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Tobacco Free Zones for smoking cessation

Tobacco use is a major global health concern claiming eight million lives annually. Sri Lanka has made major strides in reducing the overall smoking prevalence rate in recent years, but tobacco still claims more than 20,000 lives each year.

 

Commit to Quit

“Commit to Quit” is the theme of this year’s World No Tobacco Day marked on 31 May 2021, and provides a welcome focus on smoking cessation by advocating strong cessation policies, increasing access to cessation services, and empowering users to successfully quit the deadly habit through “quit and win” initiatives.

The benefits of smoking cessation go beyond the individual; most immediately and directly through reduced involuntary smoke exposure and higher disposable income for household members. It is, therefore, crucial to have effective, long-term cessation interventions.

According to the latest Institute of Policy Studies (IPS) research, strengthening existing Tobacco Free Zones (TFZs) and creating new TFZs are a promising initiative in promoting smoking cessation. This article examines the effectiveness of prevailing TFZs and suggests ways to improve them so that Sri Lanka’s public healthcare can be further strengthened.

 

TFZs in Sri Lanka

TFZs are geo-specific areas where the sale of tobacco is prohibited. This is a community-led decision, rather than a top-down imposition. Usually, public health inspectors (PHIs) work with the whole community, and the decision to stop tobacco sales is taken by local shop owners, with the support of community leaders, non-governmental organisations (NGOs), village-level voluntary organisations, religious leaders, and other influential actors with the sole aim of safeguarding public health.

The TFZ approach is to conduct a series of discussions, led by the area PHI and community members, with retail shop owners, to stop the sale of tobacco smoking-related products. Once all the parties come to an agreement, the area is declared a TFZ. Sri Lanka has, to date, established close to 200 TFZs including Mahakumbukkadawala in the Puttalam District, Gurudeniya in the Kandy District, Nugalanda in the Ampara District, Walagedara in the Kalutara District, Hakmana in the Matara District, and Beliatta in the Hambantota District.

 

TFZs as a long-term policy measure

IPS research shows that TFZs are cost effective and crucial to reach a wider audience within a shorter period of time. TFZs are also proven to be beneficial in achieving higher quit rates among those who smoke while creating a highly visible tobacco control environment. Research encourages the TFZ model as a promising policy option for tobacco cessation not only because it encourages the remaining stock of smokers to quit but also because it reduces their chances of becoming victims to pandemics such as Covid-19. Scientific evidence shows that smokers are at a higher risk of developing severe Covid-19 outcomes and death.

Further, studies also recommend that successful smoking cessation interventions should be a priority especially during the Covid-19 pandemic. Therefore, strengthening the prevailing TFZs should be a long-term policy measure in Sri Lanka’s tobacco control agenda.

 

The way forward

TFZs are meant to be a community-based programme, but according to IPS research, the prevailing ones are highly dependent on PHIs. This affects their sustainability as the PHIs are regularly transferred. This calls for greater community involvement right from the initiation while the PHIs should ideally play an advisory role.  

Voluntary and other organisations, which have worked on tobacco control, can continue to extend their support by providing training to community leaders to enable them to assume stronger leadership roles and thereby ensure greater sustainability. This can involve training sessions, educational programmes, and awareness campaigns that communicate clear messages to children, youth, and businesses in particular.

It is equally important to identify implementation bottlenecks and understand the power structure around TFZs at the local level. For instance, the lack of support from community members and other government officers, and industry interference are some key issues which must be addressed when expanding the programme.

Covid-19 has motivated millions of tobacco users to quit, and therefore, improving prevailing TFZs will not only help people quit, but will also reduce their chances of falling victim to future pandemics. A multi-sectoral approach can be followed in sustaining TFZs, bringing together all stakeholders, especially in areas where smoking prevalence is high; this includes soliciting the participation of political actors to ensure its success.

 

(The writer is a Research Officer at the IPS with research interests in behavioural economics, labour economics, infrastructure development, and regulatory governance. She can be contacted at chathurga@ips.lk.)