Of course not, a tissue is much better. But in a situation, for example, when a waiter is taking your order/carrying your food, or a doctor is in a patient's room and talking to that patient, or other situations like this where hygiene is important, if a tissue isn't readily available, the next best thing is to do the action into the spot where your elbow bends(On the inside of your arm). The thing is, it seems weird to a person who doesn't know about this, but once you do it a few times, it becomes a habit.
Ah okay, I see. I just thought it was unusual to put the elbow down as the preferable option on the poster when I always thought tissues were the better choice.
Pretty interesting about the elbows though.
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