Tobacco and Public Health - TCSC Indonesia

RON BORLAND AND CLAIRE DAVEY 719
to smoking areas alternatives will be needed for those smokers who cannot readily or
will not take advantage of the situation to attempt to quit. There is a need to explore the
utility of nicotine replacement therapy as a substitute for cigarettes in these contexts,
not just as a cessation aid.
The main area where there appears to be strong resistance to the implementation of
smoke-free policies is in hospitality venues, particularly those that also serve alcohol,
but also extending to restaurants of all kinds and gaming venues. Of these restaurants
and bars have been most studied. It seems to be the case that implementing smoking
bans in bars is the area that arouses the most apposition. Arguments against bans are
based on presumed preferences of users of such venues. Proprietors fear loss of patronage
from smoking clients with no clear expectations of increased patronage from
non-smokers. All of the evidence to date indicates that proprietors fears are misplaced.
Indeed for the hospitality sector overall the net effect seem to be beneficial. A recent
systematic review of the economic impact of bans on the hospitality industry showed
that virtually all the evidence of adverse effect came from studies with weak designs
and/or reliance or opinion measures (Scollo et al. 2003). Studies with strong designs
and actual expenditure measures found either no impact or a small positive impact of
bans. It was notable that all studies showing adverse effects used weaker designs and
were also funded by the tobacco industry or sources close to them. It is now certain
that there are no overall adverse economic consequences of bans on smoking in hospitality
venues. A minority of individual business may be adversely affected if they are
unable to adapt, but overall there are potential economic benefits as well as the social
and health benefits of maintaining clear air. For the most part, proprietors have nothing
to fear. It seems that much of the concern has been whipped up by the tobacco
industry who may have more to fear as such bans may affect tobacco use (see later).
Bans in restaurants when implemented are complied with and accepted without
need for coercive measures at least in some jurisdictions (Hyland et al. 1999; Chapman
et al. 2001). Furthermore, complete bans do not lead to infrastructure costs associated
with implementation of separately ventilated smoking rooms. Less is known about
bans in bars, but in the limited number of places where they have been implemented
both compliance and acceptance seem to be high (August and Brooks 2000). For all
that is known, the only area where there appears to be any need for significant compensatory
efforts is in residential facilities, and here opportunities to go outside and
use of NRT are likely to be adequate solutions in most cases.
Smoke-free homes
Smoking in homes can be done by residents and/or visitors. Clearly there are different
challenges involved in implementing bans when residents smoke than when it is only
a matter of discouraging visitors. Further, the issue of having a ban only really emerges
when there is a possibility of somebody smoking. As a consequence surveys of the
prevalence of smoking bans in non-smoking households may underestimate the true