Misperceptions of Peer Norms for Tobacco Use Are Widespread and Associated with Personal Use Among US Secondary School Students

Introduction Nicotine consumption initiation is most likely to occur between the ages of 11 and 17. Previous research has demonstrated the strong tendency of people to conform to social norms as they look to others to give guidance on expected attitudes and behaviors in various settings. Social norms within the school context may be an important determinant of tobacco use initiation and frequency as youth look to peers for social cues on what to believe and how to behave. Yet misperceptions about these social norms are likely to be widespread.

Methods Data were collected from 27,545 students in grades 6-12 across 63 schools in 11 U.S. states from 1999 to 2014 via anonymous online surveys. This study distinguishes between actual peer norms about tobacco use attitudes and behavior among youth (i.e. the attitudes and behaviors held and practiced by a majority of the peer group) and perceived peer norms about tobacco use attitudes and behavior among youth (i.e. what an individual believes to be the attitudes and behaviors held and practiced by a majority of people in that peer group). We also examine the associations of actual and perceived peer norms with personal attitude and personal use.

Results Believing that tobacco use is okay and actually using tobacco during the year were rarely normative in any grade level in any school. Dramatic misperceptions about these positive norms were found across a diversity of schools and students, however. Although 77% of students said tobacco use was never good, 64% of students believed that most others in their grade thought use was okay. Similarly, although 78% of students reported never using tobacco, 67% of students perceived that students in their grade most typically used tobacco monthly or more often. Misperceptions were pervasive across race, grade cohort size, school socio-economic status, and survey years, with greater prevalence of misperceptions and more extent of inaccuracy across increasing grade and age levels. Regression analyses showed that perception of the attitudinal norm was highly predictive of personal attitude about use. Further, misperceiving tobacco use as the norm among same-grade peers strongly predicted personal tobacco use even after adjusting for the actual same-grade prevalence of tobacco use, personal attitude about use, and several other factors.

Conclusions There is opportunity to reduce misperceptions of peer norms and highlight the healthy anti-tobacco attitudes and behaviors that actually exist among students. Taking a social norms approach to reducing misperceptions would presumably reduce tobacco use among youth who do use tobacco as well as encourage students who do not use tobacco to resist initiation of use and be more vocal about their own healthy attitudes and behaviors.