Compliance with smoke-free legislation in public places: An observational study in a northeast city of Bangladesh

Abstract

Background Bangladesh is one of the highest tobacco-consuming countries in the world, with a large number of adult users of a variety of smoked and/or smokeless tobacco products. Bangladesh tobacco control act prohibits smoking in public places and requires the owners of public places to display ‘no smoking’ signages. Objectives The objective of this study was to assess the level of compliance with the tobacco control act (smoke-free laws) in public places in a northeast city of Bangladesh. Methods This cross-sectional study was conducted between June 1 and August 25, 2020, across 673 public places in Sylhet city, Bangladesh. The data was collected using a structured observational checklist that included variables such as the presence of active smoking, the presence of designated smoking areas, the display of ’no smoking’ signages, evidence of recent smoking such as ashes, butts/bidi ends, and the presence of smoking aids. Results Among 673 public places, a total of 635 indoor locations and 313 outdoor locations were observed. Only 70 (11%) indoor locations were found to be in good compliance, and 388 (61.1%) indoor locations were found to be in moderate compliance with smoke-free laws. On the other hand, only 5 (1.6%) outdoor locations were in good compliance, and 63 (20.1%) outdoor locations were in moderate compliance with smoke-free laws. The overall compliance with smoke-free laws at indoor locations was 52.7%, and at outdoor locations was 26.5%. The highest compliance was observed at healthcare facilities (58.6%) and the least at transit points (35.7%) for indoor locations. In outdoor locations, the highest compliance was observed at offices and workplaces (37.1%) and the least at transit points (2.2%). Higher active smoking was observed in public places where there was an absence of ‘no smoking’ signage and the presence of points of sale (POSs) (p-value <0.05). Further, higher active smoking was observed in places where any smoking aids, cigarette butts, bidi ends, or ashes were present (p-value <0.05). Conclusion This study found moderate compliance at indoor locations and very low compliance at outdoor locations. The government should focus more on implementing smoke-free laws in all kinds of public places, particularly at most frequently visited places and transit sites. ‘No smoking’ signages should be displayed per legislation across all public places. Policymakers should consider the prohibition of POS in/around a public place as it has a positive effect on smoking.

Non-compliance with smoke-free law in public places: a systematic review and meta-analysis of global studies

“…From the included studies, the highest non-compliance with smoke-free law was found to be 98.2% in food and drinking establishments ( 32 ) and the lowest non-compliance was 10.3% in healthcare facilities ( 36 ). Regarding the study country, four studies were conducted in India ( 29 , 31 , 35 , 37 ), two in China ( 17 , 30 ), two in Russia ( 28 , 38 ), one in United states ( 15 ), one in Guatemala ( 24 ) one in Indonesia ( 16 ), two in Ethiopia ( 14 , 36 ), two in South Africa ( 23 , 32 ), one in Australia ( 19 ), one in Portugal ( 34 ), one in European Union ( 27 ), one in Bangladesh ( 26 ), one in Vietnam ( 33 ), one in Turkey ( 22 ), one in Pakistan ( 21 ), and one in Nepal ( 25 ). Among the included the studies, the sample size ranged between 25,475,032 ( 15 ) and 40 ( 37 ) ( Table 1 ).…”

“…Regarding methods of data collection, thirteen studies collected data using observational methods ( 14 , 16 , 21 , 25 , 26 , 29 , 30 , 32–37 ), five studies using review report ( 15 , 23 , 28 , 31 , 38 ), three studies using self-administered questionnaire ( 17 , 19 , 27 ), one study using both observational and interview ( 22 ), and one study collected using data measuring ( 24 ) ( Table 1 ).…”