Tobacco and Public Health - TCSC Indonesia

RON BORLAND AND CLAIRE DAVEY 725
that has moved as far as anywhere to becoming smoke-free, there has been an increase
in the prevalence of non-daily smoking, even as daily smoking has declined (Pierce
et al. 1998).
Effects on cessation
The evidence on the impact of bans on smoking cessation is less clear. Chapman et al.
(1999) concluded no clear evidence of any effect, but Hopkins et al. (2001) relying on
studies with comparison groups concluded that there is an effect for cessation but
acknowledge studies that have looked at smoking prevalence have been equivocal.
Biener and Nyman (1999) found evidence of increased cessation associated with bans
over a three-year period, but only where the evidence suggested the bans were effectively
enforced. There is some evidence that the onset of bans is associated with an
increase in quitting, with the event being used by some smokers as a good time to quit
(Chapman et al. 1999). The frequency of this and whether such actions increase overall
quitting or merely change its timing is unclear. Further, in the period when workplace
bans were becoming most prevalent in Australia, the USA, and some other countries,
was a period where there was little or no change in population smoking prevalence
(Hill et al. 1995; MMWR 1999).
Related to the possible effects on quitting, bans should reduce relapse in ex-smokers
by providing an increased range of safe places. However, there is no clear empirical
evidence to show that this is a real benefit to those trying to stay stopped, but that
is because of a lack of studies rather than a failure to find effects.
Based on all of this work, we tentatively conclude that while these may be small positive
effects of bans on cessation, they are unlikely to be of a magnitude to make
a major contribution to reducing population smoking prevalence. However, as restrictions
become more prevalent in homes and in recreational venues, it seems likely that
effects on cessation are likely to increase in magnitude.
Possible effect on smoking uptake
One of the most intriguing possible effects of smoke-free places impact is on uptake of
regular tobacco use. Theories around possible effects vary by the type of restriction.
The example bans set and what they say about social norms should have a positive
effect, as should the reduction in opportunities to smoke. The only possible adverse
effect relates to exiled smoking. As restrictions on smoking often result in smokers
going out into outdoor public areas to smoke, their smoking becomes more noticeable
by bystanders. There is no evidence that this activity entices non-smokers in the
workplace to smoke (Clarke et al. 1997), but it may affect the bystanders if it effects
their perceptions of the prevalence of smoking (U.S. Department of Health and
Human Services 1994). On the other hand, if those smokers are perceived negatively
(e.g. as slightly desperate), it might act to discourage smoking, by making it seem less
attractive.