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.
Highlights
To protect everyone from the detrimental effects of exposure to second-hand tobacco smoke,[1,2] the World Health Organization’s Framework Convention on Tobacco Control has called for comprehensive legislation to eliminate tobacco smoking in all indoor public places and workplaces.[3,4] In Turkey – ranked among the top 10 countries in the world for tobacco use in 20085 – the mean cigarette consumption among the 41.5% of men and 13.1% of women who smoked was 20.3 and 15.3 per day respectively in 2012.6Turkey passed a law in 2008 that prohibited smoking in indoor public places and workplaces.[7]
In an attempt to evaluate compliance with the legislation on smoking in indoor public places in Turkey more comprehensively, we adapted a guide on compliance studies that was published by the International Union Against Tuberculosis and Lung Disease, the Campaign for Tobacco Free Kids and the Johns Hopkins Bloomberg School of Public Health in 2014.12 We used the presence of individuals who were smoking and/or cigarette butts as indicators of noncompliance with the legislation and the presence of ashtrays, the absence of no-smoking signs and the presence of cigarettes for sale as possible facilitators of non-compliance
Bars/nightclubs, presence of ashtrays and presence of cigarette sales were found to be associated with the observation of outdoor smoking, and ashtrays and cigarette sales were found to be associated with the observation of cigarette butts outdoors (Table 3). In this evaluation of compliance with smoke-free legislation across 12 cities in Turkey, we found good compliance in the non-dining areas of government buildings, hospitals and universities – since smoking was observed in 2% or less of such areas
Summary
To protect everyone from the detrimental effects of exposure to second-hand tobacco smoke,[1,2] the World Health Organization’s Framework Convention on Tobacco Control has called for comprehensive legislation to eliminate tobacco smoking in all indoor public places and workplaces.[3,4] In Turkey – ranked among the top 10 countries in the world for tobacco use in 20085 – the mean cigarette consumption among the 41.5% of men and 13.1% of women who smoked was 20.3 and 15.3 per day respectively in 2012.6Turkey passed a law in 2008 that prohibited smoking in indoor public places and workplaces.[7]. To protect everyone from the detrimental effects of exposure to second-hand tobacco smoke,[1,2] the World Health Organization’s Framework Convention on Tobacco Control has called for comprehensive legislation to eliminate tobacco smoking in all indoor public places and workplaces.[3,4] In Turkey – ranked among the top 10 countries in the world for tobacco use in 20085 – the mean cigarette consumption among the 41.5% of men and 13.1% of women who smoked was 20.3 and 15.3 per day respectively in 2012.6. In addition to evaluating compliance with the legislation on indoor smoking, we assessed outdoor exposure to second-hand tobacco smoke near the buildings
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