Japan Research and Analysis
through Internet Information

by Yasuharu Dando

Japanese People Who Don't Grow out of Dependency on Tobacco
(October 2003)(Japanese edition:12/Jun/2003)

In last year's Vital Statistics of Population published in the beginning of June, what attracted people's attention was the fact that the number of deaths due to lung cancer exceeded 40,000 for the first time. The death rate on a population basis had strikingly increased within half a century. Although the smoking rate among men had declined, it was still extraordinarily high among developed countries. The smoking rate among young women had also increased.

Recently, some local governments have placed a ban on smoking on the street and have started to penalize violators with fines. Taking this as an opportunity, the campaign against smoking in public places or offices has been advanced. However, there is still a long way to go to become free from dependency on tobacco. In this article, I would like to dig into the reality of this tobacco dependency by setting out a viewpoint close to people who smoke, instead of attacking tobacco as being evil.

Serious Increase in the Death Rate due to Lung Cancer

Under "Death" in the Vital Statistics, you can see the "year-on-year transition of the cancer death toll and death rate (per population of 100,000) by region." One shocking statistic is the number of deaths among males due to lung cancer, which is 41,115. Moreover, the death rate of 4.3% in 1955 has seen an increase at an accelerating rate every 10 years, such as 11.2%, 19.6%, 35.3%, and 54.8%, recording 66.8% last year. The death rate is expected to reach 70% in 2005. This is actually 18 times that a half century ago.

For females also, the death rate due to colon cancer at 26.5% and that of lung cancer at 23.7% are quickly catching up with that of stomach cancer at 27.0%, which currently ranks at the top. It is expected that these death rates will overtake stomach cancer in the very near future. However, yesterday's smoking does not simply appear as today's cancer. It has appeared as an increase in the death rate of middle-aged people who have smoked a long time for 10 or 20 years. The large number of cancer-causing components contained in tobacco not only cause lung cancer but also affect the development of cancer in other areas. The sharp increase of lung cancer is a dramatic indicator, but this is not all; the affect on other diseases such as heart disease is also significant.

You could argue that people who smoke deserve those diseases, but this is also a problem for nonsmokers who are forced to inhale secondhand smoke containing nicotine. At the end of March, New York City issued "New regulations for the New York City Smoke-Free Air Act" that prohibits smoking in all restaurants and bars in the city.

Also in Japan, which had not taken such measures, the Ministry of Health, Labor, and Welfare issued "Passive smoking prevention measures" along with the enforcement of the Health Regime in April. The measures state, "The current air cleaners installed indoors are effective for removing particulates in tobacco smoke but not sufficient for removing its gaseous contents. Upon using these air cleaners, therefore, special considerations on ventilation of smoking areas shall be required." That is, it points out that the functions of the current air cleaners are not enough. Now that even the installation of air cleaners was found to be insufficient, the pressure for an absolute ban on smoking has increased.

As target facilities, the Health Regime lists "schools, gyms, hospitals, theaters, pavilions, assembly halls, exhibition halls, department stores, business offices, government facilities, and restaurants." It also lists "train stations, bus terminals, passenger airplane terminals, passenger boat terminals, banking facilities, art galleries, museums, social welfare facilities, shops, hotels, inns, other accommodation facilities, stadiums, game halls, amusement facilities" as other facilities. Moreover, it includes even "railway cars, buses, taxies, airplanes, and passenger boats."

Smokers have thus been closed in more and more tightly, but the number of smokers has not decreased significantly.

What is the Cause for the Turn about in Smoking Rates in 1995?

In 1995, the "Tobacco action plan investigative commission report" was issued. This year is noted as the year when the government set off to tackle the issue of tobacco. In this year, however, the smoking rates, which had been continuously falling until then, ironically turned into a sudden increase. According to the research data on adult smoking rates, this tendency is prominent for men in their 20s to 50s and women in their 20s and 30s. For men in their 20s, for example, the previous year's 45% jumped up to 60%. For men in their 30s, the previous year's 51% also increased to 60%.

What was the cause for this? Recently, I realized something while I was checking on reports and discussions regarding nursing personnel.

According to the Japanese Nursing Association, the smoking rate among doctors is lower than that of the general public. For nurses who support the medical services together with doctors, however, the smoking rate is higher than that of the general public. In particular, the smoking rate of female nurses is 24.5%, which is approximately twice of that of general women. Of course, few of the nurses actually smoke in the hospitals; most of them smoke outside their places of work. Nevertheless, why do these healthcare people, who should have firsthand knowledge of the adverse effects of smoking, still smoke?

Here, I would like to present some research that suggests their psychology. The result of inquiring into the behavioral factors of smoking among student or freshman nurses was: "For freshman nurses who are satisfied with having become a nurse, the percentage of smokers is lower than that of freshman nurses who do not think so. Similarly, for student nurses who are satisfied with being a student nurse, the percentage of smokers is lower than that of student nurses who do not think so. In addition, among nurses who have job concerns, hope for a change of position, or are dissatisfied with their salaries or other working conditions, the percentage of smokers is higher than that of other nurses."

That is, even nurses who are fully aware of the health hazards of smoking succumb to the stressful environment that surrounds them.

Now, what happened in the year in question? Looking at the top-ten news of 1995, exceptionally major incidents occurred during the year, such as the Great Hanshin Earthquake, dispersal of sarin gas in the subway system by the Aum Shinrikyo cult, failures of financial institutions, and overvaluation of the yen such as 80 yen to the dollar. In other words, 1995 was the year when the myth that Japan is a safe country collapsed in various phases altogether.

As the result of the National Nutrition Survey of 2001, the "year-on-year transition of habitual smokers (by sex and age group)" indicates that the smoking rate for the overall population has decreased to a level close to that of 1994, just before the turn about in the smoking rate in 1995. However, the cause for the decrease is because elderly people have quit smoking while younger people seem to have maintained their high smoking rate.

_________Smoking rate_________
_____%_______20s____30s____40s____50s____60s____70s and older

Today's people in their 20s also suffer from stress from the difficulty of finding employment. In this country, preaching against the evils of smoking is simply not enough to lower the smoking rates. The entire society appears to overlook behaviors lacking self-responsibility. Comparing the anti-smoking education in Japan and the United States, Mr. Tsuyoshi Kawamura, Chief of the Health Center of Hyogo Prefecture, said in his lecture "Can you save those whom you love?" as follows:

"In the United States, there are many sudden deaths from cardiac causes and the main causes are cardiac infarctions. They ask children, 'Do you know what causes a heart infarction?' They thus bring out an answer 'tobacco' from children. Indeed, tobacco is a major cause for heart infarctions. But they don't say, 'So don't smoke when you grow up.' Instead, they say, 'Be well aware of this when you smoke.' Thus, American smokers show some sort of guts because they smoke knowing the risk to their lives. Japanese smokers are also OK as long as they are aware of the possibility of death when they smoke. However, if they cry for help as soon as they fall ill, I would say that they were not entitled to smoke."

By the way, how are the situations in foreign countries among nurses who smoke? I found an interesting report. In the Weekly Medical World News in 1997, "Real Life of Nurses in England" reports, "For many years, the smoking rate among nurses had been much higher than that of the general public although the smoking rate among doctors had been low. In the recent survey, however, the smoking rate among nurses was 14.3%, which was approximately half of the average national rate of 28%. It would appear that nurses have developed strong self-consciousness as professionals who promote the nation's health, just like doctors."

(Special thanks to translation by PHP Institute Inc.
"JAPAN CLOSE-UP" October 2003)
Related work!!---"The U.S.-Japan Gap in Attitude Towards Smoking"

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