Implementation of Smoke-Free Law in Denpasar Bali: Between Compliance and Social Norms of Smoking

Abstract

Background: Since 2013, City of Denpasar government has adopted a smoke-free law. Implementation of the law faces several obstacles, partly due to the high social acceptability of smoking in the city, where cigarette and smoking has been deeply engrained within social life and become part of hospitality. This study aims to assess the smoke-free law compliance and to explore the social norms that may affect the compliance. Design and Methods: The study was a mix of cross-sectional compliance survey and qualitative exploration conducted in Denpasar in 2019. Survey included 538 samples, which were selected using stratified random sampling and a walking protocol. The qualitative data was collected through in-depth interviews and Focus Group Discussion (FGD) in four sub-districts of Denpasar.Results: Of the 538 venues, 32.9% complied with the seven compliance indicators. The university has the highest compliance (83.3%), while public places including worship places have a low compliance. The three most common violations were the absence of no-smoking signage (58.6%), provision of ashtray (17.5%), and smell of tobacco smoke (15.8%). The poor compliance was related to the lack of awareness of the regulation, and the fact that smoking is highly acceptable and part of the culture. The informants highlighted the essential role of public figures and potency of local policy as social disapproval of smoking.Conclusions: Compliance to the smoke-free law in Denpasar remains low, continuous education, socialization and improved supervision are crucial. Meanwhile, social and cultural acceptance of smoking is considered as an essential factor that hampers the implementation of the smoke free law.

A Qualitative Evaluation of Smoke-Free Policy Implementation among the Hospitality Industry in Yogyakarta, Indonesia

“…Support for SFPs from hotel management plays an important role in increasing compliance (Devhy et al, 2014). Nevertheless, this compliance is also influenced by political and government commitment (Asyary & Veruswati, 2018;Robertson et al, 2018) as well as individual awareness (Robertson et al, 2018;Suarjana et al, 2020;Wahyuti et al, 2019). Most hospitality managers in this study found that customer resistance, unclear sanctions, and a lack of socialization from the government were three interconnected obstacles to enforcing SFPs.…”

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 ).…”

“…Notwithstanding the compressive interventions that have been taken to create smoke-free environment across the world, the prevalence of cigarette smoking and exposure to secondhand smoke is still increasing in different countries except Brazil and Turkey ( 13 ). For instance, evidence from recent studies showed that the prevalence of non-compliance with smoke-free law was as high as 87.9, 79, 67.1, and 41.2% in public places of Ethiopia ( 14 ), United States ( 15 ), Indonesia ( 16 ), and China ( 17 ), respectively, 39.9% among patients in Spain ( 18 ), 39.1% in healthcare facilities of Australia ( 19 ), and 32% among healthcare workers in the United Kingdom ( 20 ).…”

Implementation level indicators of public facilities in Surabaya to smoke-free area regulation

“…Visually, the installation of a no-smoking sign is also very important to raise public awareness for law and order, and not smoking in public facilities. 16 The fourth indicator was no cooperation with tobacco industries, with an estimated CFA value of -.056 meaning that this indicator does not shape the level of SFA implementation. When the public facility cooperates with the tobacco industry it does not mean that the facility does not comply with regulations in a smoke-free area.…”