Birth cohort-specific smoking patterns in Japan (1906-2004): a population-based study from the NC-CCAPH consortium

Shiori Tanaka; Hikaru Ihira; Tetsuya Tajima; Rieko Kanehara; Yosuke Inoue; Takehiko Doi; Nozomu Kobayashi; Yuka Kato; Yukiko Nishita; Maki Konishi; Yoko M Nakao; Isamu Kabe; Chihiro Morioka; Seitaro Dohi; Paramita Khairan; Ahmed Arafa; Zui C Narita; Naho Morisaki; Yukai Lu; Rei Otsuka; Taiki Yamaji; Hiroyuki Shimada; Tetsuya Mizoue; Norie Sawada; Shoichiro Tsugane; Motoki Iwasaki; Manami Inoue

doi:10.1016/j.lanwpc.2025.101562

Birth cohort-specific smoking patterns in Japan (1906-2004): a population-based study from the NC-CCAPH consortium

Lancet Reg Health West Pac. 2025 May 7:58:101562. doi: 10.1016/j.lanwpc.2025.101562. eCollection 2025 May.

Authors

Shiori Tanaka¹, Hikaru Ihira^{2

3}, Tetsuya Tajima⁴, Rieko Kanehara⁴, Yosuke Inoue⁵, Takehiko Doi⁶, Nozomu Kobayashi^{7

8}, Yuka Kato⁹, Yukiko Nishita¹⁰, Maki Konishi⁵, Yoko M Nakao⁹, Isamu Kabe¹¹, Chihiro Morioka⁹, Seitaro Dohi¹², Paramita Khairan⁹, Ahmed Arafa⁹, Zui C Narita¹³, Naho Morisaki¹⁴, Yukai Lu⁴, Rei Otsuka¹⁰, Taiki Yamaji², Hiroyuki Shimada⁶, Tetsuya Mizoue⁵, Norie Sawada⁴, Shoichiro Tsugane^{4

15}, Motoki Iwasaki^{2

4}, Manami Inoue^{1

4}

Affiliations

¹ Division of Prevention, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
² Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan.
³ Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Hokkaido, Japan.
⁴ Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.
⁵ Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
⁶ Department of Preventive Gerontology, Center for Gerontology and Social Science National Center for Geriatrics and Gerontology, Aichi, Japan.
⁷ Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
⁸ Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan.
⁹ Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
¹⁰ Department of Epidemiology of Aging, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan.
¹¹ KUBOTA Corporation, Ibaraki, Japan.
¹² Mitsui Chemicals, Inc., Tokyo, Japan.
¹³ Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
¹⁴ Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
¹⁵ Graduate School of Public Health, International University of Health and Welfare, Tokyo, Japan.

Abstract

Background: This study aimed to estimate Japan's age-specific history of smoking prevalence, initiation, cessation, and intensity by birth cohort, using data from multiple cohort studies.

Methods: We pooled data from eight eligible cohorts surveyed between 1989 and 2020 as part of the National Center Cohort Collaborative for Advancing Population Health (NC-CCAPH). An Age-Period-Cohort model was employed to estimate birth cohort- and sex-specific smoking patterns for individuals born between 1920 and 1999.

Findings: Among 393,023 participants (40.9% female, mean age 51.8 years), smoking prevalence peaked in early adulthood (20s-30s) and declined with increasing age. Recent birth cohorts showed lower prevalence and smoking initiation in both sexes, albeit with increases in mid-female cohorts (1960s-1980s). Smoking cessation surged in the late 1990s and peaked around 2010, coinciding with tax-driven cigarette price hikes. Peak cigarette consumption occurred in 1990, followed by a steady decline. However, all birth cohorts maintained a mean consumption above 10 cigarettes smoked per day for both sexes.

Interpretation: This study highlights a generational shift in smoking behavior, in which younger birth cohorts smoked less and quit earlier than older birth cohorts. The study also reveals that smoking behaviors in males were strongly influenced by cigarette accessibility, such as price increases, while smoking initiation in females was more likely affected by societal changes, especially in the evolving roles of women. Smoking intensity remained stable across cohorts and sexes, emphasizing the need for stronger health policies, including higher tobacco taxes, to further reduce smoking and its health impact.

Funding: This study was conducted within the National Center Cohort Collaborative for Advancing Population Health (NC-CCAPH) and supported by grants from the Japan Health Research Promotion Bureau (JH) (2019-(1)-1, 2024-B-05).

Keywords: Age-period-cohort model; Cessation; Cohort studies; Initiation; Intensity; Japan; Prevalence; Smoking.