Content analysis of media coverage on smoke-free policy implementation in ten low- and middle-income countries

Low- and middle-income countries (LMICs) face a disproportionate exposure and disease burden from secondhand smoke (SHS). Creating completely smoke-free indoor public places is effective in protecting people from SHS. This study examines how online news outlets in LMICs discuss existing smoke-free policies and their implementation.

In September 2023, we used Tobacco Watcher (www.tobaccowatcher.org), a tobacco news surveillance platform, to identify articles using the built-in topic 'Air' (i.e. smoke-free policy) and search terms 'implementation' or 'compliance' in 10 LMICs from 2022 to 2023. Two trained coders independently assessed all articles for their relevance (either substantially discussing in multiple paragraphs or holding a clear position on smoke-free policy implementation). A content analysis was conducted, with the coders independently coding each article for argument position, content, evaluation of current implementation efforts, and argument presenters until reaching 80% agreement or higher. Discrepancies in coding were resolved through discussion.

Among 634 articles retrieved, 345 met the inclusion criteria. Most of these articles (81%, n=276) supported implementation of existing smoke-free policies; 31% (n=107) considered current smoke-free policy implementation efforts unsuccessful, citing lack of enforcement, signage, and other violations, while 20% (n=70) considered implementation to be successful; 21% (n=74) suggested a need for stronger smoke-free policies, including the elimination of designated smoking areas. Common argument presenters included government agencies (84%, n=291), civil society organizations (e.g. civil society: 40%, n=139), WHO (19%, n=67), and researchers or experts (18%, n=62).

Discourse around smoke-free policy implementation in online news media of LMICs was generally supportive, praising complete bans and active implementation. However, coverage highlights that enforcement remained a challenge and pointed to a need for stronger policies. News media can be utilized as avenues for raising awareness surrounding tobacco control challenges, building support for policy, and countering tobacco industry narratives.