The influence of societal individualism on a century of tobacco use: modelling the prevalence of smoking

Background: Smoking of tobacco is estimated to have caused approximately six million deaths worldwide in 2014. Responding effectively to this epidemic requires a thorough understanding of how smoking behaviour is transmitted and modified. Methods: We present a new mathematical model of the social dynamics that cause cigarette smoking to spread in a population, incorporating aspects of individual and social utility. Model predictions are tested against two independent data sets spanning 25 countries: a newly compiled century-long composite data set on smoking prevalence, and Hofstede's individualism/collectivism measure (IDV). Results: The general model prediction that more individualistic societies will show faster adoption and cessation of smoking is supported by the full 25 country smoking prevalence data set. Calibration of the model to the available smoking prevalence data is possible in a subset of 7 countries. Consistency of fitted model parameters with an additional, independent, data set further supports our model: the fitted value of the country-specific model parameter that determines the relative importance of social and individual factors in the decision of whether or not to smoke, is found to be significantly correlated with Hofstede's IDV for the 25 countries in our data set. Conclusions: Our model in conjunction with extensive data on smoking prevalence provides evidence for the hypothesis that individualism/collectivism may have an important influence on the dynamics of smoking prevalence at the aggregate, population level. Significant implications for public health interventions are discussed.