Adoption to smoking bans does not guarantee compliance: global data

News in the smoking ban front seem to have been steadily good: As of today, 179 countries have signed the WHO’s Framework Convention on Tobacco Control (FCTC), which compels the signatories to enact comprehensive smoking bans. In addition, there are always news items popping up ranging from ban plans moving way beyond the restaurant and bars, ranging from beaches to prisons!

We don’t get to hear a lot, however, on the level of compliance to smoking bans: without compliance it would be impossible to have public health benefits. Research shows that compliance is better in some countries than others and this variation in compliance does not correspond to the variation in adoption of banning policies (data from WHO); this suggests that what drives a country to adopt banning measures does not necessarily lead this country to enforce these measures.

In a study we just published, Richard Perkins and Eric Neumayer from the London School of Economics examine the determinants behind countries’ adopting smoking bans in public places and their ability to put these measures into effect. Using a large sample (N=99-184) from low, middle and high income countries and applying econometric techniques, they estimate the influence of several variables on  cross-national variations in the adoption and compliance of second-hand smoking laws. These variables include income per capita, smoking prevalence, domestic economic dependance on tobacco-related industries and public health expenditures.

The main results can be summarized as follows:

– Richer countries are both more likely to have smoke-free policies in restaurants and bars and have a better general compliance with smoke-free policies. This could be explained by bigger popular opposition for bans in such places. Unless there is a big societal demand for bans in such places, governments are less likely to enforce the bans. Such a demand from society can be expected to be stronger in richer countries.

– With the exception of restaurants and bars, income per capita,  was not found to be a significant predictor of smoke-free policies  but was a significant predictor of compliance. This could be explained by the fact that, although smoking bans are not so costly to adopt on paper, they entail larger expenses when the governments attempt to implement them. Additionally, lower income countries might have other motives for adopting smoke-free policies, such as improving their international standing on health-related issues, without costs.

– Compliance was found to be worse in countries with more smokers and higher tobacco leaf production; these factors, however, do not make any difference in countries’ adoption of smoking bans.

– Health expenditures matter for compliance but not adoption of policies.

The authors conclude that countries should not only be encouraged to adopt smoking bans, but also to enforce them. This could be achieved by holding governments more accountable to the anti-smoking policies they have adopted and by doing more to publisize their records of compliance.

What is the experience from your country? Are smoking bans adopted in public places? Are they adhered to? If not, what do you think the reasons might be? We are looking forward to your comments!