Abstract

BackgroundSmoke-free environments decrease smoking prevalence and consequently the incidence of heart disease and lung cancer. Due to issues related to poor enforcement, scant data is currently available from low/middle income countries on the long-term compliance to smoke-free laws. In 2006, high levels of secondhand smoke (SHS) were found in bars and restaurants in Guatemala City. Six months after a smoking ban was implemented in 2009, levels significantly decreased. However, in 2010, poor law compliance was observed. Therefore, we sought to assess long-term compliance to the ban using SHS measurements.MethodsIn 2014 we assessed SHS exposure using airborne nicotine monitors in bars (n = 9) and restaurants (n = 12) for 7 days using the same protocol as in 2006 and in 2009. Nicotine was measured using gas-chromatography (μg/m3) and compared to levels pre- (2006) and post-ban (2009). Employees responded to a survey about SHS exposure, perceived economic impact of the ban and customers’ electronic cigarette use. In addition, we estimated the fines that could have been collected for each law infringement.ResultsMost (71 %) venues still have a smoking section, violating the law. The percentage of samples with detectable nicotine concentrations was 100, 85 and 43 % in 2006, 2009 and 2014, respectively. In bars, median (25th and 75th percentiles) nicotine concentrations were 4.58 μg/m3 (1.71, 6.45) in 2006, 0.28 (0.17, 0.66) in 2009, and 0.59 (0.01, 1.45) in 2014. In restaurants, the corresponding medians were 0.58 μg/m3 (0.44, 0.71), 0.04 (0.01, 0.11), and 0.01 (0.01, 0.09). Support for the law continues to be high (88 %) among bar and restaurant employees. Most employees report no economic impact of the law and that a high proportion of customers (78 %) use e-cigarettes. A total of US$50,012 could have been collected in fines.ConclusionsLong-term compliance to the smoking ban in Guatemala is decreasing. Additional research that evaluates the determinants of non-compliance is needed and could also contribute to improve enforcement and implementation of the smoke-free law in Guatemala.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2960-x) contains supplementary material, which is available to authorized users.

Highlights

  • Smoke-free environments decrease smoking prevalence and the incidence of heart disease and lung cancer

  • Smoke-free environments decrease smoking prevalence by increasing cessation and decreasing initiation; and as a consequence, heart disease and lung cancer rates have decreased in countries and cities that have implemented smoke-free environments [1]

  • secondhand smoke (SHS) exposure was measured using monitors that consist of a filter cassette, a filter treated with sodium bisulfate and a nucleopore windscreen that allows airborne nicotine to reach the filter [8]

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Summary

Introduction

Smoke-free environments decrease smoking prevalence and the incidence of heart disease and lung cancer. Due to issues related to poor enforcement, scant data is currently available from low/ middle income countries on the long-term compliance to smoke-free laws. In 2006, high levels of secondhand smoke (SHS) were found in bars and restaurants in Guatemala City. Smoke-free environments decrease smoking prevalence by increasing cessation and decreasing initiation; and as a consequence, heart disease and lung cancer rates have decreased in countries and cities that have implemented smoke-free environments [1]. In 2005, Guatemala ratified the FCTC and must protect citizens from SHS exposure in all workplaces [2, 3]. Exposure was highest in bars and restaurants, where nicotine concentrations were 710 and 114 times higher as compared to those found in a public

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