An exploratory analysis of the impact of a university campus smoking ban on staff and student smoking habits in Japan

In May 2011, Nayoro City University was comprised of 101 teachers and office workers (male: 50, female: 51) and 712 students (male: 118, female: 594), all of whom participated in the survey. Students belonged to The Faculty of Health and Welfare Science or Early Childhood Education.

Data collection was done anonymously in May 2011 by means of a self-administered, multiple-choice questionnaire. The questionnaire asked for information about gender, status in the school (i.e. teacher, office worker or student), and smoking characteristics (i.e. non-smoker, ex-smoker, or smoker). Ex-smokers were asked about their motivations for quitting smoking. The questionnaire also asked smokers about the number of cigarettes smoked per day, years of smoking, items from the Fagerström Test for Nicotine Dependence (FTND), their smoking habits while at the university (i.e. abstinence or not), smoking area while at the university, impact of the smoking ban, the effect of a price increase on the number of cigarettes smoked per day, and their intention to quit smoking.

The protocol of this study was approved by the Ethics Committee of Nayoro City University.

Data were digitized then analyzed with descriptive statistics according to characteristics of subjects. With respect to smokers, differences in years of smoking and FTND between teachers/office workers, and students were analyzed by Student’s t-test and Mann Whitney U-test, respectively. In the same way, the relationship between smoking habits of smokers while at the university, and smoking characteristics and FTND were analyzed with the same tests. All P-values were based on a two-tailed test and a significance level lower than 0.05 was defined as significant. Statistical analysis was performed using the Dr. SPSS 2 for Windows 11.0.1 J statistical package.

Among 813 subjects, we obtained valid responses from 56 teachers and office workers (recovery rate: 55.4%) and 449 students (recovery rate: 63.1%) (Table 1). Among respondents, the smoking prevalence was 17.9% among teachers and office workers, and 4.0% among students.

Ex-smokers were asked to indicate the most appropriate motivator THAT LEAD THEM TO QUIT SMOKING. Among the listed motivators, none of the ex-smokers replied that the most appropriate motivator for quitting smoking was the ban on smoking (Table 2).

The smoking characteristics of smokers is shown in Table 3. The number of years smoking among teachers and office workers was greater than among students (P=0.007: Student’s t-test). Statistically, there was no difference in FTND between teachers/office workers, and students (Mann Whitney U-test). Among all smokers, 46.4% did not abstain from smoking while at the university and they indicated their smoking areas were “on the streets next to the campus”: 16 and “outdoors on campus”: 3, respectively (Table 4). Number of cigarettes smoked per day and FTND among non-abstinent smokers were significantly greater than those among the abstinent smokers (number of cigarette: P=0.001: Student’s t-test and FTND:P=0.029: Mann Whitney U-test, respectively, Table 5).

The impacts of the ban on smoking and the price increase on the number of cigarettes smoked per day are shown in Table 6. As for the smokers’ intention to quit smoking, 48.1% replied “I do not want to quit smoking now”, and another 48.1% replied “I want to quit smoking in the near future”, while only one student replied, “I am trying to quit smoking now” (Table 7).

According to a previous survey on female students in the Department of Nursing Science at Nayoro City University (students in other departments were not included), smoking prevalence was 12.3% in 2002 and 10.5% in 2003, respectively [5]. In this 2011 survey, smoking prevalence had decreased to 4.3% of students. A school policy restricting smoking based on the Health Promotion Law might be a contributory factor in discouraging the initiation of smoking. As a result, the yearly admission of students who do not later take up smoking may have had a cumulative effect, leading to an overall decrease in the prevalence of smoking [4].

As for smokers, 29.6% of them reduced the number of cigarettes smoked per day as a result of the smoking ban. More than half of smokers abstained from smoking at the university. The ban on smoking was demonstrated to have a certain effect in smoking reduction for smokers.

By contrast, none of the ex-smokers also replied that their principal motivation for quitting smoking was the smoking ban. In the case of smokers, around 30% of them reduced the number of cigarettes smoked per day in consequence of the ban on smoking, however, almost all of them were not willing to quit smoking. The ban on smoking served a motivator for smokers to reduce in smoking, but not serve as an effective motivator to quit smoking.

The preventative effects of a reduction in smoking on smokers’ own tobacco-related diseases differs across studies [6‐9]. Although it is still uncertain if a reduction in smoking has any preventative effect on smokers’ tobacco-related diseases, several studies have confirmed the health benefits of quitting smoking [10]. However, almost all the surveyed smokers were unwilling to quit smoking right now in spite of current school policy. For smokers, the ban on smoking did not provide an effective motivator to quit smoking but led to smoking on the streets off campus while at the university. In this study, a heavy addiction was related to non-abstinence while at the university, and smoking on the street. The impact of a smoke-free policy on attitudes and quitting behaviors varies among studies [11‐15]. The reason might be that the principal aim of the Health Promotion Law and school policy based on that law is to protect non-smokers from second-hand smoke, but not to encourage smokers to quit smoking. Changing attitudes and behaviors among smokers would be an unintended consequence of this legislation and/or policy. In order to encourage addicted smokers to quit smoking, other approaches that incorporate effective educational and medical measures may be necessary. In Japan, smoking cessation therapy with nicotine gum/patches and varenicline has been covered by health insurance under certain conditions since 2006 [16]. But almost all student smokers are excluded from this insured treatment because of the short duration of their smoking. Smoking cessation therapies for adolescents and young adults with a short history of smoking should be covered by health insurance in order to prevent heavier addiction. In this study, smoking teachers and office workers with a longer smoking history were not any more willing to quit smoking than student smokers.

This study was conducted in a small university with a small sample size. Student subjects constituted a near homogeneous age group. Smoking prevalence was investigated once in 2011 in a cross-sectional survey, but a survey was not conducted in 2006 when the policy was first declared. This study focused on smokers’ attitudes and desires to quit, however non-smokers’ perceptions were not investigated. Although the results may not be generalizable, they do, however, provide some evidence of the impact of a school, smoke-free policy based on the Japanese Health Promotion Law on staff and students who are habitual smokers.