Dear Editors,

There are different approaches employed to control of tobacco use all over the world and the World Health Organization Framework Convention for Tobacco Control (WHO-FCTC) advocates for smoke-free cities as an effective tobacco-control strategy¹. Sri Lanka was the fifth country in the South-East Asian Region to sign the Framework Convention for Tobacco Control in September 2003, and the first country in the region to ratify it in November 2003. Under the WHO-FCTC, Sri Lanka enacted the National Authority on Tobacco and Alcohol Act, No. 27, in 2006, and it is one regulatory measure that Sri Lanka has applied to prevent issues regarding alcohol and tobacco use.

According to a study conducted on the NATA Act, the support of the community to authorized officers in implementing the Act and the implementation of the Act at the community level are poor. There is an important provision on smoking in indoor-places that includes the prohibition of smoking in indoor-places, with exceptions, for the protection of public health². According to the legal measures in Sri Lanka, smoking is prohibited in many indoor public-places, workplaces and on public transport. But smoking is permitted in smoking areas in airports, hotels having more than 30 rooms, restaurants having a seating capacity of a minimum of 30 persons. In Sri Lanka second-hand smoke exposure in the home and in public places remains a significant problem, even though laws prohibit public smoking.

Previous studies also have revealed that smoke-free zones decrease smoking among the youth³. Studies regarding smoke-free zones are scarce in Sri Lanka. Various health promotional programs are conducted by Governmental and Non-Governmental Organizations. The Ministry of Health and the National Authority on Tobacco and Alcohol commenced a specific program to establish smoke-free zones in Sri Lanka, targeting the prevention of non-smoker exposure to second- and third-hand smoking. Therefore, the overall objective of this study was to explore factors affecting the establishment of smoke-free zones, with special reference to the Central Province of Sri Lanka.

This qualitative study was carried out in November 2015 in the Central Province of Sri Lanka, in three administrative districts (Kandy, Matale, and Nuwara–Eliya). Public Health Inspectors (PHI) were the study subjects and all PHIs of the three districts participated in the study (n=132). Thirty-four focus-group discussions (14 in Kandy, 13 in Nuwara–Eliya, 7 in Matale) and five in-depth interviews were conducted to collect data. First, positive factors, including strengths and opportunities, were explored. After that, negative factors including weakness and threats were explored, within the form of a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis (Table 1). Data were analyzed through a framework-analyzing method.

We recommend that the above factors be taken into consideration together with the necessary steps to further develop the strengths and opportunities, as well as to minimize the weaknesses and threats, to create a supportive environment prior to establishing smoke-free zones. According to the respondents’ views, the gaps of the NATA Act were identified as a weakness, and therefore the strengthening and revision of the Act should be given priority. Other infrastructure requirements that are, more or less, similar for each and every district need also to be addressed properly, to ensure the future of smoke-free zones in the country.