Compliance with tobacco control laws before and after the enactment of a national Tobacco Control Act in Ghana

Abstract

Background: Tobacco smoke contains around 70 known toxins and carcinogens. Worldwide, billions of nonsmokers, including children are exposed to secondhand tobacco smoke (SHS), contributing to over 600,000 annual deaths. Public smoking ban is an effective policy to protect nonsmokers from SHS exposure, yet, only 7 of 47 countries in Sub-Saharan Africa (SSA), have comprehensive smoke-free policies. In 2012, Ghana enacted and implemented a national Tobacco Control Act, the Public Health Act 851, which prohibited smoking in all public places. The study aimed to evaluate the impact of the public smoking ban on SHS exposure in hospitality venues. Methods: Public recreational places (N=137) in towns across Ghana, including Accra, were surveyed (2007: n=88, 2015: n=49). Research assistants recorded indoor PM2.5 concentrations along with information on services, infrastructure and smoke-free policy of the selected facilities. At least 30 minutes was spent in each facility to record PM2.5 concentrations using Sidepak monitor. Wilcoxon rank sum test and Mann-Whitney analysis was used to compare the PM2.5 concentrations in the facilities surveyed before and after the enactment of the Tobacco Control Act using SAS 9.4. Results: Indoor smoking was observed in 86% and 56% of the facilities surveyed pre- and post-legislation, respectively. The average PM2.5 concentrations was median 553 [IQR 259-1038] at all venues that smoking was allowed (75) in 2007 and median 439 [IQR 234-576] in 2015. The average PM2.5 concentrations was significantly lower post-legislation compared to pre-legislation (p-value= < .0001).Thus, there is no statistically significant difference between pre-legislation period in 2007 and post-legislation period in 2015 (z = -1.660, p = 0. 0969). Conclusions: The introduction of the smoke-free policy in Ghana did not reduce the SHS exposure in hospitality venues, suggesting lack of compliance to the policy and the need for extension of smoke-free policies.