摘要：Objectives. We assessed the prospective impact of individual, social-normative, and policy predictors of quit attempts and smoking cessation among Massachusetts adults. Methods. We interviewed a representative sample of current and recent smokers in Massachusetts by telephone in 2001 through 2002 and then again twice at 2-year intervals. The unit of analysis was the 2-year transition from wave 1 to wave 2 and from wave 2 to wave 3. Predictors of quit attempts and abstinence of longer than 3 months were analyzed using multilevel analysis. Predictors included individual, social-normative, and policy factors. Results. Multivariate analyses of 2-year transitions showed that perceptions of strong antismoking town norms were predictive of abstinence (odds ratio = 2.06; P < .01). Household smoking bans were the only policy associated with abstinence, but smoking bans at one's worksite were significant predictors of quit attempts. Conclusions. Although previous research showed a strong relation between local policy and norms, we found no observable, prospective impact of local policy on smoking cessation over 2 years. Our findings provide clear support for the importance of strong antismoking social norms as a facilitator of smoking cessation. Increasing the rate of successful smoking cessation is one of the most effective public health strategies for improving the health of the population. 1 To provide guidance for future intervention efforts, it is vital that we understand the factors that contribute to successful cessation at the population level. Longitudinal studies of population-based samples are one of the best ways to examine the process of change in smoking behaviors. The UMass Tobacco Study was a 3-wave longitudinal investigation examining personal, social-normative, and policy factors that contribute to favorable change in smoking behavior among residents of a state that had a comprehensive tobacco control program in place for almost 10 years. 2 The study hypothesized that local clean indoor air policies and those that reduced youths' access to tobacco would have a beneficial effect on adult smoking primarily by increasing antismoking norms. Local tobacco control regulations, such as restaurant smoking bans, may influence the way individuals perceive the community norm because they can no longer smoke in restaurants, because they observe fewer people smoking in restaurants, or because they see the restaurant's “No Smoking” sign as indicating community disapproval. Regulations may influence individual's perceptions even when their own behavior is not regulated. An adult who sees a store clerk check the identification of a young person attempting to buy cigarettes may infer that the community disapproves of tobacco use, at least by young people. Support for the hypothesis that strong local policies affect social norms about smoking was obtained in an analysis of the baseline data from the UMass Tobacco Study, which showed that adults living in towns with higher numbers of strong tobacco control policies were more likely than those living in towns with fewer policies to report that town residents disapproved of smoking and that fewer people smoked. 3 This relationship remained significant even after preexisting antitobacco sentiment in the town and other demographic characteristics of the town and its residents were controlled. The connection between policy and norms was also shown in cross-sectional analyses of the impact of local restaurant smoking bans on youths' perceptions of norms. 4
