[Association of information collection with indoor smoking regulations and legal understanding, and public health center approaches with legal compliance in eating and drinking establishments].

Abstract

Objectives　We aimed to determine how owners of eating and drinking establishments gather information on indoor smoking regulations and to assess owners' understanding of the revised Health Promotion Act. Additionally, we sought to identify factors that promote compliance with these regulations.Methods　We conducted Internet-based surveys targeting owners of eating and drinking establishments in five prefectures, in 2022, and targeting owners of new establishments across Japan, in 2023, were conducted. Valid responses were obtained from the owners of 257 existing establishments in the 2022 survey and from the owners of 202 new establishments in the 2023 survey. Participants provided information on location, opening date, seating capacity, indoor smoking policies, sources of information on indoor smoking regulations, legal understanding, and public health center (PHC) approaches (2023 survey only). The proportions of different information sources and legal understanding, comprising five core items and four items on the smoking-room criteria, among regulated, transitional-measure, and new establishments, were compared. Logistic regression analysis was used to calculate the odds ratios (ORs) for suspected legal non-compliance and pooled ORs for pre-existing and new establishments were calculated using random-effects meta-analysis.Results　The owners of regulated, transitional-measure, and new establishments gathered information on indoor smoking regulations from similar sources. However, establishments under transitional measures were less likely to correctly understand indoor smoke-free principle than those under regulations. Suspected non-compliance was identified in 22.8% of pre-existing establishments and in 17.8% of new establishments. A good understanding of the smoking-room criteria, but not the core items, was associated with a higher likelihood of suspected legal non-compliance compared with a good understanding of the core items but not the smoking-room criteria (pooled OR=3.36, 95% confidence interval [CI]: 1.36-8.29). However, in establishments that confirmed their indoor smoking policies or provided information about the regulations when applying for a business license at a PHC, there was lower potential to be suspected of non-compliance (OR=0.25, 95% CI: 0.07-0.87).Conclusions　Suspected legal non-compliance was identified in approximately 20% of establishments. A good understanding of smoking room criteria, but not the core items of the law, was associated with a higher suspicion of legal non-compliance. This stems from a lack of awareness of owners of the compliance requirements and the complexity and ambiguity of these regulations. To improve compliance, terminating transitional measures and clarifying smoking-room criteria would be effective. Confirming indoor smoking policies or providing information on these regulations during PHC administrative procedures may play key roles in advancing second-hand smoke prevention measures.