Adherence to tobacco control policy implementation: a cross sectional study in a selected area in Ragama town, Sri Lanka

Sri Lanka was the first Asian country to ratify the World Health Organization (WHO) Framework Convention of Tobacco Control (FCTC) in 2003. Initiated by this undertaking, the National Authority for Tobacco and Alcohol (NATA) Act No 27 of 2006, the first legislature for tobacco control was enacted in parliament, with provisions for advertising, sales and promotion regulations for tobacco and creating smoke free environments in the country [1].

Sri Lanka was the first Asian country to ratify the World Health Organization (WHO) Framework Convention of Tobacco Control (FCTC) in 2003. Initiated by this undertaking, the National Authority for Tobacco and Alcohol (NATA) Act No 27 of 2006, the first legislature for tobacco control was enacted in parliament, with provisions for advertising, sales and promotion regulations for tobacco and creating smoke free environments in the country [1].
Despite anti-smoking regulations being in place for indoor public places, high levels of indoor air pollution have been recorded in restaurants [2]. NATA authorized officers have also identified the need for stronger monitoring and evaluation processes and community support in enforcing the Act [3]. Amidst the staggering global evidence on public health problems associated with tobacco smoking and limited evidence on regional or national level tobacco policy implementation in Sri Lanka, this study aimed to observe the implementation of tobacco control legislature based on the NATA Act No. 27 of 2006 in the Ragama town, Sri Lanka.
We conducted non-participatory, direct observations based on a pre-prepared checklist and an interviewer administered survey, independently. The study setting included five public places and 11 commercial establishments in the Ragama town.
Researchers randomly approached adult persons at public places, commercial establishments and on the street in the Ragama town and executed a quick interviewer administered questionnaire with their informed consent. An observation checklist was prepared based on a WHO report [4]  This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
items dedicated for commercial establishments and three for public places. Observations were done discreetly and recorded immediately afterwards. The questionnaire assessed the awareness level of the NATA Act regulations specified in which were given a score from zero to 19. The study was approved by the Ethics Review Committee, Faculty of Medicine, University of Kelaniya (P/196/12/2016).
We observed all public places in the Ragama town area, including the railway station, private and public bus stands, post office and the Colombo North Teaching Hospital premises. Tobacco was not sold or promoted at any of the above. 'NO SMOKING' signs were available only at the railway station. Smoking, however, was observed at the North Colombo Teaching Hospital premises, as well as public and private bus stands (n=3, 60%) ( Figure 1).

Research letter
We observed eleven randomly selected commercial establishments in the Ragama town including, restaurants, hotels, grocery stores, and supermarkets. Tobacco was sold in six locations (54.5%), of which only two (18.8%) had a notice for minimum purchase age while one provided supportive facilities for smoking ( Figure 2). A male actor who purchased cigarettes was not asked for age confirmation at any of the above six locations.
Of the 384 participants of the survey 59.9% (n=230) were males and 40.1% (n=154) were females. Participants' age ranged from 18 to 87 years, while 10.6% (n=33) were employed at public or commercial establishments. Seventy two percent of the general public (n=311) and 70% of commercial and public institution employees achieved a good score (12 or above out of 19) on awareness of tobacco control legislation.