Assessing Compliance with Smoke-Free Laws in Purbakhola Rural Municipality, Nepal: A Cross-Sectional Observational Study

Introduction Despite Nepal’s comprehensive tobacco control legislation, evidence on its implementation at the local level, particularly in rural areas, remains scarce. This study assessed compliance with smoke-free laws in public places within Purbakhola Rural Municipality, Palpa, Nepal. Methods A cross-sectional observational survey was conducted from May, 2025, across all six wards of the municipality. A total of 219 public places across 14 categories were selected. Compliance was measured using an adapted observational checklist assessing six key indicators: presence of signage, active smoking, astryas, designated smoking areas, and cigarette butt litter. Data were analyzed using IBM SPSS 31. Results Compliance was high in institutional settings such as health facilities (100.0% on most indoor measures), educational institutions (100.0%), and government offices (88.8-100.0%). Significant gaps were identified in the hospitality sector, where only 45.0% of restaurants were free from active indoor smoking and only 37.5% had no visible ashtrays. A critical finding was the systemic lack of compliant no-smoking signage, even in high-compliance settings, with 54.5% of health facilities non-compliant indoors and 100.0% of government offices non-compliant outdoors. The visible ashtrays were the strongest predictor of smoking, with indoor ashtrays associated with dramatically higher odds of observed smoking. In contrast, no statistically significant association was found for signage, though a promising signal showed 0% smoking in venues with indoor signage present. Conclusion This study reveals a significant implementation gap of tobacco control in a rural municipality of Nepal The findings underscore the urgent need for a dual strategy: rigorous enforcement to remove ashtrays–a major environmental cue for smoking–and a concerted campaign to ensure the universal installation of standardized ‘No Smoking’ signage to align practice with policy and protect public health.