Dear Editor
Indonesia is the largest of six developing countries that has not ratified the World
Health Organization Framework Convention for Tobacco Control (WHO FCTC). However,
local governments have established smoke-free zones (SFZs) in order to control tobacco
use, as in Bogor City, a city of over 1 million people. Local regulation No.12 of
2009 was implemented in May 2010, and in 2011 Bogor City’s Health Office released
its monitoring and evaluation results with regard to compliance in smoke-free zones
(SFZs)
1,2
.
Compliance to this local regulation was measured by eight indicators: 1) a no-smoking
sign at the entrance gate, 2) no one found smoking inside the building’s zones, 3)
a no-smoking room within the building’s zones, 4) no smoking equipment found such
as ashtrays, 5) no smell of smoke, 6) no cigarette butts found inside the building’s
zones, 7) no one selling tobacco, and 8) no tobacco promotion on the premises
1,3
.
In the 2011 overall assessment, hotels and nightclubs were the only zones with poor
compliance (below 80%)
1
. A previous study only describes hotel and nightclub compliance
4
. On the other hand, we conducted an observational study in 49 out of a total 71 hotels
and nightclubs in Bogor City. For these 39 hotels and 10 entertainment outlets participants
were selected by their willingness to participate, according to informed consent as
ethical approval. For the hotels, a wide variety of zones were monitored, such as:
the lobby, restaurant, waiting room, meeting room, business center, a minimum of two
toilet rooms, fitness room, floors with a minimum of four bedrooms, and other places
such as the bar and/or spa center.
Eleven questions were posed (Table 1) derived from eight indicators, and a score of
1 given if it met the criteria and 0 if it did not. Table 1 shows that 8 zones had
a score of 8 (16.3%) while 7 zones (14.3%) had either a score 10 or 6. There were
2 zones (4.1%) that had zero score and 2 zones (14.3%) a score of 11.
Table 1
Compliance indicators of the implementation of 49 zones for SFZ local regulation in
Bogor City
Compliance questions
Yes (%)
No (%)
Compliance rate (% cum.)
Total of zones (n=49)
Is there a no-smoking sign at the entrance?
9 (18.4)
40 (81.6)
1 (9.1)
4
Are there any no-smoking signs inside the building?
40 (81.6)
9 (18.4)
2 (18.2)
7
Does the no-smoking sign mention the SFZ local regulation?
35 (71.4)
14 (28.6)
3 (27.3)
10
Is there any law enforcement sign for the SFZ perpetrator?
35 (71.4)
14 (28.6)
4 (36.4)
12
Is there any particular place for smoking inside the building?
24 (49.0)
25 (51.0)
5 (45.5)
15
Is there any person found smoking inside the building?
30 (61.2)
19 (38.8)
6 (54.5)
22
Is there any cigarette butt found inside the building?
36 (73.5)
13 (26.5)
7 (63.6)
27
Is there any ashtray or such found inside the building?
15 (30.6)
34 (69.4)
8 (72.7)
35
Is there any smell of cigarette smoke inside the building?
27 (55.1)
22 (44.9)
9 (81.8)
40
Is there any item or similar thing with regard to smoking promotion (printed either
on napkin table, glass, coaster, poster, banner, etc.)?
36 (73.5)
13 (26.5)
10 (90.9)
47
Is there either any shape or type of cigarette found written on sales promotion, or
is it only written ‘cigarettes available’?
31 (63.3)
18 (36.7)
11 (100)
49
Compliance in Bogor City increased over time. The compliance rate in 4453 buildings
was 26% initially, but increased to 78% by the end of year
5
. However, this rate was still below the acceptable indicator rate of 80%. Our findings
show that management support is essential for a successful SFZ local regulation.
Another similar study was undertaken in luxury hotels in Badung Municipality, Bali
in 2014
6
. It showed that hotel compliance to the SFZ local regulation was still low (15.4%)
and that the smoking behaviour of the management of these zones significantly obstructed
SFZ implementation
6
.
In developed countries, SFZs are well implemented by applying effective law enforcement,
accompanied by preparatory health education campaigns and quitting facilities and
advice. In Bogor City, government compliance indicators for SFZs are the same as in
California, but in Bogor there is no obligation to provide smoke detectors in each
room. The California Government’s Smoke-Free Act resulted in 88% compliance, a decrease
in the number of smokers, and protection of both employees and visitors from second-hand
smoke
7
. Similarly in Scotland, the SFZs government Act was supported by pub workers before
implementation
8,9
. In all, 80% of pub workers believed that this regulation would help to protect their
health at work, but 49% were concerned that it would negatively affect business. After
implementation, support for this regulation increased and the negative perception
decreased to 20%
8,9
. These studies showed that compliance rates in SFZs not only depend on political
commitment but also implementation and enforcement by management, as well as perception
by workers and the community.
Our study found that the Bogor City SFZ implementation was still below 80%, but it
was progressing, involving political and managerial commitment, and community and
worker acceptance. However, sustained and new approaches are necessary to achieve
the target of 80%, with ongoing monitoring.