title: Compliance with smoke-free legislation within public buildings: a cross-sectional study in Turkey.
abstract: OBJECTIVE
  To investigate public compliance with legislation to prohibit smoking within public buildings and the extent of tobacco smoking in outdoor areas in Turkey.
  
  
  METHODS
  Using a standardized observation protocol, we determined whether smoking occurred and whether ashtrays, cigarette butts and/or no-smoking signs were present in a random selection of 884 public venues in 12 cities in Turkey. We visited indoor and outdoor locations in bars/nightclubs, cafes, government buildings, hospitals, restaurants, schools, shopping malls, traditional coffee houses and universities. We used logistic regression models to determine the association between the presence of ashtrays or the absence of no-smoking signs and the presence of individuals smoking or cigarette butts.
  
  
  RESULTS
  Most venues had no-smoking signs (629/884). We observed at least one person smoking in 145 venues, most frequently observed in bars/nightclubs (63/79), hospital dining areas (18/79), traditional coffee houses (27/120) and government-building dining areas (5/23). For 538 venues, we observed outdoor smoking close to public buildings. The presence of ashtrays was positively associated with indoor smoking and cigarette butts, adjusted odds ratio, aOR: 315.9; 95% confidence interval, CI: 174.9-570.8 and aOR: 165.4; 95% CI: 98.0-279.1, respectively. No-smoking signs were negatively associated with the presence of cigarette butts, aOR: 0.5; 95% CI: 0.3-0.8.
  
  
  CONCLUSIONS
  Additional efforts are needed to improve the implementation of legislation prohibiting smoking in indoor public areas in Turkey, especially in areas in which we frequently observed people smoking. Possible interventions include removing all ashtrays from public places and increasing the number of no-smoking signs.
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street (Office W7033B), Baltimore, MD 21205, United States of America (USA).
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
authors.affiliation: Department of Psychology, Kadir Has University, Istanbul, Turkey .
authors.forename: Asli
authors.initials: A
authors.lastname: Çarkoğlu
authors.affiliation: Izmir Dokuz Eylül School of Medicine, Izmir, Turkey .
authors.forename: Gül
authors.initials: G
authors.lastname: Ergör
authors.affiliation: Hacettepe University Cancer Institute, Ankara, Turkey .
authors.forename: Mutlu
authors.initials: M
authors.lastname: Hayran
authors.affiliation: World Health Organization Country Office, Çankaya, Ankara, Turkey .
authors.forename: Toker
authors.initials: T
authors.lastname: Ergüder
authors.affiliation: Ministry of Health General Directorate of Health Research, Ankara, Turkey .
authors.forename: Bekir
authors.initials: B
authors.lastname: Kaplan
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street (Office W7033B), Baltimore, MD 21205, United States of America (USA).
authors.forename: Jolie
authors.initials: J
authors.lastname: Susan
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street (Office W7033B), Baltimore, MD 21205, United States of America (USA).
authors.forename: Hoda
authors.initials: H
authors.lastname: Magid
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street (Office W7033B), Baltimore, MD 21205, United States of America (USA).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Pollak
authors.affiliation: Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA .
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Cohen
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011633:Public Facilities / Q000706:statistics & numerical data*; D061845:Smoke-Free Policy; D014421:Turkey