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T. Sobue



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    ED12 - Regional Tobacco Control Policies: Advances & Challenges (ID 281)

    • Event: WCLC 2016
    • Type: Education Session
    • Track: Epidemiology/Tobacco Control and Cessation/Prevention
    • Presentations: 1
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      ED12.05 - Tobacco Control Policies in Japan (ID 6493)

      12:00 - 12:15  |  Author(s): T. Sobue

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      Abstract:
      Background Although Japan ratified the FCTC in 2004, progress in tobacco control is still limited. In the WHO report on the global tobacco epidemic, 2015,[1)] Japan was scored “No or weak policy” for smoke-free policies, mass media and advertising bans, “Minimal policy” for health warnings, and “Moderate policy” for cessation program and taxation. In order to accelerate tobacco control activities, evidence-based official summary report on health effects of tobacco products and effectiveness of tobacco control is needed.　A report of Surgeon General in the US[ 2)] and Monograph series from International Agency for Research on Cancer [3)] are the examples. In these reports, causal relationship was judged systematically considering scientific evidences through systematic review comprehensively based on certain criteria. A causal conclusion conveys the inference that changing a given factor will actually reduce a population’s burden of disease, either by reducing the overall number of cases or by making disease occur later than it would have. So far in Japan, although such official summary reports were published three times, judgement on the causal relationship was not included. Here we report the 4th version of the report which contain judgement on the causal relationship between smoking and various diseases.[4)] Methods Health effect of active and passive cigarette smoking was categorized into 4 levels (sufficient/suggestive causal relation, insufficient evidence and suggestive no causal relation). Causal relationship was judged comprehensively in terms of consistency, strength, time-relation, biological plausibility, dose-response relation and risk reduction after cessation, which are similar to US Surgeon General Report.[5) ]It was judged by each corresponding writer of the disease first, then discussed in the committee and determined by consensus. Effectiveness of tobacco control activities and economic impact was also evaluated. Results Based on the previous evidence reports (domestic and international), health effects of active cigarette smoking were evaluated for cancer, cardiovascular diseases, respiratory diseases, reproductive effects, and other effects, such as diabetes and dental diseases. Health effects of passive smoking and adolescence use was also evaluated. It is judged that the evidence is sufficient to infer a causal relationship with active smoking (Level 1) for cancer of the lung, oral cavity/pharynx, larynx, nasal cavity, esophagus, stomach, liver, pancreas, bladder and cervix uteri. For cardiovascular diseases, ischemic heart disease, stroke, abdominal dissecting aneurysm and peripheral arteriosclerosis, and for respiratory diseases, chronic obstructive pulmonary diseases (COPD), decline of pulmonary function and deaths due to tuberculosis are judged as Level 1. Active smoking of pregnant women is judged as causally related to preterm delivery, low birth weight, fetus growth retardation and sudden infant deaths syndrome (SIDS). For other diseases, type 2 diabetes mellitus, periodontitis and nicotine dependency are judged as Level 1. For passive smoking, it is judged to be sufficiently causally related (level 1) for lung cancer and ischemic heart disease and stroke in adulthood. Odor annoyance and nasal irritation as acute effect for respiratory system, and asthma and sudden infant death syndrome (SIDS) for children are judged as level 1. For smoking in adolescence, deaths due to all cause deaths, cancer and circulatory disease and increased risk of cancer incidence are judged as level 1. Tobacco control activities were summarized according to the MPOWER. Although prevalence of current smokers has decreased (32.2% for males and 8.5% for females in 2014), pace of decrease slowed recently.

      Although the Health Promotion Act (2003) and revision of the Industrial Safety and Health Act (2015), which mandates company to protect workers from passive smoking with best efforts, have made some progress to promote smoke-free environment, especially in schools, hospitals and governmental offices, problems still remain in other places, such as restaurants and bars. Cessation support in the community and workplace, cessation support using OTC cessation medicines at pharmacy and cessation treatment using health insurance are the 3 pillow conducted in Japan. Warning labels on tobacco packages in Japan uses only characters and too many words, which results in few impact on smokers. Almost no mass media campaign has been conduct to provide information to the public. Regulation to tobacco industry mostly relies on voluntary basis and their CSR activities have been conducted with no regulation. Although after recent tax increases, tax rate became almost in the middle among developed countries and tobacco consumption decreased, tobacco price is still low (Fig 1).[6-8)] It is summarized that activities were weak for smoke-free policies, mass media advertising bans and health warnings in Japan. Regarding smoke-free policy, Tokyo Olympic/Paralympic 2020 will be the best occasion to further promote the policy at national level. Conclusion Evidence-based summary reports should be effectively used in order to accelerate tobacco control activities in Japan. References 1) WHO Tobacco Free Initiative （TFI）. 2015. 'Tobacco control country profiles', Accessed 2016/01/31. http://www. who. int/tobacco/surveillance/policy/country_profile/en/ 2) The Health Consequences of Smoking - 50 Years of Progress A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. 3) IARC. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 100E, Personal Habits and Indoor Combustions. Lyon, France: International Agency for Research on Cancer; 2012 4) Committee on the health effect of smoking. Smoking and Health – report from the committee on the health effect of smoking, 2016. 5) The Health Consequences of Smoking: A Report of the Surgeon General. In: Service USPH, ed. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. 6) Ministry of Finance. Tax and stamp revenue settlement amount investigation. List of statistical tables. 7) Ministry of Internal Affairs and Communications. White paper for local finance. 8) Tobacco Institute of Japan. Statistical data on cigarette. Time trend table for sales performance by fiscal year. Fig 1. Trends of tax income, tobacco consumption and smoking rate in Japan.[6-8)] Figure 1



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