Smoking In Japan Research Articles

Regulating smoking in Japan: from manners to rules

Abstract Opinions vary in Japan on whether smoking is deviant today, but the behavior, once widely accepted, faces increasing regulation. Recent reforms, moving beyond reliance on nonsmokers' tolerance and smokers' etiquette, impose stricter and more detailed rules on smoking, along with penalties for noncompliance. As the Japanese government's promotional materials note, the reforms move “from manners to rules” (manā kara rūru e). The evolution of Japan's smoking regulations exemplifies a shift toward more legalistic modes of social control. Historically, Japanese governance relied on non-binding “soft law,” administrative guidance, and societal cooperation. Legalistic governance, in contrast, hinges on formal rules and proceduralized enforcement mechanisms. This article, drawing on twenty-eight interviews and qualitative analysis of policy deliberations, advocacy organization documents, court rulings, and Japanese news coverage, traces how societal actors contributed to this legalistic turn. Tobacco control advocates filed lawsuits, pursued voluntary changes through local activities, and provided information subsidies to policymakers while lobbying for local and national reforms. They thereby helped de-normalize smoking and render it regulatable. By uncovering bottom-up drivers of legalistic governance and the strategies through which societal actors influence regulatory style, this paper contributes to scholarship on governance, policy diffusion, and law and social change.

Tobacco usage in the home: a cross-sectional analysis of heated tobacco product (HTP) use and combustible tobacco smoking in Japan, 2023.

Heated tobacco product (HTP) use continues in Japan as the second most common product after cigarettes. While the health effects of HTPs and their secondhand emissions are not well-studied, the tobacco industry has actively marketed HTPs as a smokeless, health-conscious alternative to cigarettes to encourage home consumption. We investigated the prevalence of current tobacco product use and usage at home. The present study conducted a cross-sectional analysis of data from the 2023 wave of a nationwide, Internet-based, self-reported survey. 29,354 individuals aged 16-74 were included in the analysis. We assessed the prevalence of current (past-30-day) use for HTPs, cigarettes, non-cigarette combustible tobacco, and dual (combustible plus HTP) use. The frequency of use (daily or more than monthly) in the home was calculated for both HTPs and combustible tobacco. Multivariable Poisson regression models were employed to identify factors associated with home usage. Adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were computed. All analyses were weighted to address the Internet-based sample's selectivity and yield nationally representative estimates. In 2023, the prevalence of current use was 12.4% (HTPs), 18.9% (cigarettes), 3.6% (non-cigarette combustible tobacco), and 7.4% (dual use). Among current users of any tobacco (N = 5,818), 49.8% reported daily tobacco usage within their homes, and 67.1% reported monthly or more frequent home usage. Compared to exclusive combustible tobacco smokers, exclusive HTP users exhibited higher prevalence of daily home usage (APR = 1.54; 95% CI = 1.43-1.67), as did dual users (APR = 1.10; 95% CI = 1.01-1.20). Daily home usage prevalence was notably higher for those without complete tobacco-free rules at home or workplaces, older individuals, and those with lower education levels. Those living with adult or child household member and current drinkers showed significantly lower daily home usage prevalence. Home usage was more common among HTP users than among combustible tobacco smokers. Ongoing efforts to assess and address the impact of indoor tobacco product use, including HTPs, on health are warranted. Regulatory and educational strategies should be considered to discourage tobacco consumption in both public and private spaces.

Association between work stress and health behaviours in Korean and Japanese ageing studies: a cross-sectional study

ObjectivesLimited research has focused on the association between work stress and health behaviours in Asian countries. We aimed to explore the effect of work stress on two health behaviours among...

Association of Sources of Worry and Stress with Smoking in Japan: Findings from the Comprehensive Survey of Living Conditions 2010.

The purpose of this study is to examine which sources of worry and stress are associated with smoking behavior and if these associations are varied by gender. The anonymous data of 28,588 men and 30,813 women aged 20-79 years old in Japan were analyzed. We defined the subjects who chose "smoking everyday" as "smokers." We also assessed 20 sources of worry and stress. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) of smoking for each source of worry and stress were calculated using logistic regression analysis. We found significant association of financial stress with smoking behavior in both genders. The multivariable OR (95% CI) of smoking according to stress from financial stress was 1.22 (1.15-1.31) in men and 1.66 (1.53-1.80) in women. Moreover, the OR of smoking according to stress from human relationships and job affairs was significantly higher for women. We found that some sources of worry and stress were related to smoking behavior and these associations were found to be gender-specific.

Association Between Social Isolation and Smoking in Japan and England.

BackgroundExisting evidence suggest that those who are socially isolated are at risk for taking up or continuing smoking. This study investigated country-based differences in social isolation and smoking status.MethodsWe performed a repeated cross-sectional study using two waves of data from two ongoing aging studies: the English Longitudinal Study of Ageing and the Japan Gerontological Evaluation Study. Participants from both studies aged ≥65 years were included. We applied a multilevel Poisson regression model to examine the association between social isolation and smoking status and adjusted for individual sociodemographic characteristics. We used the social isolation index which comprises the following domains: marital status; frequency of contact with friends, family, and children; and participation in social activities. Interaction terms between each country and social isolation were also entered into the mode.ResultsAfter exclusion of never smokers, we analyzed 75,905 participants (7,092 for ELSA and 68,813 for JAGES, respectively). Taking ex-smokers as the reference, social isolation was significantly associated with current smoking; the prevalence ratios (PRs) were 1.06 (95% credible interval [CrI], 1.05–1.08) for men and 1.08 (95% CrI, 1.04–1.11) for women. Taking Japan as a reference, the interaction term between country and social isolation was significant for both sexes, with increased PRs of 1.32 (95% CrI, 1.14–1.50) for men and 1.30 (95% CrI, 1.11–1.49) for women in England.ConclusionsOlder people who were less socially isolated were more likely to quit smoking in England than in Japan, possibly explained by the strict tobacco control policies in England.

Widening Socioeconomic Inequalities in Smoking in Japan, 2001-2016.

BackgroundJapan is one of the world’s largest tobacco epidemic countries but few studies have focused on socioeconomic inequalities. We aimed to examine whether socioeconomic inequalities in smoking have reduced in Japan in recent times.MethodsWe analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted every 3 years (n ≈ 700,000 per year) in Japan, during 2001–2016. Age-standardized smoking prevalence was computed based on occupational class and educational level. We calculated smoking prevalence difference (PD) and ratio (PR) of (a) manual workers versus upper non-manual workers and (b) low versus high educational level. The slope index of inequality (SII) and relative index inequality (RII) by educational level were used as inequality measures.ResultsOverall smoking prevalence (25–64 years) decreased from 56.0% to 38.4% among men and from 17.0% to 13.0% among women during 2001–2016. The PD between manual and upper non-manual workers (25–64 years) increased from 11.9% (95% confidence interval [CI], 11.0–12.9%) to 14.6% (95% CI, 13.5–15.6%) during 2001–2016. In 2016, smoking prevalence (25–64 years) for low, middle, and highly educated individuals were 57.8%, 43.9%, and 27.8% for men, and 34.7%, 15.9%, and 5.6% for women, respectively. SII and RII by educational level increased among both sexes. Larger socioeconomic differences in smoking prevalence were observed in younger generations, which suggests that socioeconomic inequalities in smoking evolve in a cohort pattern.ConclusionsSocioeconomic inequalities in smoking widened between 2001 and 2016 in Japan, which indicates that health inequalities will continue to exist in near future.

REVISITING ASYMMETRIC CAUSAL LINK BETWEEN HAPPINESS AND SMOKING IN JAPAN

Smoking and happiness both can affect health. A complex question on whether there is correlation between smoking and happiness cannot be simply examined by symmetric methodology. Japan is one of the country with the large smoking population in Asia. This paper reexamines the relationship between happiness and smoking in Japan over the period from 1961-2003, using an asymmetric Granger causality test proposed by Hatemi-J [1]. Empirical results indicate asymmetric Granger causal relationship did exist between happiness and smoking behaviour in Japan. Our results have important policy implications in Japan.

COMPARATIVE STUDY ABOUT RECOGNITION OF TOBACCO PACKAGE DISEASE RISK WARNING MESSAGE AND AWARENESS OF COPD BETWEEN TOBACCO-FREE NONMEDICAL JAPANESE UNIVERSITY STUDENT AND FACULTY/STAFF

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Recently, in Japan the momentum for promoting smoking cessation is rising, but it is still insufficient. In this regard, it is inferred that insufficiency of Warning Messages(WMs) is also involved. The Japanese cigarette package has only 8 WMs. However, the number of WMs is less than in other countries, it is mild and small size text. The recognition of these WMs is not revealed in Japan. Furthermore, the recognition of COPD(So-called abbreviated Tobacco Lung ≒"TABAKO HAI [Japanese]"), which is more than 90% due to smoking in Japan is low level(around 25%). Therefore, we investigated the recognition of WMs between Tobacco-Free-University Students and Faculty/Staff and the degree of the awareness of COPD. METHODS: Questionnaire for all Students(Group A[A]) and Faculty/Staff(Group B[B]) was performed[(A||B)]. The breakdown of the 8 WMs are that 4 (Ⅰ) are risk WMs for tobacco-related-diseases, other 4 (Ⅱ) are the General WMs(The risk of “Nicotine dependency”, “Minors smoking risk”, “Second-hand smoke damages”, “Pregnant women”). RESULTS: Characteristics of subjects(n=641[A]||132[B]) were Male/Female(%)=53.4/46.6/60.6/39.4||20.4±1.6yrs (Mean±SD) [Range;19-29]||44.6±11.6[23-72], respectively. Smoking prevalence(%) was Current: 8.2/Ex:5.6/Never:86.7||8.3/25.0/ 66.7. Recognition rate of WMs(Ⅰ) was almost the same in both groups, and ”Lung cancer” was significantly higher than “Emphysema”, “Stroke” and “Myocardial Infarction”(70.5/43.7/41.3/38.4||60.3/25.2/27.3/32.1% [multiple answers act]). On the other hand, for the (Ⅱ) WMs, Nicotine dependency was the lowest awareness in both groups(Nicotine dependency/Minors smoking risk/Second-hand-smoke damages/Pregnant women=43.4/51.2/63.7/70.8||26.7/36.6/55.0/57.3% [multiple answers act]). COPD is association with smoking is strong, however, Know was only 9.8%(Heard of:24.8%/Unknown:61.8%) in A ,similarly data of B:13.8/26.2/60.8%. CONCLUSIONS: Eight WMs should be recognized uniformly, but the results of this survey showed imbalance. We were particularly concerned that the recognition was low despite the fact that nicotine-addiction is one of the most causes of smoking habit in the current situation where nicotine replacement therapy and/or Varenicline is used as a method of smoking cessation. Furthermore, as there was low recognition of Emphysema, we thought that it was necessary to change the name of WM and further raise awareness of COPD. CLINICAL IMPLICATIONS: By setting the tobacco warning messages to the same level as other countries, it is expected that smoking cessation promotion effect can be expected and it will be useful for health promotion, raise awareness of COPD. DISCLOSURES: No relevant relationships by Tomoyasu Uno, source=Web Response No relevant relationships by Tomoyasu Uno, source=Web Response

Scallop mantle extract inhibits insulin signaling in HepG2 cells.

Scallops are important marine products in Hokkaido, Japan. Not only scallop adductor muscle but also mantle is often eaten at sashimi or smoking in Japan. We showed previously that feeding the scallop mantle epithelial cell layer causes an increase in serum glucose concentration and the death of rats. To clarify the mechanism of glucose metabolism disorder by mantle epithelial cell layer, we investigated whether extracts from mantle tissue (mantle extract) induce insulin resistance using HepG2 cells. Mantle extract suppressed insulin‐stimulated phosphorylation of Akt, key protein which is involved in insulin signaling. In addition, treatment of HepG2 cells with mantle extract decreased significantly glycogen content and mRNA expression levels of glucose‐6‐phosphatase (G6Pase) and phosphoenolpyruvate carboxykinase (PEPCK) involved in gluconeogenesis, suggesting that mantle extract inhibits insulin signaling. These results show that mantle extract inhibits insulin signaling in HepG2 cells, suggesting that an increase in serum glucose concentration in vivo may be due to the inhibition of insulin signaling.

Smoking among adults with serious psychological distress: Analysis of anonymized data from a national cross-sectional survey in Japan

BackgroundSmoking behavior among people with serious psychological distress (SPD) has not been fully investigated in Asia, although smoking has become a public health concern worldwide. Many Western population-based studies indicate that people with psychological distress are more likely to smoke. MethodsThis study used a national representative data set from the 2010 Comprehensive Survey of Living Conditions of Japan. SPD was defined as scores ≥13 or greater on the Kessler Psychological Distress Scale (K6). Multivariate logistic regression analyses were conducted to analyze the association between SPD and current smoking in Japanese adults. ResultsIn both men (n = 27,937) and women (n = 30,786), SPD was significantly associated with current smoking (adjusted odds ratios [95% confidence intervals]: 1.169 [1.030–1.328] for men and 1.677 [1.457–1.931] for women). Among men, SPD was significantly associated with current smoking only in people aged ≥50 years (1.519 [1.232–1.874]) and married (1.456 [1.228–1.728]). SPD was significantly associated with current smoking in women of all ages. SPD had a greater impact on current smoking for women aged 20–49 years than for those aged ≥50 years (1.832 [1.552–2.162] and 1.445 [1.099–1.900], respectively). LimitationsThe cross-sectional design precludes assumptions about the direction of causality. In addition, smoking status was self-reported. ConclusionsSPD was significantly associated with current smoking in Japan and the association was much stronger for younger women. Clinical strategies are needed to reduce the prevalence of smoking among people with SPD to reduce excess mortality in this population.

The relationship of cigarette smoking in Japan to lung cancer, COPD, ischemic heart disease and stroke: A systematic review.

Background: To present up-to-date meta-analyses of evidence from Japan relating smoking to major smoking-related diseases. Methods: We restricted attention to lung cancer, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD) and stroke, considering relative risks (RRs) for current and ex-smokers relative to never smokers. Evidence by amount smoked and time quit was also considered. For IHD and stroke only, studies had to provide age-adjusted RRs, with age-specific results considered. For each disease we extended earlier published databases to include more recent studies. Meta-analyses were conducted, with random-effects RRs and tests of heterogeneity presented. Results: Of 40 studies, 26 reported results for lung cancer and 7 to 9 for each other disease. For current smoking, RRs (95%CIs) were lung cancer 3.59 (3.25-3.96), COPD 3.57 (2.72-4.70), IHD 2.21 (1.96-2.50) and stroke 1.40 (1.25-1.57). Ex-smoking RRs were lower. Data for lung cancer and IHD showed a clear tendency for RRs to rise with increasing amount smoked and decrease with increasing time quit. Dose-response data were unavailable for COPD and unclear for stroke, where the association was weaker. Conclusions: Compared to studies in other Asian and Western countries, current smoking RRs were quite similar for IHD and stroke. The comparison is not clear for COPD, where the Japanese data, mainly from cross-sectional studies, is limited. For lung cancer, the RRs are similar to those in other Asian countries, but substantially lower than in Western countries. Explanations for this are unclear, but less accurate reporting of smoking by Japanese may contribute to the difference.

Content analysis of newspaper reports on passive smoking regulations in Japan

Objectives Ever since Tokyo was awarded the privilege to host the 2020 Olympic Games, the Japanese Ministry of Health, Labour, and Welfare has worked toward implementing a ban on passive smoking. This study examined the present situation of passive smoking in Japan, and the coverage of passive smoking regulations in newspaper reports, based on a content analysis. This was followed by a comparison with the contents of the "White Paper on Tobacco," published by the Japanese Ministry of Health, Labour, and Welfare in August, 2016.Methods In total, 182 articles published from September 7, 2013 to March 31, 2017 were collected from three major newspapers based in Tokyo (Asahi, Yomiuri, and Mainichi). The article search criteria included the presence of the following keywords in the title or main text: "passive smoking OR entire surface smoking cessation OR indoor smoking OR indoor smoking cessation OR smoking cessation in the site OR smoking cessation in the building." Online posts and articles that did not focus mainly on the regulation of passive smoking were excluded. The 37 coding categories that were developed were classified either as positive or negative (with respect to coverage of passive smoking regulations). The assessment of passive smoking in the White Paper on Tobacco informed the coding categories, to allow the evaluation of the extent to which the contents of the White Paper were reflected in newspaper reports.Results Among the 182 articles examined, 107 addressed only the positive aspects of the regulations, while 7 addressed only the negative aspects. Further, 50 articles addressed both positive and negative aspects, while 18 addressed neither. Among those addressing both positive and negative aspects, 14 (28%) included counterarguments to the negative comments, which consistently reflected the contents of the White Paper on Tobacco.Conclusions Majority of the articles reported only on the positive aspects of the regulations. Persuasive articles that presented both the positive and negative aspects of the issue, which included counterarguments to the negative opinions, were scarce. However, such articles were found to some degree in the editorials of newspapers. The influence of such editorials may increase if newspapers include the pros or cons of this issue, and present counterarguments. Additionally, some topics were not reported sufficiently. Thus, problems were observed in the newspaper reports regarding passive smoking regulations.

PRS60 - Benefits of Quitting Smoking in Japan on Working Productivity and Activity Impairment and Indirect Costs

PRS60 - Benefits of Quitting Smoking in Japan on Working Productivity and Activity Impairment and Indirect Costs

Web-based survey on smoking cessation behaviors of current and former smokers in Japan

Objective:To investigate the long term smoking cessation behaviors in a population of Japanese current smokers (CS) and former smokers (FS).Research design and methods:Retrospective survey of Japanese men and women ≥20 years of age who were CS (those who smoked any number of cigarettes at the time of the survey, 24–27 June 2013) or FS (those who had smoked any number of cigarettes in the past but did not consider themselves smokers at the time of the survey). CS/FS were selected from a prescreened source population recruited by online advertisement that was age- and gender-matched, to represent Japanese smokers. Clinical and socio-demographic characteristics and smoking/smoking cessation history were assessed through a web-based questionnaire.Main outcome measures:Main outcome measures were number of past quit attempts and time to relapse; others included methods used to achieve smoking cessation, and reasons for wanting to quit.Results:Overall, 1261 Japanese subjects were surveyed (CS, n = 631; FS, n = 630). Nearly half (45.6%) of CS had never attempted to quit smoking. Of those who had attempted to quit smoking, one single quit attempt was the most common for both CS and FS (19.0 vs. 39.0%). Estimated median time to relapse was 105 days (FS and CS combined). Unaided smoking cessation was the most common method both for CS and FS (78.2 vs. 63.4%).Conclusions:In our survey, >70% of smokers used unaided smoking cessation methods, which may have resulted in a lower success rate. Participants relapsed after a median of 105 days of abstinence (25% within 7 days; the remainder had resumed smoking after 1260 days). As with all surveys, recall bias may have influenced the results. Our observations could be combined with other data in health economic models of smoking cessation to identify appropriate measures to reduce the prevalence of smoking in Japan.

Community-level socioeconomic status and parental smoking in Japan

Community-level social environment has been considered to be associated with smoking behavior. However, no study has examined the association between community-level environmental factors and parental smoking behavior in families with young children. The aim of the present study was to examine the association between community-level socioeconomic status (SES) and parental smoking behavior. We used data from a cross-sectional study conducted from 2005 to 2006. We randomly selected 44 Japanese municipalities, 39 of which municipalities agreed to participate in this survey. The study subjects were participants in health check-ups for three-year-old children. Smoking status and individual demographic characteristics were obtained using self-administered questionnaires. Community-level variables were obtained from national census data for 2005. The prevalence of employment in tertiary industries and of unemployment was used to measure community-level SES. Multilevel Poisson regression models were used to calculate prevalence ratios (PRs) for smoking. Of 4143 subjects, a total of 3301 parents in 39 municipalities participated in our survey. Among the 2975 participants (71.8%) included in our analysis, 59.0% were smokers. There was no association between the job of the head of the household considered as an indicator of individual-level SES and smoking. By contrast, when we examined the relationship between prevalence of employment in tertiary industries as community-level SES and smoking, parents living in low middle SES municipalities had a significantly higher prevalence ratio for smoking, compared to parents living in the highest SES municipalities. This result suggested that those with lower community-level SES tended to have a higher prevalence of parental smoking regardless of individual-level SES.

Mobile Phone Use does not Discourage Adolescent Smoking in Japan

The possibility that smoking prevalence among junior and senior high school students may decrease with increasing mobile phone bill was reported by the mass media in Japan. We conducted a nationwide survey on adolescent smoking and mobile phone use in Japan in order to assess the hypothesis that mobile phone use has replaced smoking. A total of 70 junior high schools (response rate; 71%), and 69 high schools (90%) from all over Japan responded to 2005 survey. Students in the responding schools were asked to fill out an anonymous questionnaire about smoking behavior, mobile phone bill, and pocket money. Questionnaires were collected from 32,615 junior high school students and 48,707 senior high school students. The smoking prevalence of students with high mobile phone bill was more likely to be high, and that of students who used mobile phones costing 10,000 yen and over per month was especially high. When "quitters" were defined as students who had tried smoking but were not smoking at the time of survey, the proportion of quitters decreased as the mobile phone bill increased. The proportion of students who had smoking friends increased with the increase in the mobile phone bill per month. The hypothesis that the decrease in smoking prevalence among Japanese adolescents that has been observed in recent years is due to a mobile phone use can be rejected.

The Impact of Menthol Cigarettes on Smoking Initiation among Non-Smoking Young Females in Japan

Japan presents an excellent case-study of a nation with low female smoking rates and a negligible menthol market which changed after the cigarette market was opened to foreign competition. Internal tobacco industry documents demonstrate the intent of tobacco manufacturers to increase initiation among young females through development and marketing of menthol brands. Japanese menthol market share rose rapidly from less than 1% in 1980 to 20% in 2008. Menthol brand use was dominated by younger and female smokers, in contrast with non-menthol brands which were used primarily by male smokers. Nationally representative surveys confirm industry surveys of brand use and provide further evidence of the end results of the tobacco industry’s actions—increased female smoking in Japan. These findings suggest that female populations may be encouraged to initiate into smoking, particularly in developing nations or where female smoking rates remain low, if the tobacco industry can successfully tailor brands to them. The Japanese experience provides a warning to public health officials who wish to prevent smoking initiation among young females.

The Income Elasticity of Education and Tobacco Smoking in Japan: The Family Income and Expenditure Survey during the 2000^|^ndash;2005 Year Period

The Income Elasticity of Education and Tobacco Smoking in Japan: The Family Income and Expenditure Survey during the 2000^|^ndash;2005 Year Period

Perioperative tobacco use interventions in Japan: a survey of thoracic surgeons and anaesthesiologists

Tobacco use interventions in surgical patients who smoke could benefit both their short-term outcome and long-term health. Anaesthesiologists and surgeons can play key roles in delivering these interventions. This study determined the practices, attitudes, and beliefs of these physicians regarding tobacco use interventions in Japan. Questionnaires were mailed to a national random sampling of Japanese anaesthesiologists and thoracic surgeons (1000 in each group). The survey response rate was 62%. More than 80% of respondents agreed or strongly agreed with the statements affirming the benefits of abstinence to surgical patients. However, only 26% of surgeons and 6% of anaesthesiologists reported almost always providing help to their patients to quit smoking. Compared with anaesthesiologists, surgeons were more likely to perform the elements of current recommendations for brief intervention, and to have attitudes favourable to tobacco use interventions. The most significant barrier to intervention identified by both groups was a lack of time to perform counselling. Compared with non-smokers, physicians who smoked were less likely to perform each of the recommended tobacco interventions Although current rates of intervention provided by anaesthesiologists and surgeons are low, there is considerable interest among these physicians in learning more about interventions. Given the relatively high prevalence of smoking in Japan and the potential for surgery to serve as a 'teachable moment' to promote abstinence from smoking, leadership by these specialists in the area of tobacco control could have a major impact on public health in Japan.

Population attributable fraction of mortality associated with tobacco smoking in Japan: a pooled analysis of three large-scale cohort studies.

BackgroundQuantitative measures of the burden of tobacco smoking in Asian countries are limited. We estimated the population attributable fraction (PAF) of mortality associated with smoking in Japan, using pooled data from three large-scale cohort studies.MethodsIn total, 296,836 participants (140,026 males and 156,810 females) aged 40-79 years underwent baseline surveys during the 1980s and early 1990s. The average follow-up period was 9.6 years. PAFs for all-cause mortality and individual tobacco-related diseases were estimated from smoking prevalence and relative risks.ResultsThe prevalence of current and former smokers was 54.4% and 25.1% for males, and 8.1% and 2.4% for females. The PAF of all-cause mortality was 27.8% [95% confidence interval (CI): 25.2-30.4] for males and 6.7% (95% CI: 5.9-7.5) for females. The PAF of all-cause mortality calculated by summing the disease-specific PAFs was 19.1% (95% CI: 16.0-22.2) for males and 3.6% (95% CI: 3.0-4.2) for females. The estimated number of deaths attributable to smoking in Japan in 2005 was 163,000 for males and 33,000 for females based on the former set of PAFs, and 112,000 for males and 19,000 for females based on the latter set. The leading causes of smoking-attributable deaths were cancer (61% for males and 31% for females), ischemic heart diseases and stroke (23% for males and 51% for females), and chronic obstructive pulmonary diseases and pneumonia (11% for males and 13% for females).ConclusionThe health burden due to smoking remains heavy among Japanese males. Considering the high prevalence of male current smokers and increasing prevalence of young female current smokers, effective tobacco controls and quantitative assessments of the health burden of smoking need to be continuously implemented in Japan.