Adherence to smoke-free laws at retail points-of-sale and associated factors in 10 cities in Ethiopia

Objectives The objective of this study was to assess adherence to smoke-free laws at points-of-sale (PoS), i.e., retail outlets that sell various goods including tobacco products, and to identify predictors of low adherence. Methods This cross-sectional observational study was conducted in December 2022 across 10 Ethiopian cities covering 1,323 PoS such as regular shops, permanent kiosks, khat shops, supermarkets and minimarkets. Sampling was performed using a two-stage cluster design, with random selection of PoS. Data were collected using checklists through covert observations. Logistic regression identified predictors of low adherence. Results More than half of PoS (52.5%) showed good adherence, 23.2% moderate, 20.8% poor or none, and only 3.4% met full adherence. Supermarkets/minimarkets had the highest rates of good or full adherence (83.9%), whilst kiosks and khat shops had the lowest (40.7% and 35.4%, respectively) rates of good or full adherence. Low adherence was higher in kiosks [adjusted odds ratio (aOR)=7.02, 95% CI: 3.76-13.13)] and khat shops (aOR=6.26, 95% CI: 3.48-11.26). Low adherence was also observed in Semera-Logia (aOR = 21.27, 95% CI: 13.26–34.12) and Gambella (aOR = 12.07, 95% CI: 7.64–19.08). Predictors of indoor smoking included being a khat shop (aOR=3.13, 95% CI: 1.29-7.60), being located in Semera-Logia (aOR=8.47, 95% CI: 3.49-26.54), presence of outdoor smoking (aOR=3.38, 95% CI: 2.07-5.51) and lighters (aOR=5.26, 95% CI: 3.05–9.06). Conclusion The study highlights enforcement gaps at PoS, particularly in khat shops, kiosks, and in Semera Logia and Gambella cities. Strengthening smoke-free law implementation requires region-specific interventions for high-risk areas and retail outlets.