Too many Japanese university students are still smoking tobacco

Japanese society represents an ongoing challenge for antismoking movements. The domestic market is dominated by Japan Tobacco, of which the government owns a share [1] and is legally obliged to promote cigarette sales [2]. Large multinational corporations are also present, with innovative and culturally-specific techniques such as the 'clean cigarette' for a clean nation [3], among others. Tobacco taxes are relatively low by international standards, allowing Japan to provide some of the most affordable cigarettes in the world [4]. Smoking rates among Japanese men have remained high, while the prevalence among young women has also been increasing in recent years. By 2003 however, lung cancer had begun exceeding stomach cancer as the leading cause of mortality [2]. Some national cohort studies have also shown that the life expectancy of Japanese decreases as their level of smoking increases [5]. Despite these facts, many Japanese health care workers and their student counterparts continue to smoke tobacco at relatively high rates when compared internationally.Tobacco use among health care students has been recently reviewed from a global perspective, with high smoking rates being documented in Japanese medical, dental and nursing faculties [6-8]. A survey of Japanese university students was also conducted by the Ministry of Health, Labor and Welfare (MHLW) in 2007 [9], which showed that dental students had the highest smoking rates across health science faculties, with 62% of male and 35% of females being current smokers. Their tobacco usage exceeded national averages for the same age group, where around 49% of men and 19% of women in their 20s, smoked [9]. Interestingly, it was also higher (among males) than an antecedent study of dental students in the United Kingdom, during which 54% of male and 40% of female students used tobacco products [10], even though the latter research had been conducted in the early 1960s. Cultural differences are important to consider how