BACKGROUND: Tobacco consumption and exposure to second-hand smoke (SHS) remain significant public health challenges in Pakistan. The Government enacted the "Prohibition of Smoking and Protection of Non-Smokers Health Ordinance" in 2002, mandating creation of smoke-free public places. Compliance with this ordinance is crucial to protect the public from SHS. In Karachi, district Tobacco Control Cells (TCCs) undertook a "Tobacco-Smoke-Free Karachi Initiative" in two districts, South and East, in 2021, expanding to Hyderabad and two new districts of Karachi, Keamari and Central, in 2023-24.
METHODS: A cross-sectional observational study was carried out by Sindh TCC and the University of Karachi in October-November 2024 to assess compliance with the law in all five districts. A total of 1500 venues were visited across 10 venue categories. The enumerators collected data on the presence of active smoking, ashtrays, cigarette litter, designated smoking areas and no-smoking signage. Data were collected on mobile phones using either online forms or physical forms when internet was unavailable; analysis was conducted in Excel.
RESULTS: Compliance rates varied by district and across venue types but with overall high compliance in East and South Districts and low compliance in the three districts of Central, Keamari and Hyderabad. The full results will be presented demonstrating the difference between the two groups which is found to be greater in venues with very high levels of observed smoking in the three districts. For example, smoking was observed in 8% and 6% of restaurants in East and South Districts, respectively, compared to 58%-68% in the other three districts, an approximately seven-fold difference. However, in health facilities, smoking was observed in 28%-38% in the three districts compared with 10%-11% in East and South, an approximately three-fold difference.
CONCLUSIONS: The compliance with smoke-free polices is substantially higher in East and South District following efforts of tobacco control cells and enforcement agencies.