Changes in smoking habits
The prevalence of smoking was lower in 2005 than in 1975. The decrease in the intervening period was, however, far from linear. In the 1990s there were instances of increase. The patterns of change were not identical across sex and grades. The decrease in the prevalence of smokers stopped during a period and even increased a little; this was probably neither caused by changes in cigarette prices nor in buying capacity. Cigarette prices continued to increase in the 1990s and the buying power was similar to that in the period before and after (8). It is therefore possible that the flattening can be explained by reduced preventive efforts.
The decrease in smoking from 2000 to 2005 is remarkable. If one sees all three grades in secondary school and both sexes in one, the proportion of daily smokers in secondary school decreased from about 10 % to about 5 % in this period. At the first National (Norwegian) Tobacco Conference in 2002, Health Minister Dagfinn Høybråten launched the goal to halve smoking among adolescents during the next 5-year period. His ambitious goal proved to be realistic.
There are several explanations for this reduction in prevalence of smokers among adolescents. In the period we have studied, there was a substantial decrease in smoking also among adults. As young people's smoking habits are much affected by those of their parents; the fact that fewer parents were smokers in 2005 than in 2000 may be an explanation for the decrease. A logical next question will then be what may have caused this decrease among adults. The strong political signals against smoking when Høybråten was Minister of Health may have contributed to the decrease. From 2003, more powerful measures than those previously used in the Norwegian smoking control programme were introduced, and there was an increase in the use of mass media campaigns. Researchers at the Norwegian Institute for Alcohol and Drug Research (SIRUS) suggested and advocated that campaigns with more use of fear appeals would be effective in reducing smoking. This was well received by politicians, and a campaign containing straightforward and realistic descriptions of health consequences of smoking was launched in 2003. It proved to be controversial, but may have contributed to changing attitudes to smoking and social norms related to smoking. The total ban on smoking in restaurants and bars, which came into force June 1st 2004, probably also contributed to the reduction in smoking. Public debates on the introduction of the total ban on smoking may well have contributed to raise awareness and disseminate health information.
Last, but not least, it should be mentioned that the decrease in smoking from 1975 to 1985 (among girls) and the decrease in the period 2000 to 2005 (both sexes), may be associated with campaigns in secondary school. Towards the end of the 1970s, the Norwegian Council on Smoking and Health produced an educational programme about smoking and health that was used by schools nationwide (9), and in the 1990s the Norwegian Cancer Society developed a programme that was later distributed by the Directorate of Health and Social Affairs (BE smoke FREE). Evaluation of this last programme showed that the proportion of daily smokers among pupils by the end of grade 10 was reduced by about one third (10). A study which showed that many schools used only parts of the programme led to development of a revised version that is easier to implement and which is easier to integrate in the schools' teaching plans (11). This newest version of the programme is called FREE.