Factors that Influence Support and Enforcement of the Smoke-Free Law in Turkey: A Survey of Hospitality Venue Owners and Employees

Abstract

Introduction: Turkey enacted smoke-free legislation in 2008 that extended to hospitality venues in 2009. Although current law prohibits indoor smoking in all workplaces, compliance is low in some hospitality venues, such as bars and nightclubs. Our objective was to identify characteristics associated with knowledge of health effects from secondhand smoke (SHS) exposure, support for the law, and enforcement of the law that can contribute to improving implementation of the smoke-free law. Methods: From May to September 2014, we conducted a cross-sectional survey of hospitality venue owners and employees in 7 cities in Turkey. A total of 400 interviews (100 owners and 300 employees) were conducted in 262 restaurants and modern cafes, 41 traditional coffee houses and 88 bars and nightclubs. Descriptive analyses and logistic regression models were run to estimate odds ratios of knowledge of health effects from SHS, support and enforcement of the smoke-free law by a series of characteristics. Results: Only 37.3% had adequate knowledge of the health effects of SHS, support for the smoke-free law was 71.3% and enforcement behavior was 19.5%. Older individuals, women, participants who worked in bars and nightclubs, venue owners who reported fines for non-compliance, and current smokers were less likely to support the law. Participants who worked 70 hours or more per week were more likely to support the ban. Participants working in traditional coffee houses, former smokers, and participants with a high school education or higher were more likely to enforce the ban. Among current smokers, those who indicated that their smoking behavior was positively influenced by the law were more likely to support and enforce it. Conclusion: Although support for the smoke-free law is relatively high, positive interventions are needed to increase knowledge on the health effects of SHS and to facilitate behavior to enforce the law among owners and employees of hospitality venues in Turkey.