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Impact of a smoking ban in public places: a rapid assessment in the Seychelles
  1. Bharathi Viswanathan1,
  2. Chloé Plumettaz2,
  3. Jude Gedeon1,
  4. Pascal Bovet1,2
  1. 1Ministry of Health, NCD Section, Victoria, Republic of Seychelles
  2. 2Institute of Social and Preventive Medicine (IUMSP) and University Hospital Centre (CHUV), Lausanne, Switzerland
  1. Correspondence to Dr Pascal Bovet, Consultant, NCD Section, Ministry of Health, PO Box 52, Victoria, Seychelles; bovet.pascal{at}gmail.com

Abstract

Background We assessed the impact of a smoking ban in hospitality venues in the Seychelles 9 months after legislation was implemented.

Methods Survey officers observed compliance with the smoking ban in 38 most popular hospitality venues and administered a structured questionnaire to two customers, two workers and one manager in each venue.

Results Virtually no customers or workers were seen smoking in the indoor premises. Patrons, workers and managers largely supported the ban. The personnel of the hospitality venues reported that most smokers had no difficulty refraining from smoking. However, a third of workers did not systematically request customers to stop smoking and half of them did not report adequate training. Workers reported improved health. No substantial change in the number of customers was noted.

Conclusion A ban on public smoking was generally well implemented in hospitality venues but some less than optimal findings suggest the need for adequate training of workers and strengthened enforcement measures. The simple and inexpensive methodology used in this rapid survey may be a useful approach to evaluate the implementation and impact of clean air policy in low and middle-income countries.

  • Enforcement
  • law
  • policy compliance
  • secondhand smoking
  • survey method
  • Seychelles
  • Africa
  • environmental tobacco smoke
  • harm reduction
  • public opinion polls
  • public policy
  • surveillance and monitoring

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Introduction

Comprehensive smoke-free laws fully protect non-smokers, help smokers quit, reduce cigarette consumption, diminish the worldwide burden of disease from exposure to secondhand smoke and are easier to enforce than partial bans.1–4

The Republic of Seychelles is located in the Indian Ocean, east of Kenya, and the majority of the 86 000 population is of African descent. The crude national gross domestic product per capita grew from US$600 in 1976 to US$8492 in 2004, as a result of booming tourism and industrial fishing industries and a growing service-oriented economy. Since the late 1980s, an active tobacco control programme has been ongoing, including health education programmes, policy prohibiting all tobacco advertising and smoking in health and education premises, high tax on tobacco products and a programme for smoking cessation.5 Consistent with these efforts, the prevalence of smoking decreased markedly between 1989 and 2004 among adults (with a much higher prevalence in men than women),6 but remains fairly high among youths (with only a small gender difference).7 In 2003, Seychelles ratified the Framework Convention on Tobacco Control (FCTC) (the first country in the African region).

The Seychelles Tobacco Control Act, prepared by a national multisectoral committee appointed by the Minister of Health in 2000, was unanimously adopted at the National Assembly in June 2009 and enacted in August 2009. It took several years to overcome resistance to a total ban on public smoking from the hospitality industry in a country that relies heavily on tourism, and the drafting of the law by the office of the Attorney General was not a high priority. The legislation is comprehensive and includes a total ban on smoking in all enclosed public places, workplaces, in all outdoor areas of health and education premises, sport stadiums and on all public transport,8 and mandates that ‘no smoking’ signs are displayed in places where smoking is prohibited. This ban has been widely and repeatedly publicised in all mass media and through information sent to owners of the affected places. Although the legislation allows for substantial fines for a person who smokes and for an owner who lets a person smoke where it is prohibited, no legal suit was filed against offenders up to the time of the survey.

We conducted a survey to evaluate the compliance with the smoking ban in hospitality venues in the Seychelles and to assess support for the law, impact on the health of workers and on business as reported by customers, workers and managers of hospitality venues.

Methods

In May 2010, seven survey officers visited 38 of the Seychelles' 58 restaurants, including the most popular ones and all bars, discotheques and nightclubs. Managers and workers were not informed in advance of the visits. In each venue, one survey officer observed for 15 minutes whether patrons and workers were smoking in the enclosed premises and then administered a structured closed-ended questionnaire to two patrons selected randomly, two workers and one manager of the venue. The two selected patrons were the most centrally located but from separate tables. The selected manager was the one in charge. The two selected workers were those most involved with service with the selected patrons. The survey officers were volunteers (laboratory technicians, teachers and a fireman) from the National Forum for Consumers, a non-profit non-governmental organisation that aims to promote consumer and social wellbeing. Survey officers were trained for the administration of the questionnaire during a 1-day session. Visits to the establishments took place at expected peak times: end of the week and late evening for bars and discotheques. The survey had been approved by the Ministry of Health after technical and ethical review.

Interviews were conducted anonymously and on a voluntary basis. No patron, worker or manager declined to participate in the survey. However, in a few small hospitality venues, fewer than two patrons, fewer than two workers or no manager could be found at that time.

The questionnaire inquired whether clients, managers and workers, respectively, were aware of the Tobacco Control Act, how frequently they had noticed patrons smoking on the premises over the past week, how they felt about the smoking ban, what owners/managers and workers did if a client was smoking, whether they observed a change in attendance of the place after the smoking ban and whether workers noticed a change in their health status or in attendance of clients. (The questionnaire can be obtained from the authors.)

Results

The survey was conducted in 38 hospitality venues and a questionnaire was administered to 63 patrons (36 women and 27 men aged 18–57), 66 workers (39 women and 27 men aged 17–51) and 34 managers. Among them, 10 patrons, 13 workers and five managers were current smokers. Table 1 summarises the main findings.

Table 1

Compliance with smoking ban as reported by patrons, workers and managers of 38 hospitality venues in the Seychelles

Several indicators show reasonable compliance with the smoking ban: survey officers witnessed virtually no smoking in the visited indoor premises and answers from patrons, workers and managers further suggest that compliance with the smoking ban is fairly good.

However, a third of workers and managers had requested a customer to stop smoking during the past week, suggesting some residual smoking. Most managers and workers reported that smokers readily agreed to discontinue smoking when asked to do so. But about a third of workers had not systematically requested it. There was strong support for the smoking ban, by approximately 90% of patrons, workers and managers.

Most managers (97%) reported to have provided adequate training to their workers but less than half of the latter declared having received such training. Only 71% and 56% of customers, respectively, knew that a smoker could be fined for smoking where it is prohibited and a manager could be fined for allowing it.

One worker out of five declared better subjective health after the smoke-free law was implemented, as assessed by a question on breath and cough. With respect to its impact on business, 21% of managers and 9% of workers reported a decrease in the number of customers, but 21% of managers observed the presence of new clients.

Discussion

This study shows that a ban on smoking in all enclosed public places in the Seychelles was generally well implemented in hospitality venues 9 months after legislation was enacted. Compliance with smoke-free law is consistent with experience in other countries.9–11 Observed during a ‘grace period’, our findings support the view that smoke-free laws have a large potential for self-implementation, conditional on some favourable circumstances, but there is room for improvement. In England and Ireland, nearly complete compliance with smoke-free laws has been documented,12 13 which may be attributable to enforcement of penalties to offenders (a measure not yet enacted in the Seychelles at that time). Future surveys should include information on whether the incidents where staff intervened or where smoking was observed were isolated or common occurrences, and whether groups of people were smoking or just one or two individuals.

Consistent with other countries,10 14–16 a large majority of customers, managers and workers at the hospitality venues supported the smoking ban thanks to favourable circumstances in the Seychelles. Several tobacco control measures had been taken over 20 years.5 It has been shown that high public awareness of harmful effects of secondhand smoke and effective communication about it promote smoke-free policy compliance.17 18 It has been demonstrated in several countries that the acceptance of tobacco control measures is enhanced when anti-tobacco behaviours and social disapproval of smoking are already prevalent19 and, in contrast, a weak and fragmented social tissue.18 20 Finally, the absence of local franchises of large tobacco companies in the Seychelles has helped prevent interference with the law-making processes.20

Almost a third of workers were reluctant to intervene with the minority of customers who would not refrain from smoking. This has also been noticed among hospitality workers in other countries.21 In the Seychelles, limited willingness to intervene may reflect inadequate training of workers and lack of enforcement of fines for offences. Also, because it is socially more acceptable for men than women to smoke in the Seychelles, women hospitality workers may not feel comfortable asking a man to stop smoking. These findings emphasise the need for adequate training and strict enforcement of the law. Previous studies showed implementation of smoke-free laws should be authoritative, consistent, coordinated, uniform and continuously reinforced by the health authorities in order to obtain long-lasting compliance.22 23

Based on only one question about cough and breath, 20% of workers reported improved subjective health since the smoking ban had been implemented. This positive effect is consistent with the well demonstrated health benefits associated with clean air policy.2 10 11 24 Better evidence might have been obtained if health had been assessed with objective tools such as spirometry, inflammatory markers or hospital admissions.2 10 24

It has been shown that smoke-free policy has little negative impact on business in hospitality venues.2 10 11 25 In our study, although a minority of workers and managers reported a decrease in business after the smoking ban, some managers observed an increase in new clients, consistent with findings in an Irish study.10 However, our data are qualitative and other measures would be needed to accurately evaluate this aspect of implementation since this is an element favouring bar owners' compliance.22

There are several limitations in our survey. We did not measure cotinine, particulate matter or other objective measures of smoke exposure. These methods are costly, limiting their use in low and middle-income countries. To our knowledge, only one study in Ghana has used such an objective instrument in the African region.26 The lack of data on implementation of smoke-free policies in Africa and the limited resources available emphasise the need for inexpensive methods. The sample size was small, but consistency in answers supports some validity of our findings and we surveyed a large portion of hospitality venues. We cannot exclude a social desirability bias since answers were obtained through face-to-face interviews.

Our rapid survey provides an example of a simple and inexpensive tool to evaluate the implementation of a smoke-free law in hospitality venues. While we could include all most popular hospitality premises in our study, a similar methodology could be applied in larger countries by selecting an adequate sample of establishments, perhaps oversampling venues most highly frequented by smokers, like nightclubs, discotheques and bars.27 While customers, workers and managers of hospitality venues may not necessarily represent the general population, information gathered from those most involved in implementation is useful for improving enforcement.

What this paper adds

  • A ban on smoking in all enclosed public places in the Seychelles was generally well implemented in hospitality venues 9 months after legislation was enacted.

  • Good acceptance of the smoking ban may have been moulded by vigorous tobacco control activities during the past two decades.

  • However, less than optimal compliance suggests the need for adequate training of workers and strengthening of enforcement measures.

  • The simple and inexpensive methodology used in this rapid survey may be a useful approach to evaluate the implementation and impact of clean air policy in low and middle-income countries.

Acknowledgments

The authors thank the personnel of the establishments visited for their cooperation and the survey officers for collecting the data. The authors are also grateful to the Ministry of Health, the National Forum for Consumers of Seychelles (NATCOF) and WHO for support to the survey.

References

Footnotes

  • Competing interests None.

  • Ethics approval The study was approved by the authorities of the Ministry of Health of the Republic of the Seychelles after technical and ethical review.

  • Provenance and peer review Not commissioned; externally peer reviewed.