University of Occupational and Environmental Health, Japan

1. 2011 Nov 3 18:10-18:25 An exchange program, Catholic University & IIES, UOEHIssues of Tobacco control in Japan:-Secondhand smoke exposures in workplaces in Japan- • History of measures against secondhand smoke (SHS) in Japan: Smoking corner →Smoking room →Partial ban(1990’) (2000’) (2010’) • Present problems of SHS in Japan University of Occupational and Environmental Health, Japan Institute of Industrial and Ecological Sciences, Dept. of Health Development. Prof. H. Yamato

2. Workplaces History of measures against SHS in Japan Necessity of measures against SHS in workplaces • Ministry of Labour 1992: Notification of Comfortableness in Workplaces 1996: Guidelines for Smoking Control in Workplaces 2003: Revised Guidelines for Smoking Control in Workplaces • “Designated smoking” should be implemented in WP • Smoking room or smoking corner • Exhaust fan or air purifier National offices Public places • Ministry of Health • 2002: Guidelines for Smk Control in Public Places • National Personnel Authority • 2002: Guidelines for Smoking Control in National Offices 1) Designated smoking room (1st choice), smoking corner (2nd choice) 2) Exhaust fans is necessary for creating negative pressure Health Promotion Law (2003) Some measures against SHS in all the enclosed spaces

3. Air purifier was recommended in the guidelines for smoking control by Ministry of Labour, in 1998 Dust monitor(non-smoking area) Dust monitor (smoking corner: On the airpurifyer) This type of measures did not work so that the guideline was soon revised in 2003.

4. Health Promotion Law (2003) • The managers of public places should take effective measures against SHS • All the enclosed places are involved including offices and entertainment industries • Partially effective(banks, post offices, department stores voluntarily became total smoking ban after 2003) • Disadvantage: no investigation, no punishment, no fine and designated smoking rooms are recognized as “Effective”

5. “Smoking room” recommended by the revised guideline also does not work for protecting against SHS Dust monitor (in smoking room) There is no choice except total smoking ban inside the buildings as WHO-FCTC recommended.

6. “Guidelines for implementation Article Article 5.3, 8, 9, 10, 11, 12, 13, 14” (2011) WHO Framework Convention on Tobacco Control Article 8: Protection from exposure to tobacco smoke Approaches other than 100% smoke free environments, including ventilation, air filtration and the use of designated smoking areas (whether with separate ventilation systems or not), have repeatedly been shown to be ineffective and there is conclusive evidence, scientific and otherwise, that engineering approaches do not protect against exposure to tobacco smoke. Each Party should strive to provide universal protection within five years of the WHO FCTC’s entry into force for that Party. Deadline was Feb. 27 2010 http://www.who.int/fctc/protocol/guidelines/adopted/guidel_2011/en/index.html

7. Trend of measures against SHS is total smoking ban Comprehensive National Policies: Smoking ban without any exemptions Strong National Policies with Limited Exemptions (such as cigar lounges, designated smoking rooms) Comprehensive or Strong Local Policies: at a sub-national level

8. Admission of acute coronary syndrome decreased by 17% after Smoke-free Law was implemented in Scotland in 2006 Before Ban After Ban Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome Jill P. Pell et al., N Engl J Med. 2008; 359: 482-91.

9. Trend of measures against SHS is total smoking ban Comprehensive National Policies: Smoking ban without any exemptions Strong National Policies with Limited Exemptions (such as cigar lounges, designated smoking rooms) Comprehensive or Strong Local Policies: at a sub-national level

10. India >Korea=Japan> Pakistan > Sri Lanaka> China> Malaysia SHS exposure in hospitality venues in 7 Asian countriesInternational Journal of Hygiene and Environmental Health 213 (2010) 348–351, J Lee et al. X. Guo R. Kamath H. Yamato J. Lee A. Abas A. Nafees S. Nandasena 6 1 3 2 7 4 5 Cafes Restaurants Bars Entertainments

11. Only Hong-kong implemented comprehensive smoking ban in Asia Ban on smoking started from restaurants in 2007. Comprehensive ban including casinos and bars started in 2009.

12. Reasons why tobacco control is not promoted in Japan１ • Tobacco sales was monopolized by the government in 1898 • JT was separated from the government in 1985 but Ministry of the Finance still keeps more than half of its stocks • Tobacco Business Act aiming promoting tobacco sales was implemented in 1985. JT is protected by the law

13. Reasons why tobacco control is not promoted in Japan 2 • Sectionalism among 3 ministries National offices Ministry of Health, Labour and Welfare • Ministry of Labour 2003: Revised Guidelines for Smoking Control in Workplaces • National Personnel Authority2002: Guidelines for Smoking Control in National Offices Workplaces Public places • Ministry of Health2002: Guidelines for Smk Control in Public Places • Wrong policy that permit designated smoking rooms • Each guideline and Health Promotion Law

14. Reasons why tobacco control is not promoted in Japan 3 Ministry of Health = Public places Ministry of Labour = Workplaces Hospitality venues should be protected by the both policies Both of the Ministries think that it is difficult to ask the customers not to smoke. If it is allowed to smoke in restaurants and bars, the atmosphere for controlling tobacco would not change. We should emphasize that millions of workers in those industries are occupationally exposed to SHS in order to protect them and change the public opinion.

15. SHS in restaurants Both customers and workers Dust monitor in smoking section Wearable sensor

16. Tobacco smoke spread from smoking section to non-smoking section Non-smoking Smoking section

17. Workers are exposed to several times higher SHS while serving Wearable sensor Coffee Side-stream Low level in non-smoking section High exposure while serving

18. Kanagawa Pref. implemented the Smoke-free Ordinance in 2010 • Restaurants larger than 100m2 should take measures against SHS

19. Before and after the Kanagawa Ordinance Smoke-free Ordinance is effective to protect both customers and workers Re-measurement after the ordinance

20. Which measure, PPE or Smoke-free policy, is feasible?

21. 2011 Nov 3 18:10-18:25 An exchange program, Catholic University & IIES, UOEHIssues of Tobacco control in Japan:-Secondhand smoke exposures in workplaces in Japan- • Health Promotion Law or Guidelines of ministry level are existing, but no inspection, no punishment. • Smoking room is still allowed as the 2nd choice (might mislead the direction of measures) • Still exposed to SHS in many situations (public offices, private offices, transportation, entertainment industries, etc.) • Hospitality industries are excluded in the present regulation What we need is to implement the Smoke-free Law (national level) without any exception as FCTC recommends

22. Issues of tobacco control in Japan - Present situation of secondhand smoke - • Regulation against SHS in Japan (2010) • Health Promotion Law or Guidelines of ministry level are existing, but no inspection, no punishment. • Smoking room is still allowed as the 2nd choice (might mislead the direction of measures) • Still exposed to SHS in many situations (public offices, private offices, transportation, entertainment industries, etc.) • Entertainment industries are excluded in the present regulation What we need is to implement the Smoke-free Law (national level) without any exception as FCTC recommends