Abstract
Smoking and exposure to secondhand smoke are leading causes of disease and premature death in low- and middle-income countries (LMICs), where over 80% of smokers live. Over 152 LMICs, including Thailand, have passed laws designating that indoor and outdoor public spaces should be smoke-free. Throughout LMICs, implementation of laws has been a persistent problem. We identified one activist in Thailand who developed his own highly effective strategy for ensuring implementation of smoke-free laws, and whose approach has potential for being a model for implementation activists in other LMICs. We set out to describe the implementation activist's strategy and impact, and to explore his perspective and motivations. We conducted in-depth interviews with the activist, reviewed video recordings and transcripts, and used narrative analysis to identify key themes and illuminating statements. In the implementation activist's assessment, administrators and officials were not being held accountable for their responsibilities to enforce laws, resulting in low public compliance. The activist developed his strategy to first identify public places where no-smoking signs were not posted and/or where people were smoking; take photographs of violations and make notes; and file citizen's complaints at police stations, submitting his photographs as evidence. The implementation activist documented over 5,100 violations of smoke-free laws throughout Thailand and reported violations to police. Often, police officers were unsure how to deal with his complaints, but when he educated them about the law, most undertook enforcement actions. The activist's work has contributed substantially to creating smoke-free schools, sports facilities and parks. This implementation activist's approach can be a model for preventing youth from using tobacco/nicotine, and preventing exposures to secondhand smoke and e-cigarette emissions. Based on his successes, we provide a list of elements that implementation activists can use to be effective, along with recommendations for policy and practice.
Highlights
Most low- and middle-income countries (LMICs) face challenges ensuring that tobacco control laws are strongly and consistently implemented locally, and that smokers universally comply with laws designed to create smoke-free public spaces (Open Society Institute, 2007; Minh et al, 2016; Wang et al, 2017; Byron et al, 2019)
Our study shows that Loong Joon is a passionate and effective implementation activist who is determined to ensure that young people do not take up smoking, and that all public places in Thailand become smoke-free
His activism is borne out of his frustration seeing that higher-level and local officials who are legally responsible for education and enforcement have not fulfilled their duties under the law
Summary
Most low- and middle-income countries (LMICs) face challenges ensuring that tobacco control laws are strongly and consistently implemented locally, and that smokers universally comply with laws designed to create smoke-free public spaces (Open Society Institute, 2007; Minh et al, 2016; Wang et al, 2017; Byron et al, 2019). Findings: In the implementation activist’s assessment, administrators and officials were not being held accountable for their responsibilities to enforce laws, resulting in low public compliance The activist developed his strategy to first identify public places where no-smoking signs were not posted and/or where people were smoking; take photographs of violations and make notes; and file citizen’s complaints at police stations, submitting his photographs as evidence. These research findings show that there are aspects of sociocultural context wherein implementation activists can focus their work
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