the health communication strategy known as entertainment-education. There is little research, however, that compares these theoretical constructs from Mozambique, a setting that has not been researched to the same extent as other EE practice locations. This study uses mixed methods data from the midline evaluation of Ouro Negro (English translation: Black Gold), an EE radio program for individual health and social change in Mozambique to answer two research questions: what is the relationship between exposure to Ouro Negro and narrative persuasion?, and what is the relationship between narrative persuasion with Ouro Negro and social norms? Quantitative results related to the first question indicated that exposure significantly predicted three narrative persuasion constructs in multivariate regression models, results confirmed by a storytelling activity in focus groups. Quantitative results for the second question, which utilized propensity score matching, were not significant, and findings from a qualitative 2 × 2 table activity confirmed that behaviors were not normative in the directions promoted by the radio drama. Implications and recommendations for future entertainment-education research are discussed.

When a Personal HPV Story on a Blog Influences Perceived Social Norms: The Roles of Personal Experience, Framing, Perceived Similarity, and Social Media Metrics

The current study examines how a personal health story on a blog can influence individuals' perceived social norms, adopting the notion that social norms are "group identity-based codes of conduct". For that, we tested the effects of story framing and personal experience on perceived similarity, which interacts with social media metrics in forming perceived social norms. In an online experiment, college students (N = 220) were recruited to read a blogger's story in either a gain-frame (the blogger received the HPV vaccine and, thus, prevented cancer) or a loss-frame (the blogger did not receive the vaccine and, thus, developed cancer) with either high or low social media metrics. Participants reported that they were more similar with the blogger in the gain-framed story than the one in the loss-framed story, especially among those who have received the HPV. This perceived similarity was positively associated with both descriptive and injunctive norms; however, the positive association between similarity and descriptive norms disappeared when the blog had low social media metrics. Theoretical and practical implications are discussed.

Developing a Scalable Dynamic Norm Menu-Based Intervention to Reduce Meat Consumption

How can we curb the current norm of unsustainable levels of meat consumption? Research on dynamic norms finds that learning that others are starting to eat less meat can inspire people to follow suit. Across four field experiments, we test efforts to scale dynamic-norm messages by incorporating them into restaurant and web-based menus. Studies 1–3 find increases in vegetarian orders when dynamic norms are included in menus (1–2.5 percentage points), although this effect does not always reach statistical significance and varies across populations and analytic models. In Study 4, dynamic norms significantly reduced vegetarian orders. These results raise two critical questions. First, where and with whom should a dynamic norm message reduce meat consumption? Our field data and past theory point to non-high socioeconomic contexts, and contexts where the reference group of people who have changed is meaningful to consumers. Second, how can the treatment be strengthened? Over five online experiments, we find that the visibility of the messages can be greatly improved, and more relatable norm referents can be selected. Although impacts on food orders appear modest, the minimal costs of scaling menu-based dynamic norm messages and the possibility of improving effect sizes make this a promising approach.

Normative Influences on the Role of Prescription Medicine Misuse among College Students in the United States

Prescription medicine misuse is a growing problem in college campuses across the US. The Center for Disease Control (CDC) recently declared that the problem has reached epidemic proportions and is leading to a significant loss of lives every day. Norms-based public health campaigns that have been used in the past to address substance abuse issues among college students have had mixed success rates. Using the theory of normative social behavior, this study argues that a lack of focus on relevant mediators and moderators could be responsible for the failure of previous norms-based campaigns. Specifically, we test and support the mediating influence of perceived outcome expectations and injunctive norms on the effect of descriptive norms on intentions to misuse prescription medicines. In addition, perceived self-efficacy and trait reactance moderated the role of descriptive norms on outcome variables. Theoretical and practical implications of the findings are discussed.

The reduction in anemia through normative innovations (RANI) project: study protocol for a cluster randomized controlled trial in Odisha, India

BACKGROUND

More than half of women in India are anemic. Anemia can result in fatigue, poor work productivity, higher risk of pre-term delivery, and maternal mortality. The Indian government has promoted the use of iron-folic acid supplements (IFA) for the prevention and treatment of anemia for the past five decades, but uptake remains low and anemia prevalence high. Current programs target individual-level barriers among pregnant women and adolescents, but a more comprehensive approach that targets multiple levels among all women of reproductive age is needed to increase uptake of IFA and iron-rich foods.

METHODS

The Reduction in Anemia through Normative Innovations (RANI) project is a norms-based intervention to reduce anemia among women of reproductive age. We will evaluate the intervention through a clustered randomized controlled trial in Odisha, India. We will collect data at three time points (baseline, midline, and end line). For the study, we selected 89 clusters of villages, which we randomized into treatment and control on a 1:1 basis. The treatment arm will receive the RANI project components while the control arm will receive usual care. Fifteen clusters (40-41 villages) were selected and 4000 women (2000 in each arm) living in the selected clusters will be randomly selected to take part in data collection. Women in both study arms will have their hemoglobin concentrations measured. They will also complete in-person surveys about their knowledge, attitudes, perceptions of iron folic acid supplements, and nutritional intake. We will also select a smaller cohort of 300 non-pregnant women (150 in each arm) from this cohort for additional physical activity and cognitive testing. We will conduct both within- and between-group comparisons (treatment and control) at baseline, midline and end line using t-tests. We will also conduct structural equation modeling to examine how much each factor accounts for IFA use and hemoglobin levels.

DISCUSSION

This RCT will enable us to examine whether a social norms-based intervention can increase uptake of iron folic acid supplements and iron rich foods to reduce anemia.

TRIAL REGISTRATION

This trial was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.

Normative Substance Use Antecedents among Sexual Minorities: A Scoping Review and Synthesis

Although sexual minority stress remains the dominant perspective for understanding disproportionate substance use among lesbian, gay and bisexual (LGB) populations, social norms are among the most predictive and commonly targeted substance use antecedents in other high-risk groups. This scoping review seeks to bring clarity to the body of norms-focused alcohol, tobacco, and other drug (ATOD) research conducted with LGBs over the past 20 years, identify intervention implications, and present priority directions for future research. Fifty-two peer-reviewed studies published between June 1999 and June 2019 were identified from searches of PubMed, PsycInfo, and Medline databases using combinations of terms related to: social norms; sexual orientation or sexual minority status; and, the use of alcohol, tobacco, and other drugs. A far greater number of studies focused on actual ATOD norms than perceived ATOD norms or discrepancies between actual or perceived norms, illuminating the need for additional research focused on these levels of analysis. Taken together, this literature suggests that: (1) perceived ATOD norms are reliable predictors of LGBs' ATOD use; (2) actual ATOD use norms are low among LGBs participating in representative, population-based survey studies; and, (3) LGBs over-estimate the ATOD use of peers. Thus, intervention strategies including personalized normative feedback, psychoeducation, and social branding may hold promise in reducing LGBs substance use. However, additional research is needed to increase our understanding of injunctive ATOD norms, identify meaningful LGB reference groups, elucidate environmental influences on ATOD norms, and examine relationships between stigma experiences, perceived norms, and ATOD use.

Who Uses Tobacco Products? Using Peer Crowd Segmentation to Identify Youth at Risk for Cigarettes, Cigar Products, Hookah, and E-Cigarettes

Background: Understanding which adolescents are at greatest risk for cigarettes and other tobacco products is critical to inform tailored and targeted interventions. Objectives: We used peer crowds (macro-level subcultures) to identify subgroups of adolescents at-risk for using and being open to using cigarettes; cigars, cigarillos, and little cigars (cigar products); hookah; e-cigarettes; any tobacco product; and multiple products. Methods: In 2017, youth ages 12-17 in five U.S. states completed cross-sectional surveys (n = 1,167). Participants provided data on cigarette use (experimentation) and openness to use (susceptibility); cigar product, hookah, and e-cigarette use (ever use) and openness to use (curiosity); and identification with five peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular). We used chi-square tests to compare rates by peer crowd, and multivariate logistic regressions to assess odds of use and openness for each crowd (reference: Mainstream). Results: Risk differed by peer crowd. Hip Hop youth reported high rates of use, ranging from 12.8% (cigarettes) to 33.4% (e-cigarettes). Regressions revealed increased odds of use for Hip Hop compared to Mainstream for all products, especially cigar products and multi-product use. Popular (cigar products, e-cigarettes) and Alternative (cigarettes) demonstrated increased odds of use compared to Mainstream. We also observed elevated odds of cigarette openness among Alternative, Country, and Hip Hop youth, and of hookah openness among Hip Hop and Popular youth compared to Mainstream. Conclusions/Importance: Peer crowd-tailored cigarette education campaigns can be extended to address other tobacco product risk, especially for higher-risk peer crowds such as Hip Hop.