Smoke-free law compliance and predictive factors in Ethiopia: observational assessment of public places and workplaces

Abstract

ObjectivesThe primary objective of this observational study was to assess the status of public place and workplace compliance with smoke-free provisions in Ethiopia.MethodsThis study was conducted in four regions of Ethiopia (Oromia; Sidama; Harari; and Southern Nations, Nationalities, and Peoples’ Region) from September to October 2021. Data were collected using a standardised smoke-free checklist. Χ2tests were used to assess the association between categorical variables and the smoke-free status. Multivariable binary logistic regression analysis was used to identify factors associated with the presence of at least one person actively smoking.ResultsApproximately 97% (95% CI 93.1%, 98.8%) of government buildings, 92.5% (95% CI 85.7%, 96.2%) of educational institutions, 89.8% (95% CI 86.3%, 92.5%) of bars, restaurants and cafés, 88.4% (95% CI 82.9%, 92.3%) of food establishments and 84.0% of hotels (95% CI 79.5%, 87.6%) were non-compliant with the tobacco control law. Overall, only 12.3% of sites met the requirements of the current smoke-free law. The multivariable logistic regression models showed that transit facilities (adjusted OR (AOR)=26.66 (95% CI 7.53, 94.41)) and being located in the Harari region (AOR=4.14 (95% CI 2.30, 7.45)) were strongly associated with the presence of active smoking observed during the site visit.ConclusionThis study indicated that public place and workplace non-compliance level was very high in all sites. This calls for more effective implementation of complete smoke-free provisions across all government buildings and institutions in all regions, such as public educational campaigns about the laws and enforcement action for non-compliance. Furthermore, all regional states should adopt Federal Proclamation 1112/2019.

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

“…In this meta-analysis, 25,573,329 study participants were involved. Five of the included studies focused on healthcare facilities ( 19 , 34–37 ), sixteen studies ( 14–17 , 21–27 , 29–31 , 33 , 38 ), one study on education sector ( 38 ), and one study on food and drinking service establishment ( 32 ). All of the included studies followed cross-sectional study design.…”

“…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 ).…”

Mixed progress in global tobacco control

“…Less than a third of countries with smokefree policies provide the necessary funding to enforce the policy, undermining their effectiveness. For example, in Ethiopia, which has nominally achieved the highest level of smokefree policy according to the WHO Report, compliance is low; according to one observational study, only 12.3% of sites visited were fully compliant with the smokefree law [ 8 ].…”