Broad changes in normative health behavior are critical to overcoming many of the contemporary challenges to public health. Reduction in tobacco use during the last third of the 20th century-one of the greatest improvements in public health-illustrates such change. The culture change from accommodation to intolerance of smoking is irrefutable. The role of health communication in predisposing, enabling, and reinforcing the normative social changes that ensued, however, has been less well documented with the linear, cause-and-effect methods of controlled intervention research. We examine the role of mass communication in the cultural transformation that reduced tobacco use, concluding that its influence on reduction in tobacco use follows a pathway as much through secondary transmissions within groups of people as through direct influence on individuals.
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