“Trikala Quits Smoking”: A Citizen Co-Creation Program Design to Enforce the Ban on Smoking in Enclosed Public Spaces in Greece

Abstract

Background: Tolerance and acceptance of smoking indoors by consumers is common in Greece, and for the most part, authorities turn the other cheek in enforcing long-standing legislation banning smoking in enclosed public places. Focus of the Article: This case study describes the “Trikala Quits Smoking” initiative, which was designed to enforce smoking legislation in Trikala, creating a new social norm to counter the national indifference to enforcing the law regarding smoking indoors. Declared a smart city three times since 2009 and considered one of the most digitally progressive cities in the country, Trikala presents a good example of how to achieve behavior change in a high-context culture. This article outlines the processes used and the lessons learned to achieve the long-term goal of protecting adults and children from the effects of indoor second-hand smoking (SHS) by changing perception and acceptance of indoor smoking by the community, business owners, and local government. Program Design/Approach: A citizen co-creation approach was used to design the program to attain community buy-in and change existing social norms. The Socio-Ecological Model guided this process. It engaged upstream, midstream, and downstream stakeholders, including medical professionals, commercial business owners, the municipal leadership, and citizens to initiate the change. The deCIDES framework was used to guide project implementation. Planning for the initiative started in January 2017, with implementation commencing September 2017 and the project ending June 2019. Importance to the Social Marketing Field: This case study is the first documentation of social marketing in Greece. Implementation of this initiative shows the value of social marketing in changing social norms for high-context cultures. Methods: Primary data were gathered using a citizen-orientated information gathering process consisting of open community meetings, closed group stakeholder meetings, and project member meetings. Data from the city council regarding the number of fines issued to businesses provided evidence of the intervention’s success. Results: Before the start of the intervention, less than five percent of businesses were compliant with the law; after implementation, 90% of the businesses were compliant. Over 1,200 inspections took place, and only 50 fines for lack of compliance were issued over 18 months. The initiative was deemed successful in banning smoking in enclosed public spaces and shifting social norms about SHS. In late 2019, a national ban on smoking in enclosed public places was enforced by the newly elected parliament.