Association between Knowledge, Perceptions, and Participation and Smoke-Free Area Implementation

Abstract

Background: Tobacco use remains a major global public health concern, contributing to more than 8 million deaths annually. Exposure to secondhand smoke continues to affect a large proportion of non-smokers, particularly in Southeast Asia and the Western Pacific. Smoke-free area (SFA) policies are essential public health strategies to reduce tobacco exposure; however, their effectiveness depends on behavioral and participatory factors such as knowledge, perceptions, and community participation. This study aimed to analyze the association between knowledge, perceptions, and participation with the implementation of smoke-free areas in a primary health care setting.

Methods: This study used an analytic observational design with a cross-sectional approach. The study population consisted of visitors to a primary health care facility, with 120 respondents selected using consecutive sampling. Data were collected through structured questionnaires assessing knowledge, perceptions, and participation related to SFA policies, and direct observation checklists to assess SFA implementation. Data were analyzed using univariate and bivariate analysis (Chi-square or Fisher’s exact test) with a significance level of p < 0.05.

Results: Most respondents were aged 20–40 years (70%), with equal distribution by sex. Good knowledge (85%), positive perceptions (90%), and passive participation (65%) were dominant. Adequate SFA implementation was observed in 70% of settings. Knowledge, perceptions, and participation were significantly associated with SFA implementation (p < 0.05). Respondents with good knowledge were 2.3 times more likely to be associated with adequate implementation (PR = 2.30; 95% CI: 1.20–4.40). Positive perception showed the strongest association (PR = 4.55; 95% CI: 1.25–16.60). Active participation increased the likelihood of adequate implementation by 1.53 times (PR = 1.53; 95% CI: 1.22–1.91).

Conclusion: Knowledge, perceptions, and participation are significant determinants of smoke-free area implementation. Strengthening public education, improving community engagement, and enhancing enforcement strategies are essential to optimize smoke-free policy implementation in health care settings.