The indicators are based on article 8 of the WHO Framework Convention on Tobacco Control, and its guidelines for implementation, which relate to protecting people from exposure to tobacco smoke. And require complete smoking bans in all indoor workplaces, public transport, indoor public places and, as appropriate, other public places.

MPOWER P Protect from tobacco smoke

The letter P in MPOWER denotes the "Protect from tobacco smoke" measure. Second-hand tobacco smoke is present in virtually all places where smoking is permitted, and there is no safe level of exposure. Breathing secondhand tobacco smoke has serious and often fatal health consequences.

Globally, it is estimated that about one third of adults are regularly exposed to secondhand tobacco smoke. 100% smoke-free environments (without designated smoking rooms or areas) are the only proven way to adequately protect the health of people from the harmful effects of secondhand tobacco smoke. This indicator measures the implementation status of the P measure in eight selected indoor public places.

Country's legislation is assessed to determine whether each of the following places is required to be completely smoke-free (without designated smoking rooms or areas allowed)

• healthcare facilities;
• educational facilities other than universities;
• universities;
• government facilities;
• indoor offices and workplaces;
• restaurants;
• pubs and bars;
• public transport.

Smoke-free facilities

Health care facilities: Health care facilities are all publicly and privately managed places where health care is provided in a public setting (i.e., not in the home). For example, laws that prohibit smoking only in “public hospitals” (and not in private ones) or only in “hospitals” and not other health care facilities, are not complete bans for health care facilities. Note that a "complete smoking ban" is defined such that smoking is not allowed at any time in any indoor area under any circumstance, including private functions and separate smoking rooms. Under the definition of complete smoking ban, health care facilities may exempt enclosed rooms in psychiatric facilities and long-term facilities, such as nursing homes for patients or residents' use.

Education facilities except universities: Smoking is banned in educational facilities except universities. "Educational facilities except universities" includes all primary and secondary schools, both private and public. This also includes the schools’ facilities, meaning any building used as a part of the students' educational program. Note that a "complete smoking ban" is defined such that smoking is not allowed at any time in any indoor area under any circumstance, including private functions and separate smoking rooms.

Universities: Smoking is banned in universities. "Universities" includes all public and private post-secondary educational institutions, usually intended for adults. A university, as an educational institution, may be covered under the same law as other educational facilities if the language of the law is broad enough. Often laws for educational facilities do not include higher education facilities such as universities. Universities may have an internal policy that bans smoking, however, this indicator in concerned with whether the ban is required by a national law. Note that a "complete smoking ban" is defined such that smoking is not allowed at any time in any indoor area under any circumstance, including private functions and separate smoking rooms.

Government facilities: "Governmental facilities" includes all buildings used in carrying out government business, not limited to office buildings. Note that a "complete smoking ban" is defined such that smoking is not allowed at any time in any indoor area under any circumstance, including private functions and separate smoking rooms. Under the definition of complete smoking ban, government facilities may exempt designated smoking rooms in prison facilities or other similar institutions.

Offices and workplacesSmoking is banned in indoor offices and workplaces not elsewhere specified. "Indoor offices and workplaces" includes all private sector offices and workplaces, including buildings, vehicles and other indoor places used as workplaces. A "complete smoking ban" is defined such that smoking is not allowed at any time in any indoor area under any circumstance, including private functions and separate smoking rooms.

Restaurants primarily serve food that is made and consumed on the premises, though it may be taken-away. Restaurants may also serve alcoholic beverages, but the substantial portion of profit should come from the sale of food. Note that a "complete smoking ban" is defined such that smoking is not allowed at any time in any indoor area under any circumstance, including private functions and separate smoking rooms.

Pubs, bars and cafés: Smoking is banned in pubs, bars and cafés. Pubs, bars and cafés are defined as establishments that make a substantial portion of their profits from the sale of beverages, whether alcoholic or not. They may also sell food or other items. Note that a "complete smoking ban" is defined such that smoking is not allowed at any time in any indoor area under any circumstance, including private functions and separate smoking rooms.

Public transport: Smoking is banned in public transport. Transport includes transport by land, water or air and includes generally buses, taxis, trams, trains, domestic air transport, international air transport, domestic water transport and international water transport. Note that a "complete smoking ban" is defined such that smoking by anyone (including the driver) is not allowed at any time in any indoor area under any circumstance, and separate smoking rooms are not allowed.

Overall compliance with smoking bans (score): The level of compliance with the law was measured by asking in-country experts to provide their assessments by interview. These experts included at least three, and up to five, of the following persons:

• the most senior government official in charge of tobacco control or tobacco-related conditions;
• the head of a prominent NGO dedicated to tobacco control;
• a health professional (e.g. physician, nurse, pharmacist) specializing in tobacco-related conditions;
• a staff member of a public health university department;
• the Tobacco Free Initiative focal point at the WHO country office.

Assessments were requested for each provision which is in place under a national law banning smoking in indoor public places, workplaces and public transport. Provisions not in place, or provisions put in place too recently to assess, were excluded from the request. An assessment of overall compliance with the law (all provisions considered together) was also requested.

The provisions of interest for assessing compliance with smoke-free laws are:

1. A complete smoking ban in health care facilities.
2. A complete smoking ban in educational facilities except universities.
3. A complete smoking ban in educational facilities.
4. A complete smoking ban in governmental facilities.
5. A complete smoking ban in offices and workplaces facilities.
6. A complete smoking ban in restaurants.
7. A complete smoking ban in cafes, pubs and bars.
8. A complete smoking ban in public transport.

A compliance score of 0-10 was calculated based on the average responses of the 3-5 experts. If all experts said compliance was "high", a score of 10 was achieved. If all experts said compliance was "minimal", this resulted in a score of zero. A mix of high, moderate and minimal responses resulted in an average score calculated out of 10. Missing responses were scored as "missing" unless there were at least 3 non-missing responses given.

WHO assessment of original and translated legislation and regulation documents.

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Biannual