Compliance with smoke-free legislation within public buildings: a cross-sectional study in Turkey

Abstract

ObjectiveTo investigate public compliance with legislation to prohibit smoking within public buildings and the extent of tobacco smoking in outdoor areas in Turkey.MethodsUsing a standardized observation protocol, we determined whether smoking occurred and whether ashtrays, cigarette butts and/or no-smoking signs were present in a random selection of 884 public venues in 12 cities in Turkey. We visited indoor and outdoor locations in bars/nightclubs, cafes, government buildings, hospitals, restaurants, schools, shopping malls, traditional coffee houses and universities. We used logistic regression models to determine the association between the presence of ashtrays or the absence of no-smoking signs and the presence of individuals smoking or cigarette butts.FindingsMost venues had no-smoking signs (629/884). We observed at least one person smoking in 145 venues, most frequently observed in bars/nightclubs (63/79), hospital dining areas (18/79), traditional coffee houses (27/120) and government-building dining areas (5/23). For 538 venues, we observed outdoor smoking close to public buildings. The presence of ashtrays was positively associated with indoor smoking and cigarette butts, adjusted odds ratio, aOR: 315.9; 95% confidence interval, CI: 174.9–570.8 and aOR: 165.4; 95% CI: 98.0–279.1, respectively. No-smoking signs were negatively associated with the presence of cigarette butts, aOR: 0.5; 95% CI: 0.3–0.8.ConclusionAdditional efforts are needed to improve the implementation of legislation prohibiting smoking in indoor public areas in Turkey, especially in areas in which we frequently observed people smoking. Possible interventions include removing all ashtrays from public places and increasing the number of no-smoking signs.

Factors that influence attitude and enforcement of the smoke-free law in Turkey: a survey of hospitality venue owners and employees

“…As published elsewhere, the SHELT study selected 12 cities in Turkey, 1 from each Turkish Region defined by the European Union's Nomenclature of Territorial Units for Statistics 27. This included the three largest cities in Turkey (Istanbul, Ankara (Western Anatolia) and Izmir (Aegean Region)) as well as nine cities in the remaining nine regions (West Marmara, Eastern Marmara, Mediterranean, Middle Anatolia, Western Black Sea, Eastern Black Sea, Northeastern Anatolia, Middle Eastern Anatolia and Southeastern Anatolia).…”

“…While the overall prevalence of smoking has decreased from 32.1% in 2008 to 27.1% in 2012 (47.9–41.5% among men, 15.2–13.1% in women) in Turkey,26 the implementation of the legislation has been challenging in specific hospitality venues. The lack of compliance, especially in bars and night clubs and traditional coffee houses was recently evidenced by the Secondhand Smoke Evaluation of Legislation in Turkey (SHELT) study 27. The SHELT study comprehensively evaluated compliance across 12 cities in Turkey using observations of persons smoking and of cigarette butts in indoor public places as indicators of non-compliance with the law 27.…”

“…The lack of compliance, especially in bars and night clubs and traditional coffee houses was recently evidenced by the Secondhand Smoke Evaluation of Legislation in Turkey (SHELT) study 27. The SHELT study comprehensively evaluated compliance across 12 cities in Turkey using observations of persons smoking and of cigarette butts in indoor public places as indicators of non-compliance with the law 27. To identify drivers of attitude towards and enforcement of the smoke-free legislation in Turkey and to provide information that can be useful for Turkey and other countries who are facing challenges with implementation of smoke-free laws, we interviewed hospitality venue owners and employees as a follow-up to the observational evaluation of public places conducted by SHELT.…”

Effects of smoking ban in Turkey on patients with chronic obstructive pulmonary disease: A retrospective analysis

“…[19] Comprehensive legislation has been prepared within the scope of the Framework Convention on Tobacco Control prepared by the World Health Organization to protect individuals against the hazardous effects of second hand smoking. [20][21][22] In 2015, Navas-Acien et al [23] conducted a cross-sectional study on the ban on smoking in governmental buildings in Turkey and recommended that indoor areas, places near entrances, as well as patios and gardens, should be included in the scope of the smoking ban to prevent second-hand smoking.…”

Correlates of compliance with national comprehensive smoke-free laws

“…Six years after the adoption of a national comprehensive smoke-free law in Turkey, the compliance was found to be very high in indoor offices, schools and other indoor places. Nonetheless, when assessed in coffee houses and the dining areas of government buildings and hospitals, compliance was found poor and very poor in bars and nightclubs 11. Despite a similarly comprehensive law in Albania, the exposure to second-hand smoke remained high in private workplaces, restaurants and cafes/bars/nightclubs 3 years after introduction 12.…”