Implementing smoke-free policies in low- and middle-income countries: A brief review and research agenda
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Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, United States
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
American Cancer Society, Atlanta, United States
Department of Political Science, Marquette University, Milwaukee, United States
Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, United States
M. Justin Byron   

Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Dr., Campus Box 7595, Chapel Hill, NC 27599, United States
Publish date: 2019-08-05
Tob. Induc. Dis. 2019;17(August):60
Some low- and middle-income countries (LMICs) struggle to implement smoke-free policies. We sought to review the academic and gray literature, and propose a research agenda to improve implementation of smoke-free policies and make them more effective in LMICs.

We reviewed 10 databases for variations of (‘implementation’ /‘enforcement’ /‘compliance’) and (‘smoke-free’ /‘ban’ /‘restriction’) and (‘tobacco’ /‘smoking’). We also reviewed cited sources and the gray literature including non-governmental organization reports. We included articles that described problems that arose, attempted solutions, lessons learned, and research questions posed regarding smoke-free policy implementation in LMICs. We excluded studies of high-income countries, institution-level implementation, voluntary smoke-free policies, smoke-free homes, and outdoor smoke-free policies.

The academic literature review led to 4931 unique articles, reduced to 1541 after title screening, 331 after abstract screening, and 101 after full-text review. The citation and gray literature review led to an additional 179 publications of which 67 met the inclusion criteria. In total we retained 168 sources. We conducted a narrative review and synthesis of the literature, extracting key themes and noting research gaps.

We find that progress is urgently needed in five categories: identifying the critical lessons learned for effective implementation, evaluating different enforcement approaches, learning how to rejuvenate stalled smoke-free policies, learning how to increase ground-level will to enforce policies, and developing a conceptual framework that explains implementation. Investigation into these topics can improve implementation of smoke-free policies in LMICs.

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
There was no source of funding for this research.
Not commissioned; externally peer reviewed.
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