Compliance with Smoke-Free Tobacco Legislation in Indoor Public Places in 12 Cities in Turkey

Abstract

*Context:* In 2008, Turkey passed its smoke-free legislation prohibiting smoking in indoor public spaces, but this legislation is only as effective as its level of compliance. *Objective:* To assess the level of compliance with the smoke-free legislation in 12 cities across Turkey. Methods:* In each city, we selected 10 sampling points using a random sampling strategy. Using a standardized protocol, we visited universities, schools, hospitals, government buildings, shopping malls, and hospitality venues between December 2012 and July 2013. During each visit, fieldworkers used checklists to collect information on the number of smokers, the presence of cigarette butts, ashtrays, no smoking signs, fines or penalty signs, signage visibility, and cigarette sales. Fieldworkers also observed smoking in taxicabs during rides taken to and from study venues. In each venue, we defined compliance as no smoking observed in any indoor location. In taxis, we defined compliance as no smoking by the taxi driver. We observed a total of 898 venues, 4,395 indoor locations, 39,936 people, and 356 taxi rides. In Istanbul, Ankara, and Izmir, we observed 404 venues, 1,988 indoor locations and 20,120 people. In the 9 smaller cities, we observed 494 venues, 2,407 indoor locations and 19,816 people. Results:* Compliance with the smoke-free legislation was above 95% in schools, 94% in government buildings, 92% in shopping malls and 97% in universities. In hospitals, compliance was 79%. In hospitals, schools, government buildings, and universities, the areas with poor compliance were the cafeterias and dining areas. In hospitality venues, compliance was 20% in bars and nightclubs, 78% in traditional coffee houses, 93% in restaurants and 94% in cafes. Compliance was 95% in taxis. Conclusions:* These findings support the need to improve the enforcement of the law in hospitality venues, especially bars and nightclubs, and traditional coffee houses.