Editorials
Impact of Legislation for Smoking Cessation and the Tokyo Olympic and Paralympic Games 2020
2016 Volume 80 Issue 12 Pages 2432-2434
Details
2016 Volume 80 Issue 12 Pages 2432-2434
Total risk management including smoking cessation and cardiac rehabilitation has an essential role in improving the prognosis of cardiovascular disease (CVD). However, maintaining continuity of both these approaches is often difficult, and several indispensable measures are needed to achieve these objectives.
Article p 2528
First, patients need to clearly understand the benefits of these treatments. Oxidative stress and endothelial function are well-established surrogate markers of CVD, and not only controlling hypertension, dyslipidemia and diabetes mellitus, but also smoking cessation and cardiac rehabilitation can reduce oxidative stress and improve endothelial function relatively soon after the start of treatment.1–3 In addition, smoking cessation, the main subject of this paper, may lead to improved functionality of high-density lipoprotein cholesterol (HDL-C) without changing its serum levels.4 Higher serum levels and optimal functioning of HDL-C are recognized as beneficial for preventing atherosclerosis. Coronary spastic angina is also associated closely with smoking. It is important to diagnose coronary spastic angina because it may be associated with major adverse events that can be prevented by the use of appropriate vasodilator therapy and avoidance of aggravating stimuli (eg, smoking).5 It has been reported that 2 or 4 years of smoking cessation may reduce the cardiovascular risk to a level observed in non-smokers.6,7
Patients may sometimes need pharmaceutical assistance to alleviate symptoms associated with withdrawal from smoking tobacco. Nicotine replacement therapies, such as nicotine patches and chewing gum, are prescribed to treat nicotine addiction. The Symptoms of Nicotine Withdrawal Varenicline is a nicotinic receptor partial agonist that stimulates nicotine receptors more weakly than nicotine itself. In this respect it is different from nicotine replacement therapy. As a partial agonist it reduces the craving for cigarettes and other tobacco products and also decreases their pleasurable effects, thereby assisting patients to quit smoking.
Economic and legal forces, as well as effective treatments. are needed to accelerate the decrease in cigarette smoking. “Tobacco 21” laws establish a legal age of 21 years or older to buy tobacco, including cigarettes, electronic cigarettes, cigars and cigarillos, and have been used as a new tool to reduce young people’s access to cigarettes and e-cigarettes.6 From 2013 to March 2016, the number of localities in the USA that have adopted Tobacco 21 laws increased from 8 to at least 125. A multivariate analysis of pooled cross-sectional data of the effects of the law adopted in Needham, Massachusetts, showed a 47% reduction in the smoking rate of high-school students and a reported decline in retail tobacco purchases.6 The rate of smoking in the USA as a whole has shown a steady decline in adults that began in the early 1960 s and accelerated markedly during the 7 years of the Obama presidency. This administration has introduced several countermeasures against smoking, including economic and legal actions. The cumulative effect of these actions has led to very good results. The actual cigarette-smoking rate in the USA has decreased at a rate of about 0.78 percentage points per year as a consequence, more than double the rates observed during the administrations of Bill Clinton and George W. Bush (mean decreases of 0.28 and 0.36 percentage points per year, respectively).
Another benefit of legal action against smoking is to protect non-smokers from the harmful effects of second-hand smoke (SHS). In this issue of the Journal, Sato et al demonstrate that legislation banning smoking may possibly reduce the number of patients with the acute coronary syndrome, though the degree of benefit is dependent on the level of adherence.8 Their study is the first large-scale investigation conducted during implementation of smoking ban legislation in Japan, and they propose that legal action may be effective in reducing the harmful effects of SHS. It is important that compliance with the legislation is managed strictly by use of penalties. Tan et al also reported that smoke-free legislation was associated with a lower risk of smoking-related cardiac, cerebrovascular, and respiratory diseases, with more comprehensive laws being associated with greater reductions in risk.9 The findings of these 2 studies suggest that widening the area of the smoking ban to include not only public places and workplaces, but also restaurants and bars, may lead to a greater preventive effect against SHS.
Smoke-Free Legislation for the Tokyo Olympic GamesThe World Health Organization (WHO) reported that SHS kills 0.6 million people (including 6,800 people in Japan), while active smoking kills 5.4 million people annually in the world, including 130,000 people in Japan.8 The WHO Framework Convention, titled “Protection from exposure to tobacco smoke” concluded that “approaches other than 100% smoke-free environments, including ventilation, air filtration and the use of designated smoking areas (whether with separate ventilation systems or not), have repeatedly been shown to be ineffective and there is conclusive evidence, scientific and otherwise, that engineering approaches do not protect against exposure to tobacco smoke”. As a result, 45 countries have enforced complete bans on indoor smoking. In addition, the International Olympic Committee (IOC) adopted a no smoking policy at Olympic Games after the Calgary Games in 1988. Since the Athens Olympic Games in 2004, all the Games have been held in countries with smoke-free legislation and a penal code that completely bans smoking in every indoor facility, including the service industry such as restaurants. Compared with developed countries in the West, Japan, the host of the 2020 Tokyo Olympic and Paralympic Games, is still developing programs to ban smoking (Figure).10
Effectiveness of counter measures against smoking in 20 major cities with a population over 7 million (as of July 2015). The list is based on the slides used by Dr Douglas Bettcher, a WHO director in charge of prevention of non-communicable diseases, and countermeasures against smoking in lifestyle-related diseases. WHO report on the global tobacco epidemic 2013: enforcing bans on tobacco advertising, promotion and sponsorship. http://www.who.int/tobacco/global_report/2013/en/ (accessed October 25, 2016).
The Japanese organization “24 Scientific Societies in the Tobacco Control Medical-Dental Research Network” presented a petition to the Organizing Committee of the 2020 Tokyo Olympic and Paralympic Games, Governor of Tokyo, Minister of the Tokyo Olympic and Paralympic Games, and Minister of Education, Culture, Sports, Science and Technology, which requested that before the Games open Tokyo introduces metropolitan smoke-free legislation with a penal code that completely bans smoking in every indoor facility including the service industry.11 It is anticipated that this petition will be accepted and that the guests who are to come to Japan from all over the world will be welcomed with clean, fresh air in accordance with international standards. The introduction of this legislation may be a major key to ensure the success of the 2020 Tokyo Olympic and Paralympic Games.
