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Soc Sci Med. 2020 Jan 21;247:112805. doi: 10.1016/j.socscimed.2020.112805. [Epub ahead of print]

Enhancing implementation of smoke-free places: A comparative qualitative study across seven European cities.

Author information

1
Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany. Electronic address: martin.mlinaric@medizin.uni-halle.de.
2
Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany. Electronic address: laura.hoffmann@medizin.uni-halle.de.
3
Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Department of Adolescent Psychiatry, Tampere, Finland. Electronic address: pirjo.lindfors@uta.fi.
4
Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany. Electronic address: m.richter@medizin.uni-halle.de.
5
Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Italy.
6
Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Belgium.
7
Institute of Health and Society, Université Catholique de Louvain, Brussels, Netherlands.
8
Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Germany.
9
Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Finland.
10
Faculty of Social Sciences, Health Sciences, University of Tampere, Ireland.
11
TobaccoFree Research Institute, Focas Research Institute, Dublin, Ireland.

Abstract

BACKGROUND:

Advocacy, resources and intersubjective reasonable arguments are known as factors that contribute to smoke-free (SF) adoption and implementation in Chinese and Anglo-Saxon places. Less is known about how the implementation of smoking bans differs across European places. The aim of this qualitative comparative study is to identify and classify the SF policy implementation processes and types undertaken at the local level in seven European cities according to the views of local bureaucrats and sub-national stakeholders.

METHOD:

Semi-structured expert interviews (n = 56) with local decision makers and stakeholders were conducted as qualitative part of the comparative SILNE-R project in Belgium (Namur), Finland (Tampere), Germany (Hanover), the Republic of Ireland (Dublin), the Netherlands (Amersfoort), Italy (Latina), and Portugal (Coimbra). Qualitative interviews were analyzed using the framework analysis.

RESULTS:

Implementation of SF environments predominantly focuses on indoor bans or youth-related settings. Progressive-hungry (Dublin), moderate-rational (Tampere), upper-saturated (Hanover, Amersfoort), and lower saturated (Namur, Coimbra, Latina) implementation types can be distinguished. These four types differ with regards to their engagement in enhancing SF places as well as along their level of perceived tobacco de-normalization and public smoking visibility. In all municipalities SF environments are adopted at national levels, but are differently implemented at the local level due national policy environments, enforcement strategies and the level of collaboration. Major mechanisms to expand SF regulations were found to be scientific evidence, public support, and the child protection frame. However, counter-mechanisms of closure occur if data on declining prevalence and new youth addiction trends trigger low prioritization.

CONCLUSIONS:

This study found four SF implementation types two mechanisms of progressive expansion and defensive closure. Development and enhancement of smoking bans requires a suitable national policy environment and indirect national-level support of self-governed local initiatives. Future SF policies can be enhanced by laws pertaining to places frequented by minors.

KEYWORDS:

Cities; Framework analysis; Health policy; Implementation; Local level; Smoke-free; Smoking bans; Tobacco control

Conflict of interest statement

Declaration of competing interests The authors declare that they have no competing interests. None of the authors have received funding from the (tobacco) industry.

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