Hitting two targets with one shot: waiving fines for smoke-free violations to increase cessation service use

Fines are a common tool to enforce smoke-free policies, but they offer no direct support for quitting, a crucial step in reducing tobacco smoke at its source and improving health. In June 2020, South Korea introduced a policy offering fine waivers to individuals who violated smoke-free regulations if they enrolled in cessation programmes. We examined the characteristics and quit success rates of these participants.

We analysed cohort data from 159 920 individuals enrolled in smoking cessation clinics at public health centres between June 2020 and July 2021. Participants were categorised into fine-exemption (n=984) and voluntary enrolment (n=158 936) groups. Their characteristics and quit success at 6 months were compared descriptively, and logistic regression was used to identify factors associated with 6-month cessation success.

The fine-exemption group was younger (aged <30: 17.9% in the voluntary group, 41.9% in the exemption group, p<0.001), less likely to be covered by the national health insurance system (71.4% in the voluntary group and 59.7% in the exemption group, p<0.001), and had a higher proportion of non-response on education items (31.5% in the voluntary group and 38.2% in the fine-exemption group, p<0.001). Despite having lower smoking amounts, shorter smoking duration, and lower nicotine dependence, the exemption group showed lower success rates than the voluntary group (32.9% vs 26.3%; OR=0.67, 95% CI 0.57 to 0.78, p<0.001).

The fine-waiver policy reached individuals who differed from typical cessation clinic users, suggesting potential to expand access. However, additional strategies are needed to enhance motivation and improve success rates among individuals enrolling for fine waivers.