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Kazunori Kayaba, MD, Chihiro Wakabayashi, MHE, Naoko Kunisawa, MA, Hiromi Shinmura, MS and Hiroshi Yanagawa, MD, MPH

The authors are with the Department of Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan.

Correspondence: Requests for reprints should be sent to Kazunori Kayaba, MD, Professor of Public Health and Epidemiology, Department of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya, Saitama 343-8540 Japan (e-mail: kayaba-kazunori{at}spu.ac.jp).

We conducted a nationwide survey to evaluate the effect of implementing a smoke-free policy in municipalities that forbid teachers to smoke on school premises. Questionnaires were mailed to 3207 municipalities throughout Japan. After we adjusted for population size and the standardized mortality ratio for male lung cancer, we found that assigning a high priority to tobacco control in municipal health promotion activities was significantly associated with implementation of school tobacco-control policies (odds ratio = 1.50, 95% confidence interval=1.24, 1.81).