Introduction: The hardening hypothesis states that with the declining prevalence and growing social disapproval of smoking, remaining smokers are more unwilling and unable to quit as well as increasingly characterized by low socioeconomic 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- to 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 smoking 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 changes 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 hypothesis, 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 adolescent daily smokers was observed.
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