Tobacco and Public Health - TCSC Indonesia

724
IMPACT OF SMOKE-FREE BANS AND RESTRICTIONS
More controversial, there is weak evidence that declines in consumption dissipate
over time (Owen and Borland 1997; Levy et al. 2001). For example, the Owen and
Borland (1997) study which found a decline, was of a group who initially changed
more than average. However, another study (Borland et al. 1991) found no declines in
other workplaces with smaller initial declines 18 months after bans were implemented.
Declines in reduction in consumption should not be assumed, but if they occur they
are likely to relate to changing opportunities for compensatory smoking.
Compensatory smoking will effect overall consumption effects. Some studies report
that smoking bans have not increased compensatory smoking (e.g. Olive and Ballard
1996) whilst others indicate considerable compensation (e.g. Parry et al. 2000). The
degree of compensatory smoking is likely to be affected by the ease with which smokers
can find acceptable places to smoke. Leaving work to smoke can be common.
A survey of workers in Victoria, Australia found that half of smokers reporting leaving
work to smoke, with one-fourth leaving work more than three times a day (Borland
et al. 1997b). If these opportunities are curtailed, consumption reduction should
increase, but if new opportunities to smoke emerge, consumption might increase.
Most of the research has looked at reported cigarette consumption rather than measures
of tobacco intake. Gomel et al. (1993) in a small study found that workers reduced
their overall and daily consumption of cigarettes after a total ban was imposed.
However, biological measures indicated that contrary to the self-report, consumption
reverted to baseline levels after an initial decrease. It is possible that some smokers
come to compensate by getting more from each cigarette they smoke. Chapman et al.
(1997) observed that workers puffed longer on cigarettes than other people who were
on city streets. Reductions in consumption of number of cigarettes should not be
assumed to translate into comparable reductions in exposure to tobacco-related toxins.
Regardless of the effects on smokers, reductions in consumption can have adverse
effect on tobacco companies. Approximately, 22.3% of the 2.7 billion decrease in cigarettes
consumed in Australia between 1988 and 1995 has been attributed to smoke-free
workplaces as has 12.7% of the 76.5 billion decrease in the USA over a similar time
(Chapman et al. 1999). This is almost certainly the main reason tobacco companies
spend so much effort trying to discourage restrictions.
Even if some of the reductions in consumption do not result in reduced exposure,
there is some evidence that reduced consumption can make quitting easier (Pierce
et al. 1998) and it reduces the amount they spend on cigarettes. It seems safe to conclude
that these are clear benefits to smokers as a result of the effects of bans in leading
to many of them smoking less.
Little is known about the effects of consumption on bans outside the workplace. It is
likely that they will add to consumption declines. The limiting factor for dependent
smokers is likely to be the amount they need to satisfy their addiction. As it becomes
more difficult for smoker to smoke, it is possible that more will break their addictions
and either quit altogether or become non-addicted users. Indeed, in California, a place