Behavioural and psychological responses of lower educated smokers to the smoke-free legislation in Dutch hospitality venues: A qualitative study

Abstract

Objective: In 2008, smoke-free legislation was implemented in hospitality venues (HV) in the Netherlands. We investigated how continuing smokers with a lower educational background respond behaviourally and psychologically to the legislation and the norm it communicates.

Design: In 2010, 18 lower-educated daily smokers were interviewed. Transcripts were analysed with MAXQDA software. Theories of self-awareness and social in- and exclusion were applied to interpret findings.

Results: Smokers had become more self-aware and the experience of a more negative norm surrounding smoking had made them reevaluate their smoking. Smokers had also become more self-aware of their own smoking, both in HV and in general. Feelings of increased social exclusion were reported. Participants dealt with the increased awareness and feelings of social exclusion in different ways depending on their evaluation of the smoking ban, changes in attitude towards own smoking, changes in HV patronage and changes in smoking behaviour.

Conclusion: Theories of self-awareness and social in- and exclusion were useful in understanding consequences of a HV smoking ban on continuing smokers. Four different types of responses were identified, i.e. (1) actively trying to quit, (2) socially conscious smoking, (3) feeling victimised and (4) rejecting the norm. Implications for future smoke-free legislation are discussed.

Keywords:

• smokers
• policy impact
• smoking ban
• interviews
• lower socio-economic status
• self-awareness
• social exclusion

Acknowledgements

We would like to thank all the interviewees who participated in the study and all the people who helped in the design, writing, coding and translating. Furthermore, we are greatly indebted to two anonymous reviewers who provided valuable suggestions for the improvement of a previous version of the manuscript. This study was performed under MIRO, a national program for optimising smoking cessation. MIRO is an initiative of Pfizer and Caphri. This project is supported by an unrestricted grant from Pfizer and Caphri. The views expressed are those of the authors and not necessarily of the funders.