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Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor
To the Editor: Dr Glantz and Ms Charlesworth1 reported that after smoke-free restaurant ordinances
were enacted in California, the number of tourists traveling there from Japan
increased. However, they failed to address several confounding factors, and
the question remains whether implementation of such laws may actually increase
the number of international tourists.
As shown in Figure 1,2 the percentage of smokers in Japan has been decreasing
slightly since 1995. This confounding factor may explain in part the result
of the study. In fact, smoke-free American-style coffee shops have been gaining
popularity, and their number has been increasing in Japan.
The exchange rate, which exerts much influence on international tourism,
is another confounding factor. Figure 1
illustrates the exchange rate of the Japanese yen to the US dollar during
the last 12 years.3 The value of the yen
has been declining since the time the smoke-free restaurant ordinances went
into effect but has not resulted in the expected decrease in tourists from
Taken together, consideration of these confounding factors provides
further support for the authors' conclusion that smoke-free restaurant ordinances
do not adversely affect tourism.
Noto H. Tourism and Smoke-Free Restaurant Ordinances. JAMA. 2000;283(13):1686–1687. doi:10.1001/jama.283.13.1685
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