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 premises1,3.

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 compliance4. 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 questionsYes (%)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 year5. 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 20146. 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 implementation6.

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 smoke7. Similarly in Scotland, the SFZs government Act was supported by pub workers before implementation8,9. 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.