Second-hand smoke in restaurants after enforcement of a health promotion law in Japan.

Environmental tobacco smoke, called herein second-hand smoke (SHS) has been shown to cause adverse respiratory, cardiovascular, and carcinogenic effects and affect fetal development and reproduction. Although restrictions and bans on smoking in public places are common in many countries, Japan did not, until recently, have such restrictions and bans. On May 1, 2003, Japan passed a Health Promotion Law. Article 25 of the law requires facility managers to endeavor to take necessary measures against SHS. The facilities specified in this law include schools, hospitals, government and municipal offices, restaurants, department stores, shops, hotels, trains, and buses. The law promotes efforts against SHS but does not impose penalties for violations. Restaurants are one of the most frequently visited public places where both smokers and non-smokers congregate. Customers and employees are often exposed to SHS, even if they do not smoke. Employees may be continuously exposed. In November 2003, six months after passage of the law, we sent questionnaires to randomly chosen restaurants in Kyoto prefecture and evaluated data from 267 participants who completed them.