Abstract
When it comes to smoking, apprentices are considered a ‘vulnerable’ population. They have been the subject of targeted approaches based on the assumption of common characteristics. In contrast to most public health studies, that assume homogeneity of vulnerable groups, this article, based on Lahire’s ‘theory of the plural individual’, aims to examine inter- and intra-individual variability in relation to tobacco exposure. It is based on a secondary analysis of 30 interviews with apprentices in France on the stigma attached to their use in their different living environments. Our study confirms that the family and the Centre de Formation des Apprentis, as a whole, encourage smoking. It also provides a better understanding of the mechanisms by which inequalities are perpetuated (permissive rules, loans and gifts of cigarettes, spillover effects, lack of incentives to quit). Nevertheless, it allows us to observe that, in some families and in some companies, smoking is denormalised, even stigmatised. Several apprentice profiles emerge: those who are protected from tobacco and seem to be able to quit easily; those who are permanently confronted with it and for whom it is difficult to consider quitting or reducing; and those who are confronted with a plurality of norms, who seem ambivalent and whose consumption varies significantly. These results will allow us to adapt the interventions according to the profile of the apprentices and by including their entourage. In particular, it will be necessary to propose a ‘go-to’ approach that goes beyond the school setting and involves the family and the workplace.
Introduction
While the smoking denormalisation strategies implemented in recent decades have been successful in reducing the overall number of people who smoke (Alamar & Glantz, 2006; Hammond et al., 2006; Malone et al., 2012), they nevertheless seem to have contributed to reinforcing health inequalities in several ways. First, they have only benefited the most advantaged sections of society (Brown et al. 2014; Jarvis et al., 2003; Killoran et al., 2006; Warner & Burns, 2003), which is an inherent characteristic of the population approach (Frohlich & Potvin, 2008). Second, in addition to the differentiated impact on smoking initiation and cessation according to socioeconomic status (Barreto et al., 2013; Bauld et al., 2007; Green et al., 2014; Looze et al., 2013), they have limited smokers’ access to healthcare in some national contexts (Bell et al., 2010). Third, the denormalisation process has brought about a profound social and spatial transformation, which has manifested in the exclusion of smokers from most public spaces, the reinforcement of a pejorative ‘smoker’ identity and the creation of ‘smoking islands’ (Thompson et al., 2007), particularly within socioeconomically disadvantaged groups. This transformation has also been accompanied by a spatial redistribution of smoking norms, where outdoor smoking, for example, is more stigmatised in non-disadvantaged than in disadvantaged neighbourhoods (McCready et al., 2019).
Worldwide and specifically in Europe, adolescents enrolled in vocational education institutions (technical schools, institutes of technology, apprenticeship training, career and technical education, polytechnic institutions, etc.) are a particularly relevant population for the study of the (re)production and reinforcement of smoking-related inequalities. They are indeed evolving away from the denormalisation process and are at a higher risk of smoking (Atorkey et al., 2021; Chyderiotis et al., 2020; Hanke et al., 2013; Kwak et al., 2022; Looze et al., Ibid.). In Germany (Montag et al., 2015) and France (Spilka et al., 2018), studies have shown, for example, that the proportion of ‘apprentices’ who smoke on a daily basis is, respectively, 40.7% and 47.3%. Apprentices, defined as adolescents and young adults who follow an educational pathway combining on-the-job training and classroom learning, have thus been identified as a ‘vulnerable population’ in terms of smoking and have been subject to targeted approaches (Cathelineau et al., 2021; Minary et al., 2009; Andersen et al., 2016; Haug et al., Ibid). These programmes form part of a settings approach, which is defined as ‘integrating a commitment to health within the cultures, structures, processes and routine life of organizational and other settings’ (Dooris et al., 2014). The rationale for this targeted approach, which has been shown to be effective in terms of cessation for a proportion of apprentices (Andersen et al., Ibid.; Haug et al., Ibid.; Minary et al., 2013), is the assumption that apprentices share common characteristics that distinguish them from young people in conventional academic school systems. In addition to economic characteristics (El-Khoury Lesueur et al., 2018), other characteristics may explain these differences such as engagement in other drug use, sum of money received (pocket money, salary from a job or from an internship or apprenticeship), parental smoking and the apprenticeship setting (Chyderiotis et al., Ibid.).
Thus, these apprentices share the same educational setting and employment status, receive a salary and are more likely than other youth in mainstream academic school systems to come from low socioprofessional backgrounds. However, the family contexts in which they have grown up have been found to be socioeconomically heterogeneous (Gagné et al., 2018). The multiplicity of apprenticeship pathways (sales sector, construction sector, food sector, etc.) also implies a diversity of professional settings and potentially therefore a diversity of norms with regard to smoking. In addition, studies have shown that smokers can have different relationships to smoking (Poland et al., 2000). In short, the literature suggests that apprentices should not be viewed as a homogeneous group, particularly with regard to the smoking norms in the different settings of their everyday life. In particular, such an approach could help explain why smoking cessation programs offered to apprentices only reach a portion of them.
Alongside the inter-individual variability, it is also important to consider intra-individual variability, particularly through the different contexts in which an apprentice lives (school, family, and workplace), where the rules regarding smoking may vary. According to Lahire, contemporary Western societies are characterised by a marked differentiation in spheres of activity (Lahire, 2016). The contemporary individual whatever their social class may thus be defined as a ‘plural individual’, that is, a being whose existence is played out in a plurality of settings where norms may be ‘consonant’ (i.e. concordant and homogeneous), divergent or even contradictory, confronting the individual to ‘dissonance’ phenomena (Lahire, 2006). We can also consider the example of apprentices can be particularly heuristic to better understand this plurality and dissonances. In addition to evolving in the two socialising universes of family and (vocational) school (in France, Centre de Formations des Apprentis (CFA)), they enter the world of work at an early age. They thus navigate between at least three different worlds in which smoking norms may be potentially different, exposing them to dissonance.
The aim of this article was to examine the (de)normalisation of smoking in the apprentice population considered vulnerable to smoking initiation. In contrast to the majority of public health intervention studies, which assume vulnerable groups to be homogeneous, the objective here was to provide an understanding of the plurality of settings and norms that apprentices are exposed to by examining the relationship to smoking (between denormalisation and normalisation) in their settings (school, work, and family) and giving information on the consonance and dissonance phenomena they are confronted with. We will also try to understand how the norms within these different environments seem to influence the smoking behaviours of apprentices and their own relationship to smoking.
Methods
Context and Study Design
This study is a secondary analysis of qualitative data (Heaton, 2004) collected as part of the COMET project (COMprehending the mEchanisms behind Tobacco cessation in adolescents in the context of assisted decision-making). One of the objectives of this project was to identify possible stigmatisation of the apprentice population due to their smoking and, in particular, the potentially stigmatising effects of a smoking intervention in two CFAs. This intervention included in-class smoking discussion sessions for all apprentices and, for those who wished to quit smoking, consultations with a physician tobaccologist, combined with group sessions to reinforce motivation to quit. Interviews with apprentices who smoked at the time of the smoking cessation intervention during the 2017–2018 academic year permitted us to meet this initial objective. In France, apprenticeship contracts are work contracts open to people aged 16–29 and combine 2 weeks of in-company training alternated with 1 week of courses. Interviewed apprentices were in the 2nd year of the CAP (Certificat d’Aptitude Professionnelle) degree at two CFAs with very different contexts (rural setting/training in the construction sector versus urban setting/training in the care, retail, automotive and food and beverage sectors).
The COMET project received ethical approval from the Comité de Protection des Personnes Ouest-II and complied with the Commission Nationale Informatique et Liberté’s reference methodology MR-001 for the processing of personal data in the field of health research.
Data Collection
Semi-structured interviews were conducted by a sociologist (SS) with a sample of apprentices in February and March 2018. The recruitment strategy consisted of an in-class call for volunteers. The sample was diversified according to two criteria: 1) apprenticeship pathway and 2) participation/non-participation in the smoking cessation programme offered at the CFA.
Thirty individual interviews were conducted using an interview schedule. The number had been established beforehand in the research proposal to obtain data saturation (Francis et al., 2010; Guest et al., 2006). Thirty was indeed a sufficient number to obtain a ‘codes saturation’, but also a ‘meaning saturation’ (Hennink et al., 2017). In particular, this number has allowed to encompass the diversity of social contexts (apprentices coming from privileged or disadvantaged backgrounds), in particular with regard to smoking norms (families or companies where tobacco is omnipresent or, on the contrary, absent and banned). This number also made it possible to interview a diversity of situations with regard to apprentices’ relationship with tobacco (those engaged in the process of quitting, those wishing to quit or those wishing to quit in a more distant future).
The interview guide (see Appendix 1) sought to explore the initial objectives of the study. After questions about apprentice’s smoking behaviours (initiation, current consumption, relationship with smoking and desire to quit), the smoking behaviours of the members of his or her entourage and their reactions to his or her smoking were explored, as well as the apprentice’s perception of the cessation program set up in the CFA. Demographic and general data were also collected (age, apprenticeship pathway and parents’ SES).
The interviews, which lasted between 10 and 45 minutes, were recorded and transcribed. This article is based on a secondary use and analysis of these interviews, which provided a substantial amount of information for the study of the diversity of smoking norms in the different environments frequented by apprentices, as well as the plurality of behaviours and positions of apprentices with regard to tobacco.
Analysis
Theoretical Framework
Our analyses were grounded in ‘plural individual’ theory (Lahire, 2006, 2016) which was deemed particularly relevant in view of the diversity of standards and situations that emerged during the interviews. This theory is a renewed approach to Bourdieu’s theory of domination and social inequalities. While granting, like Bourdieu, an importance to the processes of socialisation and the incorporation of dispositions, Lahire shows that actors are uniformly shaped by his social milieu. Individuals live simultaneously and successively heterogeneous and sometimes contradictory social experiences. They are part of a plurality of worlds, incorporate a multiplicity of habits and act differently according to the contexts they encounter. Drawing on this theory, we sought to capture the heterogeneity of smoking norms, experiences and habits in the different contexts of apprentices’ lives. We also sought to understand the influence of these norms on their behaviour and perceptions.
Analysis Strategies
The data were subjected to a thematic content analysis using an inductive approach. An exploratory reading of the corpus by the research team (KLF, JK, GLD, LM and SS) first established the analysis categories and led to the identification of four types of relationship to smoking: valorised, normalised, denormalised and stigmatised.
The data were then coded by GLD, SS and JK. The analysis consisted of 1) categorising the apprentices’ three main settings (family, work and CFA) with regard to the relationship to smoking in each (valorised, normalised, denormalised and stigmatised); 2) linking the socioeconomic characteristics of the apprentices’ families with the nature of the smoking norms in their homes and 3) identifying the consonance and dissonance phenomena for each apprentice, especially in relation to smoking cessation.
The apprentices’ parents’ socioprofessional levels were recoded according to the ESCAPAD survey nomenclature (Spilka et al., Ibid.), in other words according to status of the parent with the highest profession and/or social category.
We drew on Lahire’s ‘portraits’ method to study the consonance and dissonance phenomena and used his profiles typology: ‘legitimate consonant profiles’ (the individual lives in settings where the norms are similar and socially valorised); ‘illegitimate consonant profiles’ (the individual lives in settings where the norms are similar and socially devalorised); and ‘dissonant profiles’ (the individual is confronted with contradictory norms that are socially valorised and devalorised) (Lahire, 2006). We sought to identify not so much profiles, however, as ‘situations’, which could be either consonance situations, where the apprentice lived in settings presenting similar smoking norms (whether in the normalisation or denormalisation camp), or dissonance situations, where the apprentice was confronted with both pro- and anti-smoking norms.
Results
Apprentices’ Characteristics.
The study involved 30 apprentices, enrolled on either the construction (n = 19), bakery (n = 7), sales (n = 3) or mechanics (n = 1) apprenticeship pathway. They were aged 15–20 years and mainly male (n = 23). A third of them (n = 10) were participating in the cessation support programme.
These apprentices were living in a variety of residences. Four no longer lived with their parents. Among those still living with their parents (n = 26), three lived under a shared residence arrangement, staying alternately with their mother and their father, and three boarded at the CFA during the week.
The vast majority (83%) of the apprentices came from either a modest (n = 21) or a disadvantaged (n = 4) background.
Diversity of Smoking Norms in the Apprentices’ Settings
Our analyses revealed a diversity of smoking norms in the apprentices’ settings, where smoking could be valorised, normalised, denormalised or stigmatised.
The CFA: A Place where Smoking Is Valued
Smoking was classed as ‘valorised’ at the CFA because, one, a high proportion of people smoked and, two, we found that smoking could be explicitly encouraged, for example, when individuals offered cigarettes to non-smokers. This valorisation also manifested in an absence of encouragement and even active discouragement when individuals were trying to quit smoking.
In both CFAs, the apprentices who smoked would congregate in the smoking areas during their breaks. At the time of the study, these areas were authorised by law in France in cases where a ban on smoking might present safety issues (e.g. proximity of a road or railway line). The smoking areas were described by the apprentices as spaces for sociability and conviviality and even as the place where everyone, even non-smokers, gravitated towards during breaks: Non-smokers still come to the smoking area because usually their mates are there.
1
(E. 11)
The two CFAs thus appeared to be places likely to foster the initiation of smoking: All my mates, they smoke… When I hang out with them, they’re smoking their cigarettes, and ‘do you want a go?’ And then that’s it, you cough at the start, you don’t like it, but after a while… (E. 6)
Two apprentices stated that they started smoking at the CFA in connection with a feeling of exclusion: ‘It was just to follow them, to smoke with them, so I wouldn’t feel left out because I didn’t smoke’ (E. 19); ‘When someone smokes, you either go outside with them or you stay inside. And so I felt a little left out and I started like that’ (E. 28).
The CFAs were also described as places where it was potentially difficult to begin or to adhere to a cessation support programme because of peer pressure mechanisms. One apprentice, who was participating in the programme, described how much willpower was needed to stop smoking at the CFA and the potential isolation that comes with participating in the programme: If you really want to stop, doesn’t matter where you are, you can. But actually most people smoke at the CFA. When we go on a break, most of them are outside smoking, so it’s not easy at all for those who don’t really have the willpower to stop. But if I feel like it, if I don’t want to smoke at break time, I don’t go out there. I don’t feel I’ve got to go outside and smoke just cos all the others are doing it. (E. 27)
This apprentice also told us about the discouraging comments made by her smoker friends: ‘I talked about my [cessation] programme with friends at the CFA. The non-smokers said “that’s good, Elodie,” they encouraged me, and the smokers said “that’s nonsense” and that I wouldn’t keep it up, that I didn’t have the willpower…’ (E. 27).
The CFA was described by thirteen of the apprentices as a place where their smoking consumption increased. For example, one apprentice explained that he sometimes went outside to smoke even though he did not really want to, just to stay with his ‘mates’ and not be left on his own: I actually didn’t feel like smoking sometimes, but I’d see my mates smoking and just think well I’m gonna go and have a cigarette with them even though I didn’t really want to smoke, it was just to stay with them, to smoke with them, so that I didn’t feel left out cos I didn’t smoke. (E. 19)
For those who were not allowed to smoke within their family, the CFA could represent a space of freedom, away from the familial gaze: ‘I was a boarder at the CFA during the week, I could do what I wanted during the week. If I smelled of cigarettes, it was no big deal, I didn’t care. The only time I didn’t smoke at home was at the weekends’ (E. 18).
Although the CFA is a place likely to encourage smoking, a minority of apprentices expressed difficulties and frustration regarding the restrictions around where and when they could smoke: ‘During the day, I always feel the need to smoke, I really want to, it’s difficult’ (E. 3); ‘it’s a place of education, so it bothers me to always smoke, and then to go outside each time…’ (E. 8); ‘Here, [at the CFA], you have to go to the smoking corner, because otherwise, you get yelled at’ (E. 16).
The Normalisation of Smoking in Families and Companies
Smoking was classed as ‘normalised’ in settings where the majority of people smoked and where the act of smoking, although not explicitly valorised or encouraged, was commonplace. When it constituted a collective practice (lending and exchanging of cigarettes, smoking together, smoking indoors), it was also normalised.
This was the case in the majority of the apprentices’ homes (n = 19). Three types of households were identified 2 : households where all the people of smoking age smoked, which accounted for the majority of cases (n = 17); mixed households, consisting of smokers and non-smokers (or ex-smokers) (n = 13); and households where no one smoked except the apprentice (n = 3).
The first type of household can be illustrated by the case of Kevin’s family (E. 25), consisting of his two parents and sister. His mother smoked 40 cigarettes a day, and his stepfather, around 60. He had an older sister who also smoked. After an initial period of disapproval from family members regarding his smoking, he increasingly began to smoke with them inside the house. However, he explained that they were considering stopping smoking indoors: ‘Well we’ve, we’re gonna stop cos the walls are getting really yellow. So we’re gonna redo the walls and then we’ll just smoke outside’. Smoking inside the house is a practice mentioned by eight other apprentices.
This normalisation of smoking was found in all four ‘disadvantaged’ households, thirteen of the twenty ‘modest’ households and one of the five ‘intermediate’/‘advantaged’ households.
In most cases (n = 20), the parents had expressed their disapproval (in the form of anger, irritation or disappointment) when they discovered that the apprentice smoked, even in homes where smoking was commonplace. This disapproval had either been maintained over time or it had given way to some form of resignation or fatalism: My mum didn’t like it at first, but now it’s okay. (E. 4)
In a minority of the households (n = 5), indifference and even a form of connivance were identified: When he found out I was smoking, he gave me one of his smokes (laughs). He doesn’t really care. (E. 23)
Finally, while we identified no explicit encouragement to smoke from smoker parents, some of the young people indicated that the proximity of their parents’ cigarettes had played a role in their taking up smoking: Well I tried, I was what, eight, actually it was on the cigarette butts my dad threw away. (E. 3)
Normalisation with regard to smoking was also found, although to a lesser extent, within the apprentices’ work setting. At the time of the interviews, twelve of the businesses seemed to present a normalised relationship to smoking. One example was the bricklaying company where Edouard (E. 3) was doing his training. He told us he had almost quadrupled his consumption (from half a pack to two packs a day) since starting at the company and attributed the increase to periods of inactivity: ‘Sometimes I haven’t got anything to do for a bit… And then, well, that’s it. When I’ve got five minutes, I’ll go and make a rolly and go and smoke it’. He said that his apprenticeship supervisor and some of his colleagues smoked and that they were allowed to smoke on the building sites. Some companies were also characterised by the fact that they allowed smoking in the workplace, which seemed to be linked to the nature of the activity (indoor or outdoor work site), but also to the degree of tolerance and the smoking status of the boss: ‘In the warehouse, our boss does not forbid us to smoke’ (E. 4); ‘In the afternoon, we smoke in the kitchen with the boss’ (E. 20).
Denormalisation in Businesses and Families
Smoking was classed as ‘denormalised’ in settings where either a minority or no one but the apprentice smoked, where the act of smoking could constitute a form of taboo and where smokers had to either refrain from smoking entirely or go outside or remain at a distance to smoke.
This denormalisation was found in fourteen of the businesses. One of these was the bricklaying company where Benjamin, aged 17, was doing his training. He often worked alone with his employer and said that he only smoked three or four cigarettes at work (compared to fifteen at the CFA). He attributed this disparity to the fact that he did not have time to smoke at work and said that he never took a pack of cigarettes with him to the site. His apprenticeship supervisor, who was not a smoker, tolerated his smoking but did not want him to smoke in front of him or on the building site. Benjamin was therefore allowed to smoke one cigarette before work and another during his lunch break, and he was not given any smoking break in the morning or afternoon. He told us that his supervisor had also made a comment about the smell on two or three occasions. For many other apprentices, companies were also places where they either did not allow themselves to smoke, they tried to hide their smoking, or they went away to smoke: ‘I would go outside so as not to bother the customer, since I can understand that people don’t like it’ (E. 15); ‘In the morning, I don’t like to smoke, there are a lot of customers, I think it’s unhygienic to smell cigarettes’ (E. 20); ‘I always make sure I don’t smell, because I think it’s disrespectful, I’m still going to be touching the food, the services’ (E. 27). One apprentice who was trying to quit and had joined the programme also explains that he coached his apprenticeship supervisor: ‘My apprenticeship supervisor, he bought himself an electronic cigarette, he said “I’ll follow you.” Now he’s vaping’ (E. 22).
Denormalisation was also found in some (n = 11) of the family homes. This was the case with Antoine, aged 18, who lived with his parents, both ex-smokers: My mum knows, she’s not happy about it she just puts up with it really. She tries to encourage me to stop but she doesn’t force me […]. My dad, well, over the two years, he hasn’t liked it at all, and then lately, since I’ve been an apprentice, I avoid the subject and when I feel like smoking, I don’t go and do it in front of him, I’ve been so used to hiding away when I smoke that now, out of respect, cos he knows I smoke, I always do it away from him so he doesn’t see me. (E. 16)
Unlike apprentices who lived in families where smoking was normalised, those who lived in families where it was not normalised could either hide their smoking or smoke on the side, even if their parents knew about it: ‘I used to smoke so much on the side, that now, out of respect, since he [my father] knows that I smoke, I always put myself on the side so that he doesn’t see me’ (E. 15).
From Denormalisation to Stigmatisation in Homes and Businesses
Finally, the relationship to smoking could be described as ‘stigmatised’ in a small proportion of the business and homes in which these young people were living. This classification was applied to settings where few people or no one but the apprentice smoked, where disapproval was openly expressed and where the smokers were subject to negative comments or even discrimination.
This relationship to smoking was found in four of the businesses. For example, Mathilde, aged 18, told us she had received comments from her apprenticeship supervisor that she found difficult to deal with because they were so frequent: Some people are always going on, trying to lecture us, it’s more annoying than anything else. My boss is always lecturing me, ‘you’ll be ugly', ‘you’ll get spots', ‘you’ll have yellow teeth', ‘you’ll die of cancer', comments… Yeah, he thinks that by trying to shock me like that, it’ll He really goes on. (E. 14)
Smoking was also found to be stigmatised in three of the family homes, where the apprentice sometimes had to cover up their smoking: ‘I’ve started smoking a little bit' I told them [my parents]. Straight away they told me to stop […]. After a year at boarding school, even at the weekends I was having a sneaky smoke. Now that I’m 19, they’ve said, do what you want but you’ve been warned and whatever.
Interviewer: And do you smoke in the house?
No, I’m not allowed. Interviewer: So outside then? And when your mum sees you smoking… Yeah, outside, and they’re always making comments, having a go at me… She’s embarrassed by it, and when there’s a family meal, you’ve got to get up and leave the table for her, cos she really doesn’t like it. (E. 18)
Relationship to Smoking in the Family Homes and Businesses.
Apprentices’ Portraits and Smoking Cessation
In a second stage of the analysis, we identified the intra-individual variations and classified the apprentices according to the dissonance and consonance phenomena they were exposed to. Within these portraits, we also examined the apprentices’ discourse towards cessation and (non)participation in the cessation program.
Legitimate and Illegitimate Consonant Profiles
We identified a small number of cases (n = 4) where the apprentices were living in settings (excluding the CFA) where smoking was denormalised. These apprentices were therefore only likely to be tempted to smoke when they were at the CFA. One example was Jean (E. 22), who was participating in the cessation support programme. At home, his mother was a non-smoker and did not tolerate smoking in the house, and his father smoked outside. At work, his employer, whom he mostly worked alone with, was also trying to quit. He described his environment as one that was conducive to quitting. However, his attendance at the CFA could create a form of dissonance, although this should be considered in the context of the fact the institution had given him access to the cessation support programme: ‘We’ll say that me apart from the CFA, my environment follows me, even professionally’. Another example was Jeanne, 20 years old and in sales, with an internship in a bakery. She had been smoking since the age of 17 and had started in a festive context. She enrolled in the program offered in the institution and now smokes 4 cigarettes a day. She wanted to quit because she often felt like throwing up when she smoked and because she was afraid of the cosmetic consequences (yellow teeth in particular). She said that she lived in an environment of non-smokers. Her environment (her mother and boyfriend in particular) had encouraged her to quit. At the CFA, her close circle was made up of people who were also involved in the withdrawal program and wanted to quit.
We also identified some apprentices who were living in settings where smoking was normalised and where the apprentice is not confronted with any constraint, which seems to contribute to an increase in their consumption. This type of case was also rare (n = 5). A first example is Michel (E. 7), whose parents both smoked (‘My father often smokes 60 cigarettes a day, my mother 20-30 cigarettes a day’). At the time of the interview, he said he smoked a pack of 30 cigarettes a day and explained that he also smoked with his parents. He also described his company as a very supportive environment for his smoking: ‘I have colleagues and a foreman who smoke (…), I smoke while working and I smoke a lot more at work, yes’. He had no plans to quit but wanted to decrease, in particular pushed by his new girlfriend, who did not smoke and commented the odour: ‘I don’t have the will to stop smoking, I prefer to continue, maybe a little less (…) I have decreased a little since I am with my girlfriend. Because sometimes she says to me “ah you smell like a cigarette”’. A counter-example is Madeleine (E. 26), who was doing a sales apprenticeship in a bakery. She explained: ‘My parents, my brother, my boyfriend… My grandparents used to, but they managed to quit. All my friends at the CFA, all my colleagues, I’m just surrounded by smokers’. However, she was participating in the cessation programme but described the people around her as not very supportive: ‘it is not my entourage that will help me, support me’. She had not told her parents she was trying to quit and described the process as a solitary one. Her approach to quitting was linked to the frequenting of other social universes, in this case, the world of sport: ‘I do box and I know since I smoke, I have a lot of trouble breathing at the end of the matches…’. When asked about the presentation of the weaning program offered in the establishment and what she would have learned from it, she explained: That the veins shrink when you smoke, that really impressed me. I thought, I hope this doesn't happen to me. Then the next day, I went to the hospital to have my blood drawn and they told me I had the veins of a smoker. So I had two triggers at once, plus the sport, I have trouble at the end and everything, so the third one, I said to myself, you really have to stop
Dissonant Profiles
The third type of case identified, which concerned the majority of the apprentices (n = 21), was characterised by some settings where smoking was normalised and some where it was denormalised or stigmatised. The apprentices in this case were subject to different and even dissonant norms, which led notably to variation in their consumption depending on the context.
One example was Corentin (E. 6), who was doing his apprenticeship in a bricklaying company. At home, his father and two sisters smoked. When asked why he had started smoking, he immediately linked it to his family and his ‘mates’: ‘Because my dad smokes and my two sisters, and then all my friends all smoke as well and…’. He described his work placement as a context in which he smoked a lot less than in other settings. He attributed this to the fact that he was always busy and that his employer often made negative comments about smoking: The older ones don’t smoke. My apprentice supervisor doesn’t smoke, so… And we don’t have much time to anyway, an’all that. My apprentice supervisor, he stopped smoking five years ago, with the patches. And he said to me every time I smoked next to him: ‘Oh, fuck, that thing stinks’.
He had also tried to quit before, using an electronic cigarette, and said he planned to quit someday, although he didn’t know when:
Interviewer: And would you like to quit in the near or distant future?
Oh, yeah. I think I’ll get there. I think I’ll get there but I don't know now… I mean I don’t know soon or in a long time. I don’t know, I don’t know when.
While explaining that the conference was interesting and made him think, he said that he did not sign up for the program because of the influence of his peers, thus giving voice to a form of internal strife: ‘Yes, yes, I could have but… I don’t know why… And then it depends on who you’re with. If sometimes your friends say: “Oh, it’s useless” and then you follow them’. Antoine presented another form of dissonance in that his parents did not want him to smoke and encouraged him to stop, but his workplace encouraged his smoking, which he himself had sought to regulate by smoking rolled cigarettes instead: ‘When I’m on my own, I smoke three or four; when I’m at work, I smoke a pack a day (…). Now I smoke rolled cigarettes, it takes more time, because otherwise I would smoke every ten minutes’. He had also tried to quit twice, with patches, but had started smoking again because of a cigarette offered by a friend. When asked about the conference and the program, he seemed to suggest that it had not arrived at the right time, while showing hesitation: ‘No, I didn’t sign up, I didn’t know if I wanted to quit or not actually (…) I still like to smoke a cigarette now and then’.
Discussion
Contributions of Lahire’s Theory on Apprentice Smoking
Using Lahire’s theory of the plural individual to analyse our data not only allowed us to better understand the mechanisms by which apprentices smoke but also allowed us to better understand why some of them take steps to stop.
By exploring, as Lahire proposes, the different spheres of socialisation of apprentices, and in particular the three main environments in which they live, we see that the CFA is first and foremost a ‘smoking island’ (Thompson, Pearce, Barnett, Ibid.) where smoking is not just normalised but valorised among peers. In this setting, the apprentices socialise with peers who smoke in a context of practices that encourages smoking initiation, resumption or increased consumption through the offering of cigarettes along with the risk of isolation in the event of abstinence. The CFA is also a place sheltered from the parental gaze, especially when parents are disapproving of smoking. This result corresponds with those from studies on adolescent smoking and networks (Mercken et al., 2009; Fujimoto & Valente, 2012; Christakis & Fowler, 2008) and notably confirms Fujimoto and Valente’s finding that the congregation of adolescents in a same place is likely to favour smoking. The high proportion of apprentices who smoke could thus be largely explained by contagion effects and ‘diffusion through direct communication’ (Christakis and Fowler Ibid.) in the CFAs that seem to carry just as much weight as the family smoking legacy. Our results are also consistent with findings on the role of the family in smoking of these apprentices, which had previously been explored through the relationship between parental smoking status and the smoking of apprentices (Chyderiotis et al. Ibid.). However, our study provides more specific data on how inequalities are perpetuated within families, both through facilitated access to tobacco (stealing cigarettes from parents, lending or sharing cigarettes, shared smoking, smoking inside the home) and through lack of support from family members when the learner tries to quit. It thus seems that these two main socialisation universes, the CFA and the family, are decisive and contribute to understanding why almost half of the apprentices start to smoke.
However, the role of the workplace in the development of smoking among apprentices appears more ambivalent. Companies seem to support the smoking of apprentices, especially when the workplace manager is himself a smoker and allows smoking on the work site. In more than half of the companies, however, smoking was banned, which helped to significantly limit smoking among apprentices. More than the industry, workplace managers appear to be important players in that their status as (non)smokers and their stance on smoking appear to determine the nature of the norms applied in their companies and on worksites. The study also noted the importance of the apprenticeship supervisor, who was often mentioned in the interviews by apprentices and who appears to be a guardian and authority figure.
Our study also draw attention to the process of quitting smoking explored via the method of portraits and the attention to the phenomena of dissonance and consonance. In line with Lahire’s observation that consonant situations are the exception (Lahire, 2006), we have first shown that situations of consonance are rare, whether this consonance goes in the direction of normalisation or denormalisation. When the apprentice evolves in a family and a company where smoking is denormalised, this seems to constitute a configuration particularly conducive to a cessation process. This also seems to determine the relationship of these apprentices to the norm, as they seem to have integrated the fact that smoking might be a potentially disturbing behaviour for others. By moving closer to non-smoking peers at the CFA, these apprentices can also protect themselves from the training effects of the CFA. On the contrary, who surround themselves or are surrounded by, at CFA, at work and in the family, testify to the difficulty of finding support from their entourage to stop smoking. We also see that this seems to be less conducive to the apprentice’s reflexivity regarding their practice, which, on the contrary, leads to an increase in consumption. The fact of evolving in a set of environments in which tobacco is normalised thus constitutes a configuration particularly conducive to the reproduction of social inequalities related to tobacco use. However, there are exceptions, such as the case of Madeleine, previously presented, who had undertaken a cessation process despite the fact that she was perpetually surrounded by people who smoked. Her case raises questions similar to those raised by ‘class defectors’ defined as ‘actors whose personal history has followed a trajectory that fails, or appears to fail, the determinism of social reproduction’ (Jacquet, 2014). Through the Madeleine’s portrait, we were able to show that participation in another universe of socialisation – the boxing club – seemed to be decisive. This, combined with a series of events (the program’s conference and a medical appointment), led her to begin the process of quitting, which was a particularly difficult and lonely process.
Exploring the path of these ‘tobacco defectors’ as well as the role of these other socialisation universes in the initiation but especially the cessation of tobacco use seems an important avenue for future studies. For apprentices facing the dissonance of the smoking norm, who were the majority in our study, we were able to identify significant variations in their consumption depending on the context in which they found themselves. The interest in the conference and the cessation programme, as well as their ambivalence and uncertainty about quitting or not quitting, also suggests that these apprentices are at a fork in the road and seem just as likely to engage in quitting smoking as to persevere in their smoking career.
Implications for Policy and Intervention
Our analyses show a gradient of vulnerability to smoking and different levels of exposure to pro-smoking norms among these apprentices. Some of the apprentices are highly exposed (i.e. confronted with pro-smoking norms in all their settings – the ‘illegitimate consonant profiles’), some are only minimally exposed (‘legitimate consonant profiles’) and some are variously exposed (‘dissonant profiles’). These different levels of exposure to smoking and to pro-smoking norms in individuals’ different settings should be considered in future interventions to adjust the program delivery and identify most at-risk apprentices.
It is indeed necessary to keep in mind that the interventions are likely to fulfil several functions. First of all, they can provide support for apprentices who are already involved in the cessation process and who tend to have legitimate consonant profiles (e.g. John and Jane) or illegitimate consonants (Madeleine). These interventions can also provide information and make cessation tools and support options accessible and attractive to those who are ambivalent and hesitant (e.g. Corentin and Antoine). By reinforcing a phenomenon of dissonance, they can help to encourage apprentices to commit to a cessation process. Finally, the interventions can also help to raise awareness and inform those who had no intention of quitting (e.g. Michel). This last task with those situated furthest from the dominant norms of behaviour is without doubt the most difficult that public health actors face in their efforts to combat smoking in young people. Reaching them without stigmatising and risking reinforcing their smoking behaviour is a major issue in public health interventions.
Our study also calls for encouraging interventions in workplaces (Parkinson et al. 2022), especially involving apprenticeship teachers who seem to play an important role with apprentices. As other authors have already suggested, it also confirms the need to encourage family-based smoking education and cessation programs (Legleye et al., 2023). Finally, it is necessary to continue, multiply and diversify interventions in the CFA, as this environment remains a place of contagion and diffusion of tobacco use. In this respect, it would be wise to also imagine interventions more focused on primary prevention, such as, for example, arrangements aimed at making non-smoking areas attractive and user-friendly. Programs such as the one developed in Iceland that focus on the development of user-friendly spaces, sports activities and intervention in families may be appropriate (Kristjansson et al., 2020).
Limitations and Research Tracks
The limits of our analyses are firstly related to the fact that they constitute secondary analyses of interviews which were not initially intended to explore the phenomena of dissonance and consonance and the influence of the different living environments on the smoking behaviours and careers of apprentices. More in-depth interviews should be conducted, making it possible to return, as Muriel Darmon has done, for example, with regard to anorexia (Darmon, 2008), to a more detailed examination of what prevents or encourages the development of these smoking careers. A more in-depth study of the processes of incorporation or distancing from norms related to tobacco, especially when apprentices are subjected to different norms, seems particularly appropriate. It should also be noted that the interviews were very uneven, largely due to the fact that the apprentices were more or less comfortable expressing themselves and also more or less willing to be interviewed. As researchers have done in other studies (Ancian, 2022), repeated interviews may be particularly relevant.
Since the study is also based on volunteers, it is possible that apprentices who are even more marginalised from the denormalisation process than those we interviewed may have escaped the research process. Apprentices who did not smoke or had stopped smoking were also not interviewed, although this could provide interesting insights into identifying protective factors. The same study could also examine these phenomena of dissonance and consonance of adolescents from CFAs but also from general courses of study. Finally, the question of gender, which we have not been able to include in this article, deserves to be developed, particularly in relation to the sector (sale vs. construction) and the expectations of employers.
Footnotes
Author Contributions
SS, LM, JK, and KLF conceived the manuscript idea. The first author of the article (SS) conducted the interviews and drafted the manuscript. SS, KLF, JK, LM conducted an initial exploratory reading of the corpus and first established the categories of analysis. The data were then coded by SS, GLD, and JK. LM, KLF, GLD, JK reviewed the content of the manuscript. LM led the COMET project in which the survey was conducted. All authors read and approved the final manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the INCa (Institut National du Cancer) as part of a call for projects in 2017 to reduce smoking and curb the prevalence of tobacco-related cancers. The project number was INCa_11506.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author.
Ethical Approval
The study on which this article is based received ethical approval from the Comité de Protection des Personnes Ouest-II (2017-A02148-45) and complied with the Commission Nationale Informatique et Liberté’s reference methodology MR-001 for the processing of personal data in the field of health research.
Informed Consent
Consent was obtained from the young people interviewed and from their parents if they were under 18 years of age.