Tobacco and Public Health - TCSC Indonesia

advanced. Although in countries like the USA where the most is known there is considerable
variation in the current situation (Shopland et al. 2001).
The strategy to progress will need to include both public education, legislative measures,
and compliance systems. The order in which the first two are introduced will vary
by jurisdiction, and if the public education component is adequate, there is unlikely
to be a major need for large scale compliance measures as the rules are likely to be
self-enforcing. At least, that has been the experience where appropriate mixes of education
and rules have been introduced.
But what will the future look like? Enclosed public places and workplaces will be all
smoke-free. Some facilities will have separately ventilated smoking rooms, especially
where suitable outdoor smoking venues are not available. These rooms will need to
be places where people do not need to work for extended periods (they will need to be
cleaned), and they should not have alcohol served or available given the interactive
health harms between tobacco and alcohol (IPCS (International Programme on
Clinical Safety) 1999). The alternative to smoking areas is to force addicts into areas
where they can ‘sneak’ a smoke. Some of these areas may create other risks, such as of
fire and/or risks to the physical security of the smokers. We do not think that such
smoking rooms will be needed at most workplaces, they clearly will not, but there will
be a need for some in crowded business areas and such places as airports where people
sometimes need to spend extended periods.
For private environments, the move towards smoke-free rooms are likely to depend
more on public education and changing social norms than on legislation. As smoking
is restricted in public places, pressure to implement restrictions in homes (and cars) is
likely to build. Not smoking in homes will become normative, but in a small number of
cases smoking will persist, most notably in multi-floor dwelling without balconies.
At least in richer countries, it is likely that building regulations will be modified to
ensure at least some exposure reduction mechanisms are available for these situations,
but in poorer countries, such solutions may be too costly.
Tobacco smoking will retreat to being a private activity engaged in alone or among
consenting adults. This social marginalization of smoking is likely to encourage cessation
and reduce uptake, contributing to other efforts that will help to create what is effectively
a smoke-free world for most of its inhabitants. The overwhelming majority of nonsmokers
will be able to live their lives free of harmful and annoying exposure to ETS.
The movement to control ETS is one of the great successes of public health already in
some countries, and we expect it to become the case in the rest of the world quite quickly.
References
RON BORLAND AND CLAIRE DAVEY 727
Ashley, M. J. and Ferrence, R. (1998). Reducing children’s exposure to environmental tobacco smoke
in homes: issues and strategies. Tob Control, 7(1), 61–5.
August, K. and Brooks, L. (2000). Support for smoke-free bars grows stronger in California.
California Department of Health Service, CA.