ABSTRACT
Objective.
To assess compliance with smokefree regulations at hospitality venues in two cities 8 months after implementation of national regulations establishing 100% smokefree areas in all indoor workplaces, public places, and public transportation.
Methods.
A cross-sectional observational field study was conducted in the capital cities of the states of Puebla and Aguascalientes from October 6 to 21, 2023. Data was collected from a convenience sample of hospitality venues across six areas defined by income. A survey was conducted by trained data collectors to document compliance with smokefree indicators in all public areas of each venue 8 months after the national policy went into effect on January 14, 2023.
Results.
The analysis included 410 venues (199 restaurants, 141 cafés, and 70 bars), among which nearly 80% were completely free of smoking and/or electronic device use; however, bars showed significantly lower levels of compliance. Cigarette butts and/or ashtrays were observed in fewer than 10% of venues, and “designated smoking area” signage was present in only 1.2%. No venues fully complied with the no smoking signage. Restaurants had the highest compliance for no smoking/e-cigarette use (87.9%), while bars had the lowest (47.1%). Puebla showed a higher level of compliance for all indicators compared with Aguascalientes. Middle-income areas had the highest level of compliance, while high-income areas had the lowest. The proportion of people who were observed smoking or using electronic devices differed significantly by venue area (indoor versus semi-outdoor).
Conclusions.
The findings of this cross-sectional study suggest that hospitality venues, except for bars, are largely in compliance with national smokefree regulations, despite confusion caused by litigation and misinformation from the tobacco companies and their allies. Given this, efforts to assess compliance with the smokefree regulations should be repeated once the litigation is resolved.
Keywords: Smoke-free environments, smoke-free policy, tobacco control, Mexico, Latin America
RESUMEN
Objetivo.
Evaluar el cumplimiento de las regulaciones de ambientes libre de humo de tabaco en establecimientos de hostelería en dos ciudades ocho meses después de la aplicación de regulaciones nacionales que establecen zonas 100% libres de humo en todos los lugares de trabajo cerrados, lugares públicos y transporte público.
Método.
Se realizó un estudio de campo, de tipo observacional y transversal, en las capitales de los estados de Puebla y Aguascalientes (México), del 6 al 21 de octubre del 2023. Los datos se recopilaron a partir de una muestra de conveniencia de establecimientos de hostelería de seis zonas definidas por su nivel de ingresos. Se llevó a cabo una encuesta realizada por recopiladores de datos con una capacitación específica para documentar el cumplimiento de los indicadores de prohibición de fumar en todas las zonas públicas de cada establecimiento ocho meses después de la entrada en vigor de esta política nacional el 14 de enero del 2023.
Resultados.
El análisis incluyó 410 locales (199 restaurantes, 141 cafeterías y 70 bares), y en casi el 80% de ellos se constató una ausencia total de consumo de tabaco y de uso de dispositivos electrónicos; sin embargo, los bares mostraron niveles mucho más bajos de cumplimiento de la regulación. Se observaron colillas de cigarrillos o ceniceros en menos del 10% de los locales, y solo el 1,2% contaba con carteles que señalaban una zona habilitada para fumadores. Ningún local cumplía de manera cabal con las regulaciones sobre la señalización de la prohibición de fumar. Los restaurantes registraron el mayor cumplimiento de la prohibición de fumar y de usar dispositivos electrónicos (87,9%), mientras que los bares registraron el menor cumplimiento (47,1%). En Puebla se observó un mayor nivel de cumplimiento de todos los indicadores, en comparación con Aguascalientes. Las zonas de ingresos medianos registraron el mayor nivel de cumplimiento, mientras que las zonas de ingresos altos registraron el nivel más bajo. La proporción de personas a la que se observó fumando o utilizando dispositivos electrónicos variaba de manera significativa según la zona del recinto (interior en comparación con semiexterior).
Conclusiones.
Los resultados de este estudio transversal sugieren que, con la excepción de los bares, los locales de hostelería cumplen en gran medida con las regulaciones nacionales de ambientes libre de humo de tabaco, a pesar de la confusión causada por los litigios y la información errónea divulgada por las tabacaleras y sus asociados. En vista de ello, una vez resuelto el litigio, deberían reanudarse los esfuerzos para evaluar el cumplimiento de las regulaciones antitabaco.
Palabras clave: Ambientes libres de humo, política libre de humo, control del tabaco, México, América Latina
RESUMO
Objetivo.
Avaliar o cumprimento da legislação antifumo em espaços de hospitalidade de duas cidades 8 meses após a entrada em vigor da legislação nacional que instituiu ambientes 100% livres de fumaça em locais de trabalho fechados, espaços públicos e transporte coletivo.
Métodos.
Realizou-se um estudo observacional transversal nas capitais dos estados de Puebla e Aguascalientes entre 6 e 21 de outubro de 2023. Os dados foram coletados de uma amostra de conveniência de espaços de hospitalidade distribuídos em 6 regiões definidas por nível de renda. A pesquisa foi conduzida por equipes treinadas em coleta de dados com o objetivo de documentar o cumprimento dos indicadores de ambientes livres de fumaça em áreas de uso coletivo de cada espaço de hospitalidade 8 meses após o início da vigência da política nacional em 14 de janeiro de 2023.
Resultados.
A análise incluiu 410 espaços de hospitalidade, sendo 199 restaurantes, 141 cafeterias e 70 bares, entre os quais quase 80% estavam totalmente livres do tabagismo e/ou do uso de dispositivos eletrônicos para fumar. No entanto, o cumprimento da legislação foi significativamente menor nos bares. Observou-se a presença de bitucas e/ou cinzeiros em menos de 10% dos espaços e de sinalização de “área designada para fumantes” em apenas 1,2%. Nenhum espaço cumpria integralmente a sinalização de proibido fumar. O cumprimento da proibição do tabagismo e do uso de cigarros eletrônicos foi maior nos restaurantes (87,9%) e menor nos bares (47,1%). Em todos os indicadores, Puebla apresentou um nível mais alto de cumprimento em comparação com Aguascalientes. As áreas de renda média apresentaram o maior nível de cumprimento, ao passo que as áreas de alta renda apresentaram o menor. A proporção de pessoas observadas fumando ou usando dispositivos eletrônicos para fumar variou significativamente de acordo com a área do espaço (interno versus semi-externo)
Conclusões.
Os achados deste estudo transversal sugerem que, com exceção dos bares, a maioria dos espaços de hospitalidade cumpre a legislação nacional antifumo, mesmo diante da confusão causada pelos litígios e pela desinformação promovida pelas empresas de tabaco e seus aliados. Diante disso, deve-se reavaliar o cumprimento da legislação antifumo após a resolução desses litígios.
Palavras-chave: Ambientes livres de fumo, política antifumo, controle do tabagismo, México, América Latina
On May 28, 2004, Mexico became the first country in the Region of the Americas to ratify the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). The WHO FCTC is an evidence-based global treaty that was ratified by 183 Parties covering more than 90% of the global population. This framework provides regulatory guidelines and strategies to address the global tobacco epidemic. Article 8 of the WHO FCTC outlines the establishment of 100% smokefree public places, which has been proven to be the most effective measure to protect non-smokers from the harms of secondhand tobacco smoke (SHS) (1).
In February 2008, Mexico City became the first subnational jurisdiction in the country to adopt a 100% smokefree law in all indoor public places. In May 2008, four years after becoming a Party, Mexico adopted a national tobacco control law that required, among other measures, indoor smokefree areas in most public places. However, the national law notably allowed designated smoking areas (DSAs). This contradiction between the two laws (city and country levels) created substantial confusion in the public (2). Following the Mexico City smokefree law example, several other states adopted subnational 100% smokefree laws (3).
Then, in February 2022, following the recommendations of FCTC Article 8 guidelines, the Mexican government amended the national tobacco control law to require all indoor public places, workplaces, and public transportation to be 100% smokefree without any exceptions and/or DSAs (4). The amended law also banned the use of any nicotine and tobacco products including electronic cigarette devices (e-cigarettes) and heated tobacco products (HTPs) in all indoor public places, and established a comprehensive ban on tobacco advertising, promotion, and sponsorship (TAPS) (5). New implementing regulations, which established smokefree provisions including new “no smoking” signage, were adopted in December 2022 and entered into force in February 2023 (6). In May 2022, a presidential decree banned the circulation and commercialization of electronic nicotine delivery systems, electronic non-nicotine delivery systems, alternative nicotine delivery systems (such as HTPs), e-cigarettes, and vaping devices with similar uses (7). This decree was followed by a national constitutional amendment in December 2024 (ratified by all states) that would codify the ban and will be implemented after the Congress of Mexico adopts an enabling legislation that has been under consideration since September 2025.
With the new national smokefree law and regulations, Mexico joined South America (8) and most of Central America (9) in becoming 100% smokefree. Now, the entire Latin American subregion is closer to becoming 100% smokefree—the remaining countries are Cuba, Dominican Republic, Haiti, and Nicaragua. In addition, Mexico became the third country in the subregion, after Ecuador and Paraguay, to ban the use of e-cigarettes and HTPs in indoor public places (8).
According to the Mexico Global Adult Tobacco Survey (GATS) conducted from March to May 2023, self-reported SHS exposure has decreased since the 2009 GATS, on public transportation (24.2% to 14.4%), in government buildings (17.0% to 9.5%), at workplaces (18.6% to 11.4%), in restaurants (29.6% to 17.8%), and at bars and/or clubs (81.2% to 70.3%) (10).
The primary objective of this study was to assess the level of compliance with the new national smokefree provisions in select hospitality venues located in two cities in Mexico, 8 months after implementation. A secondary aim was to monitor compliance with other tobacco control measures (including TAPS and emerging products sales ban) in the same observed venues.
METHODS
This was a cross-sectional observational field study conducted in the capital cities of 2 Mexican states: Heroica Puebla de Zaragoza (hereafter, Puebla) and Ciudad de Aguascalientes (hereafter, Aguascalientes) from October 6 to 21, 2023 to measure compliance with the new national smokefree regulations 8 months after implementation. The convenience sample included 410 hospitality venues.
Sampling approach and data source
In each city, data were collected from a convenience sample of 200 hospitality venues distributed proportionately across venue types. To select the venues for observation, we used a 2022 national database of hospitality venues categorized as “temporary accommodation and food and beverages preparation services” downloaded from the Directorio Estadístico Nacional de Unidades Económicas (National Statistical Directory of Economic Units database) (11), maintained by the Instituto Nacional de Estadística y Geografía (National Institute of Statistics and Geography [INEGI]).
Data were filtered by state (Puebla and Aguascalientes), municipality (Puebla and Aguascalientes cities), and five relevant hospitality venue subcategories from a total of 21. These five subcategories were: “bar, pubs and similar,” “coffee shops, soda and ice cream shops, refreshments and similar,” “restaurants with a la carte or fast-food preparation service,” “restaurants that sell fish and seafood,” and “restaurants with self-service.” A total of 1768 venues were obtained for Aguascalientes and 3416 for Puebla. The three restaurant subcategories were merged for reporting into one labeled “restaurants,” and the other two were renamed as “bars” and “cafés” for the final three categories of analysis. In each city, a proportional sample for each type of venue was obtained considering a sample of 200 (Table 1).
TABLE 1. Sample distribution by type of venue in Aguascalientes City and Puebla City.
|
Venue type |
Aguascalientes |
Puebla |
||
|---|---|---|---|---|
|
Total venue, No. (%) |
Proportional sample |
Total venue, No. (%) |
Proportional sample |
|
|
Restaurants |
704 (40) |
80 |
1711 (50) |
100 |
|
Cafés |
805 (46) |
92 |
1271 (37) |
74 |
|
Bars |
248 (14) |
28 |
434 (13) |
26 |
|
Total |
1768 |
200 |
3416 |
200 |
Location and selection of venues
In each city, six areas of different socioeconomic levels (SEL) were selected (two high-, two middle-, and two low-income areas) using maps developed by the Asociación Mexicana de Agencias de Investigación de Mercado y Opinión (Mexican Association of Market Intelligence and Opinion Agencies [AMAI]). These six areas were formed by one or more Area Geoestadística Básica—a basic geostatistical area delineated by natural (e.g., lakes, rivers, mountains, etc.) or cultural barriers (e.g., streets, avenues, highways, etc.) established by INEGI (12). The SEL of each geostatistical area is established by the AMAI.
Selection criteria for the six areas included that (1) areas with the same SEL should be geographically separate from one another, and (2) areas should be safe for data collectors—to avoid any potential episode of violence. After selection, the sample was distributed considering SEL and type of hospitality venue (Table 2).
TABLE 2. Sampling distribution by socioeconomic level (SEL) and type of venue, Aguascalientes City and Puebla City.
|
Areas by SEL |
Aguascalientes |
Puebla |
||||
|---|---|---|---|---|---|---|
|
Bars |
Restaurants |
Cafés |
Bars |
Restaurants |
Cafés |
|
|
High 1 |
5 |
13 |
16 |
4 |
17 |
12 |
|
High 2 |
5 |
14 |
15 |
5 |
17 |
13 |
|
Middle 1 |
5 |
13 |
16 |
4 |
16 |
12 |
|
Middle 2 |
4 |
14 |
15 |
5 |
17 |
13 |
|
Low 1 |
5 |
13 |
15 |
4 |
16 |
12 |
|
Low 2 |
4 |
13 |
15 |
4 |
17 |
12 |
|
Total |
28 |
80 |
92 |
26 |
100 |
74 |
Data collection
A structured questionnaire was developed that consisted of 38 questions based on direct and indirect indicators of compliance with the provisions established in the implementing regulations. Based on the questionnaire, smoking refers to the use of conventional tobacco products, such as cigarettes, whereas electronic device use refers to the use of e-cigarettes, HTPs, and/or non-tobacco and nicotine electronic devices. Data collectors were unable to distinguish between the types of electronic devices due to similarities in appearance. These provisions included and were assessed by:
Absence of smoking of any tobacco and nicotine products inside any public places (observing no persons smoking conventional tobacco products and/or using electronic devices, including e-cigarettes, HTPs, and/or other non-tobacco and nicotine electronic devices in any area of the venue, including indoor areas and/or semi-open areas)
Placement of “no smoking/no vaping” signage in compliance with location (present at entrance, indoors, and at each semi-outdoor area), number and content (3 specific types of signage), and size (legible) according to a manual developed by the Comisión Federal para la Protección contra Riesgos Sanitarios (Federal Commission for the Protection Against Health Risks [COFEPRIS]), a regulatory agency of the Ministry of Health (13)
Ban of DSAs within the establishments, including all indoor and/or semi-open areas (absence of “smoking area” signage)
Indirect indicators of smoking included the presence of ashtrays and/or cigarette butts in any area of the venue, including indoor and/or semi-open areas.
Lastly, we used indicators related to other tobacco control provisions, including no display of conventional tobacco products, no display or sale of electronic tobacco and nicotine products, no sale of single sticks, and no TAPS in any area of the venue.
The questionnaire was programmed on KoboToolbox (14), a data collection, management, and visualization web-based platform. Six surveyors participated in a 2-day online training that covered information on the provisions of the Mexican smokefree law and its regulations, the research protocol, and the questionnaire. The second day included a pilot study. Results of the pilot were reviewed and discussed with the surveyors to refine survey questions and solve potential challenges. Trained data collectors accessed the survey through smartphones. They worked in pairs and followed a basic walking protocol: at a pre-determined starting point, data collectors were to visit every restaurant, bar, or café on the streets located in the selected area until they completed the requisite sample size. Venues were visited at their peak hours as follows: restaurants and cafés from Monday to Saturday from 1 pm to 10 pm; and bars from Thursday to Saturday from 1 pm to 5 pm and from 6 pm to 1 am.
Each venue was observed for at least 20 minutes or until tobacco smoking and/or electronic device use was observed, whichever happened first. During the observations, data collectors inspected all accessible public spaces of the venue, including indoor (e.g., halls, dining rooms, and restrooms) and semi-outdoor areas. Indoor public areas were defined as those totally limited by physical barriers such as walls (of any material) and ceilings. Semi-outdoor areas included any area that was part of the venue but lacked a ceiling or walls (independent of construction material or whether the structure was permanent or temporary). These included gardens, patios, and terraces, including on the rooftops and/or on the sidewalks surrounding the building. Data collectors were discreet and did not inform venue employees or managers regarding the study being conducted.
Data analysis
This was a descriptive study, and proportions of the level of compliance for each indicator by city, by venue, and by income level were calculated using Microsoft Excel. In addition, a chi-square test of independence was conducted manually to test the significance of a specific relationship between two of the variables.
RESULTS
The analysis included 410 venues (199 restaurants [48.5%], 141 cafés [34.4%], and 70 bars [17.1%]), among which nearly 80% (327) of the venues were completely free of smoking and/or electronic e-cigarette device use. Bars, however, showed substantially lower levels of compliance. The distribution of the venues was 204 in Puebla and 206 in Aguascalientes. The number of restaurants and bars in the sample was slightly higher than cafés because of lack of cafés in the low- and middle-SEL areas in Aguascalientes.
Overall compliance
In most venues (79.8%), we observed no smoking and/or electronic device use in any areas of the establishment, including indoor and/or semi-open areas. Nearly all venues (98.8%) were completely free of DSA signage, which is particularly notable in Puebla, which had allowed DSAs prior to the new law. No cigarette butts were found in 92.0% and no ashtrays in 91.7% of the venues—suggesting high compliance. Compliance with the other tobacco control measures were all greater than 95% (no display of conventional tobacco products [98.3%]; no sale of single cigarette sticks [99.3%]; no display/sale of electronic devices [99.3%]; no TAPS [100%]) (Figure 1).
FIGURE 1. Proportion of overall compliance with smokefree and other tobacco control regulations in Puebla and Aguascalientes, Mexico, October 2023.
Abbreviations: DSA, designated smoking areas; TAPS, tobacco advertising, promotion, and sponsorship.
Regarding the “no smoking” signage compliance, none of the observed hospitality venues were in full compliance with this indicator description: design of the signage according to the manual developed by the Ministry of Health, location of signage, number of signs, and legibility. In 63.2% of the venues, there was at least one type of no smoking signage with or without the requirements of design, size, number, and location. No signs were observed at 36.8% of the venues.
Level of compliance by city, SEL, and type of venue
These data were analyzed by city, SEL and type of venue to explore differences in compliance with the smokefree indicators across these variables (Table 3).
TABLE 3. Level of compliance with tobacco control regulations in Puebla compared with Aguascalientes, by type of venue and socioeconomic level (SEL).
|
Variable |
Smokefree regulation, No. (%) |
Other tobacco control regulation, No. (%) |
|||||||
|---|---|---|---|---|---|---|---|---|---|
|
No smoking/no electronic device use |
No ashtrays |
No butts |
No DSA signage |
Signage |
No display of conventional tobacco products |
No sale of single sticks |
No display/sale of electronic devices |
No TAPs |
|
|
Overall (n = 410) |
327 (79.8) |
376 (91.7) |
377 (92.0) |
405 (98.8) |
0 |
403 (98.3) |
407 (99.3) |
407 (99.3) |
410 (100) |
|
City | |||||||||
|
Puebla (n=204) |
173 (84.8) |
191 (93.6) |
193 (94.6) |
202 (99.0) |
0 |
199 (97.5) |
202 (99.0) |
203 (99.5) |
204 (100) |
|
Aguascalientes (n=206) |
154 (74.8) |
185 (89.8) |
184 (89.3) |
203 (98.5) |
0 |
204 (99.0) |
205 (99.5) |
204 (99.0) |
206 (100) |
|
Venue type |
|||||||||
|
Restaurant (n=199) |
175 (87.9) |
189 (95.0) |
190 (95.5) |
198 (99.5) |
0 |
196 (98.5) |
199 (100) |
197 (99.0) |
199 (100) |
|
Café (n=141) |
119 (84.4) |
134 (95.0) |
131 (92.9) |
137 (97.2) |
0 |
137 (97.2) |
141 (100) |
140 (99.3) |
141 (100) |
|
Bar (n=70) |
33 (47.1) |
53 (75.7) |
56 (80.0) |
70 (100.0) |
0 |
70 (100.0) |
67 (95.7) |
70 (100.0) |
70 (100) |
|
SEL | |||||||||
|
High (n=141) |
107 (75.9) |
122 (86.5) |
127 (90.1) |
138 (97.9) |
0 |
136 (96.5) |
140 (99.3) |
139 (98.6) |
141 (100) |
|
Medium (n=137) |
113 (82.5) |
132 (96.4) |
128 (93.4) |
136 (99.3) |
0 |
137 (100.0) |
135 (98.5) |
137 (100) |
137 (100) |
|
Low (n=132) |
107 (81.1) |
122 (92.4) |
122 (92.4) |
131 (99.2) |
0 |
130 (98.5) |
132 (100) |
131 (99.2) |
132 (100) |
Abbreviations: DSA, designated smoking areas; TAPS, tobacco advertising, promotion, and sponsorship.
Compliance by city. The level of compliance with each of the smokefree indicators was slightly higher in Puebla than in Aguascalientes, except for the no smoking signage, for which no venue in either city was compliant. For the other tobacco control indicators, we found no notable differences in the level of compliance between the cities.
Compliance by type of venue. Restaurants showed the highest level of compliance with most smokefree indicators, except for the absence of DSA signage. Bars showed the lowest level of compliance with most smokefree indicators, except for DSAs signage. Cafés had the lowest compliance with the ban of DSAs signage (97.2%). For the other tobacco control indicators, the level of compliance was consistently high in all types of venues.
Compliance by SEL. Venues located in areas with middle SEL had the highest level of compliance with all smokefree indicators. The lowest level of compliance for all smokefree indicators was observed in areas with high SEL.
Indoors vs. semi-outdoor areas
An analysis to evaluate if there were differences in smoking or electronic device use between indoor and semi-outdoors areas of the venues was conducted (Table 4). A chi-square test of independence was performed to assess the association between being in an indoor area versus a semi-outdoor area, and whether people were observed smoking or using electronic devices. The association between these variables was significant, (X2 [1 412] = 17.2; P <.001). Among venues with both semi-outdoor and indoor areas, smoking and electronic device use was more likely to be observed in semi-outdoor areas than in indoor spaces. Results remained significant when a similar chi-square test of independence was conducted to compare semi-outdoor spaces with the indoor spaces of venues with semi-outdoor areas and the indoor spaces of venues without semi-outdoor areas, (X2 [2 616] = 20.3; P < .001).
TABLE 4. Smoking/electronic device use in indoor vs semi-outdoor areas by city, and by socioeconomic level (SEL).
|
Variable |
Indoor areas (n=410) |
Semi-outdoor areas (n=206) |
|---|---|---|
|
No smoking/no electronic device use, n (%) |
No smoking/no electronic device use, n (%) |
|
|
Overall |
368 (88.5) |
154 (74.8) |
|
City |
||
|
Puebla |
194 (95.1) |
78 (78.4) |
|
Aguascalientes |
169 (82.0) |
76 (71.6) |
|
SEL |
||
|
High |
123 (87.2) |
65 (71.4) |
|
Medium |
119 (86.9) |
47 (79.7) |
|
Low |
121 (91.7) |
42 (75.0) |
DISCUSSION
This observational study shows that overall compliance with the new smokefree law and regulations was high in both cities. Puebla had a slightly higher level of compliance than Aguascalientes. Both states had previously adopted state smokefree laws at the state level; however, Puebla state law allowed DSAs (2010), whereas Aguascalientes state adopted a comprehensive smokefree law (2019).
Regarding types of venues, bars showed a much lower level of compliance in comparison with restaurants and cafés. Previous studies have also shown that bars tend to have lower levels of compliance compared to other hospitality venues (15-18) Patrons may exhibit different smoking behavior patterns based on the type of venue. For example, those who often smoke in bars may not do so in restaurants (15) Additionally, bars are more likely to be compliant if competing bars are also in compliance, and similarly, noncompliance may be replicated if competing bars continue to violate laws despite consequences. Bars that comply with a smokefree law may not want to lose their smoking customers to bars that do not comply (allow patrons to smoke) (19, 20).
Smoking and/or use of electronic devices were observed in more than half of the bars sampled and no venue fully complied with signage requirements, indicating two areas needing increased attention. To protect all workers and patrons from the serious health effects associated with SHS, education efforts must raise awareness of the new regulations and enforcement must be heightened to improve compliance, especially at bars. Improving the smokefree signage in hospitality venues should be part of this effort.
Previous assessments of SHS exposure have been carried out in other Mexican jurisdictions. A study conducted in Mexico City after the implementation of the city smokefree law reported that exposure to SHS decreased in all public spaces; however, bars and cantinas still reported the highest exposure compared with restaurants and cafes (44% vs. 18%) (21). The 2023 GATS in Mexico reported the highest exposure of SHS in bars and nightclubs (70.1%) compared with restaurants (17.8%) (10). These data are also consistent with findings in other countries, such as Turkey (15) and Indonesia (18), where bars showed the lowest level of compliance compared to other hospitality venues (16). This may be because it is more challenging for the authorities to monitor bars during late hours and/or due to a lack of political will.
Compliance with no smoking signage per the requirements specified by the COFEPRIS, was nonexistent. This could be due to the complex requirements established in the manual, which are not definitely clear in terms of number, location, and size. A monitoring study in hospitality venues in Uganda also reported zero compliance with the no smoking signage according to the law requirements for size, format, content, and placement (22)
Higher violations regarding smoking in semi-open areas versus closed areas have been reported before. For example, a study conducted in Chile reported a higher percentage of violations in semi-open areas up to 10% in hospitality venues versus 0% in enclosed areas of any establishment (23). In Mexico, legislation indicated that semi-outdoor areas would usually be the designated smoking areas—before the 2022 law implementation; perhaps this is the reason that smoking and electronic device use was more likely to be observed in semi-outdoor areas than in indoor spaces.
Regarding other tobacco control regulations, overall compliance was high.
Limitations
Throughout the study period, the regulations were under legal challenge. Several establishments (mostly hospitality venues) across Mexico challenged the smokefree provisions by filing injunctions on the grounds that they were not able to provide food and drink services in designated smoking areas within the establishments. These injunctions not only temporarily suspended the implementation of the regulations in those places but also created confusion in the hospitality industry by making the injunction “extensive” to other places. This situation may explain a lower level of compliance under the “protection” of the challenge. Given that only the enforcement authorities could request that managers and/or owners display the documents that supported the injunction in the specific venue, it was not possible for the observers to know whether the venue had actually been suspended due to an injunction.
Conclusions
The findings of this cross-sectional observational field study suggest that despite ongoing industry opposition, hospitality venues in these two Mexican cities are largely in compliance with the new smokefree regulations, thereby protecting workers and patrons from the many harms of SHS. Although smoking was not observed in nearly 80% of all venues, compliance can and should be higher. Increased education and enforcement are needed, especially in bars, and the courts must protect the law and its regulations when challenged.
Acknowledgements.
We would like to thank Daniel López with the International Legal Consortium at the Campaign for Tobacco-Free Kids, for his contribution in the interpretation of the provisions of the Mexican implementing regulation and the manual.
Funding Statement
This work was supported by Bloomberg Philanthropies. The sponsors did not influence the design, the data collection, the analysis, the writing in any way, and the decision to publish these results.
Footnotes
Funding.
This work was supported by Bloomberg Philanthropies. The sponsors did not influence the design, the data collection, the analysis, the writing in any way, and the decision to publish these results.
Disclaimer.
Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the RPSP/PAJPH and/or the Pan American Health Organization.
REFERENCES
- 1.World Health Organization Framework Convention on Tobacco Control: guidelines for implementation Article 8; 2013 edition. [Accessed on 25 October 2025]. Available from: https://fctc.who.int/resources/publications/m/item/protection-from-exposure-to-tobacco-smoke.; World Health Organization. Framework Convention on Tobacco Control: guidelines for implementation Article 8; 2013 edition. [Accessed on 25 October 2025]. Available from: https://fctc.who.int/resources/publications/m/item/protection-from-exposure-to-tobacco-smoke
- 2.Crosbie E, Sebrié EM, Glantz SA. Strong advocacy led to successful implementation of smokefree Mexico City. Tob Control. 2011;20(1):64–72. doi: 10.1136/tc.2010.037010. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Crosbie E, Sebrié EM, Glantz SA. Strong advocacy led to successful implementation of smokefree Mexico City. Tob Control. 2011;20(1):64-72. doi: 10.1136/tc.2010.037010 [DOI] [PMC free article] [PubMed]
- 3.Ponce-Hernandez DJ, Sordo L, Reynales-Shigematsu LM, Regidor-Poyatos E, Henares-Montiel J, Calderón-Villarreal A. Progress and challenges in tobacco control policies in Mexico, 2003-2017: an approach using the Tobacco Control Scale. J Public Health Policy. 2022;43(3):431–444. doi: 10.1057/s41271-022-00359-5. doi. PMID: 36038768. [DOI] [PubMed] [Google Scholar]; Ponce-Hernandez DJ, Sordo L, Reynales-Shigematsu LM, Regidor-Poyatos E, Henares-Montiel J, Calderón-Villarreal A. Progress and challenges in tobacco control policies in Mexico, 2003-2017: an approach using the Tobacco Control Scale. J Public Health Policy. 2022;43(3):431-444. doi: 10.1057/s41271-022-00359-5. PMID: 36038768. [DOI] [PubMed]
- 4.Crosbie E, Perez S, Rocha Camarena A, Ochoa Vivanco V, Severini G, Gutkowski P, et al. The perfect storm: applying the multiple streams framework to understand the adoption of a WHO Framework Convention on Tobacco Control-Based Policy in Mexico. Int J Environ Res Public Health. 2024;21(7):917. doi: 10.3390/ijerph21070917. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Crosbie E, Perez S, Rocha Camarena A, Ochoa Vivanco V, Severini G, Gutkowski P, et al. The perfect storm: applying the multiple streams framework to understand the adoption of a WHO Framework Convention on Tobacco Control-Based Policy in Mexico. Int J Environ Res Public Health. 2024;21(7):917. doi: 10.3390/ijerph21070917 [DOI] [PMC free article] [PubMed]
- 5.Cámara de Diputados del Honorable Congreso de la Unión . Ley general para el control de tabaco de México. Ciudad de Mexico: [17 February 2022. Accessed 22 April 2025]. Available from: https://www.diputados.gob.mx/LeyesBiblio/pdf/LGCT.pdf. [Google Scholar]; Cámara de Diputados del Honorable Congreso de la Unión. Ley general para el control de tabaco de México. Ciudad de Mexico, 17 February 2022. [Accessed 22 April 2025] Available from: https://www.diputados.gob.mx/LeyesBiblio/pdf/LGCT.pdf
- 6.Cámara de Diputados del Honorable Congreso de la Unión . Reglamento de la ley general para el control del tabaco. Mexico: [December 16, 2022]. [Accessed 22 April 2025]. Available from: https://www.diputados.gob.mx/LeyesBiblio/regley/Reg_LGCT.pdf. [Google Scholar]; Cámara de Diputados del Honorable Congreso de la Unión. Reglamento de la ley general para el control del tabaco. Mexico, December 16, 2022. [Accessed 22 April 2025]. Available from: https://www.diputados.gob.mx/LeyesBiblio/regley/Reg_LGCT.pdf
- 7.Diario Oficial de la Federación . Decreto por el que se prohíbe la circulación y comercialización en el interior de la República, cualquiera que sea su procedencia, de los sistemas electrónicos de administración de nicotina, sistemas similares sin nicotina, sistemas alternativos de consumo de nicotina, cigarrillos electrónicos y dispositivos vaporizadores con usos similares, así como las soluciones y mezclas utilizadas en dichos sistemas. Diario Oficial de la Federación; Mexico: [31 May 31 2022]. [Accessed 22 April 2025]. Available from: https://www.dof.gob.mx/nota_detalle.php?codigo=5653845&fecha=31/05/2022#gsc.tab=0. [Google Scholar]; Diario Oficial de la Federación. Decreto por el que se prohíbe la circulación y comercialización en el interior de la República, cualquiera que sea su procedencia, de los sistemas electrónicos de administración de nicotina, sistemas similares sin nicotina, sistemas alternativos de consumo de nicotina, cigarrillos electrónicos y dispositivos vaporizadores con usos similares, así como las soluciones y mezclas utilizadas en dichos sistemas. Diario Oficial de la Federación. Mexico, 31 May 31 2022. [Accessed 22 April 2025]. Available from: https://www.dof.gob.mx/nota_detalle.php?codigo=5653845&fecha=31/05/2022#gsc.tab=0
- 8.Severini G, Sandoval RC, Sóñora G, Sosa P, Gutkowski P, Severini L, et al. Towards a smoke-free world? South America became the first 100% smoke-free subregion in the Americas. Rev Panam Salud Publica. 2022;46::e103. doi: 10.26633/RPSP.2022.103. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Severini G, Sandoval RC, Sóñora G, Sosa P, Gutkowski P, Severini L, et al. Towards a smoke-free world? South America became the first 100% smoke-free subregion in the Americas. Rev Panam Salud Publica. 2022;46:e103. doi: 10.26633/RPSP.2022.103 [DOI] [PMC free article] [PubMed]
- 9.Pan American Health Organization . Report on Tobacco Control for the Region of the Americas 2022. Revised edition. Washington, DC: PAHO; 2023. doi. [DOI] [Google Scholar]; Pan American Health Organization. Report on Tobacco Control for the Region of the Americas 2022. Revised edition. Washington, DC: PAHO; 2023. doi: 10.37774/9789275127032
- 10.Instituto Nacional de Salud Pública . Encuesta Global de Tabaquismo en Adultos. Cuernavaca, México; 2023. [Accessed 22 April 2025]. Available from: https://www.gob.mx/cms/uploads/attachment/file/895921/REPORTE_COMPLETO_GATS_2023.pdf. [Google Scholar]; Instituto Nacional de Salud Pública. Encuesta Global de Tabaquismo en Adultos. Cuernavaca, México 2023. [Accessed 22 April 2025]. Available from: https://www.gob.mx/cms/uploads/attachment/file/895921/REPORTE_COMPLETO_GATS_2023.pdf
- 11.Instituto Nacional de Estadística, Geografía e Informática [November, 2022]; [Accessed 22 April 2025];Servicios de alojamiento temporal y de preparación de alimentos y bebidas parte 1 y 2. Available from: https://www.inegi.org.mx/app/descarga/?ti=6. [Google Scholar]; Instituto Nacional de Estadística, Geografía e Informática. Servicios de alojamiento temporal y de preparación de alimentos y bebidas parte 1 y 2, November, 2022. [Accessed 22 April 2025]. Available from: https://www.inegi.org.mx/app/descarga/?ti=6
- 12.Instituto Nacional de Estadística, Geografía e Informática . Encuesta Agropecuaria 2019 Manual de Cartografía. Aguascalientes; 2020. [Accessed 22 April 2025]. Available from: https://www.inegi.org.mx/contenidos/productos/prod_serv/contenidos/espanol/bvinegi/productos/nueva_estruc/702825197315.pdf. [Google Scholar]; Instituto Nacional de Estadística, Geografía e Informática. Encuesta Agropecuaria 2019 Manual de Cartografía. 2020, Aguascalientes. [Accessed 22 April 2025]. Available from: https://www.inegi.org.mx/contenidos/productos/prod_serv/contenidos/espanol/bvinegi/productos/nueva_estruc/702825197315.pdf
- 13.Comisión Federal para la Protección contra Riesgos Sanitarios . Manual de identidad gráfica y señalización para los espacios 100% libres de humo de tabaco y emisiones. Ciudad de México; 2023. [Accessed 22 April 2025]. Available from: https://www.gob.mx/cms/uploads/attachment/file/829988/MANUAL_TABACO_2023_02062023_compressed.pdf. [Google Scholar]; Comisión Federal para la Protección contra Riesgos Sanitarios. Manual de identidad gráfica y señalización para los espacios 100% libres de humo de tabaco y emisiones. Ciudad de México, 2023. [Accessed 22 April 2025]. Available from: https://www.gob.mx/cms/uploads/attachment/file/829988/MANUAL_TABACO_2023_02062023_compressed.pdf
- 14.Kobo Inc [Accessed 25 October 2025];KoboToolbox. Available from: https://kf.kobotoolbox.org/#/projects/home. [Google Scholar]; Kobo Inc. KoboToolbox. Accessed 25 October 2025. Available from: https://kf.kobotoolbox.org/#/projects/home
- 15.Ay P, Evrengil E, Guner M, Dagli E. Noncompliance to smoke-free law: which hospitality premises are more prone? Public Health. 2016;141:1–6. doi: 10.1016/j.puhe.2016.08.008. doi. [DOI] [PubMed] [Google Scholar]; Ay P, Evrengil E, Guner M, Dagli E. Noncompliance to smoke-free law: which hospitality premises are more prone? Public Health. 2016;141:1-6. doi: 10.1016/j.puhe.2016.08.008 [DOI] [PubMed]
- 16.Barnoya J, Monzon JC, Briz P, Navas-Acien A. Compliance to the smoke-free law in Guatemala 5-years after implementation. BMC Public Health. 2016;16:318. doi: 10.1186/s12889-016-2960-x. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Barnoya J, Monzon JC, Briz P, Navas-Acien A. Compliance to the smoke-free law in Guatemala 5-years after implementation. BMC Public Health. 2016;16:318. doi: 10.1186/s12889-016-2960-x [DOI] [PMC free article] [PubMed]
- 17.Navas-Acien A, Çarkoğlu A, Ergör G, Hayran M, Ergüder T, Kaplan B, et al. Compliance with smoke-free legislation within public buildings: a cross-sectional study in Turkey. Bull World Health Organ. 2016;94(2):92–102. doi: 10.2471/BLT.15.158238. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Navas-Acien A, Çarkoğlu A, Ergör G, Hayran M, Ergüder T, Kaplan B, et al. Compliance with smoke-free legislation within public buildings: a cross-sectional study in Turkey. Bull World Health Organ. 2016;94(2):92-102. doi: 10.2471/BLT.15.158238 [DOI] [PMC free article] [PubMed]
- 18.Suarjana K, Astuti PAS, Artawan Eka, Putra IWG, Duana MK, Mulyawan KH, Chalidyanto D, et al. Implementation of smoke-free law in Denpasar Bali: Between compliance and social norms of smoking. J Public Health Res. 2020;9(3):1747. doi: 10.4081/jphr.2020.1747. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Suarjana K, Astuti PAS, Artawan Eka Putra IWG, Duana MK, Mulyawan KH, Chalidyanto D, et al. Implementation of smoke-free law in Denpasar Bali: Between compliance and social norms of smoking. J Public Health Res. 2020;9(3):1747. doi: 10.4081/jphr.2020.1747 [DOI] [PMC free article] [PubMed]
- 19.Kataoka A, Muraki I, Nakamura M, Ito Y. How much progress has been made toward a smoke-free environment in the restaurants and bars of Japan? Lim itations of partial bans and their enforcement. BMC Public Health. 2024;24(1):3327. doi: 10.1186/s12889-024-20765-6. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Kataoka A, Muraki I, Nakamura M, Ito Y. How much progress has been made toward a smoke-free environment in the restaurants and bars of Japan? Lim itations of partial bans and their enforcement. BMC Public Health. 2024;24(1):3327. doi: 10.1186/s12889-024-20765-6 [DOI] [PMC free article] [PubMed]
- 20.Montini T, Bero LA. Implementation of a workplace smoking ban in bars: the limits of local discretion. BMC Public Health. 2008;8:402. doi: 10.1186/1471-2458-8-402. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Montini T, Bero LA. Implementation of a workplace smoking ban in bars: the limits of local discretion. BMC Public Health. 2008;8:402. doi: 10.1186/1471-2458-8-402. [DOI] [PMC free article] [PubMed]
- 21.Thrasher JF, Pérez-Hernández R, Swayampakala K, Arillo-Santillán E, Bottai M. Policy support, norms, and secondhand smoke exposure before and after implementation of a comprehensive smoke-free law in Mexico City. Am J Public Health. 2010;100(9):1789–98. doi: 10.2105/AJPH.2009.180950. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Thrasher JF, Pérez-Hernández R, Swayampakala K, Arillo-Santillán E, Bottai M. Policy support, norms, and secondhand smoke exposure before and after implementation of a comprehensive smoke-free law in Mexico City. Am J Public Health. 2010;100(9):1789-98. doi: 10.2105/AJPH.2009.180950 [DOI] [PMC free article] [PubMed]
- 22.Gravely S, Nyamurungi KN, Kabwama SN, Okello G, Robertson L, et al. Knowledge, opinions and compliance related to the 100% smoke-free law in hospitality venues in Kampala, Uganda: cross-sectional results from the KOMPLY Project. BMJ Open. 2018;8(1):e017601. doi: 10.1136/bmjopen-2017-017601. doi. [DOI] [PMC free article] [PubMed] [Google Scholar]; Gravely S, Nyamurungi KN, Kabwama SN, Okello G, Robertson L, et al. Knowledge, opinions and compliance related to the 100% smoke-free law in hospitality venues in Kampala, Uganda: cross-sectional results from the KOMPLY Project. BMJ Open. 2018;8(1):e017601. doi: 10.1136/bmjopen-2017-017601 [DOI] [PMC free article] [PubMed]
- 23.Peruga A, Molina X, Delgado I, Matute I, Olea A, Hirmas M, et al. Compliance with the smoking ban in enclosed, semiopen and open areas of workplaces and public places in Chile. Tob Control. 2021;30(5):570–573. doi: 10.1136/tobaccocontrol-2020-055632. doi. [DOI] [PubMed] [Google Scholar]; Peruga A, Molina X, Delgado I, Matute I, Olea A, Hirmas M, et al. Compliance with the smoking ban in enclosed, semiopen and open areas of workplaces and public places in Chile. Tob Control. 2021;30(5):570-573. doi: 10.1136/tobaccocontrol-2020-055632 [DOI] [PubMed]