Increase Compliance Implementation Regional Regulation No 5

Year 2008 above SFA and SRA in Surabaya Used Monitoring Team

Methods

Kurnia D. Artanti, Santi Martini, Hario Megatsari, Sri Widati, and Kusuma S. Lestari

Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia

kurnia-d-a@fkm.unair.ac.id

Keywords: SFA, SRA, Implementation, Monitoring team.

Abstract: The monitoring team for assess compliance facilities to implemented regulation about Smoke Free Areas

(SFA) and Smoke Restricted Areas (SRA) has been established by decree of the Mayor. The aim of the

study was a comparison between the facilities with a monitoring team and without a monitoring team. This

was a case control study. Cases is the places that are in the category of health facilities where there is a

monitoring team. A survey of 300 places (100 places were Case and 200 places were Control). Cluster

Random Sampling was used based on the different areas of Surabaya (East, West, Center, North, and

South). Data collection was done by an observation check list. The study found that places where the

monitoring team is significantly affects the implementation of the regulation. They showed that signage ‘no

smoking’ (p=0.00;OR3.58), No found smokers (p=0.00; OR13.68), No Smell of cigarette smoke

(p=0.00;OR32.33), No found Ashtrays (p=0.00;OR2.9), no found cigarettes butts (p= 0.00; OR5.6) and no

cigarette sellers (p=0.00;OR3.69) significantly. Only one variable (There are no smoking rooms) (p =

0.06,OR 1.85) showed no significance. The monitoring team is very important to increase the effectiveness

of the compliance with the regulation’s implementation.

1 INTRODUCTION

The establishment of a Smoke Free Area (SFA)

regulation is an obligation that all district and city

governments should implement. This is based on

Article 8 of the FCTC (Framework Convention on

Tobacco Control) has regulated the provision of

Smoke Free areas as an effort to protect against

exposure to secondhand smoke(World Health

Organisation, 2005). Beside that Government

Regulation of health No. 36 2009 on article 115

which states that every local government is obliged

to establish a Smoke Free Area in their Territory.

There are seven areas included in the Smoke Free

Area. These are health care facilities, teaching and

learning places, children's playgrounds, places of

worship, public transportation, workplace and public

places (Presiden RI ,2014).

Surabaya is one of the pioneer cities regarding

the regulation, as one of the cities in Indonesia

which already has a Smoke Free Area (SFA) and a

Smoke Restricted Area (SRA). This came with the

issuance of the regulation, namely Perda Kota

Surabaya no 5 2008 regarding SFA and SRA

(Walikota Surabaya 2008b).

A Smoke Free area is an area where it is

prohibited to produce, sell, advertise, promote and

use cigarettes. A Smoke Restricted Area is a place or

area where smoking activities are restricted to

occurring within.

A Smoke Free area referred to in local

regulations includes children’s play spaces, learning

facilities, health facilities, places of worship and

public transport. Smoke Restricted Areas are

workplaces and public places such as malls,

restaurants, hotels, sports venues, terminals,

stations.(Walikota Surabaya 2008b)

This regulation is designed to protect Surabaya

residents from exposure to second-hand smoke. This

regulation was enacted in 2008 and implemented in

2009. The Surabaya city government has established

a Smoke Free Area Monitoring Team and a Smoke

Restricted Area in Surabaya city to monitor the

implementation of Surabaya regulation no 5/2008 on

SFA and SRA. The team was formed in 2009 based

on Surabaya Mayor's Letter Number 188.45 / 330

/436.1.2/2009.(Walikota Surabaya 2008a) Many

argue that the rules on SFA have not been properly

implemented. This is because there are still many

violations found in facilities that fall into the

category of SFA or SRA.

Currently, the SFA and SRA monitoring team is

only active in Surabaya City Health Office.

Surabaya City Health Office monitors only the

Artanti, K., Martini, S., Megatsari, H., Widati, S. and Lestari, K.

Increase Compliance Implementation Regional Regulation No 5 Year 2008 above SFA and SRA in Surabaya Used Monitoring Team Methods.

In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 261-264

ISBN: 978-989-758-335-3

261

health facilities. While other facilities include a

Smoke Free Area and a Smoke Restricted Area,

there is no monitoring team that does monthly

monitoring visits. The aim of this study was

comparison between the facilities with the

monitoring team actively visiting and those that are

not visited by the monitoring team.

2 METHODS

This was case control study. The cases were in

places that are in the category of health facility in

which there is a monitoring team. The control

sample is in places in other categories for facilities

where there is no monitoring team. A survey of 300

places (100 places Case and 200 places for the

Control) that were categorised as Smoking

Restricted Areas and Smoking Free Areas under the

Regulation was conducted.

Cluster Random Sampling was used based on the

different areas of Surabaya (East, West, Center,

North, and South). Data collection was done by an

observation check list. The observation check list

have been modified based on the Guideline to

Assessing Compliance with Smoke-Free Laws,

Second Edition A “How-to” Guide for Conducting

Compliance Studies was used (Birckmayer et al.

2014). The variables consisted of people still found

to be smoking inside the building, found smoking

ban, the presence of smoking rooms, ashtrays,

cigarette butts and cigarette sellers found in the

Smoke-Free Area.

Data analysis in this study was conducted univariate

and bivariate. Univariate analysis is performed to

describe each variable. While bivariate analysis

using chi square statistical test to get how much

influence between independent variable to case or

control.

3 RESULT

The result of this research found 300 facilities

consisting of 100 facilities that were entered in the

case category and 200 facilities included in the

control category. There were 7 variables used to

assess the compliance of the facilities with the local

regulation, namely the existence of smoking

prohibitions in accordance with local regulations, no

smoking room found, no smoke smell, no ashtrays,

no cigarettes, no cooperation with the cigarette

industry and no cigarette sales.

Table 1. Distribution of the percentage of facilities with and without monitoring facilities

Variable Facilities with Monitoring team Facilities Without

Monitorin

tea

P< 0.05

Number % %

signage”no

smoking

Yes 73 73 86 43 P 0.00

OR 3.58

No 27 27 114 57

No found smoker Yes 91 91 85 42,5 P 0.00

OR 13.68

No 9 9 115 57,5

No Smoking

room

Yes 83 83 145 72,5 P 0.06

OR 1.85

No 17 17 55 27,5

No Smell

cigarette smoke

Yes 97 97 100 50 P 0.00

OR32.33

No 3 3 100 50

No found Astray Yes 64 64 76 38 P 0.00

OR 2.9

No 36 36 124 62

no found

cigarettes butts

Yes 68 68 55 27,5 P 0.00

OR 5.60

No 32 32 145 72,5

No Corporation

with Tobacco

Industr

Yes 100 100 66 33 P 0.00

Undefine

No 0 0 134 67

No Cigarette

Seller

Yes 78 78 98 49 P 0.00

OR 3.69

No 22 22 102 51

The results showed that facilities which had a

monitoring team have a smoking ban of 73% while

for facilities that did not have monitoring team, only

43% put up signage of the smoking ban. Based on

statistical calculations, it shows that facilities with a

monitoring team are more than 3 times (p <0.05; OR

INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association

262

3.58) likely to be against the installation of a

smoking ban.

The Facilities which had a monitoring team

easier to prevent smoker at that facilities. This study

found that 91% facilities no smoker founded. The

facilities with monitoring team are more than 13

times (p <0.05; OR 13.68) no found smoker than

others.

The ‘No Smoking room’ variable showed that

145 (72.5%) facilities in the control group provide a

smoking room. According to local regulations No. 5

2008 states that public facilities and facilities are

included in the Smoke Restricted Area (SRA)

category. The SRA is still allowed to provide a

smoking. It should be separate with an area declared

as a place for otherwise forbidden smoking,

equipped with exhausts and with adequate

ventilation.

Many smoking rooms were not accordance with

local regulations at the time of observation. The

room was still inside the main building, there were

no exhausts that immediately emitted the tobacco

smoke outdoors and the room’s smoking door was

often open so that the cigarette smoke got in to the

main building and resulted in second hand smoke

exposure.

The facilities which had monitoring team can

avoid some violation like as Smell cigarette smoke,

Found Astray and Found cigarette butts. This study

showed that three variabel showed significant

difference between facilities had monitoring team or

not.

Other results related to non-smoking compliance

indicated that the relevant variables of cooperation

with the tobacco industry shows the highest

compliance, as all of the monitoring team facilities

do not cooperate with the tobacco industry. Based on

statistical calculations, it shows that facilities with a

monitoring team have a significant influence on the

compliance variable in the form of no cooperation

with the tobacco industry.

Beside that, Facilities with a monitoring team

can decrease shop sell cigarette. This study show

that the facilities with monitoring team no found

seller cigarette 3 times than nor.

4 DISCUSSION

The present study showed that facilities that have a

monitoring team have a higher level of compliance

with local regulations. This is influenced by the fact

that the Surabaya city health office has a monitoring

team consisting of the staff of the Surabaya city

health office, professional organisations such as the

Indonesian Public Health Association (IPHA),

Indonesian Pharmacist Association (IPA), Satpol PP

and academics. Job description of monitoring team

is monitoring every month in health facilities that

include Hospitals, Primary Health Care, Apoteks,

Drug Stores, Clinics and General Practitioners

regularly. The role of monitoring has shown

improvement every year. It is like in the previous

study, which stated a decline in the violation in

some of the indicators used to assess implementation

compliance with SRA and SFA from 2012 to 2014

(Artanti et al., 2015).

While the facilities as controls in this study are

facilities that the categories of public places and

workplaces. The public places consist of hotels,

restaurants, malls, markets and parks. In fact all the

facilities in Surabaya have a monitoring team that

has been formed by the mayor in the mayor's decree,

but not all do their job well.

This has led to violations, especially in facilities

that monitoring team has not been well served. This

is like other studies in Greece and Bulgaria showing

that daily Greek smokers reported that they

systematically violated the existing smoking

restrictions at work, compared to the Bulgarian

employees (Lazuras et al., 2012). Nevertheless

smoking should not be allowed anywhere in public

places (Li, J., & Newcombe, 2013).

Many suggest that the implementation of local

regulations on SRA and SFA is not optimal, due to

the absence of strict sanctions on violations that

have been committed. Another study conducted by

Borland et al declared that current cigarette smokers

would support smoking bans associated with living

in a place where the law prohibits smoking. Smokers

adjust, and both accept and comply with smoke-free

laws(Borland et al., 2006).Therefore the role of the

monitoring team needs to function optimally

because it consists of Prevention, Monitoring,

Action, Evaluation and Reporting(Walikota

Surabaya, 2017).

5 CONCLUSIONS

The monitoring team is very important to increase

the effectiveness of compliance implementation.

There is a need to revitalise the function of the

monitoring teams coordinated by local government

officials.

Increase Compliance Implementation Regional Regulation No 5 Year 2008 above SFA and SRA in Surabaya Used Monitoring Team

Methods

263

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