Compliance with smoke-free laws in hospitality venues in Ethiopia: qualitative insights into barriers and facilitators using the Tobacco Control Theoretical Framework

Background: Ethiopia has made significant strides in adopting comprehensive smoke-free laws aligned with the World Health Organization's Framework Convention on Tobacco Control, which mandates that all public places, including hospitality venues, public transportation, and workplaces, be 100% smoke-free. However, effective implementation across regions remains uneven. This study examines the barriers and facilitators influencing the enforcement of smoke-free legislation in Ethiopia. Methods: This qualitative study was conducted in 10 major cities in Ethiopia, involving 41 key informant interviews with individuals working on tobacco control. For this study, a framework comprising five key concepts, namely, institutions, agendas, networks, socioeconomic conditions, and ideas, was employed. Semi-structured interview guides were developed in English and then translated into local languages. All audio-recorded interviews were transcribed verbatim and translated into English. Deductive thematic analysis was conducted using ATLAS.ti Scientific Software. Results: The study identified several key facilitators of compliance with smoke-free laws in Ethiopia, including a well-established legal framework, clear institutional structures, especially in the capital city (Addis Ababa), strong political leadership, stakeholder collaboration, supportive cultural and religious norms, and growing public awareness of the harms associated with tobacco use. However, significant barriers remain, particularly in regional areas. These include the absence of dedicated tobacco control units, lack of region specific implementation guidelines, competing policy priorities, limited budget and human resources, and insufficient law enforcement engagement. Cultural acceptance of smoking in some communities, economic reliance on tobacco farming, and misconceptions about products like shisha further undermine compliance with smoke-free laws. Additionally, weak coordination across sectors and limited ownership of tobacco control responsibilities among non-health actors hinder effective implementation. Conclusion: The study highlights the need for region-specific guidelines, accountable institutions, improved coordination, targeted education, and the addressing of socioeconomic barriers. Leveraging existing strengths and addressing identified challenges will be critical to achieving equitable and effective enforcement of smoke-free laws nationwide.