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Correlates of compliance with national comprehensive smoke-free laws
  1. Armando Peruga1,
  2. Luminita S Hayes2,
  3. Ximena Aguilera1,
  4. Vinayak Prasad2,
  5. Douglas W Bettcher2
  1. 1 Center for Epidemiology and Health Policy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
  2. 2 Prevention of Noncommunicable Diseases, World Health Organisation, Geneva, Switzerland
  1. Correspondence to Dr Armando Peruga, Center for Epidemiology and Health Policy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Las Condes 12496, Lo Barnechea 7610658, Chile; aperuga{at}


Objective To explore correlates of high compliance with smoking bans in a cross-sectional data set from the 41 countries with national comprehensive smoke-free laws in 2014 and complete data on compliance and enforcement.

Methods Outcome variable: compliance with a national comprehensive smoke-free law in each country was obtained for 2014 from the WHO global report on the global tobacco epidemic. Explanatory variables: legal enforcement requirements, penalties, infrastructure and strategy were obtained through a separate survey of governments. Also, country socioeconomic and demographic characteristics including the level of corruption control were included. Analysis: an initial bivariate analysis determined the significance of each potentially relevant explanatory variable of high compliance. Differences in compliance were tested using the exact logistic regression.

Results High compliance with the national comprehensive smoke-free law was associated with the involvement of the local jurisdictions in providing training and/or guidance for inspections (OR=10.3, 95% CI 1.7 to 117.7) and a perception of high corruption control efforts in the country (OR=7.2, 95% CI 1.1 to 85.8).

Discussion The results show the importance of the depth of the enforcement infrastructure and effort represented by the degree to which the local government is involved in enforcement. They also show the significance of fighting corruption in the enforcement process, including the attempts of the tobacco industry to undermine the process, to achieve high levels of compliance with the law. The results point out to the need to invest minimal but essential enforcement resources given that national comprehensive smoke-free laws are self-enforcing in many but not all countries and sectors.

  • Secondhand Smoke
  • public policy
  • tobacco industry
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  • Contributors AP and LSH contributed to the designing of the study. LSH was responsible for collecting the data. AP performed the data analyses. AP, LSH, XA and VP took part in the drafting of the manuscript. All the authors participated in the revising of the manuscript critically for important intellectual content and gave final approval of the version to be published. AP is the guarantor.

  • Funding WHO funded this study.

  • Disclaimer The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

  • Competing interests None declared.

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

  • Data sharing statement All available data can be obtained by contacting the corresponding author.

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