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.

Table 1

SWOT analysis

Assistance of grass-root level public-health staff
Current legal provisions relating to tobacco
Authority as an authorized officer
Skills and expertise of PHIs
Public respect for the PHIs
Availability of transport facilities (K & NE, only)
Busy time-schedule of PHIs due to heavy-duty list
Limitations of the NATA Act
Insufficient PHIs
Lack of educational material
Low enthusiasm of middle and top management
Lack of financial facilities (K & NE, only)
Administrative issues (K & NE, only)
Communication problems (K & NE, only)
Assistance of other Governmental Officers
School-health clubs
Connection between PHIs and teaching staff of school
Active participation of religious leaders
Active participation of community leaders
Active participation of community organizations (women, youth, elderly, and three-wheel drivers)
Community urge for living in a drug-free environment
Certain facilities (human resources, technical support)
Access to implementing programs at: schools, health clinics, workplaces
Positive awareness among communities
Assistance of Non-Governmental Organizations
Trade Unions (NE – 69%, K – 43%, M – 43%) Dharma schools (K & M, only)
Addicted to tobacco smoking
Traders’ negative attitude
Influence and threats by tobacco companies
Promotional strategies
Low-level education
Legal and illegal liquor sales
Tobacco farmers and processing-plant owners
Influence of peer groups
Availability of tobacco products
Poor policy implementation
Officers addicted to smoking tobacco (NE only)
Cold climate (NE only)
Youth unemployment (K only)
Mothers emigrating to find work (K only)

[i] Districts: K – Kandy, M – Matale, NE – Nuwara Eliya

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.