Tobacco and Public Health - TCSC Indonesia

RON BORLAND AND CLAIRE DAVEY 715
rose to around 65% by the middle of the 1990s (Borland et al. 1997a). Such self report
measures tend to at least partly take into account compliance, with many workers not
reporting total bans where they are mandated but not complied with. In 1999, a
national US study found 69% of all indoor workers reported smoke-free policies at
work (Shopland et al. 2001). The type and level of coverage has varied overtime within
and between countries. In the United States, Shopland et al. found that there was about
a 35% absolute difference between the State with the highest (84%) and lowest (49%)
levels of coverage suggesting that states in the USA are in or at the end of the main
uptake phase for workplace protection.
Studies that have used the existence of legislative requirements provide a somewhat
difficult picture. A review of smoking restrictions in different countries found that the
majority of countries (with data about ETS ordinance) had laws restricting smoking in
some form, but this may not reflect the amount of ETS exposure experience by workers
(Brownson et al. 2002). The most common form of restriction was national
legislation prohibiting smoking in the workplace, which included designated smoking
areas. This policy applied to half of nearly 100 countries for which there was data available,
but notable countries without such bans include the USA and Australia which are
among the few countries with any published data on population-wide levels of smokefree
workplaces. Anecdotal reports from at least some countries with legislative bans
suggests that compliance varies greatly, probably related to the cultural difference in
when legislative approaches are implemented and societal traditions of compliance.
We suspect that many of these countries have lower levels of actual protection than for
some of the countries without legislative bans, but with strong social movements
encouraging local action. Indeed Chapman (1998) gathered together brief commentaries
from 11 countries that demonstrate this for a limited range of countries at least.
A couple of examples will suffice. Poland introduced smoke-free legislation in 1996;
however, in reality it was virtually impossible to spend a day in Poland without being
exposed to tobacco smoke in the year or so afterwards (at least). Few public places are
smoke-free with corridors of hospitals and parliament full of smoke and enforcement
dependent on whether the boss smokes or not (Chapman 1998). Italy has laws that
restrict smoking but were not commonly applied. For example, a survey of three hospitals
in 1996 found that 87% of employees were exposed to ETS inside the hospital
especially in cooking areas, information desks, and corridors (Zanetti et al. 1998).
Within countries, there is a relationship between strength of laws and worker exposure
in the expected direction (Pederson et al. 1996; Shopland et al. 2001). Legislation
clearly has an important role to play; whether it is about motivating laggards or about
providing the conditions to stimulate action in the first place.
Research indicates that compliance with smoking bans and restrictions in the workplace
can be very high (Borland et al. 1990a;Wakefield et al. 1996). However, compliance
is not guaranteed. It should not be assumed that regulatory action is self-enforcing
even in countries where there is public acceptance of the need to comply (Brownson