Tobacco and Public Health - TCSC Indonesia

714
IMPACT OF SMOKE-FREE BANS AND RESTRICTIONS
a reasonable part of the solution, believe that the change is practical (it can be done)
and that it will be acceptable (enough) to affected parties. In addition, it helps if the
individual or organization believes that they have an obligation to act either out of fear
of personal injury litigation (for domestic restrictions) or to protect vulnerable loved
ones. As innovation progresses, these move from being desirable outcomes through to
becoming general expectations as to what is acceptable.
Change does not all occur at once. In some of the countries that have been at the
forefront of actions to control passive smoking (e.g. USA, Canada, Australia), the
moves to smoke-free places have been first in workplaces, then in private homes, and
last of all in hospitality venues, especially bars. Somewhere along the way, bans are
often imposed in public transport and in crowded places like cinemas and public halls,
and even in crowded outdoor sporting stadiums. In most places, bans in these places
have been enacted with a minimum of fuss. In other countries (e.g. Singapore) where
action is reputedly strong, less information has appeared in the international literature,
and so to the pattern by which change was, and is occurring. In the following sections
we review knowledge on implementation and compliance with bans in the workplace;
then in other public places, especially hospitality venues; and finally consider the home
as the issues there are quite different to those in public places. Consideration of the
effects on smoking prevalence and consumption are considered separately. In reviewing
this material, it needs to be realized that the bulk of the empirical work comes from
three countries: the USA, Canada, and Australia, all who have been innovators in ETS
control and all have low and declining smoking prevalence by world standard (Corrao
et al. 2000). The reader is encouraged to exercise caution in extrapolating from this
research to their own country’s situation, especially where the social conditions are
quite different. We have tried to be sensitive to these issues, but the lack of good data
and our lack of understanding of the diversity of world cultures means that we cannot
be certain that we have taken all important issues into consideration.
The introduction of smoke-free environments
Smoke-free workplaces
In principle, as for other contexts, workplaces can be smoke-free because they have no
smokers, or because smokers all voluntarily do not smoke there, or because smokers
comply with rules not to smoke. In most countries initial moves to smoke-free workplaces
has come from employers, followed by legislation mandating such practices,
at least legislation where there is strong expectations of compliance. In these cases
legislation has followed, largely as a way of forcing laggards to act.
Following the early authoritative reviews on the harmfulness of passive smoking,
employers in some places began to voluntarily implement restrictions in workplaces.
In some places voluntary introduction of bans was quite rapid. For example, reported
prevalence of such bans in parts of Australia in the late 1980s was under 20%, but this