Akihiro Nishi, Tetsutaro Matayoshi, Takahiro Shimizu, Masako Kinkozan, Ichiro Kawachi

At the end of January, a local newspaper company in Okinawa, Japan, Ryukyu Shimpo, published an opinion letter from a young reader, entitled “Cool Big Brother”.

The author, a first-year elementary school girl (aged 6 or 7) related a warm-hearted story of an affectionate granddaughter (herself) and a convenience store clerk (big brother). In the letter, she recounted how she had decided to prepare a surprise gift for her grandfather, who loves smoking. She went to the local convenience store and asked the store clerk to give her as many packs of cigarettes as her pocket money could buy. He convinced the girl that her grandfather would be just as pleased with the gift of one packet, and gave back her change. The girl concluded her letter with praise for him: “that big brother was really cool”.

The letter created considerable controversy, even among health professionals, with opinion divided along the lines of health concerns versus ‘excessive’ anti-smoking attitudes. Within a week, the newspaper company realised that the letter was a forgery and retracted it. The newspaper’s failure to spot the forgery came to light only after the local elementary school – which the girl supposedly attended – reported that no student with her name was enrolled there. The true author of the letter remains a mystery.

The case raises some interesting observations about smoking and social norms in Japan. It is illegal for under-age youth to purchase tobacco, and store clerks selling tobacco to minors can lose their jobs. Nobody at the editorial desk of the newspaper seems to have caught this, or the troubling consequences of a six year old child being able to purchase cigarettes. Indeed, the newspaper company decided to run this story as a heart-warming tale of a young girl’s love for her grandfather, ignoring the fact that cigarettes are a gift with deadly consequences.

It would appear that the social acceptance of smoking as an unremarkable norm in Japan meant the newspaper expected readers would enjoy the letter as an uncomplicated and touching story. These enduring social norms will continue to pose a challenge in progress toward lowering the high prevalence of smoking in Japanese society, and point to the need for health professionals to more effectively communicate the negative impacts of smoking on both individuals and society.

Author affiliations:

Akihiro Nishi, Masako Kinkozan and Ichiro Kawachi: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA

Tetsutaro Matayoshi: Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan

Takahiro Shimizu: Chibana Clinic, Okinawa, Japan

Masako Kinkozan: Osaka Head Office, The Asahi Shimbun, Osaka, Japan