Implementing smoke-free laws in low- and middle-income countries: a systematic literature review and proposed research Agenda

摘要

Background Globally, secondhand tobacco smoke causes over 365,000 deaths each year. Tofulfill their obligations under the WHO Framework Convention on TobaccoControl, low- and middle-income countries (LMICs) are increasingly enactingsmoke-free laws covering public places. These policies have proven effective inhigh-income countries, but some LMICs have struggled to implement smoke-freelaws and attain compliance. We present a systematic review and a researchagenda for improving implementation of smoke-free laws in LMICs.Methods We conducted a systematic review of the literature onimplementation of smoke-free laws in LMICs through January 2017. The search of 10databases yielded 3,894 unique articles, which reduced to 1,409 after titlescreening, 236 after abstract screening, and 66 after full text review. We alsoreviewed reports from WHO and international tobacco control NGOs and citationsin sources. The total number of sources that met inclusion criteria was 131. Weanalyzed these materials for common themes.Results We found that many of the health and economic aspects of smoke-free lawsin high-income countries carry over to LMICs: the tobacco industry aggressivelyopposes smoke-free laws, there are commonalities in lessons learned inimplementing laws across various LMICs, and a number of obstacles to successfulimplementation are faced in LMICs, especially in terms of resources andpolitical will.Conclusions Based on these findings and our own experience in the field,we suggest four central topics on which research is urgently needed: (1) determiningthe most efficient methods of working with limited resources; (2) learning howto increase political will among political leaders and enforcement officers; (3) finding methods for increasing public compliance in settings where lawshave already been passed but not achieved success; and, (4) understanding the socialand behavioral processes underlying smoke-free laws. Investigation into thesetopics can inform more effective implementation of smoke-free laws in LMICs.