Hardcore adolescent smokers? An examination of the hardening hypothesis by using survey data from two Norwegian samples collected eight years apart

Abstract

Introduction. The hardening hypothesis stat es that with declining prevalence and growing social disapproval of smoking, remaining smokers are more unwilling and unable to quit, as well as increasingly characterized by low socio - economic status and psychiatric comorbidity. However, few studies have examined whether such characteristics do in fact change in tandem with substantially decreased smoking prevalence. Methods. Two nationwide population - based surveys of 16 - 17 year - old Norwegian adolescents were conducted according to identical procedures in 2002 and 2010. In 2002, 3,438 students participated while 2,813 did so in 2010, yielding response rates of 91.0 and 83.2%, respectively. Data on smoking behavior and a variety of psychosocial variables were obtained. Results. The prevalence of daily smoki ng dropped from 23.7% in 2002 to 7.0% in 2010. The association between smoking and parental characteristics, adjustment to school and social integration also shifted, indicating smokers to be more socially disadvantaged in 2010 than 2002. However, no chang es in the relationship between smoking and mental health or use of substances such as alcohol and cannabis were found, nor did the number of cigarettes smoked by daily smokers differ between 2002 and 2010. Conclusions. The results support the hardening hy pothesis, as smokers became increasingly socially disadvantaged with decreasing smoking prevalence. However, despite reduced prevalence of smoking and growing stigmatization, neither greater psychological distress nor increased substance use among adolesce nt daily smokers was observed.