Tobacco and Public Health - TCSC Indonesia

726
IMPACT OF SMOKE-FREE BANS AND RESTRICTIONS
Smoke-free workplaces for non-smokers may reduce internal pressure to uptake
by not having smoking as part of the workplace. This effect may also influence
experimental smokers, making them more likely to quit. Bans should create a barrier
that might slow down progress from social smoking, which typically occurs later in
the day from being transformed into the levels of addictive smoking typified by smoking
soon after waking. Bans in recreational venues and other public places are likely
to have their effect by removing situations which used to be strongly linked to smoking
(e.g. dance venues) into places where smoking is no longer normative. Home
bans effects are likely to be largely through the messages they provide about parental
attitudes.
The limited research available to date is supportive of a positive contribution of all
kinds of smoke-free places on inhibiting uptake of regular smoking, but in no case
is the evidence definitive, because it is largely based on cross-sectional data, or on
professed intentions.
The evidence for effects in the home is strongest, with three studies finding effects
(Farkas et al. 2000; Proescholdbell et al. 2000; Wakefield et al. 2000b). It is of note that
two of these found the strongest effects in homes with no adult smokers, suggesting the
importance of smoke-free homes for conveying parental attitudes. Where one or more
parents smoke, there are likely to be a range of other ways by which their attitudes to
smoking are conveyed.
The workplace studies (Farkas et al. 2000; Wakefield et al. 2000b) are also consistent
with hypothesized effects, with one (Wakefield et al. 2000) finding an effect only on the
transition from experimental to regular smoking.
There is also potential for benefits of bans in recreational venues with Philpot et al.
(1999) reporting that many young social smokers who frequent pubs and nightclubs
saying that smoking bans in those venues would lead them to quit altogether. As such
venues are ones where social smokers are more likely to smoke (Trotter et al. 2002),
such effects are plausible, but yet to be demonstrated.
We conclude that smoke-free places have potential to discourage uptake of smoking,
including reducing the transition from experimental to regular smoking. There is no
evidence of any negative effects. Nothing is known of the size of any effects or of the
factors that might effect their size except for the plausible finding that poorly enforced
policies, are likely to have lesser or no positive effects.
Predictions for the future
There seems to be little doubt that the world is moving to a situation where the responsibility
to protect non-smokers from passive smoking will take priority over whatever
needs smokers have to smoke. In some jurisdictions we are getting very close to this in
2004, but for much of the world there is still an enormous amount of work to do.
Unfortunately, lack of data means that we do not have any precise estimate as to what
is required, except in a small number of places that are probably among the most