Pro-tobacco legislative representation and current smoking: an individual-level panel study of older adults in Japan

Background Tobacco industry interference in policymaking is a persistent barrier to effective tobacco control. While prior studies suggest that industry-aligned legislators hinder tobacco control efforts, individual-level evidence remains scarce. This study investigated whether electoral representation by pro-tobacco legislators was associated with current smoking in the constituency. Methods This cohort study used unbalanced panel data of 92 Japanese municipalities that participated in the Japan Gerontological Evaluation Study in 2016, 2019 and 2022. Participants were a total of 373 271 community-dwelling adults aged 65 years or older, providing 556 550 person-wave observations. Poisson regression was performed to estimate a prevalence ratio (PR) of smoking associated with residence in a constituency that elected a member of the Liberal Democratic Party’s Pro-Tobacco Caucus (LDP-PTC). Sociodemographic covariates and fixed effects of municipality, year and their interaction were adjusted for. Results Among the observations, 10.3% were persons who currently smoke, and 34.7% resided in constituencies that elected an LDP-PTC member. Living in such a district was associated with a higher prevalence of smoking (PR=1.10; 95% CI 1.05 to 1.15). Gender-stratified analysis showed a more pronounced association among women (PR=1.22; 95% CI 1.10 to 1.36) than men (PR=1.06; 95% CI 1.01 to 1.12). Conclusions Representation by pro-tobacco legislators was associated with elevated smoking prevalence among older adults. These findings suggest the importance of addressing the commercial determinants of health and insulating tobacco policy from industry-aligned influence.