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Regional disparities in compliance with tobacco control policy in Japan: an ecological analysis
  1. Takashi Yorifuji1,2,
  2. Shinichi Tanihara3,4,
  3. Soshi Takao1,
  4. Ichiro Kawachi4
  1. 1Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  2. 2Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
  3. 3Department of Hygiene and Preventive Medicine, School of Medicine, Fukuoka University, Fukuoka, Japan
  4. 4Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Takashi Yorifuji, Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan; yorichan{at}md.okayama-u.ac.jp

Abstract

Background The slow progress of tobacco control policy in Japan reflects the tension among the interests of the Finance Ministry (which remains the majority shareholder of Japan Tobacco, Inc), the Health Ministry, tobacco growers and consumers.

Methods We sought to examine regional disparities in compliance with national tobacco control legislation (the 2003 Health Promotion Law). Specifically, we sought to examine whether prefecture-level compliance with legislation was correlated with decreases in smoking prevalence, and decreases in lung cancer mortality rates. We also examined whether prefectural involvement in growing tobacco was associated with lower compliance with the law.

Results From 2001 to 2007, higher prefectural compliance with tobacco control laws was associated with decreased prevalence of smoking. Decreased tobacco consumption was in turn associated with declining lung cancer mortality. Prefectures involved in growing tobacco exhibited lower levels of compliance with national tobacco control laws. The same prefectures also exhibited the worst improvement in smoking prevalence.

Conclusions This study in Japan suggests that tobacco control policies are being unevenly implemented across prefectures, and that measures to counteract the influence of local tobacco culture are required to reduce the disparities in regional tobacco control outcomes in that country.

  • Health policy
  • tobacco
  • smoking
  • public health
  • lung neoplasm
  • litigation
  • public policy
  • smoking caused disease

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Footnotes

  • Funding The study was funded by a grant for young researchers from Okayama University.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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