Compliance with smoke-free policies at indoor and outdoor public places: an observational study in Pakistan

Abstract

Background: In 2002, the Government of Pakistan implemented a national law governing the use of tobacco products. The law included smoke-free policies banning smoking in all public places, and required no-smoking signage to be displayed at all such venues. Compliance with smoke-free policies is imperative, as it protects the health of nonsmokers. Almost two decades later, efforts to assess compliance with smoke-free policies in Karachi have been lacking, with only one study conducted in 2016. Aims: To investigate smoke-free compliance across public places in Karachi, the most populous city in Pakistan. Methods: A cross-sectional observational study was conducted in the east and south districts of Karachi between October and December 2019. Data pertaining to evidence of smoking (observed smoking, cigarette butt litter, and display of ashtrays/similar instruments), the presence of designated smoking areas/rooms (DSAs/DSRs), and the display and location of no-smoking signage were collected via direct observations. Results are reported using descriptive statistics. Results: Observations were conducted at 1704 indoor and outdoor public venues. Among the sample, 972 (57%) were compliant with the composite indicator assessing evidence of smoking. DSAs were observed at 104 (6%) places and DSRs at 16 (1%) places. No-smoking signage was displayed at the main entrance of 104 (6%) places and inside 174 (10%) places. Conclusion: Compliance with smoke-free policies is lacking in Karachi. Enhanced efforts by enforcement agencies and venue managers are needed to establish 100% smoke-free public places across Karachi.