Abstract
Background: Environmental tobacco smoke (ETS) exposure is associated with an increased risk of many diseases. Many countries have ratified a national smoking ban in public places, but studies on factors related to smoking issues in public places post-ban are lacking. Aim: To identify facilitators and barriers that influenced smokers’ compliance with smoking bans in public places. Methods: Using PubMed, MEDLINE, and the Web of Science database, we conducted a systematic search of English articles published before June 2015 on factors of smokers’ compliance with the smoking bans in public places. Results: A total of 390 references were identified, among which seventeen articles (twelve quantitative studies, two qualitative studies, three mixed-method studies) were included in this review. These studies focused on four types of public places including recreational venues (n = 7), hospital (n = 5), school (n = 4), and workplace (n = 1). Factors at the individual-, interpersonal-, and organizational-level were identified: at the individual level, nicotine dependence, insufficiency of tobacco-related knowledge, and the negative attitudes towards smoking bans were the most commonly identified barriers; at the interpersonal level, the smoking behaviors of people around, close relatives, and friends’ approval were the main barriers; and at the organizational level, the main barriers were inefficient implementation of the bans and the inconvenience of the designative smoking areas. Conclusions: This synthesis of the literature provided evidence of the identified barriers and facilitators of smokers’ compliance with the smoking bans. It will be beneficial for the policy-maker to consider interventions on multiple levels of factors to overcome the barriers and enhance smokers’ compliance with the smoking bans in public places.
Highlights
Exposure to environmental tobacco smoke (ETS) has been associated with premature death and morbidity [1]; it has been documented to be as harmful as active smoking and is the cause of a wide spectrum of morbidity and more than 600,000 premature deaths worldwide [2]
We used a set of combinations of keywords in the literature search, including words reflecting smokers, compliance, smoke-free, ban, predictor, and public places
People who were better informed with the harms of smoking and passive smoking and aware of the policy boundaries were more likely to be compliant with the smoking bans in public places than those with a lower level of knowledge [5,9,16,27,32,33,34]
Summary
Exposure to environmental tobacco smoke (ETS) has been associated with premature death and morbidity [1]; it has been documented to be as harmful as active smoking and is the cause of a wide spectrum of morbidity and more than 600,000 premature deaths worldwide [2]. There is no safe level for ETS exposure [3] and, globally, there are more than one billion smokers who can potentially expose others to ETS [4]. In response to this important public health issue, as of September 2010, national smoke-free legislation, which is a key policy under the WHO Framework Convention on Tobacco Control (FCTC), has been ratified by over 170 countries [5]. Environmental tobacco smoke (ETS) exposure is associated with an increased risk of many diseases. Aim: To identify facilitators and barriers that influenced smokers’ compliance with smoking bans in public places
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