Tobacco and Public Health - TCSC Indonesia

712
IMPACT OF SMOKE-FREE BANS AND RESTRICTIONS
Likelihood of legislative action is also likely to be determined by the views of stakeholders,
of which the key ones are general community views, those of commercial
interests, special interest groups, bureaucrats, and lastly of decision-makers themselves.
Strong opposition at any level can be enough to prevent action, while strong support at
least one level is probably necessary to stimulate action. The tobacco industry and its
allies have a long record of vigorously opposing actions to increase restrictions on
smoking, especially where they believe they will be enforced.
In countries, or eras when bans on smoking are not mandated by government the
main factors driving increased restriction on smoking imposed by employers seems to
be a mix of awareness of the risks (with associated concern for staff health), threat of
litigation, and pressure from staff. Experience in Australia suggests that government
instrumentalities were prepared to act for their own employees purely on the basis of
authoritative knowledge, but that a mix of fear of litigation and staff demands was
required to get action in most other places. For example, the landmark Australia legal
case where a judge for the first time declared the evidence in the harms of passive
smoking overwhelming (the Morling decision: (Everingham and Woodward 1991)) led
to a significant upsurge in interest in smoking bans, as did publicity for out-of-court
settlements (Palin and Young 1994). In the early days of restrictions, non-smokers,
while supportive of bans on the whole, were not typically strong advocates. While they
did not like the exposure, they were used to it and seemed reluctant to demand protection.
As more and more places become smoke-free and non-smokers got to enjoy the
benefits, and they saw that the restrictions on smokers were not unreasonable, they
have become more militant. Now unions representing workers in areas where smoking
is still prevalent are taking a leading role in advocating bans.
It is useful to consider the process from the perspective of diffusion of innovation
theory (Rogers 1995). This model describes several stages of uptake of new product or
ideas, which we will simplify to three: an early innovation stage where uptake is slow,
an intermediate period where uptake is rapid, then a third slow period where some of
those resistant to change (laggards) are gradually won over. The early innovation
period is characterized by people who either have an unusual need for the innovation
and/or a high level of interest in trying new things. Rogers divides them into two subgroups;
the innovators, the first 2.5% to change, and the early adopters (the next
13.5%). In the social arena, they are people who are prepared to act in the face of normative
pressures to preserve the status quo. This is a period when effective restrictions
on smoking are few and most smokers see no need to change their behaviour, and few
are prepared to make changes on their own initiative. Non-smokers, used to the smoke,
for the most part continue to tolerate it. Restrictions may be seen as an-in-principle
good idea, but one that may not prove practical in some situations. There is likely to be
concern over whether smokers will comply, indeed over whether they will be able to
comply or should be expected to comply. Those attempting to implement bans or
ensure compliance will often be faced with strong resistance.