Denormalizing (e-)cigarettes at school: Co-designing preventive measures with adolescents

Abstract Background In many vocational and secondary schools, smoking is still considered as normal behavior. To change this norm, the project “Here We Are” aimed to denormalize (e-)tobacco product consumption. Methods Based on a detailed literature review, three workshops with students, and advisory board consultations, a denormalizing intervention was developed and implemented at three schools (e.g., relocating smoking areas away from school entrances, removing contradictory elements such as ashtrays in non-smoking areas, improving signage, and enhancing the appeal of non-smoking areas with sunshades, lounge chairs, as well as board an outdoor games). To evaluate the effectiveness of the intervention, 14-20-year-old-students filled in standardized online questionnaires on smoking regulations, perceived norms, attitudes, and behaviors (N = 673) before, during and after the intervention. We also conducted pre-post-observations of students’ smoking behaviors during school days and semi-structured interviews (N = 54). Results The new regulations were well received, students’ knowledge about local smoking regulations increased and the perception of (e-)tobacco use as “normal” declined (even five months after the intervention). The importance the change communication, the attractiveness of smoke-free zones relative to smoking areas, and the consistent enforcement of rules were identified as critical factors for the sustainable intervention success. Other key factors for success include adherence to the rules by school staff (teachers, cafeteria employees), students’ understanding of the new regulations, the timing of implementation (avoiding mid-school year), and the involvement of facility and technical services. Conclusions The findings suggest that re-designing school areas with adolescents can promote the denormalization of smoking. Challenges and opportunities as well as current work on the multiplication and continued development of the intervention will be discussed. Key messages • Co-designing school areas can promote the denormalization of (e-)tobacco product consumption. • Success factors comprise attractive smokefree zones, change communication, and rule enforcement.