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.

2. Greeks
Love Smoking

3. Greeks
Love Smoking
Non Greeks become
& then they

4. At all levels
Greeks
Love Smoking

5. At all levels
Greeks
Love Smoking

6. Europe…
cannot understand why
Greeks
Love Smoking

7. Story so Far

8. pressure
Elf’s Mill is a thematic seasonal organization in Trikala, where for approximately 10 days series of events take place in the city. It is
an alluring family destination and attracts thousands of families. Website: http://www.milosxotikon.gr/home/
Trikala every December
becomes a major destination for
families from across Greece.
visit over a 10-day duration
Million
people

9. across Greece by shop owners to allowing smoking indoors.
this behaviour was influenced by their belief that to stop patrons
smoking inside, would mean losing customers.
by municipal police, led to the law being largely ignored.

10. Challenge
Behavioural objectives

12. Findings
Highlight behavioural objectives
73% of Greeks are non-smokers (Eurostat, 2014)
Approximately 80% of Smokers declare they intent to quit
Data from the city council indicates that approximately
90% of Trikala citizens agree with the ban on smoking in
closed spaces.
This implies only 10% would be opposed to the ban being
enforced, therefore the key to success was to motivate the
supportive 90% in changing the norm.
Many influential groups such as doctors, police officers,
and public officials could act as opinion leaders.

13. Based on these findings and the framework of the SEM, it
was surmised that the non-supporters of the smoking ban,
could be convinced to change behaviour
Findings

14. A core Intervention Design Team (IDT) including citizens &
members of all stakeholder groups - both smokers and non-
smokers & participated in all closed and open meetings.
Meetings with stakeholders
Three open meetings were held to understand the
viewpoints of those opposing the law, and another two
stakeholder meetings were held to understand their
perceived barriers and arguments against compliance.
The role of developing and sustaining partnerships was a
key element in value co-creation and successful
implementation.
Citizen Orientation

15. The project aim was twofold
Decrease the fear
Café/ restaurant and bar owners were afraid of the loss of
business and revenue from enforcing the law whilst it was
not enforced in neighbouring cities.
Enforce the ban across all of the city
Motivation through business incentives offered to all
owners e.g. free rental of outdoor space for smokers
The main social goal of the program was to protect the
community from SHS, especially families that spend
time in Trikala with their children, both locals and visitors
over the 10-day festive event.
The Social Offering

17. Intervention
Inform
1. Three (3) open stakeholder meetings. Three open consultation meetings were organized inviting stakeholders
and community to discuss the implementation.
2. One (1) Open Public meeting
3. Flyers: were placed in the restaurant and bar tables
4. Social Media campaigns: Extensive use of Social Media to raise awareness
5. Campaign logo was placed in the door of each participating store
6. Extensive media coverage to raise pride in locals being the first city in Greece, that complies with the law.
7. Sports Teams associated with the initiative. Placed a logo on their communication and clothes demonstrating
their support to Smoke Free Trikala Initiative.
Educate
1. Awareness campaigns to primary and secondary school students. Awareness campaigns and material with
messages, “I learn not to smoke” and “I learn to be Smoke Free” was delivered.
2. Sports associations were educating their members towards a smoke free attitude.
3. Events to inform on health issues were held in all seven (7) municipalities around Trikala. Participation of
doctors and scientists who, after presenting the facts in keynotes, initiated open discussion with the audience
answering questions to support the evidence and raise awareness.
Design
1. Opinion leaders, doctors, professors, teachers, police officers, city counsellors were approached, to act as role
models and not smoke in enclosed public spaces to help change social norms.
2. Dedicated Website with the complying stores, promoted the social proof.
3. Positioning “Trikala Quit Smoking”, was selected to appeal to emotions. The slogan was “It’s not a matter of
legislation, its fundamentally a matter of civilization”
4. The project team formed an intervention scheme in which participants were citizens, store owners, association
reps, officials, experts.
Support
1. All stores had a period to comply, from announcement day to the actual day of enforcement.
2. Motives for owners. Shop owners who participated in the program were offered free public space outside their
store, to use and decorate for their smoking clients.
3. Smoking Cessation Unit offered call center support and advise on smoking cessation.
Control
1. Intensive inspections followed the enforcement of the law.
2. Fines were issued even to employees of the Municipality that refused to comply, communicating the
commitment.

18. SEM Level Description
Individual
Interpersonal
Community
Organizational
Policy/Enabling
Environment
Systematic
Planning

19. Results

20. Challenges &
Lessons Learned
- Before the initiation of the city-wide programme, less than 5% of
businesses, approximately five of them, were compliant with the
law. A year after the programme implementation, 90% of them were
compliant, more than 60 businesses.
- A significant learning was that the program had little effect in
smaller communities, and villages around Trikala city as the program
was mainly focused on businesses in the urban area.
- The inhabitants of the smaller communities resisted strongly,
program implementation had poor uptake as local people and
businesses felt strongly that they should have control of their space.
This lack of uptake was further exacerbated because of the limited number of municipal
police engaged to enforce the ban. This was a direct result of the lack of attention and
inclusion of the suburban and rural areas of the municipality in the program.

21. https://www.linkedin.com/in/lskerletopoulos/
https://www.linkedin.com/in/angela-makris-58587a10/
College of Public Health, University of South Florida
National Rep.(GR) European Social Marketing Association