{
  "abstract": "Background In April 2020, Japan’s revised Health Promotion Act (HPA) banned cigarette smoking and heated tobacco products (HTP) use in indoor public places but exempted small establishments and permitted smoking-designated/HTP-designated rooms. This pre–post study evaluated the effectiveness of the HPA.Methods Data were from waves 1 to 4 (2018–2021) of the International Tobacco Control Japan Surveys among a national cohort of adults who smoke cigarettes, use HTPs and do not use any tobacco products. The sample sizes in the respective surveys were 4615, 4222, 4387 and 4254. Multivariable logistic regression models employing generalised estimating equations estimated the prevalence of observed and self-reported indoor smoking/HTP use in key public venues (restaurants/cafés, bars/pubs and workplaces), smoke-free places, and homes, and smoke-free/HTP aerosol-free home policies (model 1). The models were additionally adjusted for waves 1–4 to estimate the impacts of the HPA (model 2).Results The implementation of the HPA significantly reduced observed indoor smoking in bars/pubs (model 1: 82.2% (pre) to 55.5% (post), model 2: p=0.04) but not in restaurants/cafés (model 1: 53.0%–24.9%, model 2: p=0.15) or workplaces (model 1: 35.3%–30.1%, model 2: p=0.62). Observed indoor HTP use was also common postimplementation (restaurants/cafés: 19.6%, bars/pubs: 53.9%, workplaces: 36.4%). The implementation of the HPA was associated with a significant increase in observed HTP use in smoke-free places (model 1: 26.3%–33.3%, model 2: p=0.001) and a suggestive increase in homes without HTP aerosol-free policies among adults who smoke (model 1: 64.0%–77.0%, model 2: p=0.09).Conclusions The implementation of the HPA was limited in its effectiveness. Comprehensive regulations with no exemptions are needed in Japan.",
  "authors": [
    {
      "affiliations": [
        "Division of Population Data Science, National Cancer Center Institute for Cancer Control, Tokyo, Japan",
        "Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France"
      ],
      "name": "Kayo Togawa"
    },
    {
      "affiliations": [
        "Department of Psychology, University of Waterloo, Waterloo, ON, Canada",
        "Ontario Institute for Cancer Research, Toronto, ON, Canada",
        "School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada"
      ],
      "name": "Geoffrey T Fong"
    },
    {
      "affiliations": [
        "Department of Psychology, University of Waterloo, Waterloo, ON, Canada"
      ],
      "name": "Anne C K Quah"
    },
    {
      "affiliations": [
        "Department of Psychology, University of Waterloo, Waterloo, ON, Canada"
      ],
      "name": "Gang Meng"
    },
    {
      "affiliations": [
        "Department of Psychology, University of Waterloo, Waterloo, ON, Canada"
      ],
      "name": "Steve S Xu"
    },
    {
      "affiliations": [
        "Department of Psychology, University of Waterloo, Waterloo, ON, Canada"
      ],
      "name": "Janine Quimet"
    },
    {
      "affiliations": [
        "Shinmachi Clinic and Health Care Center, Tokyo, Japan",
        "Division of Cancer Information Service, National Cancer Center Institute for Cancer Control, Tokyo, Japan"
      ],
      "name": "Yumiko Mochizuki"
    },
    {
      "affiliations": [
        "Centre for Emergency Preparedness and Response, National Institute of Infectious Diseases, Tokyo, Japan"
      ],
      "name": "Itsuro Yoshimi"
    },
    {
      "affiliations": [
        "Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan"
      ],
      "name": "Satomi Odani"
    },
    {
      "affiliations": [
        "Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine, Miyagi, Japan"
      ],
      "name": "Takahiro Tabuchi"
    },
    {
      "affiliations": [
        "Division of Population Data Science, National Cancer Center Institute for Cancer Control, Tokyo, Japan"
      ],
      "name": "Kota Katanoda"
    }
  ],
  "title": "Impacts of revised smoke-free regulations under the 2020 Japan Health Promotion Act on cigarette smoking and heated tobacco product use in indoor public places and homes: findings from 2018 to 2021 International Tobacco Control (ITC) Japan Surveys",
  "uid": "2801bc44-2782-5361-80db-c61608470f82"
}