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Associations of disaster-related and psychosocial factors with changes in smoking status after a disaster: a cross-sectional survey after the Great East Japan Earthquake
  1. Hironori Nakano1,2,
  2. Tetsuya Ohira1,2,
  3. Masaharu Maeda2,3,
  4. Hirooki Yabe4,
  5. Akira Ohtsuru5,
  6. Yuriko Suzuki6,
  7. Mayumi Harigane2,
  8. Naoko Horikoshi2,
  9. Masato Nagai1,2,7,8,
  10. Wen Zhang1,
  11. Hideto Takahashi2,
  12. Seiji Yasumura9,
  13. Hiroyasu Iso10,
  14. Kenji Kamiya2
  15. For the Fukushima Health Management Survey Group
  1. 1 Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
  2. 2 Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
  3. 3 Department of Disaster Psychiatry, Fukushima Medical University, Fukushima, Japan
  4. 4 Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan
  5. 5 Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan
  6. 6 National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
  7. 7 Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
  8. 8 Graduate School of Medicine, Tohoku University, Sendai, Japan
  9. 9 Department of Public Health, Fukushima Medical University, Fukushima, Japan
  10. 10 Public Health Graduate School of Medicine, Osaka University, Osaka, Japan
  1. Correspondence to Mr Hironori Nakano; h-nakano{at}


Objective Few studies have comprehensively examined changes in smoking status and related factors after a disaster. We examined these factors among residents of an evacuation area in Fukushima after the Great East Japan Earthquake.

Methods The study participants included 58 755 men and women aged ≥20 years who participated in the Fukushima Health Management Survey in 2012 after the disaster. Smoking status was classified as either current smokers or current non-smokers before and after the disaster. The participants were divided into the following groups: (1) non-smokers both before and after the disaster, (2) non-smokers before and smokers after the disaster, (3) smokers before and non-smokers after the disaster and (4) smokers both before and after the disaster. The adjusted prevalence ratios and 95% CIs of changes in smoking status for demographic, disaster-related and psychosocial factors were tested using logistic regression analysis that was stratified by smoking status before the disaster.

Results Among the 44 729 participants, who were non-smokers before the disaster, 634 (1.4%) began smoking after the disaster. Among the 14 025 smokers before the disaster, 1564 (11.1%) quit smoking after the disaster, and the proportion of smokers in the evacuation area consequently decreased from 21.2% to 19.6%. In the multivariable model, factors significantly associated with beginning smoking included being a male, being younger, having a lower education, staying in a rental house/apartment, house being damaged, having experienced a tsunami, change jobs and the presence of traumatic symptoms and non-specific psychological distress. On the contrary, factors associated with quitting smoking included being a female, being older, having a higher education and having a stable income.

Conclusion The proportion of smokers slightly decreased among residents in the evacuation area. The changes in smoking statuses were associated with disaster-associated psychosocial factors, particularly changes in living conditions, having experienced a tsunami, change jobs and developing post-traumatic stress disorder.

  • disaster
  • smoking cessation
  • socioeconomic status
  • population-based
  • psychological stress

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  • Contributors HN, TO and HI contributed to the design of the present study. TO, SY, AO, MM, MH, NH, YS, HY and HT were responsible for data collection and overseeing the study procedures. The analysis was conducted by HN. The manuscript was written by HN. TO, SY, AO, MM, MH, NH, YS, HY, HT, MN, WZ, HI and KK made significant contributions to the critical interpretation of the results in terms of important practical content. All authors read and approved the final version of the manuscript.

  • Funding This survey was conducted as part of Fukushima Prefecture’s postdisaster recovery plans and was supported by the ‘National Health Fund for Children and Adults Affected by the Nuclear Incident’.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This survey was approved by the ethics review committee of Fukushima Medical University (No. 1316).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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