title: Do children overestimate the extent of smoking among their peers? A feasibility study of the social norms approach to prevent smoking.
abstract: Social norms approaches (SNA) are based on the premise that we frequently overestimate risk behaviours among our peers. By conducting campaigns to reduce these misperceptions, SNAs aim to reduce risk behaviours. This study examines the extent to which 12 to 13year old pupils overestimate smoking among their peers and explores the appropriateness of using SNA in secondary schools to prevent smoking uptake.
  
  
  METHODS
  The extent of overestimation of smoking among peers was assessed through an on-line SNA questionnaire in five schools (n=595). Based on questionnaire results, pupils developed SNA campaigns in each school. Qualitative methods of focus groups (7), interviews (7) and observation were used to explore in-depth, from the perspective of staff and pupils, the appropriateness and feasibility of the SNA to prevent smoking uptake in secondary schools.
  
  
  RESULTS
  A quarter of pupils, 25.9% (95% CI 25.6% to 26.1%) believed that most of their peers smoked, however, only 3% (95% CI 2.8% to 3.3%) reported that they actually did; a difference of 22.9% (95% CI 19.1% to 26.6%). Self-reported smoking was not significantly different between schools (X(2)=8.7 p=0.064), however, perceptions of year group smoking was significantly different across schools (X(2)=63.9 p<0.001). Qualitative analysis identified full school engagement, minimal teacher time requirements, pupils' belief in questionnaire results and understanding wider context, as key in optimising implementation.
  
  
  CONCLUSIONS
  This study shows significant misperception between self-reported and perceived smoking among peers in secondary schools, thus supporting a key premise of social norms theory. Implementing SNAs and studying effects is feasible within secondary schools.
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, United Kingdom. Electronic address: H.Elsey@leeds.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Elsey
authors.affiliation: Student Administration, University of Leeds, 17 Blenheim Terrace, Leeds LS2 9JT, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Owiredu
authors.affiliation: The Office of the Director of Public Health, Technorth, 9 Harrogate Road, Leeds LS7 3NB, United Kingdom.
authors.forename: Heather
authors.initials: H
authors.lastname: Thomson
authors.affiliation: The Office of the Director of Public Health, Technorth, 9 Harrogate Road, Leeds LS7 3NB, United Kingdom.
authors.forename: Gemma
authors.initials: G
authors.lastname: Mann
authors.affiliation: Public Health Unit, Wakefield Council, Wakefield One, Burton Street, Wakefield WF1 2EB, United Kingdom.
authors.forename: Rashesh
authors.initials: R
authors.lastname: Mehta
authors.affiliation: University of York, Heslington, York YO10 5DD, United Kingdom.
authors.forename: Kamran
authors.initials: K
authors.lastname: Siddiqi
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010379:Peer Group; D012907:Smoking / Q000523:psychology*; D066262:Social Norms; D011795:Surveys and Questionnaires
keywords: Children; Pupil; Secondary school; Smoking prevention; Smoking uptake; Social norms approach