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Thaivalappil A, Bhattacharyya A, Young I, Gosselin S, Pearl DL, Papadopoulos A. Environmental determinants of infectious and chronic disease prevention behaviours: A systematic review and thematic synthesis of qualitative research. Health Psychol Open 2023; 10:20551029231179157. [PMID: 37255528 PMCID: PMC10226319 DOI: 10.1177/20551029231179157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Regulatory health policies facilitate desired health behaviours in communities, and among them, smoke-free policies and COVID-19 restrictions have been widely implemented. Qualitative research studies have explored how these measures and other environmental influences shape preventive behaviours. The objective of this systematic review was to synthesize previously published qualitative research, generate across-study themes, and propose recommendations for behaviour change interventions. We used a comprehensive search strategy, relevance screening and confirmation, data extraction, quality assessment, thematic synthesis, and quality-of-evidence assessment. In total, 87 relevant studies were identified. Findings were grouped under six overarching themes and mapped under three categories: (i) the political environment, (ii) the sociocultural environment, and (iii) the physical environment. These findings provide insights into the environmental influences of behaviour and indicate future interventions may be more effective by considering moral norms, community norms, policy support, and group identity.
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Affiliation(s)
| | | | - Ian Young
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - Sydney Gosselin
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - David L Pearl
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
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Hoek J, Edwards R, Waa A. From social accessory to societal disapproval: smoking, social norms and tobacco endgames. Tob Control 2022; 31:358-364. [PMID: 35241613 DOI: 10.1136/tobaccocontrol-2021-056574] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrew Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
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Bommelé J, Walters BH, van Dorsselaer S, Willemsen MC. Outdoor smoking as a nuisance to non-smokers: The case for smoke-free outdoor public spaces in dense urban areas. Tob Prev Cessat 2022; 8:08. [PMID: 35280520 PMCID: PMC8859987 DOI: 10.18332/tpc/145502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite the growing number of smoke-free spaces, many non-smokers continue to be involuntarily exposed to secondhand smoke outdoors and on public streets. Both theory and research suggest that people living in densely populated urban areas are more likely to smoke than those living in less densely populated areas. Consequently, non-smokers in densely populated urban areas might be more likely to be exposed and feel annoyed by secondhand smoke outdoors. We investigated whether the extent to which non-smokers feel annoyed by secondhand smoke exposure in outdoor public spaces is related to urban population density. METHODS We used cross-sectional survey data from the Netherlands ‘Module Substance Use’ survey (2020 data, n=9375). This is a nationally representative sample of the adult population in the Netherlands. Using logistic regression models, we investigated whether urban population density predicts both smoking and non-smokers’ annoyance to secondhand smoke exposure outdoors. RESULTS We found that smoking rates were associated with urban population density. In the Netherlands, people living in extremely population-dense urban areas were more likely to smoke than those living in non-urban areas (AOR=1.59; 95% CI: 1.25–2.02, p<0.001). Feeling annoyed by secondhand smoke outdoors was also associated with urban population density: non-smokers living in extremely population-dense urban areas were more likely to be annoyed than respondents living in non-urban areas (AOR=1.65; 95% CI: 1.34–2.02, p<0.001). CONCLUSIONS These cross-sectional data highlight the importance of comprehensive local tobacco control policy programs that include creating smoke-free outdoor public spaces. This need for such smoke-free outdoor public spaces might be particularly strong in densely populated areas.
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Affiliation(s)
- Jeroen Bommelé
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Bethany Hipple Walters
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
- Massachusetts General Hospital, Boston, United States
| | - Saskia van Dorsselaer
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Marc C. Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
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Bommelé J, Troelstra S, Walters BH, Willemsen M. Does support for smoke-free outdoor spaces increase after implementation?: A case study of a Dutch research center's smoke-free campus transition. Tob Prev Cessat 2020; 6:67. [PMID: 33336119 PMCID: PMC7737562 DOI: 10.18332/tpc/129647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Policymakers may sometimes be reluctant to develop policies for smoke-free outdoor spaces due to concerns about public reaction. In this study, we investigated the support for a smoke-free campus before and after the campus of a Dutch research institute became smoke-free. METHODS We conducted two surveys among employees to measure the level of support for a smoke-free campus. The first survey (n=129) was conducted 3 months before and the second 13 months after the implementation of a smoke-free campus policy (n=134). RESULTS More employees supported the smoke-free campus after (82.1%) than before (64.3%) implementation (OR=2.55; 95% CI: 1.39–4.70; p=0.003). In addition, more employees (75.4%) employees believed it is important to have a smoke-free campus than was the situation before (56.6%) the implementation (OR=2.28; 95% CI: 1.31–3.97; p=0.004). CONCLUSIONS This case study adds to the knowledge that support for a smoke-free campus increases after implementation of a smoke-free policy. This may encourage other organizations or local governments to create policies for smoke-free outdoor spaces.
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Affiliation(s)
- Jeroen Bommelé
- Trimbos Institute, The Netherlands Expertise Centre for Tobacco Control, Utrecht, the Netherlands
| | - Sigrid Troelstra
- Trimbos Institute, The Netherlands Expertise Centre for Tobacco Control, Utrecht, the Netherlands
| | - Bethany Hipple Walters
- Trimbos Institute, The Netherlands Expertise Centre for Tobacco Control, Utrecht, the Netherlands.,Massachusetts General Hospital, Boston, United States
| | - Marc Willemsen
- Trimbos Institute, The Netherlands Expertise Centre for Tobacco Control, Utrecht, the Netherlands.,Department of Health Promotion, University of Maastricht, Maastricht, the Netherlands
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Mlinarić M, Hoffmann L, Kunst AE, Schreuders M, Willemsen MC, Moor I, Richter M. Explaining Mechanisms That Influence Smoke-Free Implementation at the Local Level: A Realist Review of Smoking Bans. Nicotine Tob Res 2020; 21:1609-1620. [PMID: 30285126 DOI: 10.1093/ntr/nty206] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/02/2018] [Indexed: 02/01/2023]
Abstract
INTRODUCTION While studies have been undertaken to understand the adoption of outdoor and indoor smoking bans, not much is known about why implementation of smoke-free (SF) environments differs at local levels. As most European countries remain at the level of indoor bans, we aim to translate existing evidence into practical recommendations on how to improve SF (outdoor) implementation within European municipalities. METHODS We applied six methodological steps of a realist review consistent with the RAMESES publication standards for realist syntheses. Literature search was conducted in PubMed/MEDLINE and Web of Science. In total, 3829 references were screened, of which 43 were synthesized. Studies dating from 2004 to 2015 with rigor evidence of SF implementation at the local level were selected. Implementation outcomes were SF enforcement, monitoring, nonsmoking compliance, and public support in cities. RESULTS The explanatory realist framework links four innovation stages with three context-mechanism-outcome (CMO)configurations. We identified "triggering trust," "increasing priorities," and "limiting opposing interests" as underlying mechanisms, when (1) establishing, (2) developing, (3) contesting, and (4) implementing local smoking bans. The CMO propositions (CMOs) support practical recommendations, such as (1) providing authorities with local data when establishing and developing bans, (2) developing long-term strategies and implementing state-funded SF programs to prioritize sustained enforcement, and (3) limiting opposing interests through the use of the child protection frame. CONCLUSIONS This is the first realist review on the implementation of SF enviroments at the local level. The process-oriented theory explains how and why CMOs determine SF development in cities and municipalities from planning until implementation. IMPLICATIONS In 2015, only 16% of the world's population lived under the jurisdiction of comprehensive SF laws. The findings of this realist review are useful to implement WHO goals of the Framework Convention on Tobacco Control (FCTC) and specifically SF environments at more local levels and to adjust them to specific contextual circumstances. This paper unpacks three mechanisms that could be triggered by SF strategies developed at local levels and that can result in improved policy implementation. Such evidence is needed to enhance SF strategies at the level of cities and municipalities and to achieve WHO "Healthy Cities Network" objectives.
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Affiliation(s)
- Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Laura Hoffmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Schreuders
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, CAPHRI-Maastricht University, Maastricht, The Netherlands.,Netherlands Expertise Center for Tobacco Control (NET), Trimbos Institute, Utrecht, The Netherlands
| | - Irene Moor
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Mlinarić M, Hoffmann L, Lindfors P, Richter M. Enhancing implementation of smoke-free places: A comparative qualitative study across seven European cities. Soc Sci Med 2020; 247:112805. [PMID: 32004999 DOI: 10.1016/j.socscimed.2020.112805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 10/15/2019] [Accepted: 01/14/2020] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany.
| | - Laura Hoffmann
- Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany.
| | - Pirjo Lindfors
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Department of Adolescent Psychiatry, Tampere, Finland.
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany.
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Murad M, Marsh L, McGee R. The contribution of smokefree outdoor areas in achieving New Zealand's Smokefree 2025 goal. Health Promot J Austr 2018; 30:199-206. [PMID: 29582509 DOI: 10.1002/hpja.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 02/16/2018] [Indexed: 11/07/2022] Open
Abstract
ISSUES ADDRESSED With the adoption of Smokefree 2025, further commitment from local government to extend smokefree outdoor area policies is becoming increasingly important in the presence of high public support. The aim of this study was to identify local government commitment in the Canterbury/West Coast (CWC) region to the New Zealand Smokefree 2025 goal through provision of smokefree outdoor areas. METHODS Document analysis of the different stages of council long-term plans (LTPs) was undertaken, including 239 draft LTP documents, 5926 public submissions on these documents and 13 final LTP documents. A comparison between the 2015 final document and the 2012 final document was undertaken. Following this, semi-structured telephone interviews were undertaken with council staff. RESULTS No council had referred to Smokefree 2025 or smokefree community spaces in any 2015 LTP draft document. Each of the CWC councils received a number of smokefree-related submissions, with the main theme being the extension of current Smokefree Outdoor Area Policy. The final LTP documents showed that 5 councils had included a brief statement about Smokefree 2025. Smokefree issues were mentioned more often in the 2012 LTP compared to the 2015 LTP. CONCLUSIONS This research highlights a need for more commitment by local government to achieving the Smokefree 2025 goal. So what? There are opportunities for health groups to work with councils to try and enhance their overall commitment to Smokefree 2025 and promote wellbeing.
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Affiliation(s)
- Manal Murad
- Cancer Society Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Louise Marsh
- Cancer Society Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Rob McGee
- Cancer Society Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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