Challenges for the smoking ban in Israeli pubs and bars: analysis guided by the behavioral ecological model

Israel Journal of Health Policy Research

Melbourne F Hovell³  Anat Drach-Zehavi¹  Vicki Cohen²  Carmit Satran²  Orna Baron-Epel² 

[1] Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, Haifa, Israel;School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, Haifa, Israel;Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA

关键词: Israel;    Behavioral ecological model;    Pubs;    Bars;    Smoking ban;   

Others  :  810336
DOI  :  10.1186/2045-4015-1-28

 received in 2011-12-06, accepted in 2012-05-24,  发布年份 2012

【 摘 要 】

Background

The latest amendment to the ban on smoking in public places in Israel was implemented in 2007, adding pubs and bars (P&B) to the list of public places in which smoking is prohibited. However, smoking in most P&B continued. The aim of the study was to identify the theoretically plausible reasons for the partial success of a public ban on smoking in P&B settings. Explanations provided by P&B owners were interpreted as probable causal factors based on the Behavioral Ecological Model (BEM).

Methods

Qualitative interviews were performed with 36 P&B owners in Tel-Aviv and 18 Israeli towns and cities of various population size.

Results

P&B owners reported a variety of situational factors (i.e., contingencies) and reinforcers as likely explanations of the partial failure of the legislated ban on smoking in public places, particularly P&B. The major reinforcers for non-adherence with the law were no or low frequency of inspections and low penalties from authorities. P&B owners also feared loss of customers and revenue if bans were enforced in their own establishment but not in competing establishments. Finally, owners reported social norms prevailing among some Israeli patrons supporting smoking in P&B settings, in part to express opposition to the new law.

Conclusions

Qualitative assessment can uncover probable social situations that operate to prevent greater adherence to smoking bans. The results warrant confirmation by quantitative analyses. Policies with mandated inspections and penalty requirements that are implemented in all bars without prejudice could lead to greater adherence to smoking bans. Positive reinforcing consequences that encourage adherence (such as publicity and support from non-smokers) would be more likely to generate both greater adherence to the policy and good will toward the government. Principles of behavior outlined in the BEM offer guidance for designing quantitative confirmation analyses of future bans.

【 授权许可】

   
2012 Baron-Epel et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Fichtenberg CM, Glantz SA: Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ 2002, 325(7357):188.
• [2]Larsson M, Boethius G, Axelsson S, Montgomery SM: Exposure to environmental tobacco smoke and health effects among hospitality workers in Sweden–before and after the implementation of a smoke-free law. Scand J Work Env Hea 2008, 34(4):267-277.
• [3]Centers for Disease Control and Prevention: Indoor air quality in hospitality venues before and after implementation of a clean indoor air law–Western New York 2003. MMWR 2004, 53(44):1038-1041.
• [4]Mulcahy M, Evans DS, Hammond SK, Repace JL, Byrne M: Secondhand smoke exposure and risk following the Irish smoking ban: an assessment of salivary cotinine concentrations in hotel workers and air nicotine levels in bars. Tob Control 2005, 14(6):384-388.
• [5]Ellingsen DG, Fladseth G, Daae HL, Gjolstad M, Kjaerheim K, Skogstad M, Olsen R, Thorud S, Molander P: Airborne exposure and biological monitoring of bar and restaurant workers before and after the introduction of a smoking ban. J Environ Monit 2006, 8(3):362-368.
• [6]Gorini G, Moshammer H, Sbrogio L, Gasparrini A, Nebot M, Neuberger M, Tamang E, Lopez L, Galeone D, Serrahima E, “Italy & Austria Before and After Study” Working Group: Italy and Austria before and after study: second-hand smoke exposure in hospitality premises before and after 2 years from the introduction of the Italian smoking ban. Indoor Air 2008, 18(4):328-334.
• [7]Hyland A, Hassan LM, Higbee C, Boudreau C, Fong GT, Borland R, Cummings KM, Yan M, Thompson ME, Hastings G: The impact of smokefree legislation in Scotland: results from the Scottish ITC: Scotland/UK longitudinal surveys. Eur J Public Health 2009, 19(2):198-205.
• [8]Repace JL, Hyde JN, Brugge D: Air pollution in Boston bars before and after a smoking ban. BMC Public Health 2006, 6:266. BioMed Central Full Text
• [9]Rosen LJ, Zucker D, Rosenberg H, Connolly G: Secondhand smoke in Israeli bars, pubs and cafes. Isr Med Assoc J 2008, 10(8–9):584-587.
• [10]Rosen LJ, Zucker DM, Rosen BJ, Connolly G: Second-hand smoke levels in Israeli bars, pubs and cafes before and after implementation of smoke-free legislation. Eur J Public Health 2010, 21(1):15-20.
• [11]Hovell MF, Hughes SC: The behavioral ecology of secondhand smoke exposure: A pathway to complete tobacco control. Nicotine Tob Res 2009, 11(11):1254-1264.
• [12]Hovell M, Wahlgren D, Adams M: The logical and empirical basis for the Behavioral Ecological Model. In Emerging theories in health promotion practice and research: Strategies for enhancing public health. 2nd edition. Edited by DiClemente RJ, Crosby RA, Kegler MC. Jossey-Bass, San Francisco; 2009:347-385.
• [13]Skinner BF: Science and human behavior. The MacMillan Company, New York; 1953.
• [14]Biglan A, Hayes SC: Should the behavioral sciences become more pragmatic? The case for functional contextualism in research on human behavior. Applied and Preventive Psychology. Current Scientific Perspectives 1996, 5:47-57.
• [15]Unrau C: Qualitative data analysis. In Social work research and evaluation: Quantitative and qualitative approaches. Edited by Grinnel RM Jr, Unrau YA. Peacock, Itasca, IL; 1997:512-551.
• [16]Morse JM: Confusing categories and themes. Qual Health Res 2008, 18(6):727-728.
• [17]U.S. Department of Health: Education and Welfare: The health consequences of smoking: A report of the surgeon general. US DHEW, Washington, DC; 2004.
• [18]World Health Organization: WHO report on the global tobacco epidemic, 2008 – the MPOWER package. WHO, Geneva; 2008:1.
• [19]U.S. Department of Health and Human Services: The health consequences of involuntary exposure to tobacco smoke. In A report of the surgeon general. Edited by Tulchinsky TH, Varavikova E. USDHHS, Washington, DC; 2006.
• [20]Hopkins DP, Briss PA, Ricard CJ, Husten CG, Carande-ulis VG, Fielding JE, Alao MO, McKenna JW, Sharp DJ, Harris JR, Woolleery TA, Harris KW: Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med 2001, 20(2 S1):16-66.
• [21]Vasselli S, Papini P, Gaelone D, Spizzichino L, De Campora E, Gnavi R, Saitto C, Binkin N, Laurendi G: Reduction incidence of myocardial infarction associated with a national legislative ban on smoking. Minerva Cardioangiol 2008, 56(2):197-203.
• [22]Connolly GN, Carpenter CM, Travers MJ, Cummings KM, Hyland A, Mulcahy M, Clancy L: How smoke-free laws improve air quality: A global study of Irish pubs. Nic Tob Res 2009, 11(6):600-605.
• [23]Siegel M, Skeer M: Exposure to secondhand smoke and excess lung cancer mortality risk among workers in the "5 B's": Bars, bowling alleys, billiard halls, betting establishments, and bingo parlours. Br Med J 2003, 12(3):333-338.
• [24]Lopez MJ, Nebot M, Albertini M, Birkui P, Centrich F, Chudzikova M, Georgouli M, Gorini G, Moshammer H, Mulcahy M, Pilali M, Serrahima E, Tutka P, Fernandez E: Secondhand Smoke Exposure in Hospitality Venues in Europe. Environ Health Perspect 2008, 116(11):1469-1472.
• [25]Room R: Smoking and drinking as complementary behaviours. Biomed Pharmacother 2004, 58:111-115.
• [26]Carter SM, Chpman S: Smokers and non-smokers talk about regulatory options in tobacco control. Tob Control 2006, 15:398-404.
• [27]Cooper J, Borland R, Yong HH, Hyland A: Compliance and support for bans on smoking in licensed venues in Australia: findings from the International Tobacco Control Four-Country Survey. Aust NZ J Publ Heal 2010, 34(4):379-385.
• [28]Tamvakas I, Amos A: “These things don't happen in Greece”: a qualitative study of Greek young people's attitudes to smoking, secondhand smoke and the smokefree legislation. Health Educ Res 2010, 25(6):955-964.
• [29]Ministry of Health: The Minister of Health's Report on Smoking 2010. MOH, Jerusalem; May 2011.
• [30]Hofstetter CR, Hovell MF, Irvin VL, Ayers JW, Hughes SC, Kang S: It's others, not the police: smoking, reprimand, and fines among adults of Korean descent in California. Health Psychol 2010, 29(3):255-261.
• [31]Scollo M, Lal A, Hyland A, Glantz S: Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry. Tob Control 2003, 12(1):13-20.
• [32]Pyles MK, Mullineaux DJ, Okoli CT, Hahn EJ: Economic effect of a smoke-free law in a tobacco-growing community. Tob Control 2007, 16(1):66-68.
• [33]Pyles MK, Hahn EJ: Economic effects of Ohio's smoke-free law on Kentucky and Ohio border counties. Tob Control 2011, 20(1):73-76.
• [34]Baron-Epel O, Keinan-Boker L, Weinstein R, Shohat T: Persistent high rates of smoking among Israeli Arab males with concomitant decrease among Jews. Isr Med Assoc J 2010, 12(12):732-737.
• [35]Baron-Epel O, Haviv-Messika A, Tamir D, Nitzan-Kaluski D, Green M: Multiethnic differences in smoking in Israel - Pooled analysis from three national surveys. Eur J Public Health 2004, 14(4):384-389.
• [36]Sprinzak E: Every man is right in his own eyes: Illegalism in Israeli society. Sifriat Hapoalim, Israel; 1986.
• [37]Rattner A, Yagil D, Pedahzur A: Not bound by the law: legal disobedience in Israeli society. Behav Sci Law 2001, 19(2):265-283.
• [38]Rattner A, Yagil D: Taking the law into one's own hands on ideological grounds. Int J Sociol Law 2004, 32(1):85-102.
• [39]Hakkert AS, Gitelman V, Cohen A, Doveh E, Umansky T: The evaluation of effects on driver behavior and accidents of concentrated general enforcement on interurban roads in Israel. Accident Anal Prev 2001, 33(1):43-63.