Tobacco and Public Health - TCSC Indonesia

718
IMPACT OF SMOKE-FREE BANS AND RESTRICTIONS
but in some cases they are subject to special regulations that may come into place
before rules mandating all workplaces be smoke-free, or in the case of hospitality venues
(in particular), might be specifically exempted from generic workplace legislation.
One interesting extension of bans is to crowded outdoor spectator areas at sporting
venues. Bans are increasingly been implemented and acceptance and compliance can
be high (Pikora et al. 1999). There seems to be little doubt that in most places bans
can be readily complied with, and come to be appreciated by smokers as well as nonsmokers
in the same way as for workplaces in general. The few more contentious issues
are discussed below.
An interesting area of research regarding smoking restrictions in public places was
initiated by Bonfill et al. (1997) in Spain. They simulated violations of public area laws
and observed bystander interventions. They found that only in a small percentage of
cases did violations lead to any action to discourage the smoking. A replication in
Australia (Salmon and Rissel 1999) found similar low levels of intervention, but also
noted some disapproving looks. Poland et al. (1999) explored public reactions to violations
and found reluctance to directly confront violators. Options ranged from ‘Grin
and bear it’, though moving away, an appeal to a third party (i.e. someone in authority),
to overt signs of displeasure. In no case is direct confrontation likely to be easy. In areas
where smoking in public is still normative, a request not to smoke may be seen as
inappropriate, while in areas where it is normative, violators may be more likely to be
anti-social and thus likely to respond to warnings in an aggressive manner. In our view
this work shows that it is not appropriate to rely on the bystander to enforce laws. If
there is a problem with compliance, public education coupled with enforcement by
trained staff should be considered. That said, where norms are appropriate, compliance
is likely to be close to complete.
Residential facilities where bans could have marked impact on residents’ capacity to
smoke have a range of unique issues. For example, prisoners are restricted in where
they can go, and hospital patients and nursing home residents are sometimes incapacitated
and unable to readily move to areas where smoking may be permitted. There is
not much systematic research on these settings. However, it is notable that an observational
study of smoking areas at a hospital found that only 10% of users were patients
(Nagle et al. 1996), suggesting that in some cases concern for clients is exaggerated.
One area that has been studied is psychiatric patients, who along with drug and alcohol
services often have very high smoking rates. Restrictions in residential facilities for
these conditions are less than for other types of hospital patients (Longo et al. 1998).
Even though studies of implementation of bans show little adverse effect, and most
of that transitory (Velasco et al. 1996) it is not clear to what extent these patients had
access to places where they could smoke or were forced to not smoke. Related to this,
Rigotti et al. (2000) found high levels of reported cravings among in-patient residents
of a general hospital, with one quarter reporting smoking, although only a minority of
these admitting to smoking where it was banned. Where in-patients cannot readily go