A Mixed Methods Investigation of Bar Atmospherics and Smoking in New Zealand

Background: Smoking is a major public health concern and a leading cause of health loss within New Zealand and globally. Smoking prevalence and initiation are particularly high among young adults and, among this age group, smoking is often associated with social contexts and alcohol use. Alcohol is viewed as a catalyst for smoking, reducing inhibitions and increasing cravings for cigarettes. While the Smoke-free Environments Amendment Act 2003 prohibits smoking inside hospitality venues such as bars and nightclubs, smoking is still permitted in outdoor areas, allowing co-use of tobacco and alcohol to persist in these settings. Consequently, these outdoor areas offer a space where smoking may be normalised, accepted, and even encouraged. This thesis investigates the attributes present within bar environments that facilitate and normalise smoking and alcohol co-use among young adults. Methods: This research consists of three parts. First, there is a review of the literature related to bar atmospherics (a marketing term describing the manipulation of environmental cues within commercial settings) and smoking with regard to specific attributes of the bar environment as well as smokers’ attitudes towards outdoor smoking areas and smoking behaviours in these areas. Second, there is a qualitative study using in-depth interviews with young adults who smoke in the outdoor areas of licensed premises. The data collected is thematically analysed, and used to inform the development of a multi-item checklist used to assess attributes present in bars and nightclubs that influence smoking. Finally, this checklist is used in a series of unobtrusive observations in a sample of New Zealand youth-oriented licensed premises to describe smoking-related atmospherics. Results: Restricting smoking to specific sets of circumstances, such as while drinking or socialising, allows young adult occasional smokers to rationalise their smoking and distance themselves from the label of smoker. In youth-oriented bars, music and volume, weather and heaters, seating and tables, crowding, shelters, ashtrays, lighting, cleanliness, the location of the area, its proximity to the inside dancefloor, the layout, and the presence of other smokers all contribute to the creation of a relaxed, comforting and appealing environment. These atmospheric attributes facilitate smoking; smoking fills a social role and functions as a justification for young adults to escape the loud and crowded interior. Outdoor areas were quieter and less crowded than inside premises, with seats for those tired from dancing inside. Ashtrays and the presence of other smokers reassured young adult patrons that the outdoor area is an area where smoking is not only permitted, but intended and normalised. Conclusions: Smoking among young adults has a strong social component, which is facilitated by attributes of the outdoor area. Expanding smoke-free areas to include the outdoor areas of licensed premises would help to decouple smoking and alcohol use, have a strong denormalising effect, and may reduce smoking frequency among young adult smokers