[Changes in knowledge, attitudes, and smoking behavior among young people in Germany. Results of repeated,...

Following an increase in tobacco consumption among 12 to 17 year olds between 1993 and 1997, a policy mix comprising various structural and behavioral prevention measures was implemented in Germany. One element of this policy mix is the "rauchfrei" ("smoke-free") youth campaign of the BZgA (Federal Centre for Health Education), a combination of media that reaches a large number of youth, personal communication, and setting-based interventions. The aim is to prevent young people from starting to smoke and to promote the cessation of smoking at an early stage. Based on a multistage intervention model, wide coverage of the measures should be achieved among young people, as well as changes in knowledge, attitudes, social norms, and behavioral intentions. Based on the intervention model, repeated, representative cross-sectional surveys were conducted to examine the development of these indicators and of tobacco consumption. Five studies were conducted during the period from 2003 to 2008, each comprising between 1,220 and 2,780 computer-assisted telephone interviews with randomly selected young people between the ages of 12 and 17. The percentage of young people reached by information offered on the subject of not smoking rose between 2003 and 2008. Participation in school-based prevention measures also rose. There was an increase in knowledge regarding the harmful substances contained in cigarette smoke, and in the percentage of young people who rated active and passive smoking as being harmful to health. In addition, the attitude towards smoking of young people who have never smoked became more critical, as did that perceived in the social environment. The proportion of young people who smoke declined substantially, from 27.5% (2001) to 15.4% (2008), and there was been a major rise in the number who have never smoked, from 40.5% (2001) to 60.6% (2008). The change in knowledge-based risk assessments, attitudes, and social norms should be further promoted by mass media and personal communication measures, as well as by setting-based and behavioral prevention measures. In order to encourage them to quit smoking, young smokers must be motivated and convinced by means of suitable behavioral prevention interventions.