Impact of ban and ordinances against indoor smoking in eating, drinking establishments

To reduce the adverse health effects associated with exposure to second-hand smoke, Japan fully enforced the Revised Health Promotion Law in April 2020, introducing a nationwide indoor smoking ban in restaurants and similar hospitality establishments. However, the law includes temporary exemptions that permit pre-existing small-scale restaurants and bars to allow indoor smoking, provided that individuals under the age of 20 are not exposed.

To mitigate the potential public health impact of these exemptions, the Tokyo Metropolitan Government and Chiba City simultaneously implemented stricter passive smoking prevention ordinances designed to further promote smoke-free environments. Therefore, the research team assessed the effects of both the national legislation and local ordinances using data obtained from a major online restaurant review platform covering the period 2016-2022.

The researchers estimated that the proportion of smoke-free establishments nationwide increased by 5.7% points immediately after the enforcement of the Revised Health Promotion Law, compared with the period immediately preceding its implementation. In areas governed by the Tokyo Metropolitan Government and Chiba City, where additional passive smoking prevention ordinances were concurrently enforced, the proportion of smoke-free establishments was estimated to have increased by 13.5% points. Of this increase, 7.8% points were specifically attributable to the local ordinances. As of December 2022, the estimated proportions of smoke-free establishments were 68.3% for restaurants, 70.2% for cafés, 32.8% for izakaya (Japanese-style pubs), and 25.0% for bars.

This study demonstrates that the implementation of the national law and complementary local ordinances was associated with a modest increase in the proportion of smoke-free establishments. However, the findings also indicate that a substantial number of establishments continue to permit indoor smoking, largely because of the exemptions allowed under the current legislation. To further reduce opportunities for exposure to second-hand smoke, the researchers emphasize the importance of eliminating existing exemptions and strengthening the enforcement of current smoke-free regulations.

This study was supported by the Health Labour Sciences Research Grants (19FA1005 and 22FA1002) from the Japanese Ministry of Health, Labour and Welfare, and a medical research grant from the Osaka Association of Adult Diseases Prevention obtained by Dr. Muraki.