Exposure to secondhand smoke in hospitality settings in Ghana: Evidence of changes since implementation of smoke-free legislation.

Introduction: Ghana has a partial smoking ban with smoking allowed in designated smoking areas. Studies evaluating smoke-free laws are scarce in Sub-Saharan Africa. Evaluation of smoke-free laws is an effective means of measuring progress towards a smoke-free society. This study assessed the level of compliance to the provisions of the current smoke-free policy using air quality measurements for fine particulate matter (PM) in hospitality venues in Ghana.

Methods: This was a cross-sectional observational study conducted in 2019 using a structured observational checklist complemented with air quality measurements using Dylos monitors across 152 randomly selected hospitality venues in three large cities in Ghana.

Results: Smoking was observed in a third of the venues visited. The median indoor PM concentration was 14.6 μg/m (range: 5.2-349). PM concentrations were higher in venues where smoking was observed (28.3 μg/m) compared to venues where smoking was not observed (12.3 μg/m) (p<0.001). Hospitality locations in Accra, Ghana's capital city, had the lowest compliance levels (59.5%) and poorer air quality compared to the cities of Kumasi and Tamale.

Conclusions: The study shows that while smoking and SHS exposure continues in a substantial number of hospitality venues, there is a marked improvement in PM concentrations compared to earlier studies in Ghana. There is still a considerable way to go to increase compliance with the law. Efforts are needed to develop an action plan to build upon recent progress in providing smoke-free public spaces in Ghana.