Does “de-normalization” change? Trends in the de-normalization of smoking in German adolescents

摘要

Introduction: The de-normalization of smoking remains a “catch-all“ diagnosis for societal norm changes with regards to tobacco. However, indicators and dimensions of these changes have been insufficiently studied from a theoretical and empirical view. The aim is to analyze trends of tobacco de-normalization processes in the triad of family, friends’, and school context. Methods: Data was obtained from two waves of the cross-sectional SILNE-R-Surveys (2013 & 2017) including 14-16 year-olds (n=1.902) from 20 German schools. Social inequalities with respect to smoke-free (SF) homes, social proximity to smoking friends, and perceived visibility of smoking students were analysed in logistic regression models regarding different aspects of the socioeconomic status (SES: subjective SES, parental education, school type). Gender, migration background and differences in individual and parental smoking, perceived smoking norms, and school tobacco policies (STPs) were included as further independent variables. Results: Weekly smoking among adolescents decreased between 2013 (10%) and 2017 (5%). Still, two thirds of the sample reported (2013: 64%; 2017: 62%) not living in a SF home. Social proximity towards smoking friends was reported by a small and shrinking minority of less than 10%. Perceived visibility of school smoking has decreased between 2013 (42%) and 2017 (22%). The multivariate analyses show a significant trend of convergence of low and high SES with regards to SF homes, although parental smoking decreases the likelihood. No significant inequalities in social proximity to smoking friends were found, but an influence of friends’ norms and individual smoking status. About 41% perceived STPs as weak, while such STPs increased significantly the likelihood of smoking visibility. Low SES schools are at a higher risk to report high visibility of smoking. Discussion: Shrinking proximity towards smokers and decreasing visibility of school smoking, as well as a convergence among SES groups with regards to SF homes give rise to a legitimate expectation for a possible tobacco endgame. Funding: This study (SILNE-R) is supported by EU Horizon 2020 (grant agreement 635056).