Kobe J. Med. Sci., Vol. 59, No. 3, pp. E93-E105, 2013

Designated Smoking Areas in Streets Where Outdoor
Smoking is Banned
HIROSHI YAMATO1, NAGISA MORI2, RUMI HORIE3,
LOIC GARCON2*, MIHOKO TANIGUCHI4, and FRANCISCO ARMADA2
1) Department of Health Development, Institute of Industrial Ecological Sciences, Universityof Occupational and Environmental Health, Japan, Kitakyushu, Japan2) WHO Centre for Health Development, Kobe, Japan
3) Tokyo Learning Centre, the World Bank, Tokyo, Japan
4) Clinical Pharmacy Laboratory, Kobe Pharmaceutical University, Kobe, Japan
Received 24 January 2013 / Accepted 29 March 2013
Key Words: Outdoor smoking bans, Designated smoking areas, Tobacco control,
Second-hand smoke exposure
ABSTRACT
Although Japan has been a signatory to the Framework Convention on Tobacco
Control since 2004, progress in translating the recommendations into national policy
has been limited. Globally, outdoor smoking bans cover outdoor dining areas, beaches,
public parks, schools, etc. In Japan, most of existing outdoor smoking bans allow
designated smoking areas (DSAs) in the no-smoking zones, thus limiting protection
from second-hand smoke (SHS). We examined the impact of DSAs on air quality in theareas of Kobe City where such ordinance is in force. Air quality measurements wereconducted near two DSAs in August 2012 by using personal aerosol monitors. Three
measurements were performed, each for 15 minutes, by four investigators: a line-up
measurement, a vertical and horizontal measurement, and a circle measurement. In theline-up measurement, over 150 g/m3 of PM2.5 was detected by the monitor four metresfrom the ashtray, gradually reducing as the distance increased. In the vertical andhorizontal measurement, 80110 g/m3 of PM2.5 was detected at 4, 11, 18 and 25 metres.
In the circle measurement, similar concentrations of PM2.5 were detected at all testing
points (mean concentration 94 g/m³). The study indicates that DSAs are sources of
SHS in zones where a street smoking ban is in force, since SHS spreads widely, bothvertically and horizontally. Street smoking bans that permit DSAs strongly limit
protection from SHS and should be eliminated if protection against SHS is to beeffective where such bans are in force.
INTRODUCTION
The Framework Convention on Tobacco Control (FCTC) became a key landmark inprotecting people from the damage of tobacco when it entered into force in 2005. Japan has
been a signatory to the FCTC since 2004, and as of December 2012 there were 176 Parties to
the Convention. [1] However, progress in translating the FCTC recommendations into
comprehensive regulations and laws has been slow. Protection against second-hand smoke(SHS) has wide public and political support in an increasing number of countries and has
Phone: +81-78-230-3100

Fax: +81-78-230-3178

E-mail:garconl@who.int
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H. YAMATO et al.
paved the way for the adoption of indoor smoking bans as major tools of tobacco control [2].
In order fully to protect people against SHS, the scope of a smoking ban must widen to
include not only indoor spaces but also outdoor areas, following the clear recommendation of
the World Health Organization (WHO) that “under some circumstances, the principle ofuniversal, effective protection may require specific quasi-outdoor and outdoor workplaces tobe smoke-free” [3]. Increasing numbers of cities worldwide have enacted regulations andlegislation banning smoking in outdoor areas, often for reasons not explicitly related tohealth – such as ensuring safety (to limit the risk of fire), and maintaining a clean andattractive environment (to control littering) [4].
Although completely smoke-free cities remain an exception (like the city of Calabasas in
the USA which enacted an ordinance banning smoking in the entire city in 2006), outdoor
smoking bans cover outdoor dining and drinking areas (e.g. in Canada and the USA),
beaches (e.g. in Hong Kong), public parks (e.g. in Australia, Bhutan, India, Italy and
Thailand), schools and playgrounds (e.g. in Finland, the Republic of Korea, Singapore and
the Philippines), sports facilities (e.g. in South Africa), and hospital grounds (e.g. in the
United Kingdom)[5]. However, streets have seldom been covered although outdoor smokingbans are becoming increasingly common.
In Japan, streets adjacent to shopping areas have been the focus of outdoor smoking bans[6]. However, these bans remain very limited in scope and, more importantly, in theirprotection of health. As such, they are weak policy instruments for restricting exposure to
SHS as they are usually implemented for environmental reasons.
Ueda et al (2011) reported that 6% of all municipalities in Japan implement ordinancesthat ban street smoking, the reasons for which were “unrelated to consideration of thesmoking issue as a health matter”. Street smoking bans by themselves are very limited as
tobacco control measures. Moreover, since these bans allow designated smoking areas(DSAs) to be located within the non-smoking streets, the protection from SHS is very
limited.
DSAs are a common feature of street smoking bans in municipalities of Japan. For
instance, although the Kobe City ordinance indicates that smoking is prohibited, smoking
areas are in fact designated within the zone that has street smoking bans [7]. The DSAs areeither constructed with public money [8] or provided by the tobacco industry [9]. For
example, Japan Tobacco Inc. (JT) reported that they often give both financial and technicalassistance to local governments for the installation of DSAs [9], and Kobe is no exception[7]. As of April 2011, JT stated that it had provided 943 DSAs in collaboration with 212
different municipalities in Japan [9]. In the case of the special wards of Tokyo, each ward
consults with JT to identify a suitable location, taking into account the accessibility, visibility
and negative health impacts of the installation of a DSA [10].
In some cases, community complaints about DSAs have been reported. For instance,
Shibuya ward of Tokyo implemented an ordinance banning street smoking in 1998 in orderto prevent littering or to “keep the city beautiful” and, as a part of this ordinance, the litteringof cigarette butts is prohibited. In this same ward, a total of 21 DSAs were provided in thepast; however, two of them have now been removed due to the large number of complaints
from the public [11]. In anticipation of such public discontent with SHS generated by DSAs,
a new approach has been introduced by a private Japanese company named General Fundex.
In this new approach, the designated smoking rooms are installed in former shops, namely
ippuku, to which passers-by can gain admission for a fee of ¥500 per week [12]. The
officially declared purpose of this kind of smoking room is to provide an opportunity forsmokers to smoke in a relaxed environment [13]. General Fundex raised concerns that, as a
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result of widely implemented street smoking bans, the numbers of places where people areallowed to smoke has been reduced [13]. As of October 2012, there were three designatedsmoking rooms (DSRs) in the streets of metropolitan Tokyo [12].
BACKGROUND
The impact of DSRs in indoor areas on exposure to SHS has been extensively
documented.
Since the early 1990s, where DSRs were encouraged as an alternative to reduce exposure
to SHS, it was already documented that, owing to several factors, the smoke leaked to areas
where a ban was in force [14], and spillovers were inevitable – specifically particulatematters of less than 2.5 m, which are “a major source of respirable suspended particles (in)cigarette smoke” [15].
As early as 1993, nicotine vapor measurement showed that, in the hospitality industry,
nicotine concentrations were as high in nonsmoking sections as in the DSR [16]. In response
to such clear evidence of the ineffectiveness of partial bans, the tobacco industry promoted
heavily the use of ventilation and filtration systems as a way to clean the air and protect
nonsmokers from SHS while at the same time allowing smokers to smoke in as many
facilities as possible.
Further studies conducted since 2000 showed that, comparatively, restaurants with a DSR
had poorer air quality than restaurants applying a complete smoking ban, despite all technicaladvances in ventilation, pressurization and filtration systems [17][18]. Indeed, unless the
DSR is completely sealed off from the outside world, leakage will always happen, evensimply when the access or exit door is opened [19]. All types of facilities have been thesubject of similar studies (restaurants, airports, office buildings, medical facilities, and games
rooms, to cite a few) with similar findings.
The leakage of environmental tobacco smoke (ETS) has been widely studied [20] [21]and it has been confirmed that DSRs, whether ventilated or nor and whether equipped withfiltration systems or not, do not protect from exposure to SHS.
In addition to air quality considerations, partial bans could legitimize smoking and may
prevent people from quitting, as has been shown in Canada where smoking areas werepermitted in some schools [22]. Moreover, as Winickoff et al. point out [23] [24], even whenabsolute no-smoking policies are implemented, nonsmokers may still be exposed to harmful
levels of toxins from “off-gasing from smoker’s clothing, through open windows and doors
and from exhaled toxins for several minutes after the cigarette is extinguished”.
Whereas, as illustrated above, ample evidence has been provided on the ineffectivenessof DSRs to fully protect people from the negative effects of SHS in indoor areas, little vetted
data is available on DSAs in outdoor areas. Thus there is a need to document the impact of
DSAs where partial bans are implemented. This study aims to assess the impact of DSAs
where a street smoking ban is enforced using data from one of the cities where such aregulation has been implemented.
Kobe City, the capital of Hyogo Prefecture, has a total population of 1.5 million(estimated as of November 2011) and is the fifth most populous city in Japan. In Kobe,
Kobe-shi poiste oyobi rojo-kitsuen no boshi ni kansuru jorei (the Kobe City ordinance on
prevention of littering and street smoking), which prohibits smoking in certain streets, cameinto force on 1 April 2008. The ordinance was intended to make the city cleaner and toprevent brush-by burns resulting from street smoking. The Bureau of the Environment is incharge of the ordinance, not the Bureau of Health. Articles 4, 8, and 9 of the ordinance focus
on smoking, stating that people must try not to smoke in any street of the city and prohibiting
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smoking within the area designated by the mayor. However, the reality is that four DSAs areprovided within the no-smoking areas.
A characteristic of urban areas in Japan is the presence of pedestrian walkways called“pedways”. These are common structures that can be seen connecting urban high-risebuildings to each other, particularly around the public transport hubs where many people
pass every day. Pedways provide quick and comfortable movement from building to building,away from the traffic and sheltered from inclement weather. In Kobe, two of the DSAs are infact installed under the stairs attached to a pedway. The DSAs are delineated by physicalpartitions and are equipped with ashtrays; some have a roof over the ashtrays as a means ofkeeping people smoking inside the DSA. The sign indicating “Smoking Area” can be seenclearly just outside the train station, directing smokers to the place where they are authorized
to smoke while in the no-smoking zone.
Since 2008, soon after the implementation of the ordinance, a fine of ¥ 1000 was applied
to illegal smokers in the red-shaded area in Figure 1. The total area of the street smoking banzone is 500 metres from north to south and 800 metres from east to west, and only public
streets are covered by the ordinance [25].
OBJECTIVE
The objective of this study was to determine the impact of DSAs on air quality in theareas of Kobe City where the municipal ordinance banning street smoking is in force. The
study was carried out as part of a broader study to assess compliance with the street smoking
ban in Kobe.
MATERIALS AND METHODSIn order to measure the air quality, we selected two different DSAs (out of four), DSA1
and DSA2, located near the central train station in Kobe where the street smoking ban isenforced, as shown in Figure 1a and 1b. DSA1 (N34 41.587 – E135 11.693) is located underan overpass linking several shopping Centres to a nearby street. It is also a resting area
nearby the taxi station located at the South entrance of the main train station in the centre of
Kobe City. The overpass which is above DSA1 provides passengers, a connection between
two public transportation systems (a train station and an automated shuttle to Kobe airport)
and a pathway to the major shopping street on the South side of the station. There isimportant pedestrian traffic as it is a central nod in Kobe for public transportation andshopping (a bus station is located nearby, as well as the three main train companies and thesubway). DSA2 (N34 41.569 – E135 11.652) is located West of DSA1, on the opposite sideof a main road linking the North and South ends of the city. DSA2 sits under the stairs of an
overpass that connects the exits of two main train stations to the shopping street below(arrows in the maps of DSA1 in Figure 2a and DSA2 in Figure 2b indicate 20 m). The two
locations were selected as a result of an earlier pilot study. Air quality measurements of thetwo DSAs were conducted in August 2012 (August 7th and August 9th) by means of a
SIDEPAK™ AM510 Personal Aerosol Monitor manufactured by TSI Inc. 1 The
concentrations of fine particulate matter of PM2.5 were measured. PM2.5 particles pose thegreatest health risks because they have the ability to penetrate deeply into the lungs, where
they may reach the peripheral regions of the lungs [24]. The monitor determines the massconcentration by the intensity of scattered laser light. As the light-scattering properties of1

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See: http://www.tsi.com/sidepak-personal-aerosol-monitor-am510/.

DESIGNATED SMOKING AREAS OUTDOOR SMOKING BANNED
particles differ according to their size and composition, it is necessary to calibrate themeasurement results of the monitor [18]. The monitor was set to record PM2.5 concentration
every 10 seconds. An impactor for 2.5 m particles attached to the inlet of the monitor
removed particles greater than 2.5 m at a flow rate of 1.7 litres [26]. We used 0.295 as acorrelation factor for measurements following the method described by Lee [26].
■Street smoking ban zone
■Designated smoking area

Sannomiya St.
DSA1
DSA2

Motomachi St.

Fig. 1a. Street smoking ban zone and DSAs

Fig. 1b. Magnifiedd view of DSA1 and DSA2

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Three different measurements were collected on two different days in August 2012. The
three different measurements were: 1) line-up (horizontal) measurement; 2) vertical andhorizontal measurement of DSA1; and 3) circle measurement of DSA2. Each measurement
lasted approximately 15 minutes. The monitoring was conducted from 8 to 9 a.m. to monitor
people smoking in the DSAs on their way to work. The data were downloaded to a computerfor calibration.
1) Line-up (horizontal) measurement

As
htr
ay

TP
2

TP
1

TP
3

TP
4

Fig. 2a. Line-up measurement
Each of the four investigators lined up with a monitor as shown in Figure 2a. The closest testing point(TP) was 4 metres away from DSA1 and the most distant TP was 25 metres away.

2) Vertical and horizontal measurement
TP
1

TP
2

TP
3

TP
4

Fig. 2b. Vertical and horizontal measurement
The four investigators lined up horizontally on the pedway above the DSA1 with a monitor, as shownin Figure 2b. The concentration of SHS was measured both vertically and horizontally with thismethod.

3) Circle measurement
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Fig. 2c. Circle measurement
The four investigators formed a circle with amonitor in hand, as shown in Figure 2c. There wasa pedestrian walkway located just above the
DSA2.

RESULTS
Line-up measurement
In the line-up measurement, the monitor at testing point 1 (TP1), which was nearest to
the ashtray point, detected more than 150 µg/m³ (Figure 3-1) and 120 g/m³ (Figure 3-2)
which represent higher concentrations of PM2.5 than the other testing points. The
concentration of PM2.5 gradually decreased with the distance. However, at the end of theline-up measurement in Figure 2, TP4, which was 25 metres from the ashtrays, recorded thelowest concentration of PM2.5.

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Vertical and horizontal measurements (Pedestrian Bridge with a DSA below)
On day 1, the monitors closest to the ashtrays, TP1 and TP2, recorded around 120 g/m³
and 94 g/m³ respectively. That represents more concentration of PM2.5 than at TP3 and TP4(Figure 4-1). However, at the end of measurement period, a high level of PM2.5 was recorded
at each of the four testing points (Figure 4-1). On day 2, under the same measurement
conditions (Figure 4-2), the concentration of PM2.5 detected was higher at TP2 than at theother testing points.

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Circle measurement
On day 1, a high-level concentration of PM2.5 was detected at TP1, TP3 and TP4, withapproximately 80110 g/m³ (Figure 5-1). On day 2, under the same measurement
conditions, at the beginning of the measurement period, PM2.5 concentration peaks weredetected at all testing points (Figure 5-2).

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DISCUSSION
The results point towards the existence of release of SHS from the DSAs into the street
where a smoking ban is in force. Although the concentration of SHS gradually decreases as
the distance from the ashtray of the line-up and vertical and horizontal measurements
increases, the furthest testing points (TP4) still detected concentrations of particulate matteras high as 30 g/m3. As shown in the figures, there is a gradual delay in detecting SHS byboth line-up and vertical and horizontal measurements as one moves away from the ashtrays
from TP1 towards TP4. The weather of the measurement was typical mid-summer pattern,
mild wind coming from south or south west (sea-side) to north or north west (mountain-side).
The flow of SHS is highly dependent on the direction and velocity of the wind; it can reachfurther than 25 metres or it may remain with a high concentration for a longer period of timein certain areas [27]. However, it should be emphasized that all the pedestrians were exposed
to high concentration of SHS at the TP1 and TP2 in the vertical and horizontal measurements
because those points are located just above the ashtray.
The circle measurement, on the other hand, constantly shows a high level of SHS
concentration at each of the four testing points. In this case, the situation is made worse by
the fact that the DSA is installed under the stairs attached to a pedway which serves as a roof
for the DSA.
The presence of a DSA can weaken the strength of an ordinance banning smoking in thestreet as the DSA is a source of SHS. The dispersion of the smoke indicates that there are nosafe levels of exposure to SHS in the presence of DSAs. Moreover, there are additional
health concerns, such as occupational health issues for cleaners of the DSA who will be
exposed to SHS; and also that DSA contribute to the social acceptability of smoking in areas
where there is a street smoking ban, as shown in Canada [22].
LIMITATIONS
A first potential limitation is that since we did not measure the wind speed and direction
on the day of the measurements, variations in the dissemination of the SHS due to weather
conditions could not be reported. However, the measurements were done in relatively stable
weather conditions. In those mid-summer days, the wind is not strong and relatively constantseasonal south wind (from seaside to mountain side) is observed because of the difference ofthe temperature between the seawater and heated land. It has been reported that, in theabsence of wind, the cigarette plume will rise if the temperature of the smoke plume is hotter
than the surrounding air and will rapidly cool and lose its upward momentum. If there iswind, the amount of rise of the thermally-induced plume is inversely proportional to the windvelocity. A strong wind will create a more horizontal but wider cone. Therefore as the winddirection changes, SHS pollution will be spread in various directions, affecting downwind
nonsmokers [28]. Secondly, Personal Aerosol Monitor also detects combustible diesel
exhaust of vehicles as its particulate matter is smaller than 2.5 μm. Since two of the DSAs
are located beside a busy main road, or near bus terminals, it is possible that the monitor has
detected diesel exhaust. In October 2004, Hyogo prefecture implemented the ordinancecalled “Creation of the preservation of the environment”, and this ordinance limits vehicles
with diesel engines in certain areas of Hyogo [29]. However, the ordinance does not include
the area in which the study was carried out. Therefore, the contamination of PM2.5 cannot be
ruled out. The baseline standard of the collected data was nevertheless clean as it was lower
than the air quality standard set by the Ministry of the Environment [30] and lower than the
WHO standard. Third, the concentration of the SHS is highly dependent on the number,
distribution, and density of the smokers. Although we targeted the time when smokers wereE102

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likely to be present, the number of smokers may vary from day to day. With regard to the
distribution of the smokers, the source of SHS cannot be defined since the border between
the DSA and the zone where there is a ban on smoking in the street remains unclear. We
should also note that the monitor may have detected SHS from sources such as illegal
smokers in the no-smoking zones, or from smokers inside cars or on motorcycles passing
along the road. Fourth, since there is currently no ordinance restricting indoor smoking in
Hyogo, it is possible that SHS is leaking out from retail premises such as coffee shops, orentertainment facilities such as amusement arcades in the neighbourhood of the DSA in thecircle measurement.
CONCLUSION AND RECOMMENDATIONSThe study suggests that Designated smoking areas are a potential source of Second-handsmoke where a street smoking ban is in force, since Second-hand smoke spreads widely,both vertically and horizontally, from the Designated smoking area. Even when there are nosmokers in the area where there is a street smoking ban, Second-hand smoke could bepresent. Therefore, street smoking bans that permit Designated smoking areas do not provide
effective protection from Second-hand smoke.
To contribute to prevent exposure to Second-hand smoke, Designated smoking areas
should not be allowed. Moreover, only comprehensive policies that follow the WHO FCTC
agreements and guidelines, further emphasized in the MPOWER report [31], will achieve aneffective and positive impact on health.
Although it would be reasonable to extrapolate the existing evidence on indoor smoking
areas to the outdoor equivalents, and the results of this study point in that direction, further
research on this topic could provide complementary evidence – including accounting forother potential sources of Second-hand smoke such as diesel, the effect of variations in thenumber of smokers, and the influence of the built environment on the Designated smoking
areas.
ACKNOWLEDGEMENTS
The authors express their appreciation to Ms Mina Kashiwabara (WHO Regional Officefor the Western Pacific) in the early stages of preparation of the research. We also
acknowledge Ms Subhi Tarim of Queen’s University, Toronto; Ms Misae Watanabe ofKwansei Gakuin University; Prof Noriaki Emoto, Dr Keiko Yagi, Ms Eriko Doi, Ms Ayaka
Hamamoto, Ms Misato Kusumoto, Ms Aki Onishi, Mr Yuki Onishi, Ms Kana Sasaki, Ms
Sakiko Shimai, Ms Sari Wakizono, Ms Miki Yagi, Ms Saki Ochiai and Ms Risa Kusunose of
Kobe Pharmaceutical University; the City of Kobe; and the Japan Cooperating Committee,
Mr Alex Ross (WKC), Ms Yoko Inoue (WKC), Dr Keiko Yamada (Hyogo Prefecture) for
their kind contributions, and Mr David Bramley for technical editing.
This research was partially funded by research grants from the Ministry of Health,Labour and Welfare, Japan.
DISCLAIMER
The views presented in this article are those of the authors and do not necessarily reflect
the decisions, policies, or views of the World Health Organization.

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