BACKGROUND-AIM:
The Public Health Agency of Sweden (The Agency) is responsible for coordinated monitoring tobacco and compiles, analyses and disseminates knowledge in order to prevent related illness. Our mission also includes overall supervision and supervision cguidance under the Tobacco Acts. In 2019 Sweden expanded the smoke-free outdoor environments in the Act of Tobacco and Similair Products (the Act) to include outdoor areas intended for use by those traveling with domestic public transports, outdoor seating areas at restaurants, cafés etc. enclosed outdoor areas mainly intended for sports activities, playgrounds where the public has access and entrances to premises and other areas subject to a smoking ban under the Act. The Swedish municipalities are responsible for the supervision of the smoking bans under the Act. The implemantaion of the new smoke-free outdoor areas included earmarked funds to support municipalities in enforcement and to have national campaigns to inform the public about the regulations. The agency has followed up the compliance of the new smoke-free outdoor environments and has concluded some important factors for a more successful implementation.

METHODS:
To follow up the compliance to the smoke-free outdoor environments the agency did annual surveys 2019-2022, asking supervisory officers in the municipalities how they assess the compliance to the smoke-free environments. The agency also did a national survey in 2019 and 2022 on how the public perceived exposure to others’ smoke in the smoke-free environments.

RESULTS:
Both the survey from the municipalities and the public supports that the smoking ban seems to work best at outdoor cafes and restaurants. The smoking ban also seems to work well at playgrounds and sports facilities. The smoking ban seems to work less well at outdoor locations connected to public transportation. A majority of the municipalities replied that the smoking ban was followed only to some extent, and the results for public entrances were similar. The perceived exposure to smoke among the public was much more common here, compared to the other areas.

CONCLUSIONS:
Some of the enabling factors that have made smoke-free environments possible include a strong commitment from our politicians and decision-makers. Earmarked funds are important to support municipalities in enforcement and to have national campaigns to inform the public about the regulations. Public awareness and strong support for smoke-free environments before legislation was strengthened with the implementation. The low smoking rates in Sweden also made it easier to introduce new measures for outdoor smoke-free environments. The supervision can be a challenge due to the difficulty to supervise, lack of resources and low priority.