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As smoking ban kicks in, difficulties smolder for Japan's universities, hospitals

A sign warning students against smoking or throwing their cigarette butts away outside is seen on Sophia University's Yotsuya Campus in Chiyoda Ward, Tokyo, on June 28, 2019. (Mainichi/Sooryeon Kim)

TOKYO -- Legal changes to clamp down on second-hand smoke go into effect this month, imposing restrictions on smoking at universities and hospitals, while businesses including restaurants will see new rules take effect in April 2020 ahead of the Tokyo Games.

However, with complicating factors including the changes' effects on neighborhoods, the present state of businesses and pre-existing bans on smoking in the streets, the law's aim for a world free of the undesirable effects of second-hand smoke is not proceeding smoothly.

Among the "type 1 institutions" affected from July by the amendments to the Health Promotion Act, it appears universities are having the most trouble enacting full bans on on-campus puffing. A survey by the Mainichi Shimbun found that among the 51 universities with the largest student populations, a majority retain outside smoking areas.

The only designated smoking area at Sophia University's Yotsuya Campus in Chiyoda Ward, Tokyo, is behind a building, far from classrooms. A warning sign reads: "Smoking outside of designated smoking areas is prohibited. If the rules are not followed, the smoking area will be closed." Just after noon, a number of students and staff could be seen lighting up in the area.

According to Sophia University, only a small portion of its students and staff smoke, at 4% and 6%, respectively. However, with smoking in the street banned under Chiyoda Ward ordinances, discussions at the university reportedly concluded that if cases of sidewalk smoking were to increase and inconvenience residents, then establishing a place to smoke on campus was the best course of action. A representative said, "It's not that we want to foster a university environment where you aren't allowed to smoke, but rather one where you don't smoke."

A not inconsiderable number of universities are using the revisions to the law as an opportunity to try and advance smoking bans. At Hiroshima University in Higashihiroshima, Hiroshima Prefecture, west Japan, the institution's smoking areas have been gradually closed. A year ago there were 30, but from July the number now stands at just two, with the university set to impose a complete puffing prohibition from January 2020. From February 2019, it also began a program to distribute medication to help students quit.

Kyushu University in Fukuoka, southwest Japan, will shutter its 27 smoking areas and implement a full no smoking policy from September 2019.

Conversely, there have also been cases of universities being forced to relax their smoking ban policies. Ryukoku University in Kyoto, west Japan, introduced a full campus no smoking rule in April 2009. But following repeated complaints from residents over problems including smoking in the surrounding area and students discarding cigarette butts, the university reversed course 1 1/2 years later. However, to encourage people to quit, the university introduced a smoking area dubbed the "smoking graduation support booth."

At Ritsumeikan University, also in Kyoto, a blanket no smoking policy was introduced in 2013, but the following year it ended up reintroducing smoking areas.

Among medical institutions, also "type 1 institutions" definition, second-hand smoking prevention measures are proceeding at a quicker pace. According to a Ministry of Health, Labor and Welfare survey, 59% of Japan's 8,412 medical institutions had banned smoking anywhere on their premises as of October 2018.

However, at mental health centers with long-stay patients, there are concerns the rules will damage their stability. At the former Kofu Hospital of Hyogo Prefecture (now Hyogo Mental Health Center) in western Japan, a smoking ban was enacted on its premises in fiscal 2014. But according to a report published in the Japan Society for Tobacco Control journal, almost 30% of staff and around half of the inpatients opposed the ban. They cited reasons including concerns about the stability of patients' mental health symptoms and a subsequent increase in prescriptions, as well as some saying they had nothing they enjoyed in life apart from tobacco.

For so-called "type 2 institutions" that include business such as restaurants, rules banning smoking indoors come into effect in April 2020.

Some businesses are already known to have met with success under the changes, particularly Kushikatsu Tanaka, a pub and restaurant chain with around 240 locations nationwide.

The chain banned smoking inside almost all of its branches in June 2018, and has since seen a boom in the number of family customers. In the company's accounting period up to November 2018, sales at its restaurants were up 2.6% on the previous financial period. A company public relations representative said, "By banning smoking, we aimed to become a firm that people from a wide age range can really love for a long time."

But some businesses with regular smokers among their clientele are worried about how to respond to the measures. A local cafe cooperative head and manager of Cafe Sao Paulo in Nagoya's Naka Ward in central Japan aired his doubts about the changes, saying, "It's going to cost a lot to do renovations for a separate smoking room. I expect a lot of small businesses (which are outside of the amendment's scope) will continue to allow smoking."

Abroad, many countries have implemented stronger rules on smoking indoors than they do outside, the opposite of Japan. According to a survey by the health ministry, in May 2017 over 10% of municipal governments nationally -- around 260 -- have some form of rule against smoking in the street.

There have been some voices opposing the move to ban indoor smoking, for reasons including that it would eliminate places for people to smoke, and that foreign visitors to Japan may be confused as to what to do. But municipal governments appear to be focusing on targeting improved manners and cleaner public spaces; there are very few calls to revise the amendments.

Consequently, to ensure there are some places where people can smoke, the health ministry introduced economic support measures in fiscal 2018 for local governments to install public designated smoking areas. The ministry says that including indoor installations, over 3,000 of the areas have already been put in place.

(Japanese original by Sooryeon Kim, Kenji Shimizu and Ryosuke Abe, Lifestyle and Medical News Department, Koichi Uchida, City News Department, and Takayo Hosokawa, Nagoya News Center)

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