BACKGROUND: The implementation of the Smoke-Free Law in Bali Province is designed to protect public health by prohibiting smoking in public spaces. Effective implementation depends on the acceptance and support of the area managers. This study aimed to assess knowledge, attitudes, and opinions of venue managers on Smoke-Free Law implementation.
METHODS: A cross-sectional study was conducted in 2023-2024 across seven districts in Bali, targeting the managers of smoke-free areas. Samples were selected using stratified random sampling for sites with pre-existing lists and walking protocol for sites without. The structured questionnaire assessed smoking-related knowledge, attitudes, and opinions toward the law, alongside self-reported smoking behaviors. Observations were also conducted using a compliance checklist to evaluate enforcement measures such as signage and violations.
RESULTS: A total of 1,198 area managers were successfully interviewed, consisting of 56.2% males and 92.6% having completed high school or higher education. Knowledge of smoking-related health risks was high, recognizing links to diseases like lung cancer (95.1%) and cardiovascular (73.2%). Similarly, 92.7% recognized the risks of second-hand smoke exposure but only 49% knew the implementation of smoke-free laws. Attitudes were positive toward the law, with 89.6% supporting stricter enforcement and 93.7% agreeing it protects public health. However, compliance gaps were evident: 61.4% of venues lacked no-smoking signs, and 79.6% reported observing smoking violations. Among smokers (36.6% of respondents), 43.6% expressed willingness to quit or reduce smoking due to the law, though only 24.2% were aware of cessation services. Non-smokers (63.4% of the sample) demonstrated greater support for stricter enforcement.
CONCLUSIONS: Strong support for the smoke-free law and awareness of smoking-related risks are promising. However, challenges such as insufficient signage and lack of awareness about cessation services remain. Addressing these gaps through public education, stricter enforcement, and integration of alternative smoking products into the regulation is essential to enhance compliance and public health outcomes.