Level of compliance to smoke-free laws by restaurants in Karachi: an observational study

Introduction: Exposure to secondhand smoke is a significant public health concern. Our study assessed the level of implementation of smoke-free laws in restaurants in Karachi, Pakistan. Methods: We conducted a cross-sectional study in District East, Karachi. We randomly selected 40 restaurants based on their meal cost: 17 low (<400 PKR/meal), 12 medium (400–600 PKR/meal) and 11 high-end (>600 PKR/meal). We assessed tobacco control law implementation using an observational checklist that included questions about the presence of no-smoking signs, presence of smokers, people/children near smokers and remains of tobacco products and developed a compliance score for smoke-free laws: compliant (all criteria met), partially compliant (1–2 criteria met) and non-compliant (none met). We asked questions about knowledge, attitudes and practices regarding smoke-free laws with each restaurant’s staff. We reported frequencies and percentages for observations and questionnaire responses by restaurant category. Results: Of the 40 restaurants, 70% (n=28) were either non-compliant or partially compliant, with 82% of low-end and 67% of medium-end were either non-compliant or partially compliant. None of the high-end restaurants were non-compliant; however, 55% partially complied with the smoke-free laws. More than half (53%, n=21) had no no-smoking signs. Smokers were observed on terraces or near children in 20% (n=8) of restaurants, and ashtrays or cigarette packs/butts were found in 40% (n=16). Fifty per cent of restaurant staff (n=20) believed that there was no tobacco control law in Pakistan, only 10% (n=4) knew the particulars of the law and 18% (n=7) were aware of any penalties for violations. In addition, 60% (n=24) reported no visits from legislative or administrative bodies to enforce compliance. Conclusion: Our study reveals disparities in the compliance of smoke-free laws between low-end and high-end restaurants, highlighting the need to enforce these laws across all restaurant categories effectively.