title: Regional disparities in compliance with tobacco control policy in Japan: an ecological analysis.
abstract: BACKGROUND
  The slow progress of tobacco control policy in Japan reflects the tension among the interests of the Finance Ministry (which remains the majority shareholder of Japan Tobacco, Inc), the Health Ministry, tobacco growers and consumers.
  
  
  METHODS
  We sought to examine regional disparities in compliance with national tobacco control legislation (the 2003 Health Promotion Law). Specifically, we sought to examine whether prefecture-level compliance with legislation was correlated with decreases in smoking prevalence, and decreases in lung cancer mortality rates. We also examined whether prefectural involvement in growing tobacco was associated with lower compliance with the law.
  
  
  RESULTS
  From 2001 to 2007, higher prefectural compliance with tobacco control laws was associated with decreased prevalence of smoking. Decreased tobacco consumption was in turn associated with declining lung cancer mortality. Prefectures involved in growing tobacco exhibited lower levels of compliance with national tobacco control laws. The same prefectures also exhibited the worst improvement in smoking prevalence.
  
  
  CONCLUSIONS
  This study in Japan suggests that tobacco control policies are being unevenly implemented across prefectures, and that measures to counteract the influence of local tobacco culture are required to reduce the disparities in regional tobacco control outcomes in that country.
authors.affiliation: Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. yorichan@md.okayama-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Yorifuji
authors.forename: Shinichi
authors.initials: S
authors.lastname: Tanihara
authors.forename: Soshi
authors.initials: S
authors.lastname: Takao
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000383:Agriculture / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006293:Health Promotion / Q000331:legislation & jurisprudence / Q000379:methods; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000331:legislation & jurisprudence*; D016540:Smoking Cessation / Q000331:legislation & jurisprudence / Q000379:methods / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D019460:Tobacco Industry / Q000331:legislation & jurisprudence*; D055815:Young Adult; D014026:Nicotiana