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College of Advanced Studies


Main Campus, Tagbilaran City

March 2019
Chapter 1




Smoking is the single largest preventable cause of disease

and premature death. It is a prime factor in heart disease,

stroke and chronic lung disease. This is not only affecting the

active smokers, but also the persons exposed to the passive

smoke. Among the most common smoke-related diseases are COPD,

heart disease, cancer and stroke. Smoking is also a common

trigger for asthma exacerbations and can influence asthma

development. Here in the Philippines, the Department of Health

(DOH) reported that ten people die every hour in the country due

to cigarette smoking.

Through the years, numerous attempts by the government have

been made in order to control and prevent not just health but

also environmental risks brought by smoking. Laws have been

passed and implemented to battle these risks. In the Philippines,

smoking is initiated as early as school-age and peaks at around

15-19 years old. Among the factors identified for initiation are

the presence of friends who smoke cigarettes and easy access to

cigarettes from stores and street vendors where even minors are

allowed to purchase (WHO, 2015).

Tagbilaran City in is a no exception of the prevailing

health risks brought about by smoking. As a result, the

legislators of the City came up with its own way of battling this

smoking problem, the approval of the Comprehensive Smoke-Free

Ordinance. With this, the researcher wants to know the awareness

and the level of satisfaction of the public regarding the

implementation of the ordinance. The findings of this study could

create an action plan and guidelines on what should be done to

improve its implementation.

Clean Air Act of 1999 (Republic Act

No. 8749)

This act shall be known as…

Health belief model
Executive Order
Preventive health behavior is
any activity undertaken by an Public health takes precedence
individual… over any…

(Hochbaum, Et al. 1950) Republic Act No.9211

Expectation confirmation theory It is the policy of the State

to protect the populace from
Expectations-confirmation hazardous…
theory posits that expectations,
coupled with perceived performance, Comprehensive Smoke-Free Ordinance
lead to satisfaction of the City of Tagbilaran s. 2017

(Oliver,1980) New ordinance imposes stiff

penalty on individuals who would
smoke or vape in public places…
Awareness and Level of

Non-smoking Smoking
Public Public


More Filipinos die of non-communicable diseases (NCDs) or

lifestyle diseases, as they are more commonly termed, today than

dengue, communicable diseases like tuberculosis and malaria or

street or organized crime. This is what Anthony C. Leachon, a

cardiologist and consultant of the Department of Health said in

his presentation. He further said that smoking is now the top

killer of Filipinos and account for as much as 50,000 deaths

every year. He said that 7 out of the top 10 diseases that kill

Filipinos are caused by smoking. These diseases include diseases

of the heart, diseases of the vascular system, cancer, pneumonia,

tuberculosis, chronic obstructive lung disease, and diseases of

the respiratory system. Only accidents, diabetis milletus, and

kidney diseases are not linked to smoking."(NCDs are) now an

epidemic, a silent disaster," Leachon said. "The problem with

smoking is that people will only stop if they are on the verge of

dying because this is an addiction."

Meanwhile, tobacco use and exposure to secondhand smoke

contribute to approximately 12 percent of all heart disease

deaths, as data from WHO showed. Ischemic heart diseases or the

“hardening of arteries” continue to be the leading cause of death

in the Philippines with more than 74,000 cases recorded in 2016.

“I would like to reiterate that tobacco use and breathing

secondhand smoke may indeed break your heart. You may have heard

this a million times, smoking is dangerous to your health, but we

still want to remind you every time we have a chance. Tobacco

smoke thickens the blood, increases the risk of blood clots,

narrows the arteries and restricts oxygen in the blood,” said

Health Secretary Francisco T. Duque III.

Several studies have shown that exposure to secondhand

smoke in workplaces, public places, bars and restaurants was

reduced after legislation prohibiting public smoking among

adults. A previous study was conducted in Spain to evaluate

whether imposing a complete ban on smoking in enclosed public

places, on public transport, and in the workplace could protect

non-smoking adolescents from secondhand smoke exposure using a

cohort sample. Many studies have evaluated the effects of

legislation on smoking indoors, including a complete smoking ban

in bars and restaurants or less comprehensive smoking bans, such

as those allowing smoking in designated rooms or areas.

Laws implementing bans on smoking have been introduced by

many countries in various forms over the years, with

some legislators citing scientific evidence that shows tobacco

smoking is harmful to the smokers themselves and to those

inhaling second-hand smoke.

World Health Organization (2015), considers smoking bans to

have an influence to reduce demand for tobacco by creating an

environment where smoking becomes increasingly more difficult and

to help shift social norms away from the acceptance of smoking in

everyday life.

Along with tax measures, cessation measures, and education,

smoking bans are viewed by public health experts as an important

element in reducing smoking rates and promoting positive health

outcomes. When effectively implemented they are seen as an

important element of policy to support behaviour change in favour

of a healthy lifestyle.

Estimates suggest that tobacco-control policies have likely

had an impact on tobacco consumption in the aggregate (Warner, Et

al., 2014). A wide array of research has suggested that excise

taxes and clean air policies are efficacious tobacco-control

policy tools, but these studies have come with several

limitations that prohibit linking policy with actual individual-

level behavior(Boardman, Et al., 2010). Studies have also found

robust effects of excise taxes on tobacco use.

Furthermore, Executive Order No. 26, otherwise known as the

Nationwide Smoking Ban issued and signed by Philippine

President Rodrigo Duterte on 16 May 2017 provides for the

establishment of smoke-free environments in public and enclosed

places. This executive issuance is not entirely new. It takes off

from where the Republic Act Mo. 9211 has left. It covers all

public and enclosed places found within the territorial

jurisdiction of the Philippines. Included in the definition of a

public place are schools, offices, workplaces, government

facilities, establishments that provide food and drinks,

accommodation, merchandise, professional services, entertainment

or other services, and outdoor spaces such as playgrounds, sports

grounds, church grounds, and the like. The ban replicates on a

national level an existing ordinance in Davao City that Duterte

created as mayor in 2002.

This executive order invoked the Philippine Clean Air Act of

1999 and the Tobacco Regulation Act of 2003. The former is a

comprehensive air quality management policy and program which

aims to achieve and maintain healthy air for all Filipinos. It

outlines the government’s measures to reduce air pollution and

incorporate environmental protection into its development plans.

It relies heavily on the polluter pays principle and other

market-based instruments to promote self-regulation among the

population. It further sets emission standards for all motor

vehicles and issues pollutant limitations for industry. The

latter which is the Republic Act No. 9211, also known as the

Tobacco Regulation Act of 2003, is an omnibus law regulating

smoking in public places, tobacco advertising, promotion and

sponsorship, and sales restrictions, among other requirements.

The Inter-Agency Tobacco-Committee issued Implementing Rules and

Regulations of the Tobacco Regulation Act of 2003. The

Committee’s Implementing Rules and Regulations are comprehensive

and cover a broad range of topics on tobacco control. In addition

to the advertising, promotion and sponsorship provisions in Rep.

Act No. 9211 and the Implementing Rules and Regulations, the

Consumer Act of the Philippines (Rep. Act No. 7394) addresses

false, deceptive, or misleading advertising in general.

This study is anchored on the Health Belief Model developed

by Hochbaum, Et al., which guides health promotion and disease

prevention programs. The Health Belief Model (HBM) is a

psychological model that attempts to explain and predict health

behaviors. This is done by focusing on the attitudes and beliefs

of individuals. The model was first developed in response to the

failure of a free tuberculosis (TB) health screening program.

Since then, the HBM has been adapted to explore a variety of

long- and short-term health behaviors, including sexual risk

behaviors, smoking problems and the transmission of HIV/AIDS.

In addition, changing a health behaviour is assumed to be

related to the individual’s beliefs and perceptions about

engaging in adopting or stopping the behaviour. Perceived

susceptibility to the consequences of smoking behaviour,

perceived severity of those consequences, and perceived and

actual barriers to change (e.g. costs of quitting, beliefs about

efficacy of treatment), as well as perceived benefits (decreased

risk, better health) are the key elements that determine whether

a smoker will quit. In addition, cues to action that stimulate

motivation and increase readiness to change must be present to

initiate a change in smoking behaviour.

According to Expectation confirmation theory developed by

Oliver in 1980, expectations that are coupled with perceived

performance, lead to post-purchase satisfaction. This effect is

mediated through positive or negative disconfirmation between

expectations and performance. If a product outperforms

expectations (positive disconfirmation) post-purchase

satisfaction will result. If a product falls short of

expectations (negative disconfirmation) the consumer is likely to

be dissatisfied.

The researchers apply the theory in a multitude of contexts

where satisfaction is a variable of interest. It seems only

logical that customers are more likely to return after

satisfactory transactions, clients will return only if satisfied

with previous service, managers will rate the work of employees

more highly if satisfied with their performance.

These concepts imply that healthy habits are up to the

individuals’ responsibility upon themselves. Our actions and

decisions greatly define our well being. If an individual engages

in positive and responsible behavior, it can create and have a

positive result and when an individual displays an unhealthy and

negative behavior, it will lead to negative results. With the

intervention of outside variable, these behaviors can be

affected. Moreover, the creation of government programs and laws

can help individuals change their negative behaviors.



The main thrust of this study is to assess the awareness and

level of satisfaction of the smoking and the non smoking public

regarding the Comprehensive Smoke-Free Ordinance in the City of


Specifically, this study aims to answer the following


1. What is the awareness of the public regarding the

implementation of the Smoke-Free Ordinance in terms of:

1.1 campaign drives and advertisements;
1.2 imposition of fines; and
1.3 designated smoking areas?
2. What is the level of satisfaction of the non-

smoking/smoking public about the implementation of the

ordinance in terms of:

2.1 designated smoking areas;
2.2 health?
3. Is there a significant difference on the level of

satisfaction between the smoking and non-smoking public

in terms of:
3.1 designated smoking areas;
3.2 health?
4. What is the proposed action plan based on the result of

the study?

Significance of the Study

The researcher believed that the result of the study would

be beneficial to the following:

City Legislators. This will give the legislators in the City

of Tagbilaran ideas and action plan on how to improve the

implementation of the Comprehensive Smoke-Free Ordinance.

Smoking Public. This study will give the smoking public more

knowledge about the existing ordinance and at the same time

hopefully will help them stop or reduce smoking.

Non-smoking Public. This study will give the Non-Smoking

Public more knowledge about the existing ordinance.

Future Researchers. This study will serve as reference and

basis for future studies on the public’s awareness and

satisfaction on smoking bans.



The researcher