Tobacco and Public Health - TCSC Indonesia

Introduction
Chapter 41
Impact of smoke-free bans and
restrictions
Ron Borland and Claire Davey
This chapter reviews the progress that is being made in protecting people from exposure
to tobacco smoke in their environments, and on the impact that these changes are
having on tobacco use. In doing so we attempt to explain the reasons for apparent differences
in progress in different countries, and make some predictions as to future
trends.
Environmental tobacco smoke (ETS) is also known as passive smoking, involuntary
smoking, or secondhand smoke. The terminology used varies, but all are intended to
refer to pretty much the same thing, although subtle distinctions can usefully be made.
It is easier to use ETS when referring to what is actually in the environment; passive
smoking (or involuntary smoking) when referring to exposures of individuals; and
secondhand smoke to what the smoker produces. Thus ‘the secondhand smoke produced
by smokers increases the level of environmental tobacco smoke which results in
higher levels of passive smoking by those in that area’. In this context we use the term
secondhand smoke to refer to both the smoke exhaled by smokers and the smoke coming
directly from the cigarette into the environment. We also describe the smoke as
coming from cigarettes but note that smoke from other forms of burnt tobacco is likely
to be equivalently toxic, but as it is much less common in almost all countries, it is easier
to simply refer to cigarettes.
Tobacco use has not always resulted in problems with passive smoking. Historically,
in Victorian England after the introduction of tobacco from the Americas, smoking
was initially an activity of the rich and they engaged in it in special smoking rooms to
protect women and children from the odours. These niceties gradually disappeared
until for much of the twentieth century smokers in most places came to assume a right
to smoke virtually wherever and whenever they choose. Non-smokers put up with the
smells which most found mildly unpleasant because to do otherwise would seem
impolite.
Modern moves to reduce passive smoking have come in the light of strong evidence
about the harmfulness of these exposures to health.