Research paper
CC-BY-NC 4.0

Implementation of an indoor smoking ban and an advertising/ sponsorship ban in Lebanon: a baseline cross-sectional study

Rima Nakkash 1,  
Rima Afifi 1,  
Nadia Fanous 1,  
Nabil Tabbal 2,  
Dahlia Saab 1  
American University of Beirut
Save the Children International, Antakya, Turkey
Tob. Prev. Cessation 2016;2(May):63
Publish date: 2016-05-22
Although the majority of countries ratified the World Health Organization Framework Convention on Tobacco Control, few have comprehensive smoke-free laws and compliance is not always satisfactory. In 2011, Lebanon, having among the highest smoking rates in the Eastern Mediterranean Region, passed a comprehensive tobacco control law (Law 174). This study aimed to assess compliance with Law 174 among smokers and non-smokers in Beirut (the capital), three months after the ban in closed public places and on advertisement and promotion came into effect.

A population-based cross-sectional survey was conducted. Multi-stage cluster sampling identified 159 households, yielding 468 respondents aged 15-65 years. Data was collected face-to-face using a structured questionnaire. Weighted descriptive and bivariate analyses were performed.

Three months after the ban came into effect in 2011, all respondents knew about Law 174. Around half witnessed other people smoking in their workplace (44.2%), restaurants/coffee shops (52.8%) and public transportation (60.0%) in the past months. Less than 20% witnessed any tobacco promotion/advertisements, reflecting good compliance of the advertising sector. Overall, more than half the smokers continued smoking (workplace/closed public places).

This study provided information about compliance to the smoking ban in Beirut. The advertising sector's compliance would hopefully decrease the tobacco industry’s influence on the public. Further studies aiming at understanding the underlying factors behind the lack of compliance to the indoor smoking ban and finding effective solutions in a politically unstable country with weak rule of law like Lebanon are crucial and can serve as an example for similar developing countries.

Dahlia Saab   
American University of Beirut, American University of Beirut, Riad el Solh street, Beirut, Lebanon, PO-box 11-0236 Beirut, Lebanon
1. World Health Organization. 10th Anniversary of the WHO Framework Convention on Tobacco Control: Saving lives for a decade. Accessed 1 June 2015.
2. World Health Organization. WHO Report on Global Tobacco Epidemic 2013: Enforcing bans on tobacco advertising, promotion and sponsorship. Accessed 2 May 2015.
3. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2009: Implementing smoke-free environments.
4. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet 2003, 362(9387):847–852. doi: 10.1016/s0140-6736(03)14338-3
5. Eriksen M, Mackay J, Schluger NW, et al. The Tobacco Atlas (5th edition). American Cancer Society 2015.
6. Studlar DT. Tobacco control: Comparative politics in the United States and Canada. Peterborough, Ontario: Broadview Press 2002. doi: 10.1017/s1537592703800427.
7. Hammond D, Fong GT, McDonald PW, et al. Impact of the graphic Canadian warning labels on adult smoking behaviour. Tob Control 2003, 12:391-395. doi:10.1136/tc.12.4.391
8. Hyland A, Laux FL, Higbee C, et al. Cigarette purchase patterns in four countries and the relationship with cessation: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2006, 15 Suppl 3:iii59–iii64. doi: 10.1136/tc.2005.012203
9. Fong GT, Hyland A, Borland R, et al. Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey. Tob Control 2006, 15:iii51-iii58. doi: 10.1136/tc.2005.013649
10. Rajkumar S, Hoffman S, Roosli M, Bauer GF. Evaluation of implementation, compliance and acceptance of partial smoking bans among hospitality workers before and after the Swiss Tobacco Control Act. J Public Health (oxf) 2015, 37(1):89-96. doi: 10.1093/pubmed/fdu021
11. Sibai A, Tohme RA, Mahfoud Z, et al. Non-communicable diseases and behavioral risk factor survey. World Health Organization- Lebanon office 2009. Accessed 1 June 2015.
12. World Health Organization. Lebanon 2011 (Ages 13-15) Global Youth Tobacco Survey (GYTS). Global Youth Tobacco Survey fact sheets and country reports. World Health Organization: Regional Office for the Eastern Mediterranean 2012.
13. Heatherton TF, Kozlowski LT, Frecker RC. The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire. Br J Addict 1991, 86:1119-27. doi: 10.1111/j.1360-0443.1991.tb01879.x.
14. The International Tobacco Control Policy Evaluation Project. Are Tobacco Control Policies Working in China? International Innovation: Professor Geoffrey Fong. Accessed 6 July 2015.
15. Lin V. Commentary: The Framework Convention on Tobacco Control and health promotion: strengthening the ties. Glob Health Promot 2010, 17 Supp1 1:76–80. doi: 10.1177/1757975909358365.
16. Sparks M. Advocacy strategies to address NCDs: Tobacco control. Global Handbook on noncommunicable diseases and health promotion, McQueen, D.V. (Ed.): Springer Science & Business Media LLC 2013. doi: 10.1007/978-1-4614-7594-1_19
17. Fong GT, Cummings KM, Borland R, et al. The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project. Tob Control 2006, 15 Suppl 3:iii3-iii11. doi: 10.1136/tc.2005.015438.
18. The Daily Star. Relaxation of smoking ban draws fire. The Daily Star, 2015. February 20, 2015. Accessed 4 June 2015.
19. Nakkash R, Lee K. Smuggling as the ‘‘key to a combined market’’: British American Tobacco in Lebanon. Tob Control 2008, 17:324–331. doi: 10.1136/tc.2008.025254
20. Nakkash R, Lee K. The tobacco industry’s thwarting of marketing restrictions and health warnings in Lebanon. Tob Control 2009, 18:310–316. doi: 10.1136/tc.2008.029405.
21. The Daily Star. Hospitality sector vows to ignore smoking ban. The Daily Star, 2012. November 8, 2015. Accessed 21 Oct 2015.
22. Alaaeddine G, Al Kuhaimi T, Al Assaad R, et al. Assessing knowledge and attitudes of owners or managers of hospitality venues regarding a policy banning indoor smoking. Public Health 2013, 127:461-466. doi: 10.1016/j.puhe.2013.01.015.
23. Salloum RG, Nakkash RT, Myers AE, et al. Point-of-sale tobacco advertising in Beirut, Lebanon following a national advertising ban. BMC Public Health 2013, 13(534). doi: 10.1186/1471-2458-13-534
24. Balane MA, Antonio MS, Munsayac R, et al. Going smoke free: enforcement of tobacco control policies at the local government level [Abstract]. 16th World Conference on Tobacco and Non-communicable Diseases. Abstract book 2015: 117. Abu Dhabi, United Arab Emirates. 17-21 March 2015.
25. Singh D. Low compliance even after declaration as smoke-free city: experience from Shimla city [Abstract]. 16th World Conference on Tobacco and Non-communicable Diseases. Abstract book 2015:115. Abu Dhabi, United Arab Emirates. 17-21 March 2015.
26. Yang J, Zhu XQ. Research on the influential factors of enforcement of smoke-free law in five cities in China [Abstract]. 16th World Conference on Tobacco and Non-communicable Diseases. Abstract book 2015:114. Abu Dhabi, United Arab Emirates. 17-21 March 2015.
27. Lazuras L, Savva CS, Talias MA, Soteriades ES. Support for smoke-free policies in the Cyprus hospitality industry. Int J Public Health Published Online First: 1 October 2015. doi: 10.1007/s00038-015-0747-y.
28. Saade G, Seidenberg AB, Rees VW, et al. Indoor secondhand tobacco smoke emission levels in six Lebanese cities. Tob Control 2010, 19(2):138-142. doi: 10.1136/tc.2009.030460.
29. World Health Organization. National Tobacco Control Program Strategic Plan for the coming year 2009-2011. Framework Convention on Tobacco Control NA Accessed 10 Oct 2015.