Public health experts have welcomed Mexico's ban on cigarette smoking in all public places, including hotels and beaches, after the introduction of new legislation on Jan 15, 2023. The ban is part of a reform of the country's General Law for Tobacco Control, extending a 2008 ban on smoking in indoor spaces, including restaurants and workplaces, as well as a ban on the promotion, advertising, and sponsorship of tobacco products. It means Mexico now has some of the world's strictest anti-tobacco laws.

"We have been in a fight to reinforce regulations on a substance that is legal and remains so-tobacco-but to offer protection to those who don't smoke and to avoid having new smokers", Evalinda Barron, Director General of the Mexican National Commission Against Addictions, told The Lancet. "It represents a step forward for public health never seen before in this country in terms of tobacco control". There are about 16 million smokers in Mexico, with 15 million aged 1019 years; 290000 cases of smoking-related illnesses and more than 50000 premature deaths have been reported over the past 10 years, she said.

Mexico was the first country in the Americas to sign and ratify the WHO Framework Convention on Tobacco Control in 2004, a regulatory strategy that addresses demand reduction measures as well as supply issues. Tedros Adhanom Ghebreyesus, WHO Director-General, praised Mexico on Jan 15, 2023, tweeting "Bravo #Mexico! WHO welcomes such a bold move on tobacco control. We call on all countries to strengthen #NoTobacco policies and help us prevent 8 million deaths every year."

"Despite having taken the lead [with the WHO Framework Convention on Tobacco Control], we then had 20 years of previous governments not being sensitive to the need to move forward on tobacco regulation", Barron said. "But there are still two points on which doubt remains in Mexico: neutral packaging for cigarettes and increased tobacco duty. These are two things that Mexico still has to achieve to meet the requirements of the convention for tobacco control."

People who smoke in public could face fines of between US$50 and $300, and businesses could be fined up to $2000. However, there remained questions around enforcement of the new law. Barron said the police would have no role in enforcement. Enforcement responsibilities will instead fall under the jurisdiction of the Federal Commission for Health Protection to ensure establishments respected the law.

"Even before enforcement comes in, there's a lot of legal issues with some restaurants threatening to sue over the new law", Xavier Tello, an independent health analyst in Mexico City, told The Lancet. "If the law is broken and people get angry, they might call the local police and it's not clear what will happen. The government hasn't communicated well to the public about the health benefits of the law, and some people might feel it's just against smokers. Also, we have a tax on cigarettes that's supposed to be spent on medical research, but politicians like to use the revenues for other things", Tello added.

Regulations around electronic cigarettes and vapes have also been tightened, and they cannot be imported, sold, or used in public places. Shops have to keep tobacco products behind a counter and cannot show any advertising promoting their use. However, flavoured capsules used with e-cigarettes remain legal and these are consumed by many adolescent smokers, Luz Sanchez Romero, an expert in tobacco and obesity interventions at Georgetown University, Washington DC, USA, told The Lancet. "Flavoured capsules are a big issue because they're marketed to adolescents, women, and people who want to stop smoking, and there should be measures around this", she added. Nonetheless, Sanchez Romero said the new law would have a positive effect on health, and she particularly welcomed the widening of the advertising ban to include those targeted at adults and at point of sale. "We did a simulation exercise and under optimistic scenarios, smoking rates could be cut by between 5% and 6%", she said.

"Mexico now has some of the strictest laws in Latin America and hopefully our evaluation and evidence will help other countries in the region and low-income and middle-income countries outside the region", said Sanchez Romero. Costa Rica banned smoking in all public places last year while Brazil, El Salvador, and Chile are also considering tobacco control policies.

Mexico faces several other major health challenges, including high rates of obesity, diabetes, and cardiovascular damage, said Tello. "If at least one of the risk factors is reduced with this new law, then it will be very beneficial", he said.

(File photo).