Assessing compliance with smoke-free laws in Purbakhola Rural Municipality, Nepal: A cross-sectional observational...

Despite Nepal's comprehensive tobacco control legislation, evidence on its implementation at the local level, particularly in rural areas, remains limited. This study assessed compliance with smoke-free laws in public places of Purbakhola Rural Municipality, Palpa, Nepal. A cross-sectional observational survey was conducted from May 7 to May 16, 2025, across all six wards of the municipality. We assessed 219 public places from 11 categories. Compliance with smoke-free provisions was measured using an adapted observational checklist covering six indicators: active smoking, no-smoking signage, designated smoking areas, ashtrays, cigarette butt litter and tobacco advertisement. Descriptive statistics estimated compliance and exploratory logistic regression examined associations between observed active smoking and environmental factors, including the presence of ashtrays and no-smoking signage. Compliance with smoke-free provisions was high in public institutional settings, including health facilities (100.0%), educational institutions (100.0%), and government offices (88.8-100.0%). In contrast, substantial non-compliance was observed in the hospitality sector, where only 45.0% of restaurants were free from indoor smoking and 37.5% had no visible ashtrays. A critical gap was the lack of systemic compliant no-smoking signage, even in high-compliance settings, with 54.5% of health facilities non-compliant indoors and 100.0% of government offices non-compliant outdoors. The presence of ashtrays was the strongest predictor of smoking, with indoor ashtrays associated with dramatically higher odds of observed smoking. In contrast, no statistically significant association was found for signage, although no smoking was observed in venues with indoor signage. There is a significant implementation gap in smoke-free law compliance particularly in the hospitality sector. The findings underscore the urgent need for strengthening enforcement, ensuring the removal of ashtrays-a major environmental cue for smoking-and promoting the universal installation of standardized no-smoking signage to align practice with policy and protect public from secondhand smoke.