Challenges and Contextual Dynamics in Implementing Smoke-Free School Policies in Thailand: A Qualitative Study

Thailand has one of the strongest tobacco control frameworks in Southeast Asia, including comprehensive smoke-free laws and a ban on e-cigarettes. However, implementation of smoke-free school policies remains uneven across diverse educational settings. This study examined the contextual and governance dynamics shaping implementation and sustainability across school types.

A qualitative study was conducted using 14 focus group discussions (FGDs) across 14 provinces. Participants (n = 122) included school administrators, teachers, and provincial tobacco control stakeholders. Data were analyzed using reflexive thematic analysis to identify key governance conditions influencing implementation.

Six interrelated themes emerged: institutional diversity, structural constraints, enforcement gaps, multi-level enablers, sustainability challenges, and field-driven recommendations. Implementation gaps were driven less by policy absence than by differentiated governance conditions. Hybrid authority structures, leadership turnover, digital diffusion of e-cigarettes, and geographic monitoring disparities constrained enforcement capacity. While teacher networks and provincial endorsement enhanced legitimacy, sustainability depended on institutional embedding rather than individual leadership.

Uniform national standards require context-sensitive implementation strategies. Embedding smoke-free criteria within evaluation systems, institutionalizing peer networks, and addressing geographic inequities are critical to strengthening sustainability and equity.

Strong legislation alone is insufficient; tailored governance approaches are essential to achieve equitable and durable implementation.