Smoke-free Policies Research Articles

Comprehensive Review of Tobacco Control Measures in Sri Lanka: Insights from the WHO Report on the Global Tobacco Epidemic, 2023

This review article provides a comprehensive analysis of the tobacco control measures in Sri Lanka as outlined in the WHO Report on the Global Tobacco Epidemic, 2023: (1) Assessing the implementation and efficacy of the MPOWER measures, (2) monitoring tobacco use, (3) protecting people from tobacco smoke, (4) offering assistance to quit tobacco use, (5) warning about the dangers of tobacco, (6) enforcing bans on tobacco advertising, promotion, and sponsorship, and (7) raising taxes on tobacco. The review focuses on the current prevalence of tobacco use among adults and adolescents. The results emphasize notable advancements in the implementation of health warnings and advertising prohibitions. However, there are still obstacles to overcome in order to reduce the affordability of tobacco, enforce smoke-free policies in public spaces, and provide comprehensive cessation support. In addition to recommendations for strengthening tobacco control policies, the article concludes with further suggestions for the future development of Sri Lanka.

Implementing a smoke-free generation policy for Canada: estimates of the long-term impacts.

The aim of this study was to assess the potential impacts of the introduction of a smoke-free generation (SFG) policy in Canada with a perpetual ban on cigarette sales to anyone born after 2009 instigated on 1 January 2025. An existing Canadian model relating to smoking cessation was adapted and augmented to assess the impact of an SFG policy on quality-adjusted life years (QALYs), life expectancy, health care costs, smoking-related taxes, and Canadian tobacco industry gross domestic product (GDP). The cumulative impact of the policy for the entire Canadian population was assessed for time horizons up to 90 years with an annual discount rate of 1.5%. After 50 years, this SFG policy would lead to 476 814 more QALYs, $2.3 billion less in health care costs, $7.4 billion less in smoking-related taxes and a $3.1 billion reduction in tobacco industry GDP. The combined value of health benefits gained and health care costs averted would exceed the sum of tax revenues foregone and reduced GDP, if the value of a QALY was at least $17 147. Use of higher discount rates and inclusion of unrelated health care costs had little impact on the interpretation of the results. The implementation of an SFG policy will bring substantive health benefits to the population in Canada. Although health care cost savings are lower than the combination of lost tax revenues and the decline in the GDP from the Canadian tobacco industry, the value of the health benefits realized outweigh the negative offsets.

Perceptions of children and young people in England on the smokefree generation policy: a focus group study.

Modelling shows smokefree generation (SFG) policies could effectively reduce smoking rates by banning tobacco sales to those born after a specific year. Little is known about how young people perceive the legitimacy and impact of the planned SFG policy in England. We conducted 7 semi-structured focus groups with 36 participants aged 12 - 21 (mean = 15) in England over video call and in person. 21 participants were female and 15 male. Participants were purposively sampled to include those from areas of greater deprivation and for use of tobacco or e-cigarettes. Data was analysed using the framework approach. Participants expressed broadly negative perceptions towards tobacco and its manufacturers. Most participants supported SFG policy goals and its focus on freedom from addiction and harm; some believed it should also encompass electronic cigarettes. Many believed the law would only be successful if it included stringent enforcement, accompanying tobacco licensing, and input from young people. A minority raised concerns about the loss of freedom to purchase tobacco. Communication of the freedom-giving nature of SFG is likely to resonate with many young people. Enforcement, communication, and involvement of young people in SFG should be considered carefully to maximise policy impact. The smokefree generation (SFG) policy's potential to offer freedom from addiction and disease can resonate with young people. Its effectiveness could be maximised through targeted enforcement in areas with high youth smoking rates and low adherence to age-of-sale laws, and through introduction of additional policies that offer restrictive licensing of tobacco retailers. A phased approach to SFG, initially covering tobacco and later incorporating e-cigarettes as smoking prevalence declines, could balance reducing youth vaping and harm reduction; future research could investigate optimal policy conditions for this approach.

Associations of smoke-free policies in multi-unit housing with smoking behavior and second-hand smoke exposure: A systematic review.

Although considerable progress has been made regarding the implementation of smoke-free policies (SFPs), many people continue to be exposed to second-hand smoke (SHS) in the home environment. The aim of this study was to conduct a systematic review on the association of SFPs in multi-unit housing (MUH) with smoking behavior and SHS exposure. In August 2022, we searched five online databases: PubMed, Embase, Web of Science, PsycINFO and CENTRAL. Keywords included terms for SFPs, MUH, smoking behavior and exposure to SHS. We searched for studies that focused on regular combustible cigarettes. Due to the high heterogeneity in methodology and outcomes of the included studies, a meta-analysis was not performed. Our search yielded 4750 articles. All of them were screened (24 based on full-text), and 17 met the inclusion criteria. All studies were published between 2001 and 2022. Most studies were conducted in the United States (n = 16) and used a cross-sectional design (n = 7) or a longitudinal design (n = 7). Seven studies evaluated smoking behavior. Five of them reported that SFPs in MUH were statistically significantly associated with decreases in either current smoking, smoking quantity, smoking frequency or smoking cessation. Fourteen studies evaluated exposure to SHS. Ten reported that SFPs in MUH were statistically significantly associated with decreases in self-reported exposure to SHS, airborne nicotine levels and particulate matter levels. Smoke-free policies in multi-unit housing appear to be associated with reduced smoking behavior and second-hand smoke exposure. Successful implementation depends on accessible cessation support and effective enforcement.

Overcoming Challenges to Adopting Smoke-Free Multi-Unit Housing Policies in a Large U.S. Metropolitan Area: Insights and Recommendations From Affected Groups in 20 Los Angeles County Cities.

Community members and non-academic partners ("affected groups") were asked to identify factors that can influence public support, impede adoption, and mitigate challenges related to adopting local smoke-free multi-unit housing policies. A series of key informant interviews were conducted with affected groups from a large U.S. metropolitan area. 20 cities in Los Angeles County without a smoke-free multi-unit housing ordinance. Interviewees were recruited from affected groups with knowledge about their community's civic and political landscape (n = 63). Data were collected and analyzed using thematic analysis to identify, code and compare themes. Most interviewees indicated civic groups, those who do not smoke, and/or groups who are educated about the negative health effects of secondhand smoke exposure would be more likely to support smoke-free multi-unit housing policies. Interviewees reported several challenges to policy adoption, including competing city priorities, public disengagement, and the cost and social burden of enforcing these ordinances. To overcome them, interviewees recommended working synergistically with local governments to build diverse coalitions, educate the public, and develop clear enforcement plans. Insights and recommendations from affected groups in 20 U.S. cities suggest that communicating with the public and priming impacted communities to support smoke-free multi-unit housing policies are promising interventions for protecting at-risk families from secondhand smoke exposure in their homes.

Smoke-Free Policies and Cigarette Consumption Impact on Myocardial Infarction Mortality in Europe

Abstract Background Limited evidence exists on the association between smoke-free policies and per-capita cigarette consumption and mortality due to acute myocardial infarction (AMI) in Europe. Therefore, our study aimed to assess this association and evaluate influencing factors. Methods We conducted an interrupted time series analysis involving 27 European Union member states and the UK, examining per-capita cigarette consumption and AMI mortality. A multivariate meta-regression assessed potential influencing factors. Results Approximately half of introduced smoke-free policies were associated with level or slope changes, or both, in per-capita cigarette consumption and AMI mortality (17 of 35). Notably, the smoking ban in Poland in 2010 resulted in the most substantial level reduction in cigarette consumption (rate ratio (RR): 0.47; 95% CI: 0.41, 0.53), while the intervention in Bulgaria in 2012 led to the largest level reduction in AMI mortality (RR: 0.38; 95% CI: 0.34, 0.42). More recent policies or those from countries with lower human development indices were linked to greater decreases in cigarette consumption. Furthermore, smoking bans encompassing bars exhibited a stronger inverse association with both cigarette consumption and AMI mortality. Conclusions Our findings indicate the effectiveness of smoke-free policies in reducing per-capita cigarette consumption and AMI mortality. Continued monitoring and data collection on tobacco, prevalence, and consumption are crucial for concerted efforts to address its health impacts. Key messages • Smoke-free policies lower cigarette consumption, reducing heart attack deaths in Europe. • Monitoring tobacco data crucial for health efforts: Study shows smoke-free policies save lives.

How does a Smoke-Free campus initiative generates changes in smoking? A theory-based evaluation

Abstract Background Smoke-free campuses (SFC) prohibit smoking and vaping on all university grounds and for all users. Despite their effectiveness in reducing smoking prevalence, passive smoking, and denormalizing tobacco use, the complex interplay between the programme activities and their impact on users and campus environments remain unclear. This study aims to improve our understanding of the transformation processes associated with SFC expected outcomes. Methods We conducted a retrospective qualitative study on the first SFC implemented in France by the EHESP School of Public Health. Guided by Mayne’s theory of change framework that includes ten dimensions of an impact pathway (e.g. activities, reach/reaction, capacity, behaviour changes, etc.), the research examined the chain of effects and hypotheses driving this SFC. Our dataset included internal documents (e.g. minutes of meetings, administrative documents) and semi-structured interviews with stakeholders (n = 16) involved in the development and implementation of the analysed SFC. Data is currently being analysed. Results Initial results suggest that the EHESP’s SFC activities included communication initiatives, student ambassadors, cessation support for smokers, installation of smoking shelters on campus periphery, etc. These activities were geared on capacity change (e.g. securing support and compliance among campus users, reduce smoking opportunities, promoting the use of cessation aids) and were intended to drive behaviour change (reducing smoking and facilitating cessation among students and staff). The goal of this SFC was not only to impact behaviors but also to educate future health service managers at EHESP to implement SFC policies and set an example for other institutions in France. Conclusions This study identifies some of the transformations that activities of the EHESP’s SFC can generate in students and staff in order to fulfil its outcomes. It also highlighted its expected impact on other institutions. Key messages • Understanding how a smoke-free campus generates its changes is essential in facilitating transferability of experiences to other universities. • Smoke-free campus policies can also generate a broader impact on other institutions.

Smoking Behavior of High School Students in Jambi City

Cigarettes are addictive substances that, when used, can cause a number of adverse health effects. The objective of this study was to ascertain the proportion of schools that conduct eight assessments of smoke-free area indicators, gain insight into the role of officers, and evaluate the supervision of smoke-free area policies. This study employed a qualitative descriptive approach, utilizing in-depth interviews and focus group discussions (FGDs) as its primary methods of data collection. Purposive sampling strategy used for qualitative research, with a sample size of 17 informants. The qualitative analysis was conducted using the Open Code application. The findings of this study indicate that the majority of the school community is aware of the dangers of smoking and the No Smoking Area policy. However, the role of officers and supervision of the No Smoking Area is still not being carried out effectively. The study findings indicate that schools in Jambi City have not implemented the No Smoking Area policy.

Recent evidence on rates and factors influencing smoking behaviours after release from smoke-free prisons: a scoping review

PurposeSmoke-free prison policies have been introduced in some countries, in part to address very high levels of tobacco use in people in prison. However, relapse rates post-release remain high. This papers aims to improve understanding of post-release smoking and/or vaping behaviour is necessary to inform support for a priority population.Design/methodology/approachThe authors searched health, social science and criminal justice databases for studies about smoking/vaping behaviours among people released from smoke-free prisons. Studies were included if they reported primary data and were published between January 2017 and March 2024 in English; the population was adults/young people (16 yr+) imprisoned or formerly imprisoned, in prisons with comprehensive smoke-free policies; and at least one of the following was reported: pre-release intention to smoke, vape or remain abstinent post-release; smoking/vaping behaviour post-release and factors influencing smoking/vaping behaviour; attempts to quit again following post-release smoking/vaping relapse.FindingsNine studies met our criteria. The evidence base is small and mainly from the USA or Australia. Evidence continues to suggest that most people resume smoking after leaving a smoke-free prison. No new interventions have been successful in reducing relapse rates. No studies report on vaping post-release, although two studies report on perceived factors affecting smoking relapse post-release from prisons allowing vaping.Research limitations/implicationsGiven very high rates of relapse, there remains a significant need to better understand what approaches are feasible and acceptable for reducing return to smoking post-release.Originality/valueThis review updates the limited evidence on smoking behaviours after leaving a smoke-free prison.

ASSESSMENT OF PASSIVE SMOKING EXPOSURE AMONG PREGNANT WOMEN

Secondhand smoke (SHS) exposure poses significant health risks to both mothers and fetuses during pregnancy. Despite global efforts to reduce smoking in public and private spaces, SHS exposure remains prevalent, particularly in low- and middle-income countries. Objective: The study aimed to assess the extent of passive smoking exposure among pregnant women in various settings, including their homes, workplaces, and public spaces, and to examine the frequency and potential health risks associated with SHS exposure during pregnancy. Methods: This cross-sectional study was conducted among 150 pregnant women attending a tertiary care hospital in Pakistan between January and June 2024. Data were collected using a structured questionnaire that captured demographic information and SHS exposure across different environments, including home, workplace, and public spaces. Descriptive statistics, including frequencies and percentages, were used to summarize the data. Results: Among the participants, 60.7% reported SHS exposure at home, with 30% experiencing SHS exposure 6-10 times weekly. Additionally, 61.3% of the women reported exposure at work, with 52.7% exposed 11-15 times monthly. Public spaces also contributed to significant SHS exposure, with 86% of participants affected. Notably, 37.3% of women reported spending 15-30 minutes daily inside a car with someone smoking. Demographically, most participants were aged 25-28 years (46.7%) and had a matric-level education (36.0%). Conclusion: This study reveals a high prevalence of SHS exposure among pregnant women, particularly at home, work, and public places. The findings underscore the urgent need for public health interventions, such as stricter smoke-free policies and public awareness campaigns, to reduce SHS exposure and safeguard maternal and fetal health.

Barriers and facilitators to implementation of smoke-free area policy in public places: a scoping review

Enforcing laws requiring smoke-free areas in different locations is one way the government can lower cigarette consumption and exposure to cigarette smoke. The purpose of this study was, thus, to examine and summarize studies that identified facilitators and barriers to the implementation of a smoke-free area policy in public places. The researchers carried out systematic searches in December 2023 within these specific databases: Scopus, PubMed, ProQuest, Emerald Insight, and EBSCO and included studies on the implementation of smoke-free area policy that were published in English between 2018-2021. Out of the 684 research reports that were found, only 12 were accepted into the scoping study. The findings exhibited several barriers to the implementation of smoke-free area policy, including personal characteristics, the presence of tobacco sellers and smoking aids, lack of enforcement management, lack of support and collaboration from local government, lack of examples of policy implementation by local government, and no smoking signs or smoke-free policy signs. Meanwhile, the facilitating factors encompass fines and penalties, the presence of access to tobacco cessation services, smoke-free policy campaigns, and knowledge and attitudes toward smoke-free area policies. The evidence collected from the review’s findings suggests that there are more barriers than facilitating factors. This indicates that numerous adverse behaviors in the implementation of the smoke-free area policy are still present. The subsequent step following this study is to carry out primary research to thoroughly investigate the execution of the smoke-free area policy in public places.

1575P Smoke-free policies in outdoor areas: A potential cancer prevention strategy in Spain

1575P Smoke-free policies in outdoor areas: A potential cancer prevention strategy in Spain

Support for regulating smoking in private and public places by adults who currently smoke and recently quit smoking in Spain.

While indoor smoking restrictions are common, outdoor restrictions are still rare. We explored opinions and support for regulating smoking in different indoor and outdoor environments among adults who smoke and those who recently quit smoking, in Spain. The 2021 ITC EUREST-PLUS Spain Survey is a cross-sectional study conducted among a nationally representative sample of 1006 adults aged ≥18 years who smoked cigarettes (n=867) or had recently quit smoking (n=139). Using Poisson regression with robust variance, we estimated adjusted prevalence and prevalence ratios of favorable opinions on regulating smoking in different indoor and outdoor environments and support for regulation in unregulated outdoor environments, by sociodemographic and smoking-related characteristics. There were highly favorable opinions for regulating smoking in places with minors (>95% in primary and secondary playgrounds, and cars with pre-school children and minors) and outdoor transportation (60-80%). There were less favorable opinions for regulating smoking in outdoor terraces of bars/pubs and restaurants (15-20%). Support for further total outdoor regulations on smoking was moderate for markets/shopping centers, public building entrances and swimming pools (40-60%), and low for restaurants/bars/pubs (29.2%). Having quit smoking, having no significant others who smoke and/or believing that cigarette smoke is harmful to others, were factors positively associated with favorable opinions and support for regulating smoking. The settings in Spain with the most favorable opinions for regulation among adults who smoke and have recently quit smoking are places with minors, private cars with others and outdoor areas of public transportation, while the settings with the least favorable opinions were outdoor terraces of bars, pubs, and restaurants. Support for further total outdoor smoking bans is generally moderate, but low for restaurants, bars, and pubs. Overall, these findings suggest the feasibility of extending smoke-free policies to other public and private settings to protect others from tobacco smoke exposure.

Smoke-free legislation impact on the hospitality sector in the Republic of Georgia

IntroductionComprehensive smoke-free (SF) policies reduce secondhand smoke exposure and improve population-level health outcomes. However, some decision-makers heed the tobacco industry’s argument that SF policies negatively impact the hospitality sector. This...

Effectiveness of Smoke-Free Campus Implementation on Smoking Behavior Control

The tobacco industry is a significant obstacle in the effort to control smoking behavior, especially since they are allowed to promote their products to the public, including students. To address this issue, the Ministry of Health developed a smoke-free zone that may be implemented in universities to reduce smoking rates among adolescents. To know the effectiveness of implementing a smoke-free campus policy on smoking behavior control at Universitas Prima Indonesia by assessing aspects of student knowledge and compliance levels. This research is a descriptive quantitative study with a cross-sectional design and uses purposive sampling techniques with the criteria of active smoker students, 74 people in the medical study program of the Faculty of Medicine, Dentistry, and Health Sciences at Universitas Prima Indonesia. Data was obtained in February-April by distributing questionnaires directly to student smokers. The results showed that smoking behavior control among students increased in 50 (67.6%) out of 74 respondents. This is supported by the relationship between the level of knowledge and students' attitudes toward smoking behavior control in the smoke-free campus area, as indicated by a p-value<0.05 (0.005<0.05 and 0.001<0.05). This study found that students’ knowledge and attitudes towards smoke-free campus areas are important aspects influencing the effectiveness of the smoke-free campus policy in controlling smoking behavior.

Prevalence of Smoking Among School Students in Iraq.

Background Developing communities like Iraq are critical to building a good community environment. Many complex patterns of behaviors like smoking among adolescents have been exacerbated rapidly in the current era which led to changes in the Iraqi community's perspectives and life expectancy. This study aims to find out the prevalence of smoking among secondary school students in Iraq and their perceived contributing factors. Methods A cross-sectional study design was used with a representative sample of Iraqi school students recruited through a multistage cluster randomization from the Nineveh Governorate's intermediate and secondary schools to ensure the representation of the general public strata. A total of 330 students were randomly selected from eight schools distributed all over Mosul city (the center of Nineveh Governorate) and its boundaries semi-rural areas. Data collection utilized a standardized, anonymous questionnaire based on the Global Youth Tobacco Survey (GYTS) administered within classrooms with the researcher's presence. The questionnaire included questions related to sociodemographic characteristics of the students, smoking state, smoking types, frequency of smoking, relative smoking state, opinion on predisposing factors for initiation of smoking, and knowledge about hazards of smoking. Data analysis was done using SPSS version 26 to calculate frequency distribution with further logistic regression analysis was performed to identify statistically significant factors contributing to initiation of smoking among the student participants with p-value estimation of any compares considered significant below 0.05. Results Prevenance of all types of smoking was 24.5% from 330 students with 30% from 246 males and 7%from 84 females has been encountered. Hookah (Shisha) was the most prevalent type of smoking.About a third of the smoker sample reported smoking at least once daily. Peer pressure (OR=3.49, P< 0.001) or family smoking (OR=1.769, P=0.019) emerged as the strongest influence for initiation of smoking, besides stress (OR=2.23, P= 0.04) and personality traits like stammering and jealousy (OR=2.58, P= 0.013), (OR=2.22, P= 0.017, respectively) have also significant odds. Interestingly, media (movie star) influence played a significant role also. (OR=1.492, P= 0.045). Conclusion The prevalence of smoking among the study sample was 24.5 % out of 330 participating students. Significant influencing factors were found that raised the concern and necessitated the development of targeted interventions. Implementing evidence-based strategies, such as comprehensive school-based educational programs and smoke-free indoor air policies, can significantly improve public health outcomes.

The Impact of Implementation Fidelity of a School-Based Multi-Component Smoking Prevention Intervention on Vocational Students’ Smoking Behavior: A Cluster-Randomized Controlled Trial

Preventing young people’s cigarette smoking is a major public health priority, and smoking is especially prevalent in vocational schools. Well-enforced comprehensive school tobacco policies accompanied by preventive efforts show potential to reduce smoking, but the implementation process is crucial to achieve the intended effect. We investigate whether and how implementation fidelity of a multi-component smoking prevention intervention impacted student smoking outcomes after 4–5 months among students in Danish vocational education and training (national age range 15–65 years, mean 25.6) and preparatory basic education (national age range 15–25 years, mean 17.6) institutions using questionnaire data from a cluster-RCT. The intervention included a smoke-free school hours policy, educational curriculum, and class competition. We calculated an overall implementation fidelity measure combining staff-reported school-level delivery (fidelity) and student-reported receipt (participation, responsiveness), and used multilevel regression models to analyze associations with smoking outcomes (smoking daily, regularly, and during school hours). We supplemented the analysis with restricted cubic spline regression. Additionally, we stratified the analyses by school types and analyzed associations between implementation fidelity of the separate intervention components and smoking outcomes. High implementation was associated with lower odds of regular smoking (OR: 0.37, 95% CI: 0.18–0.78) and smoking during school hours, but not daily smoking, and these associations varied between the school settings. When analyzed separately, implementation fidelity of the components did not affect the outcomes significantly. Our findings underline the need to support the implementation process of school tobacco policy interventions to ensure the intended effects of reducing students’ smoking.

Impact of secondhand smoke on air quality in partially enclosed outdoor hospitality venues: a review

BackgroundSmoking is a leading cause of premature mortality and morbidity globally. The pollutants generated from smoke are not only harmful to smokers, but also to those exposed to secondhand smoke. As a result of increasingly restrictive indoor smoke-free policies in many countries, there is a tendency for tobacco smoking to move outdoors into partially enclosed settings in hospitality venues. The aim of this systematic review was to evaluate the impact of secondhand smoke on air quality in outdoor hospitality venues.MethodsTwo electronic databases PubMed and Scopus were searched from 1 January 2010 to 30 June 2022 for studies of air quality impacts from tobacco smoking in outdoor hospitality venues. A total of 625 studies were screened and 13 studies were included in this review.ResultsThe majority (9 studies) of reviewed studies monitored PM2.5 concentration as an indicator of secondhand smoke. PM2.5 was reported from 10.9 µg/m3 to 91.0 µg/m3 in outdoor smoking areas, compared to 4.0 µg/m3 to 20.4 µg/m3 in outdoor control sites unaffected by smoking. Secondhand smoke can also drift into adjacent outdoor areas or infiltrate into indoor environments thus affecting air quality in spaces where smoking is not permitted.ConclusionsThe reviewed studies indicated that air quality within outdoor hospitality venues where smoking is permitted is unlikely to meet current World Health Organization (WHO) ambient air quality guidelines for PM2.5. Customers and staff in outdoor hospitality venues with active smoking, and in adjacent outdoor and indoor non-smoking areas, are potentially exposed to secondhand smoke at levels exceeding WHO guidelines. Stronger smoking control policies are recommended for outdoor hospitality venues to protect the health of customers and staff from harmful secondhand smoke exposure.Prospero registrationCRD42022342417.

Cannabis policy liberalization is only associated with increased blunt use if states lack strong tobacco control

IntroductionCo-use of tobacco and cannabis has long been an issue for prevention and intervention efforts targeting these substances. Blunt use—cannabis inside a cigar wrapper—has been a consistent mode of cannabis consumption since the 1990s. Since then, both tobacco control and cannabis policies have changed considerably. This paper examines the influence of tobacco taxes and smoke-free policies as well as medical and recreational cannabis policies on blunt use among young people. MethodsCombining state-level tobacco control and cannabis policy data with the restricted-access youth cohort of the Population Assessment of Tobacco and Health (PATH) study, we use multilevel logistic regression models to examine the impact of these policies on past-year blunt use. ResultsWhile we found a main effect whereby both legal medical and recreational cannabis policies are associated with higher odds of blunt use among youth, interaction effects demonstrate that this association only emerges in states lacking a comprehensive tobacco smoke-free policy. In states with smoke-free policies, we found no significant associations between cannabis policy and odds of blunt use. ConclusionsDenormalization through smoke-free policies may mitigate the effects of recreational and medical cannabis policies on blunt use. Smoke-free policies represent a possible cost-effective mechanism to curb the co-use of tobacco and cannabis in the form of blunts. States with medical and recreational cannabis policies may benefit from greater prevention efforts for young people specifically focused on blunt use, especially in states that do not have strong tobacco control.

A Qualitative Evaluation of Smoke-Free Policy Implementation among the Hospitality Industry in Yogyakarta, Indonesia

Background: The Indonesian government has implemented various regulations, including smoke-free policies (SFPs) aimed at reducing exposure to second-hand smoke and improving public health. However, the implementation of these policies has encountered challenges. Objective: This study aimed to investigate the implementation of SFP in the hospitality industry in Yogyakarta, Indonesia. Methods: Three focus group discussions with the managers of hotels, restaurants, and coffee shops (n=19) were conducted in November 2021. Thematic analysis was used to analyse the data. Results: Three themes were identified: 1) Efforts to implement SFPs at hospitality premises; 2) Reasons for adopting SFPs; and 3) Challenges for policy implementation. Many hospitalities industry have undertaken efforts to implement SFPs, though they are not comprehensive. The reasons for implementing SFPs include protecting second-hand smokers, meeting guest preferences, and creating a fresher environment. Resistance from customers has become a significant challenge, as some view SFPs as an infringement on personal freedom. Furthermore, unclear sanctions and enforcement from the government also highlighted by participant as the main barriers of SFPs implementation. Conclusion: Overall, while there is significant effort to implement SFPs in hospitality venues, challenges such as customer resistance and unclear government guidance persist. This condition underscores the need for clearer policies and support mechanisms for successful implementation.