Mlinarić Martin, Hoffmann Laura, Lindfors Pirjo, Richter Matthias
Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany.
Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Department of Adolescent Psychiatry, Tampere, Finland.
Soc Sci Med. 2020 Feb;247:112805. doi: 10.1016/j.socscimed.2020.112805. Epub 2020 Jan 21.
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.
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.
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.
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.
倡导、资源和主体间合理的论据被认为是在中国和盎格鲁-撒克逊地区有助于无烟（SF）政策采纳和实施的因素。关于欧洲各地吸烟禁令的实施情况差异所知较少。这项定性比较研究的目的是根据地方官僚和次国家利益相关者的观点，识别并分类七个欧洲城市地方层面的无烟政策实施过程和类型。
作为比利时（那慕尔）、芬兰（坦佩雷）、德国（汉诺威）、爱尔兰共和国（都柏林）、荷兰（阿默斯福特）、意大利（拉蒂纳）和葡萄牙（科英布拉）比较SILNE-R项目定性部分，对地方决策者和利益相关者进行了半结构化专家访谈（n = 56）。使用框架分析法对定性访谈进行分析。
无烟环境的实施主要集中在室内禁令或与青少年相关的场所。可以区分出积极进取型（都柏林）、适度理性型（坦佩雷）、高度饱和型（汉诺威、阿默斯福特）和低度饱和型（那慕尔、科英布拉、拉蒂纳）实施类型。这四种类型在加强无烟场所的参与度以及在烟草去常态化和公众吸烟可见度的认知水平方面存在差异。在所有城市，无烟环境在国家层面被采纳，但由于国家政策环境、执法策略和合作水平，在地方层面的实施方式有所不同。扩大无烟法规的主要机制是科学证据、公众支持和儿童保护框架。然而，如果关于患病率下降和新的青少年成瘾趋势的数据引发低优先级，就会出现封闭的反制机制。
本研究发现了四种无烟实施类型、两种渐进式扩展机制和防御性封闭机制。吸烟禁令的制定和加强需要合适的国家政策环境以及国家层面间接支持地方自主倡议。未来的无烟政策可以通过与未成年人常去场所相关的法律得到加强。
