禁煙科学 12巻(2018)-04-P1

Original Article

The Effect of Non-smoking Education Before and After Lecturesat the Schools of Dental Hygiene and Dental Technology
Nobutaka Okusa 1* , Kazuya Masuno 2 , Takako Toyama 3 , Kumiko Kaji 3 , Ayuko Maesoma 4 ,Aiko Hamamoto 3 , Ai Onishi 3 , Masako Terajima 3 , Tetsunari Nishikawa 2 , Pao-Li Wang 2*

SUMMARY
We studied the effects of non-smoking education using a survey of first-year students in 2016 at the Schoolsof Dental Hygiene and Dental Technology. Non-smoking education was conducted on 52 subjects (42 School of
Dental Hygiene students, 10 School of Dental Technology students). The surveys were conducted both before
and after the lecture, with the main questions as follows: age; whether they have experienced non-smoking
education lectures; reasons for not being able to stop smoking; understanding of the physical harm of smoking;passive smoking; diseases caused by smoking; the mechanisms of diseases caused by smoking; smoking
cessation methods; whether currently smoking; and knowledge of smoking experiences. In terms of the harmcaused by smoking, before non-smoking education, all students knew that smoking was harmful to the humanbody and impacted surrounding people. In the question “Name diseases caused by smoking,” the number of
diseases in the answers was tabulated with a score of 0–4. The score for this question was 93 before the lectureand 152 afterwards. For the question “Please explain the mechanisms of diseases caused by smoking,” ninesubjects answered they could explain only a little before the lecture, and 33 did so after the non-smoking
lecture. Compared with before the lecture, increases in knowledge of smoking and the motivation to stopsmoking were seen as a result of lecture attendance.
Key words: smoking, non-smoking education, School of Dental Hygiene, School of Dental Technology

1. Department of Forensic Dentistry, Osaka Dental University
2. Department of Innovation in Dental Education, Osaka Dental University
3. Osaka Dental University School of Dental Hygienist
4. Department of Oral Health Sciences, Faculty of Health Sciences, Osaka Dental University*Corresponding author：Nobutaka Okusa
Department of Forensic Dentistry, Osaka Dental University
8-1 Kuzuha Hanazonocho, Hirakata City, Osaka 573-1121, Japan
Tel & Fax： +81-72-864-3165
E-mail： okusa-n@cc.osaka-dent.ac.jp

禁煙科学 12巻(2018)-04-P2

INTRODUCTION
It is well-known that smoking can be a risk factor for disease. The issue of harm from smoking is frequently
raised in a variety of ways. The number of smokers in Japan has been on a gradual downward trend, with areport by the Ministry of Health, Labour and Welfare, 1) stating that 19.3% of Japanese were smokers in 2016.
With measures to prohibit smoking inside public places and facilities gaining ground each year, actual systems
in this regard are coming into place. According to a WHO study, although 49 countries have laws obliging thecomplete prohibition of smoking indoors in public gathering places, under the Health Promotion Act, Japan
currently remains obligated to make efforts to prevent passive smoking. The WHO has judged the response ofJapan to be the “global minimum level.” With the selection of Tokyo to host the 2020 Olympics, working onstrengthening rapid measures to prevent passive smoking has become crucial. 2) With the agreement of the
WHO and the International Olympic Committee (IOC), except for Japan, all present and future nations hosting
the Olympics enforce laws and regulations with penalties. With smoking indoors prohibited in the 2012
London Olympics, and smoking prohibited on the premises at the 2016 Olympics in Rio de Janeiro, there havebeen measures including penalties to prevent passive smoking. The WHO and IOC have raised the slogan of a
“Tobacco-free Olympics”; if the current situation continues in Japan, it might become seen as a country thatminimizes the damage to health from smoking. It is apparent that Japan must develop laws in this regard by
2020, but it is also an issue. The Ministry of Health, Labour and Welfare also encourages the promotion of nonsmoking in Health Japan 21, and has set a target of reducing the ratio of adult smokers to 12% by 2022. 1) As it
is likely that the number of smokers seeking outpatient smoking cessation will increase, after the relevant laws
are in place, there must also be progress in measures for medical treatment.
Although medical facilities naturally treat patients suffering from smoking-induced illnesses, health care
workers are not capable of persuading smokers, resulting in patients harboring doubts toward the treatment
itself. This does not apply only to dentists but also dental hygienists, dental technicians, and health careproviders. In particular, passive smoking is a risk factor for cardiovascular 3) and respiratory system diseases;
for the oral area, it is also said to be a risk factor for cancer and periodontal disease. 5)
With a view of dental hygienist and dental technician school students becoming health care providers
following graduation, the authors studied the future direction of non-smoking education, by conducting nonsmoking education lectures for these students to become involved in providing support and guidance insmoking prevention,6) and surveying knowledge of smoking and the motivation to quit smoking before andafter the lectures.

METHODS
1. Subjects
52 students of the University’s vocational schools in their first year in 2016 (42 students of School of Dental
Hygiene students, 10 students of School of Dental Technology)
2. Study method
Anonymous, self-administered survey forms were distributed to all subjects before and after the February
2017 non-smoking education lecture. Survey forms were collected after the students completed them.
3. Study details
Questions before the non-smoking education lecture: whether they have experienced non-smoking educationlectures, reasons smokers could not stop smoking, the harm of smoking, passive smoking, the mechanisms of
diseases caused by smoking, smoking cessation methods, whether currently smoking, and when started
smoking
Questions following the non-smoking education lecture: reasons smokers could not stop smoking, the harmof smoking, passive smoking, the mechanisms of diseases caused by smoking, smoking cessation methods,

禁煙科学 12巻(2018)-04-P3

whether currently smoking, and when started smoking
The study items detailed three diseases caused by smoking and four smoking cessation methods (Table 1).
These diseases were tabulated with a 4-stage score, “0,” “1,” “2,”, and “3.”RESULTS
Fifty-two surveys were collected (collection ratio of 100%); 44 subjects were aged 19 or below, 6 were aged
20–29; and 2 were aged 30–39.
1. Non-smoking education
Subjects were asked only before the lecture the question “Have you ever had any non-smoking education?”
Twenty-seven (51.9%) replied Yes, whereas 25 replied No (48.1%). (Table 2).

禁煙科学 12巻(2018)-04-P4

2. Reasons smokers could not stop smoking
For the question “Please explain the reasons non-smokers cannot stop smoking,” before the lecture, 50
subjects (96.2%) replied “I can explain,” whereas 2 (3.8%) replied “I cannot explain.” Of the 50 students who
replied that they can explain, their reasons were as follows: dependence/addiction, 43 (86.0%); because theycannot stop, 2 (4.0%); nicotine, 3 (6.0%); stress relief, 1 (2.0%); and to derive pleasure, 1 (2.0%).
After the lecture, all 52 respondents replied “I can explain.” The reasons they gave were as follows:
dependence/addiction, 43 (82.7%); and nicotine, 9 (17.3%).
3. Harm from smoking
For the question “Do you understand that smoking causes physical harm,” both before and after the lecture,
52 subjects (100%) responded “Yes.”
4. Passive smoking
For the question “Please explain passive smoking,” before the lecture, 42 subjects (80.7%) replied “I can
explain just a little”; 3 (5.8%) said “I cannot explain”; and 6 (11.5%) did not respond. Examples of “I can
explain” responses included “people around a smoker inhale second-hand smoke”; “if there is someone nearbysmoking, even if you are not, you will be harmed when you inhale the smoke”; and “people who are notsmoking inhale cigarette smoke.” Examples of “I cannot explain” included “I don’t know”; “I myself smoke”;“I am harmed by the smoke that I inhale”; and “I harm myself by smoking.”
After the lecture, 50 (96.2%) subjects replied “I can explain just a little,” whereas 2 (3.8%) did not respond.
Examples of “I can explain” responses included “non-smokers inhale second-hand smoke from cigarettes whena smoker is in the same place”; “people near a smoker inhale second-hand smoke”; and “inhaling second-handsmoke exhaled by smokers.” There were no “I cannot explain” responses.
5. Diseases caused by smoking
For the question “List three diseases caused by smoking,” before the lecture, 14 subjects (26.9%) listed threediseases; 13 (25.0%) replied with two illnesses; and 25 (48.1%) listed one disease.
After the lecture, 49 subjects (94.3%) replied with three diseases; 2 (3.8%) replied with two; and 1 (1.9%)
replied with one, for a score of 152.
6. Mechanisms of diseases caused by smoking
For the question “Please explain the mechanisms of diseases caused by smoking,” before the lecture, 9subjects (17.3%) replied “I can explain just a little,” whereas 43 (82.7%) responded “I cannot explain.”
Examples of “I can explain just a little” included “Tar adheres to the lungs and causes harm”; “Smoking
destroys lung cells, so, breathing becomes difficult and more cells are destroyed”; and “there are harmful things禁煙科学 12巻(2018)-04-P5

in smoke that cause cancer.” (Table 3)
After the lecture, 33 subjects (63.5%) replied “I can explain just a little,” whereas 19 subjects (36.5%)
responded “I cannot explain.” Examples of “I can explain just a little” included “Smoking is a risk factor thatcauses a variety of oral diseases, such as bad breath, stomatitis, and oral cancer,” “Tar has carcinogenic
substances (it causes cancer)”; and “Smoking constricts capillaries, so, the immune cells, oxygen, and nutrients
carried by blood are not sufficiently distributed throughout the entire body. It is, therefore, easier to get sickand harder to recover.” (Table 4)
7. Smoking cessation methods
For the question “Please list at least four smoking cessation methods,” before the lecture, one subject (2.0%)
listed 4 methods; 10 (19.2%) listed 3; 14 (26.9%) listed 2; and 17 (32.7%) mentioned 1. Ten (19.2%) subjects
did not list any method.
After the lecture, 24 subjects (46.1%) listed 5 methods; 11 (21.2%) listed 4; 3 (28.9 %) listed 15; 1 (1.9%)
listed 1. One (1.9%) subject did not list any method.
8. Smoking status
For the question “Do you smoke,” both before and after the lecture, 1 (1.9%) subject answered Yes; 49(94.3%) replied No; 1 (1.9%) replied “I quit”; and 1 (1.9%) did not reply. (Table 5)
9. When started smoking
For the question “When did you start smoking,” only the smokers replied; 1 subject answered “I started
smoking after starting school.”

DISCUSSION
Considering that dental hygienist and dental technician first-year students will become health care providers
following graduation, the purpose of this study was to examine the future direction of non-smoking education,

禁煙科学 12巻(2018)-04-P6

by conducting non-smoking education lectures for these students to become involved in providing support andguidance in smoking prevention, and surveying knowledge of smoking and the motivation to quit smoking
before and after the lectures. Results of the study elucidated the fact that most of the vocational school students
were non-smokers. The results also indicated the view that even students attending the non-smoking lecture forthe first time had significant understanding of the effects of smoking. It is the view of the authors that thestudents’ straightforwardness in expressing their thoughts, because of the anonymity of the survey replies, waslikely reflected in these results.
The non-smoking education was conducted partially using a lecture. In the survey before the lecture, the free-form comments were, in certain cases, vague. Following the lecture, however, the comments used moreaccurate wording, which likely indicates certain effects of the non-smoking education. Concerning the survey
question “List three diseases caused by smoking,” the fact that the score rose from 93 before the lecture to 152
after the lecture suggests the effect of the lecture.
A lifestyle survey of the first- to fourth-year students at the University’s School of Dentistry confirmed that,
overall, roughly 10% are smokers.7) In comparison, there were almost no smokers among the students at the
Schools of Dental Hygiene and Dental Technology, suggesting an extremely high motivation to stop smoking.
In particular, the fact that most first-year students at the School of Dental Hygiene are minors could be thereason for their being non-smokers. However, in the upper grades, the number of students smoking might
increase because of stress from additional clinical practice and study for national exams. To prevent smoking
due to stress, there is a need to continue with non-smoking education as students progress through school, todisseminate the fact that smoking is a risk factor for malignant tumors and periodontal disease, and to chart apath for smokers to quit and non-smokers to not start smoking.
Hosomi et al., 8) which concerned non-smoking education for university students, reported that conducting
lectures on smoking has the effect of preventing smoking through raising awareness and the acquisition of
information concerning the harm caused by smoking. However, as there are reports9, 10) of more students
taking up smoking after they turn 20, which is the legal age for smoking, it is thought that there are significant
changes in their environment because of entering university around this age. Therefore, there are expectationsof promoting the need for non-smoking education as well as smoking prevention, at this time, leading to theprevention of passive smoking and curbing of smoking. Tofukuji et al. 11) and El Ansari W et al. 12) also
reported that making an entire university campus smoke-free reduced smoking rates, from 25.2% to 7.6%
among men and from 6.9% to 0.8% among women, thereby demonstrating the effectiveness of a smoke-freecampus. Owing to such a suggestion that a smoke-free campus has certain effects, results would be expectedfrom converting our campus from having smoking and smoke-free areas to banning smoking. As such, because
it would be necessary to disseminate concerns that this would cause more students to smoke off campus, 13) it isimportant to share actively the experiences of making university grounds smoke-free. Non-smoking is asignificant hurdle for smokers that require their own determination. This is, therefore, an issue of not only
individual universities making non-smoking programs to spread awareness through education but also building
an approach from a behavioral therapy viewpoint. 14)

CONCLUSION
Non-smoking education for first-year students at the Schools of Dental Hygiene and Dental Technology
resulted in previously vague knowledge of this issue becoming sharper, following the lectures. For students toremember these results in the long-term, it is important to repeat non-smoking education while they areenrolled in school; a curriculum plan that compels them to maintain this motivation must also be selected.
In the future, we must promote non-smoking by changing the awareness of students through making
campuses smoke-free. Moreover, building rapidly a university support system and environment for students
who are training to work in the health care field will be an important issue.

禁煙科学 12巻(2018)-04-P7

ACKNOWLEDGMENTS
In conducting this study, we would like to express our appreciation to the instructors who provided a great
deal of advice and guidance, and to all first-year students of the Schools of Dental Hygiene and Dental
Technology who gave their cooperation.

REFERENCES
1)

Ministry of Health, Labour and Welfare Health Japan 21 (the second term):(http://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/kenkou/kenkounippon21/kenkounippon21/
data05.html) (date accessed: January 25, 2018)2) Matsuzawa S: Toward establishing laws to prevent passive smoking. [Translated fromJapanese.] Japanese Society for Pediatric Tobacco Research Magazine 4(2), 2014: 62–67.
3) Messner B, Bernhard D: Smoking and cardiovascular disease: mechanisms of endothelial
dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol 34(3), 2014:509–15.
4) Ishii Y: [Smoking and respiratory diseases]. Nihon Rinsho 71(3), 2013:416–420．
5) Arbes SJ Jr, Agústsdóttir H, Slade GD: Environmental tobacco smoke and periodontal diseasein the United States. Am J Public Health 91(2), 2001:253–257.
6) Oh H, Ara T, Ito K, et al: The investigation on the education of smoking and smoking
cessation in School of Dentistry and School of Dental Hygienist. Smoking Control Science3(3), 2010:41–53.
7) Okusa N, Masuno K, Tanaka T, et al.: Smoking as Understood from a Lifestyle Survey ofOsaka Dental University Students in 2016. The 12th Japanese Association of Smoking Control
Science Academic Congress Program and Proceedings. 2017: page 82.
8) Hosomi K, Hatakenaka Y: The effects of non-smoking education for the Students in the
Department of Dental Hygiene．Kansai Women’s College Bulletin 19, 2009:77–84.
9) Urushizaka M, Takanashi S, Abe M, et al: A survey of smoking status and attitudes
towards smokingin Hirosaki University undergraduate students. Japanese Journal of Tobacco
Control 5(4), 2010:111–119.
10) Saito M, Watanabe M, Watabe T, et al: Evaluation of the consciousness of pharmacy
students on smoking. Japanese Journal of Tobacco Control 5(6), 2010:158–164.
11) Tofukuji I, Kitazume H, Kobayashi H: The impact of peer smoking on university student
smoking. [Translated from Japanese.] Smoking Control Science 8(4), 2014: 6–8.
12) El Ansari W, Labeeb S, Kotb S, et al: Correlates of smoking, quit attempts and attitudes
towards total smoking bans at university: findings from eleven faculties in Egypt. Asian Pac J
Cancer Prev 13(6). 2012:2547–56.
13) Kayahira S, Abe T, Naganuma A, et al: Off-campus smoking due to smoke free university
campuses. [Translated from Japanese.] CAMPUS HEALTH 51(2), 2014:109–114.
14) Kawane H: Smoking and Medical Diseases: Evidence and Countermeasures. Smoking
Cessation Measures: Introduction of and Support for Non-Smoking Countermeasures.
[Translated from Japanese.] Diagnosis and Treatment 97(7), 2009:1405–1409.