5.29 Denormalising smoking
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Youth prevention efforts are enhanced and reinforced by strategies that denormalise the way in which smoking is portrayed or occurs in the broader community. Advocacy efforts to expose and counter the disproportionate portrayal of smoking in movies[23] are an example of this. Education strategies directed at children can help to 'correct' the tendency for young people to over-estimate the prevalence of smoking in the community.98
Bans on smoking in restaurants and bars may also have a substantial effect on adolescent smoking behaviour. Bans of this nature not only help denormalise the behaviour, but restrict opportunities for smoking. A longitudinal study undertaken in Boston has shown that where complete bans on smoking in restaurants are enforced, adolescents are significantly less likely to proceed from experimentation with smoking to established smoking patterns (having about 40% of the risk of adolescents living in areas where smoking restrictions are weak). Where restaurant bans had been in place for two or more years, adolescents aged between 1217 had only one tenth of the risk of becoming established smokers compared to adolescents living with weak smoking restrictions in restaurants, even after controlling for a wide range of confounding factors.303 There was no significant difference between rates of progression of smoking in adolescents in areas where smoking restrictions were weak or medium. The authors of this study suggest that a side effect of banning smoking in restaurants is an erosion of perceptions of both the social acceptability and the ubiquity of smoking.303 The increasing trend in Australia towards smokefree pubs, nightclubs and other entertainment venues is also likely to contribute towards increasing denormalisation of smoking.
Other research has confirmed that the opposite also applies, reporting that the more frequently young people observe smoking occurring in a range of settings, the more likely they are to have the view that smoking is both socially acceptable and normal. The authors of this work comment that restrictions on smoking have the potential to challenge established social norms by reducing young people's exposure to smoking among adult and peer exemplars, by decreasing the opportunity to smoke, by limiting opportunities for smoking in groups and sharing cigarettes, and by helping to reshape wider public opinion about smoking, all of which factors are known to influence adolescent smoking behaviour.324
Smoking restrictions in public places also help reduce smoking uptake among teenagers, but are less powerful than bans or restrictions on smoking in the home (see Section 5.7 above).78 Research has shown that providing recreational after-school activities and locations where children and teenagers can socialise under adult supervision, may bring about a modest but significant reduction in smoking rates within these groups.92, 325
The tobacco industry regards denormalisation of smoking behaviour as a significant threat to its long-term viability. See Chapter 10, Section 10.23.1 for discussion.
[23] See, for example, http://smokefreemovies.ucsf.edu/problem/moviessell.html. Tobacco imagery in movies and other media are discussed in Section 5.15.3 above, and in Chapter 11, Section 11.6.4 .
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