Smoking Behaviors and Attitudes Among School Teachers in Mie , Japan

We conducted a questionnaire survey of public kindergarten, elementary and high school teachers in Mie Prefecture, concerning smoking habits and attitudes from November 1995 to February 1996. A self-reporting questionnaire was sent to approximately 16,000 teachers and school employees. The questionnaires were collected in a way which took into consideration the privacy of the respondents. A total of 13,998 questionnaires were returned. The percentages of smokers among the teachers were 44.7% for males and 3.1 % for females, percentages which are lower than those for the general Japanese population. Almost all of the men and women agreed that anti-smoking education is needed. Most of those who did not feel anti-smoking education was needed were smokers themselves. Seventy percent of both men and women responded that anti-smoking education was a teachers' duty, however, only thirty-six percent of the male and twenty-one percent of the female teachers had actual experience at such education. Finally, almost all teachers wish that schools were totally smoke-free or had a partial ban on smoking and believe that school anti-smoking policies in Japan should be introduced . J Epidemiol, 2000 ; 10 : 16-21

Finally, almost all teachers wish that schools were totally smoke-free or had a partial ban on smoking and believe that school anti-smoking policies in Japan should be introduced .J Epidemiol, 2000 ; 10 : 16-21 smoking, teachers, smoking behaviors, smoking attitudes It has been pointed out that smoking is the number one cause of cancer 1), and that smoking is also an important risk factor with respect to non-cancer diseases').It has been reported that the risk of death due to a variety of diseases has been reported to increase the younger a person starts smoking 31.Therefore preventing adolescents from smoking is an urgent task in antismoking policies.However, while in recent years anti-smoking education has been undertaken in Japan, there are no antismoking educational programs which target families and the mass media campaign as there are in the United Kingdom 41 , thus leading one to conclude that Japan is behind other countries when it comes to anti-smoking policies aimed at adolescents.At the government level, developing national targets concerning anti-smoking policies in schools, similar to the U.S. government goals of a smoke-free environment in elementary and junior high schools by 2000 and providing anti-smoking education 5), are future issues which must be addressed by Japan.
There have been many reports stating that the role of teachers, together with that of the family, is important in anti-smok-

MATERIALS AND METHODS
In 1995 the numbers of teachers employed in Japan were 100,000 for kindergartens, 430,000 for elementary schools, 270,000 for junior high schools and 280,000 for senior high schools 18).There were also 44,000 teachers in special schools for mentally and physically handicapped children 18).
The subjects in the present study were all employees (teachers and non-teachers) working at public kindergartens, elementary, junior and senior high schools in Mie Prefecture, and the Education Office of the Mie Prefectural Government.In Mie, of all of the teachers, the proportions that were teachers of public facilities were as follows; kindergarten 36% (385/1062), elementary school 99% (6951/6970), junior high school 96% (3861/4032), senior high school 82% (3475/4223), and special schools 100% (631/631).
Prior to starting the survey we obtained the approval of the prefecture's teachers unions, school boards and principals' associations.The questionnaires were then sent to all public kindergartens and elementary, junior and senior high schools.The questionnaires were distributed to all employees at a particular kindergarten or school by a person who was asked to be that institution's contact for the survey.
Questionnaires were collected as follows to preserve the privacy of the individual respondents.The respondents filled in the questionnaires anonymously and then sealed the completed questionnaires in small, unmarked envelopes.These envelopes were then placed in a larger envelope.The names of the respondents were written on the outside of the large envelope.The contact collected the envelopes, removed the small envelopes from the large envelope, and then sent the small envelopes only to us.
The following 6 items were included in the questionnaire; (1) Smoking behaviors of the individual respondents up until the present time (2) Opinion regarding smoking in the workplace and smoking within the school premises (3) Knowledge on smoking (4) Opinions regarding the effects of smoking on children (5) Practical experiences and opinions concerning antismoking education (6) Sex, age, affiliation (name of school), subject taught, and duties Institutional response rates were 98.9% (94/95) for kindergartens, 99.1% (444/448) for elementary schools, 98.3% (174/177) for junior high schools, 93.7% (15/16) for special schools, 80.0% (52/65) for senior high schools, and 83.9% (68/81) for Education Office.A total of 14,151 questionnaires were returned, 153 of which were discarded for being incomplete.Thus, a total of 13,988 questionnaires were eligible for statistical analysis.However, we limited our analysis to 12,193 school principals, head teachers, teachers, and special school teachers.Since the objective of the study was to examine the smoking behaviors and attitudes towards smoking of teachers who influence attitudes towards smoking among adolescents, we eliminated from the statistical analysis 1805 responses from people who worked in non-teaching positions (office and clerical staffs) as well as teachers who substituted for regular teachers who were on leave (maternity, sickness, and so on).The proportion of teachers included in the statistical analyses in relation to the total number of teachers (including schools which refused to participate), according to type of schools, are as follows; kindergarten 81% (313/385), elementary school 88% (6080/6951), junior high school 83% (3195/3861), senior high school 63% (2163/3475), and special schools 67% (410/631).The overall proportion for elementary, junior high school and senior high school was 80%.
The packaged software (SPSS for Windows) was used to conduct the statistical analysis.The Chi square test was used to analyze the smoking rates by age group, smoking rates by school type and other tests examined in the present study.The 95% confidence intervals are shown for the smoking rates by age group and smoking rates according to school type.

RESULTS
The proportion of smokers according to sex and age group are shown in Table 1.The proportion of smokers (daily smokers plus occasional smokers) was 44.7% for males and 3.1% for females.There was a significant difference (p < 0.01) between the proportion of smokers in the 4 groups from 20-59 years, with the 50-59 age group being the lowest.There were also differences in the proportion of smokers according to the type of school (Table 1).There were significant differences (p < 0.01) in the proportion among male teachers at elementary, junior high, and senior high schools, with the proportion being the lowest for male senior high school teachers.
Almost all male and female teachers agreed with total or partial bans on smoking in schools (Table 2).A higher proportion of non-smokers supported a total ban on smoking, and the proportion was significantly high for male non-smokers (p < 0.01).Meanwhile, the proportion of male smokers was significantly high (p < 0.01) among those who supported a partial ban on smoking in schools.In the column in the questionnaire reserved for comments and opinions, many female teachers expressed their discontent concerning the unpleasant effects of smoke in the teachers' room and the adverse effects of smoking on adolescents.
It was found that twenty-one percent of male smokers and  five percent of female smokers smoked in the teachers' room even though smoking was banned (Table 3), while eighty-two percent of male smokers and nine percent of female smokers smoked in teachers' rooms which had not banned smoking.In general, males smoked more than females at school.Almost all males and females agreed that there was a need for anti-smoking education (Table 4).Seventy percent of both males and females replied that teachers were responsible for anti-smoking education, however, the proportion were lower than the proportion of teachers who felt that anti-smoking edu-cation was necessary.Thirty-six percent of males and twentyone percent of females had actually taught anti-smoking.However, only fourteen percent of males and eight percent of females replied in a self-evaluation that they were confident of their ability to actually teach anti-smoking education .When we investigated the answers from teachers of junior and senior high schools, where the problem of students' smoking is serious, with respect to teachers' responsibility and practical experience in anti-smoking education, higher proportion of male and female senior high school teachers recognized teachers' responsibility in anti-smoking education, but not many of them were actually carrying it out.Moreover, a larger proportion of female teachers than male teachers of both junior and senior high schools answered that anti-smoking education is teachers' responsibility, but the proportion of those who had practical experience was smaller.If we look at health and physical education teachers only, the rate was higher for females and almost all teachers had actual experience (Proportion of health and physical education teachers who had actual experience: junior high school : males 72% (217/303), females 70% (78/111), senior high school: males 90% (164/183), females 95% (40/42)).For both males and females, the proportion of teachers with actual anti-smoking education experience was higher for junior and senior high school health and physical education teachers compared to the teacher population as a whole.

DISCUSSION
The proportion of smokers among teachers in the present study were 44.7% for males and 3.1% for females .The proportion for males was lower than those observed in previous studies (45.9%-60% for males and 2 .5%-15%for females in studies conducted in 1980 or later.However, it should be noted that the study which found 60% and 15% for males and females was conducted on health and physical education teachers only) 13-17).It is believed the difference in smoking prevalence of male teachers between the present study and previous studies can be explained by the fact that smoking prevalence among the general Japanese population has been decreasing for males and stable for females in recent years according to the yearly Japan Tobacco study on smoking rates 19).Since the present study was started in December 1995, the difference for males can probably explained based on this overall downward trend.
All of the studies have found that smoking prevalence among teachers is lower than that among the Japanese adult population 13-17)This trend is not peculiar to Japan.For example, a study conducted in the United Kingdom found lower smoking rates among teachers compared to the overall population as well as compared to other occupations 6).However, while smoking prevalence among Japanese teachers is lower than that among overall adult population, it is difficult to conclude that the rate is lower than that of other occupations.Oshima et.al. 20), in a study of various occupations in Osaka (1985), found smoking prevalence of 34-54% for males and less than 10% for females (excluding nurses and telephone operators), The proportion of smokers among Japanese teachers in our study is roughly equivalent to that of specialists and professionals.
The large difference between the proportion of male and female teachers in Japan who are smokers is a peculiar characteristic.Studies in the UK 7) and Belgium s) have shown that prevalences are higher for female teachers than male teachers.Compared to other countries, male smoking prevalence is higher, while female prevalence is lower.Overall smoking prevalence among the general adult population is also higher.This is a distinctive peculiarity of Japan.In Malaysia, another Asian country, the difference between male and female teachers is even larger (males 32%, females 0.2%).This is thought to be because Malaysian society in general does not accept smoking by females 21), and while perhaps not to the same degree as that in Malaysia, there is a similar tendency in Japanese society of not accepting smoking by female teachers.
However, the low prevalence of smoking among female teachers revealed by this survey may be attributed to the low prevalence of smoking among females in Mie prefecture compared with that of other prefectures.Kawanunami et.al. 22) calculated the prevalence of National Nutrition Surveys (for five years) conducted by Ministry of Health and Welfare.According to his estimates, the prevalence of among males in Mie is slightly higher than the national average, and that among females is lower.But the number of the subjects used to calculate the smoking in his study was too small to make his estimates statistically significant.So prevalence of smoking among females in Mie is not considered to be much different from the national average.
A vast majority of the teachers agreed on establishing some sort of restrictions or regulations on smoking in schools .As to be expected, a lot of females, who are less likely to smoke ,

Table 1 .
Smoking among teachers according to age and type of school.

Table 2 .
Opinions of teachers concerning school smoking regulations according to their own smoking habits.

Table 3 .
Smoking rate in various places in the school according to whether teachers' smoking was regulated (among smokers) .

Table 4 .
Opinions and experiences concerning anti-smoking education and knowledge related to smoking , by sex.