Neighborhood Social Context and Smoking Cession: A Multilevel Study of Collective Efficacy and Social Norms

Deborah Karasek, University of California, San Francisco
Jennifer Ahern, University of California, Berkeley

Cigarette smoking has been identified as one of the most important sources of preventable morbidity and premature mortality worldwide. Additional research is needed to identify factors that support or impede individual smoking cessation, and to design interventions accordingly. This study examines neighborhood level social norms and collective efficacy, a measure of social control and social cohesion, in association with individual smoking cessation. We model the hazard of quitting over a 5 year period among 4000 participants in the 2005 New York Social Environment Study (NYSES). Multivariable analysis using Cox-Proportional Hazard models showed that neighborhood level prohibitive smoking norms were significantly associated with individual smoking cessation (HR= 1.85 [95% CI=1.08, 3.17]). The analysis did not find a significant association for the neighborhood collective efficacy measure nor significant evidence of the joint effects of collective efficacy and smoking norms on cessation. Cessation Interventions should consider avenues for neighborhood normative change.