Mobile phone use does not discourage adolescent smoking in Japan.
ABSTRACT The possibility that smoking prevalence among junior and senior high school students may decrease with increasing mobile phone bill was reported by the mass media in Japan. We conducted a nationwide survey on adolescent smoking and mobile phone use in Japan in order to assess the hypothesis that mobile phone use has replaced smoking.
A total of 70 junior high schools (response rate; 71%), and 69 high schools (90%) from all over Japan responded to 2005 survey. Students in the responding schools were asked to fill out an anonymous questionnaire about smoking behavior, mobile phone bill, and pocket money. Questionnaires were collected from 32,615 junior high school students and 48,707 senior high school students.
The smoking prevalence of students with high mobile phone bill was more likely to be high, and that of students who used mobile phones costing 10,000 yen and over per month was especially high. When "quitters" were defined as students who had tried smoking but were not smoking at the time of survey, the proportion of quitters decreased as the mobile phone bill increased. The proportion of students who had smoking friends increased with the increase in the mobile phone bill per month.
The hypothesis that the decrease in smoking prevalence among Japanese adolescents that has been observed in recent years is due to a mobile phone use can be rejected.
- SourceAvailable from: Yoneatsu Osaki[Show abstract] [Hide abstract]
ABSTRACT: To assess trends in smoking prevalence among Japanese adolescents and to analyze possible causal factors for the decrease in smoking prevalence observed in a 2004 survey. Nationwide cross-sectional surveys were conducted in 1996, 2000 and 2004. Survey schools, both junior and senior high schools, considered to be representative of the whole of Japan were sampled randomly. Enrolled students were asked to complete a self-reporting anonymous questionnaire on smoking behavior. The questionnaires were collected from 115,814 students in 1996, 106,297 in 2000, and 102,451 in 2004. School principals were asked about the policy of their respective school on smoking restrictions. Cigarette smoking prevalence (lifetime, current, and daily smoking) in 2004, based on the completed questionnaires, had decreased relative to previous years in both sexes and in all school grades. The most important trends were: a decrease in smoking prevalence among the fathers and older brothers of the students; an increase in the proportion of students who did not have friends; a decrease in the proportion of current smokers who usually bought cigarettes in stores decreased in 2004, in particular for the oldest boys. An association was found between a lower smoking rate at a school and a smoke-free school policy. Japan has experienced a decrease in the prevalence of smoking among adolescents. A decrease in smoking prevalence among the fathers and older brothers, limitations to minors' access to tobacco, an increase in the proportion of students without friends, and a school policy restricting smoking may have contributed to this decreasing trend.Environmental Health and Preventive Medicine 08/2008; 13(4):219-26.
- BMJ Clinical Research 12/2000; 321(7269):1155. · 14.09 Impact Factor
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ABSTRACT: Objective: To study the impact of tobacco advertisements and other social factors on the smoking habits of adolescents in Calcutta, India. Design: Cross sectional, school based survey of students in the IXth and XIth grades. The responses were analyzed by binary logistic regression. Participants: High School students in Calcutta aged 14 to 18 years. Main Outcome Measure: Smoking Status as defined by ever smokers of tobacco products. Results: 1973 students were interviewed (males-73.79% and females-26.21%). Increased tobacco use was associated with older age-groups, male gender, government-run schools, having parents or peers who were smokers, and if the respondent was also a chewer. The likelihood of a respondent being a smoker was 8.5 times greater (95% CI: 5.05-14.43) if he or she had a smoker friend, and about 4.5 times (95% CI: 2.7-7.4) if he or she had a smoker sibling. In the multivariate model, the parents' smoking status did not have a statistically significant association with respondent's smoking status. Television advertisements of tobacco products had no statistically significant association with respondents' smoking status. Conclusions: The finding of tobacco advertisements not having a significant association with smoking habits among adolescents could be due to the fact that, at the time of this survey, tobacco advertisements were not frequent in the prime channels due to Government regulations. Peer influence had the strongest association with adolescent smoking. It is therefore suggested that the peer influence factor should be considered for anti-tobacco regulatory activities that target adolescent smoking in India.Asian Pacific journal of cancer prevention: APJCP 02/2000; 1(4):305-309. · 1.50 Impact Factor
Asian Pacific Journal of Cancer Prevention, Vol 13, 2012 1011
Mobile Phone Use does not Discourage Adolescent Smoking in Japan
Asian Pacific J Cancer Prev, 13, 1011-1014
diseases. Given the difficulty of escaping nicotine
dependence, prevention of smoking among adolescents
has been identified as a major public health measure. The
monitoring of smoking prevalence among adolescents is
thus an important means of clarifying the characteristics
of this problem, establishing countermeasures, and
evaluating public health efforts to reduce smoking
prevalence. Many articles describe associated factors
or predictors of adolescent smoking (Sen & Basu,
2000, Ma et al., 2008; Villanti et al., 2011). Therefore,
analyzing contributing factors is important for establishing
Mobile phones are used by the majority of adolescents
as vital communication tool. There have been some reports
of an association between mobile phone use and health-
related behaviors among youth (Augner & Hacker, 2012).
In the 1990s, the prevalence of adolescent smoking
decreased in European and North American countries.
Since British researchers (Charlton & Bates, 2000)
observed that the trend in adolescent smoking prevalence
was inversely correlated with the prevalence of mobile
Cigarette smoking increases the risk of many
1Faculty of Medicine, Tottori University, Tottori, 2Faculty of Medicine, Nihon University, Tokyo, 3Fukushima Medical University,
Fukushima, Japan *For correspondence: firstname.lastname@example.org
with increasing mobile phone bill was reported by the mass media in Japan. We conducted a nationwide survey
on adolescent smoking and mobile phone use in Japan in order to assess the hypothesis that mobile phone use
has replaced smoking. Methods: A total of 70 junior high schools (response rate; 71%), and 69 high schools
(90%) from all over Japan responded to 2005 survey. Students in the responding schools were asked to fill out an
anonymous questionnaire about smoking behavior, mobile phone bill, and pocket money. Questionnaires were
collected from 32,615 junior high school students and 48,707 senior high school students.Results: The smoking
prevalence of students with high mobile phone bill was more likely to be high, and that of students who used mobile
phones costing 10,000 yen and over per month was especially high. When “quitters” were defined as students
who had tried smoking but were not smoking at the time of survey, the proportion of quitters decreased as the
mobile phone bill increased. The proportion of students who had smoking friends increased with the increase
in the mobile phone bill per month. Conclusion: The hypothesis that the decrease in smoking prevalence among
Japanese adolescents that has been observed in recent years is due to a mobile phone use can be rejected.
Keywords: Mobile phone - cigarette smoking - adolescent - behavior - Japan
Objective: The possibility that smoking prevalence among junior and senior high school students may decrease
Mobile Phone Use does not Discourage Adolescent Smoking
Yoneatsu Osaki1*, Takashi Ohida2, Hideyuki Kanda3, Yoshitaka Kaneita2, Takuji
phone use in British study in 2000, they hypothesized
that mobile phone use contributed to the decreasing in
the smoking prevalence.
Some reports contradicting these hypotheses have
subsequently been published. There was one report
indicating that the prevalence of adolescent smoking
had decreased earlier than the spread of mobile phones
(Invernizzi, 2001). In addition, the prevalence of
adolescent smoking actually increased in some of the
countries where mobile phones has spread among the
young people (Italian girls, Switzerland) (Invernizzi
et al., 2001; Lee 2001). In other counties, researchers
examined the association between smoking behavior and
the possession of mobile phone directly (Koivusidflta et
al., 2003: 2005; Sleggles & Jarvis, 2003). These studies
found that the smoking prevalence was high in the young
people who used their mobile phones frequently. These
studies all indicate that the previously proposed hypothesis
should be rejected. However, the hypothesis was not tested
in Asian countries.
In Japan, we observed a dramatic reduction in the
smoking prevalence among the junior and senior high
school students in a nationwide surveys after 2000 (Osaki
et al., 2008). The hypothesis that smoking prevalence
Yoneatsu Osaki et al
among junior and senior high school students may have
decreased due to increase in mobile phone bill was
reported by the mass media in Japan.
We conducted a national survey in 2005 to examine
whether the decrease in smoking prevalence was caused
by increasing mobile telephone use in Japan. The decrease
in the adolescent smoking prevalence is a favorable
finding regardless of the reason for the decrease, however
misunderstanding the reason for the reduction may lead to
the promotion of incorrect counter-measures in the future.
Asian Pacific Journal of Cancer Prevention, Vol 13, 20121012
Materials and Methods
among high school students noted in the 2004 survey, a
nationwide survey on smoking behavior among Japanese
junior and senior high school students was conducted
in 2005. The sampled schools in the 2005 survey were
those that had responded in the 2000 survey, so a total of
99 junior high schools and 77 senior high schools were
asked to participate in this survey. A total of 70 of these
junior high schools (response rate; 71%), and 69 of these
senior high schools (90%) responded to the 2005 survey.
The schools sampled in the 2000 survey were selected
randomly using a national school directory (Osaki et al.,
The number of students who responded to the present
survey was 32,615 junior high schools and 48,707 senior
high schools (81,322 students in total).
The anonymous questionnaire included questions
about smoking status, the monthly mobile telephone bill,
friends’ smoking habits, and their monthly amount of
pocket money in order to investigate the reasons for the
decrease in smoking prevalence. Experimenting smokers,
current smokers and daily smokers were defined as those
who had tried smoking at least once, those who had
smoked at least once during the previous 30 days, and
those who had smoked every day during the previous 30
days, respectively. The quitters were defined as students
who had tried smoking, but did not smoke at the time of the
survey. The mobile phone bill per month was assessed for
8 categories, namely no use, <1000 Japanese yen, <2000
yen, <3000 yen, <5000 yen, < 10000 yen, <20000yen, and
20000 yen and over. The mobile phone bills were then
divided into 5 categories, no use, <3000 yen, <5000 yen,
<10000 yen, and 10000 yen and over for the statistical
analyses because of the small number of subjects in some
categories. The smoking status was calculated for each of
the categories of mobile phone use.
The Cochran-Armitage test was used to evaluate for
trends in proportions. In addition, a multiple logistic
regression analysis was applied to calculate the odds
ratios of each category of mobile phone bill using the “no
use” group as a reference group to smoking status. The
current smoking was used as an independent variable in
the statistical model. The odds ratios were calculated with
current smoking used as the independent variable and
explanatory variables including sex, age, and the mobile
phone bill. The data were analyzed using the SPSS for
Windows (version 18.0) software program (SPSS Inc.;
In order to confirm the decrease in smoking prevalence
both males and females, and for both junior and senior
high school students compared with the 2000 survey. The
experimental smoking rate, current smoking rate, and daily
smoking rate for males were 43.5%, 22.0%, and 12.2%
in 2000, and were 24.7%, 10.4%, 5.0%, respectively in
2005. The rates for females were 28.4%, 10.0%, 3.6% in
2000, and 17.0%, 5.7%, 1.9% in 2005. The reduction in
smoking prevalence among junior and senior high school
students was reviewed similar to the results in the 2004
nationwide survey. The proportion of students who did
not use a mobile phone was 56.1% for junior high school
males, 42.3% for junior high school females, whereas the
figures decreased in senior high school students to 10.0%
for males and 4.0% for females. That indicates that the
vast majority of senior high school students use a mobile
Among the mobile phone users within the senior high
school student population, more than half of the students
spent 5,000 yen a month or more. The smoking prevalence
was higher for students spending 5,000 yen or more for
their monthly mobile phone bill, and the prevalence was
much higher for students spending 10,000 yen or more.
This was the case for both sexes and for both junior and
senior high school student (Table 1). We investigated
the proportion of students who quit smoking among the
experimenters in the 2005 survey. The prevalence of
quitters among all respondents was 4.8% for junior high
school males, 3.3% for females, 7.8% for senior high
school males, and 5.4% for females. When the number
of experimenters’ students was used as a denominator,
the proportion of quitters was 39.3% for junior high
school males, and 32.5% for females, and was 27.8%
for senior high school males, and 30.2% for females.
When we examined the proportion of the quitters (among
experimenters) according to mobile phone bill per month,
we found that the proportion of students tended to be lower
for those with high mobile phone bills (Table 1).
In order to assess the association between the mobile
phone bill and smoking status among students, a multiple
logistic regression analysis was applied to adjust for
differences in gender and age. The mobile phone bill was
divided into 5 categories (no use, <3000 yen, <5000 yen,
<10000 yen, and ≥10000 yen) and ‘no use’ was used as
the reference group for the other categories. Compared
with students who did not use a mobile phone, the relative
risks of the other 4 categories for current smoking was 1.1
(95% Confidence Interval; 0.9-1.4), 0.9 (0.8-1.0), 2.4 (2.1-
2.6) and 8.1(7.3-9.0), indicating that students who have
expensive mobile phone bill are more likely to be smokers.
This association remained after entering variables related
to parental and siblings smoking into the statistical model.
When an analysis was performed using smoking
cessation among the smoking experimenters as a
independent variable and with the mobile phone bill as
covariates, compared with students who did not use a
mobile phone, the relative risks of other 4 categories were
1.0 (0.7-1.3), 1.1 (1.0-1.3), 1.0 (0.9-1.1), and 0.8 (0.7-0.9).
Therefore, smokers with the highest mobile phone bills are
A decrease in the smoking rate was found in 2005 in
Asian Pacific Journal of Cancer Prevention, Vol 13, 2012 1013
Mobile Phone Use does not Discourage Adolescent Smoking in Japan
less likely to quit smoking. Moreover, when an analysis
was performed in order to assess the association between
the mobile phone bill and having smoking friends, the
proportion of students who had friends who smoked
increased as the mobile phone bill increased for both sexes
and for both junior and senior high school students.
The present study revealed that students who reported
a higher mobile phone bill were more likely to smoke
cigarettes, less likely to quit smoking, and more likely
to have friends who smoke. Therefore, the hypothesis
(Charlton & Bates, 2000) that the decrease in smoking
prevalence among adolescents during recent years is due to
mobile phone use can be rejected. This result was similar
to previous studies conducted in European countries
(Koivusilta et al., 2003: 2005; Steggles & Jarvis, 2003).
The mobile phone is an important item for adolescents,
and is a symbol of their human relationships. The use of
mobile phone, which can lead to activities, such as part-
time jobs top at the mobile phone bill, are also linked to
experience with smoking or alcohol use, and are influence
Smoking and alcohol use among adolescents is also
closely related to pocket money or spending money
(Zhang et al., 2007). The present survey also observed
associations among the mobile phone bill, pocket money
and smoking among adolescents in Japan. Since using a
mobile phone is not a reason responsible for the decline in
the smoking prevalence among adolescents, an additional
spread of mobile phone use among adolescents in the
near future will be unlikely to lead to a further decrease
in smoking prevalence.
Because the present study was a cross-sectional study,
we cannot determine which was the preceding factor
among smoking, alcohol use, mobile phone use, and
human relationship. However, the present study showed
a strong relationship among these factors. Since we can
conclude that students who use mobile phones frequently
are an important high risk group for adolescent smoking,
a health education program employing mobile phone
applications may be useful for providing information to
these high risk groups. A dramatic increase in cigarette
prices will likely be necessary before adolescent smokers
give up their smoking habit.
In conclusions, we conducted a nationwide survey
on adolescent smoking and mobile phone use in Japan in
order to assess the hypothesis that mobile phone use has
replaced smoking. We revealed that students who reported
a higher mobile phone bill were more likely to smoke
cigarettes, less likely to quit smoking, and more likely to
have friends who smoke. Therefore, the hypothesis that the
decrease in smoking prevalence among adolescents during
recent years is due to mobile phone use can be rejected.
Table 1. Smoking Status By Mobile Phone Bill Per Month
No. of current
% (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)
quitter have smoking No. of current quitters
friends students smoker
Junior high school:
<10000 yen 2660 8 ( 6.6- 8.6) 35 (30.4-38.8) 35 (32.9-36.5)
≥10000yen 1080 20 (17.3-22.0) 30 (25.0-34.6) 38 (35.4-41.2)
test for trend p<0.01
Senior high school:
no use 2474 8 ( 7.3- 9.5)
<3000 yen 2576 6 ( 5.1- 6.9)
<5000 yen 4828 6 ( 5.3- 6.6)
<10000 yen 11064 15 (14.1-15.4) 29 (27.5-30.6) 66 (64.8-66.5) 10986 6 ( 5.3- 6.2)
≥10000yen 3691 36 (34.1-37.2) 20 (18.2-21.9) 74 (72.1-75.0)
test for trend p<0.01 p<0.01
38 (32.4-43.1) 12 (11.6-13.2)
37 (27.4-47.3) 14 (12.9-15.9)
40 (33.0-47.7) 19 (17.0-20.0)
36 (31.4-40.6) 30 (28.6-31.9)
9593 2 ( 2.1- 2.7) 45 (41.9-49.0) 16 (15.4-16.9)
1809 4 ( 2.9- 4.5) 46 (38.4-52.8) 17 (15.6-19.0)
1963 3 ( 2.6- 4.2) 39 (32.2-46.1) 25 (22.7-26.5)
6565 1 ( 1.1- 1.6)
2082 2 ( 1.1- 2.2)
2515 2 ( 1.5- 2.6)
2952 4 ( 3.5- 4.9)
1396 13 (11.6-15.2) 33 (27.7-37.3) 42 (39.2-44.3)
957 5 ( 3.9- 6.8) 30 (20.8-39.0) 25 (22.5-28.0)
2069 3 ( 2.4- 3.9) 32 (24.7-39.4) 27 (25.0-28.8)
5217 2 ( 1.2- 1.9) 36 (31.3-41.2) 34 (33.0-35.6)
33 (30.3-34.6) 51 (50.5-52.3)
4845 20 (18.7-20.9) 26 (24.3-28.4) 69 (67.9-70.5)
32 (27.1-37.2) 30 (28.6-32.2)
34 (29.2-39.6) 42 (40.2-44.0)
36 (32.8-39.5) 54 (52.3-55.1)
* ‘Quitter: students who tried smoking but do not smoke currently
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