BACKGROUND: China has enacted subnational smoke-free legislations, which requires compliance evaluations to provide data for future implementation planning. This study comprehensively assessed smoke-free regulation compliance in Xining in Western China.
METHODS: Conducted in November and December 2023, the study used a mixed-methods design. Quantitative surveys of observing the existence of “no evidence of smoking” were completed by trained investigators in 993 venues and 14 public transportation vehicles. PM2.5 concentration assessments of evidence of smoking were performed in 48 venues. Staff interviews on perceptions and implementation of the smoke-free regulation were conducted in 94 venues. Descriptive analyses were utilized for quantitative data and thematic analysis was performed for qualitative data.
RESULTS: In the quantitative observational survey, 84.5% of the venues were in compliance with the regulations, with schools/educational institutions having the highest compliance rate (90.0%) and leisure/entertainment/accommodation venues having the lowest rate (65.2%). The PM2.5 monitoring found 6 out of 48 monitored venues (1 hospital and 5 leisure/entertainment/accommodation services venues) had an average PM2.5 concentration level exceeding China's air quality standard, which were highly likely caused by people smoking in the venues. The qualitative interviews revealed that lack of awareness and understanding of the regulations and related penalty and rewarding strategies and non-cooperation of their smoking clients might be the main reasons contributing to unsatisfactory compliance.
CONCLUSIONS: The study suggests a relatively optimal compliance with the local smoke-free regulations in Xining and also identifies a room for improvement. Efforts should be made to raise public awareness of smoke-free regulations and strengthen regulations’ enforcement and supervision.