BACKGROUND: Tobacco use remains a critical public health challenge in low- and middle-income countries (LMICs) like the Maldives, where effective enforcement of tobacco control laws is vital for reducing consumption. Despite the ratification of the Framework Convention on Tobacco Control (FCTC) and the enactment of the Maldives Tobacco Control Law (Act No. 15/2010), enforcement gaps persist. This study provides insights not only for the Maldives but also for other small-island developing states (SIDS) and LMICs facing similar socio-cultural and resource challenges.
METHODS: A cross-sectional study evaluated compliance in 390 retail and restaurant establishments across urban and rural areas of the Maldives. A systematic observational checklist assessed adherence to key tobacco control regulations, including age verification, product labeling, sale of single cigarettes, no-smoking signage, and non-smoking policy enforcement. Comparative analyses explored compliance differences between retail types (e.g., supermarkets, convenience stores) and dining establishments, as well as urban-rural disparities.
RESULTS: Overall compliance was moderate, with notable gaps. Age verification was observed in 62% of retailers, while 71% complied with product labeling regulations. Single cigarette sales persisted in 38% of retailers. Among restaurants, 65% displayed no-smoking signage prominently, but enforcement of non-smoking policies was inconsistent, especially in outdoor areas. Urban establishments showed higher compliance compared to rural counterparts, highlighting geographical disparities.
CONCLUSIONS: Enforcing tobacco control laws requires innovative approaches such as targeted staff training, routine inspections, and public-private partnerships. Technology-driven tools for real-time monitoring and community-driven awareness campaigns can further enhance compliance. Localized strategies are essential for addressing urban-rural disparities. Lessons from this study offer scalable solutions for SIDS and LMICs, supporting global FCTC objectives and reducing tobacco-related harm worldwide.