Social Norms, Collective Efficacy, and Smoking Cessation in Urban Neighborhoods

We examined the separate and combined relations of neighborhood-level social norms and collective efficacy with individuals' cigarette smoking cessation. We modeled the hazard of quitting over a 5-year period among 863 smokers who participated in the 2005 New York Social Environment Study. In adjusted Cox proportional hazard models, prohibitive neighborhood smoking norms were significantly associated with higher rates of smoking cessation (second quartile hazard ratio [HR] = 1.17; 95% confidence interval [CI] = 0.59, 2.32; third quartile HR = 2.37; 95% CI = 1.17, 4.78; fourth quartile HR = 1.80; 95% CI = 0.85, 3.81). We did not find a significant association between neighborhood collective efficacy and cessation or significant evidence of a joint relation of collective efficacy and smoking norms with cessation. Neighborhood social norms may be more relevant than is collective efficacy to smoking cessation. The normative environment may shape health behavior and should be considered as part of public health intervention efforts.