Research Paper Tobacco Prevention & Cessation Innovative call emerging from a qualitative study for workplace designated stop-smoking area Marie Chan Sun1, Lovena Rathoa2 ABSTRACT INTRODUCTION Designated smoking areas (DSAs) have become a common feature of public places in various developed and developing countries that have ratified the AFFILIATION World Health Organization (WHO) Framework Convention on Tobacco Control 1 University of Mauritius, Réduit, (FCTC). However, this situation is not in line with the WHO FCTC. In this Mauritius 2 Université de Bordeaux, context, this study was designed to explore the perception of stakeholders on Bordeaux, France the DSA prevailing in workplaces in Mauritius and to explore the feasibility of smoking cessation interventions in the workplace. CORRESPONDENCE TO Marie Chan Sun. University of METHODS A qualitative study using semi-structured, face-to-face interviews was Mauritius, Réduit, Mauritius. conducted among the various stakeholders in tobacco control in Mauritius. Data E-mail: [email protected] collected were transcribed verbatim for analysis. KEYWORDS RESULTS Three main themes emerged from this study: 1) a need for comprehensive workplace smoking cessation interventions, smoke-free smoke-free law, 2) a need for smoking cessation services, and 3) a need for environment, qualitative study, stakeholders’ involvement (local government, employers, and health professionals) developing countries in the promotion of tobacco cessation programs. Received: 20 August 2019 CONCLUSIONS We make a call for a workplace Designated Stop Smoking Area (DSSA) Revised: 6 November 2019 in order to phase out existing DSAs. DSSAs will be a therapeutic means to divert Accepted: 3 December 2019 smokers away from DSAs, in order to change their behaviour with respect to tobacco use. Group therapy, individual counselling, and tobacco treatment will be made accessible in these DSSAs, which with a touch of innovation can become a VIP lounge for stop-smoking services. This innovative call for DSSAs is meant to sensitize policy makers of developing countries on how to proceed for the elimination of DSAs. Tob. Prev. Cessation 2020;6(February):9 https://doi.org/10.18332/tpc/115032 INTRODUCTION free environments in all indoor public places, indoor Comprehensive smoke-free policy workplaces, on all means of public transport, and, as The World Health Organization Framework appropriate, other public places’. Convention on Tobacco Control (WHO FCTC) is an evidence-based health and legally-binding treaty Workplace designated smoking area that requires its 181 Parties to implement evidence- Article 8 also stipulates that the use of designated based measures to reduce tobacco use and exposure smoking areas (DSAs) does not provide effective to tobacco smoke1,2. Article 8 of the WHO FCTC refers protection3. Nonetheless, DSAs still exist in public to the need for protection from exposure to tobacco places in both developed and developing countries. smoke3. It emphasizes the need for ‘100% smoke- Indoor areas for smoking are mostly common in Published by European Publishing on behalf of the European Network for Smoking and Tobacco Prevention (ENSP). © 2020 Chan Sun M. and Rathoa L. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License. 1 (http://creativecommons.org/licenses/by-nc/4.0) Research Paper Tobacco Prevention & Cessation airports and are considered as ‘smoking lounges’ while 1948 Universal Declaration of Human Rights, Article DSAs exist in many workplaces4. This situation is not 1 states that ‘All human beings are born free and in line with the WHO FCTC because Article 8 of the equal in dignity and rights’14. Article 3 states that WHO FCTC highlights the need for a comprehensive ‘Everyone has the right to life, liberty and security smoking ban for effective protection from secondhand of person’14. Article 25 of the same Declaration smoke. The FCTC does not recommend enclosed mentions ‘health as part of the right to an adequate areas for smoking in public places or workplaces5. standard of living’14. Internationally, the right to It is interesting to appraise the qualitative study health was first articulated in the 1946 Constitution by Burton et al.6 who revealed that smokers never of the World Health Organization15. The General smoked in indoor designated areas but preferred to Surgeon16 put forward that ‘Non-smokers have as go outdoors to prevent others from being exposed to much right to clean air and wholesome air as smokers tobacco smoke6. Another qualitative study by Bondy must have their so-called right to smoke, which I and Bercovitz7 highlighted the need for a complete would define as a right to pollute’. However, in the smoking ban on construction worksites, instead preamble of the WHO FCTC, the Parties expressed of making provisions for DSAs. On the other hand, their determination ‘to give priority to their right Sherriff and Coleman8 revealed employers’ belief to protect public health’3. Also, the preamble to the that they would violate the rights of their employees Constitution of the WHO states that ‘the enjoyment if they did not allow them to smoke on the worksite. of the highest attainable standard of health is one of It has also been reported by Kaufman et al.4 that the fundamental rights of every human being without community members considered law enforcement as distinction of race, religion, political belief, economic a violation of smoker’s rights. or social condition’3. Concerning Article 12 of the 1966 International Workplace smoking cessation intervention Covenant on Economic, Social and Cultural Rights, The evaluation of the first smoking cessation workplace ‘it is the right of everyone to the enjoyment of the intervention in Hong Kong showed that smoking highest attainable standard of physical and mental cessation programs, chosen by smokers and supported health’ (WHO 2003)3. Considering the Convention by employers without further incentives, were feasible on the Elimination of All Forms of Discrimination in a busy working environment9. A pilot clinical against Women, adopted by the United Nations trial of smoking cessation services implemented in General Assembly on 18 December 1979, Parties will the workplace has demonstrated the feasibility and eliminate gender discrimination in the field of health efficacy of providing workplace smoking cessation care3. Focusing on the Rights of the Child, Parties to services10. A qualitative study exploring employees the Convention acknowledge ‘the right of the child who were involved in a workplace smoking cessation to the enjoyment of the highest attainable standard programme showed that contributors to quit success of health’3. were the workplace setting, quitting with colleagues, In 2017, on the occasion of the Human Rights competition and motivation, as well as group strategies Day, health was emphasized by the WHO Director- to resist smoking11. In Iowa, workplace smoking General as a fundamental human right, with good bans were nearly universal and two-thirds of the health being the resultant of other basic human workplaces offered activities to help employees quit rights including access to safe drinking water and smoking within the context of the Iowa Smokefree sanitation, nutritious foods, adequate housing, Air Act; there was practically no barrier to adoption education and safe working conditions1. The WHO and implementation of workplace smoking cessation Director-General, in 2017, stated: ‘The right to interventions12. health for all people means that everyone should have access to the health services they need, when Controversy on human rights of smokers vs and where they need them, without suffering non-smokers financial hardship…’. The central principle of the Graff13 confidently put forward the fact that ‘there 2030 Agenda for Sustainable Development is to is no constitutional right to smoke’. Referring to the ensure that no one is left behind. Tob. Prev. Cessation 2020;6(February):9 https://doi.org/10.18332/tpc/115032 2 Research Paper Tobacco Prevention & Cessation Justification for the study METHODS The Constitution of the Republic of Mauritius puts A qualitative approach was used to explore the views of forward the protection of one’s right to live in a representatives of the following stakeholders: Ministry healthy environment as follows: ‘Everyone shall have of Labour, Ministry of Environment, Ministry of Health, the right to an environment that is not harmful to their Business Process Outsourcing companies (BPOs), health or well-being’17. Considering the no-smoking Media, Trade Unions, Academia, and Non-Government policy in public places in Mauritius, which has been Organizations (NGOs). Stakeholders were identified by implemented since 2008–09, smoking is banned in a purposive sampling approach. Inclusion criteria were: all indoor public places including indoor workplaces adult, employed, literate, and consent. Participants unless a DSA is available18. Therefore, the island of were recruited until data saturation was reached. The Mauritius does not have a comprehensive smoking number of interviewees was eight. ban in workplaces. The International Tobacco Control Conducted as per the Declaration of Helsinki, (ITC) team highly recommended the elimination of this study obtained ethical clearance from the DSAs, emphasized as essential to protect non-smokers Ethics Committee of the Department of Medicine from exposure to tobacco smoke and to provide