BACKGROUND: Tobacco use remains a significant public health issue in the Maldives, necessitating stronger enforcement of control measures. While the Maldives ratified the Framework Convention on Tobacco Control (FCTC) in 2004 and enacted the Tobacco Control Act (TCA) in 2010, persistent gaps in compliance and enforcement deter progress. These challenges are compounded by limited public awareness, inadequate monitoring mechanisms, and insufficient regulatory enforcement. This study provides one of the first comprehensive evaluations of public perception, awareness, and compliance with tobacco control laws in the Maldives, offering actionable insights to guide policy improvements.
METHODS: A nationally representative, stratified cross-sectional survey of 300 participants was conducted across urban centers, rural islands, and atolls. Data collection utilized structured questionnaires available in Dhivehi and English. The survey examined three domains: (1) Public Awareness of tobacco laws, (2) Perceived Compliance with regulations, and (3) Barriers to Enforcement, such as monitoring gaps and insufficient education. Chi-square tests were used to analyze demographic differences.
RESULTS: Awareness: While 75% of participants were aware of tobacco laws, only 40% associated smoking with diseases like oral cancer and cardiovascular conditions. Compliance: 23% perceived compliance as low, while 57% observed occasional adherence to regulations. Barriers: Key issues included smoking in prohibited zones (75%), frequent sales to minors (50%), and smoking within 50 meters of health institutions and sports venues (90%).
CONCLUSIONS: The findings emphasize the urgent need for targeted public awareness campaigns, stricter enforcement mechanisms, and community-led initiatives to bridge compliance gaps. For instance, online campaigns could aim to increase awareness by 30% within two years, and deploying additional enforcement personnel could raise compliance rates by 20%. This study not only addresses enforcement challenges in the Maldives but also provides a replicable framework for similar low-resource settings. The recommendations align with FCTC priorities and contribute to global public health efforts.