When you think of Japanese culture, what comes to mind? The food, such as sushi? The tradition, such as kimono and kabuki? The classic movies by Akira Kurosawa and Yasujiro Ozu?

How about anime and manga? “Manga,” or Japanese comics, and “anime,” or TV and movies based on manga characters, have been catching Americans’ attention 
for a while.

Any person above the age of 50 will probably remember watching Astro Boy by the great Osamu Tezuka or Speed Racer on TV, both of which were recently turned into American movies and unfortunately flopped. Or how about the more recent hits of Pikachu and Dragon Ball?

Indeed, manga is much more than superheroes and robots. Its culture is rich with dizzying diversity in themes and quality. A rags-to-riches saga about a salary man rising from a lowly office staff to the president of a mega-conglomerate? Check, it’s the popular series for adult men, President Kosaku Shima. A coming of age story of a boy in an all-dorm agricultural high school with spirited classmates? Check, a new but popular manga for girls, Silver Spoon. A series of manga vignettes featuring a small, run-down diner in the middle of Tokyo that is only open from midnight until the next morning, with colorful clientele rich with ironies of life? Check, a popular, adult-oriented Late Night Diner. But you might also see something else.

One of the longest running comics in Japan features an international sniper known and feared among all national governments and spy agencies alike. With a code name of Golgo 13, little is known about him, only that he is of Japanese descent, can shoot a target from an impossible distance, and is a master of every martial art known to man. Naturally, he is stoic and extremely self-disciplined, constantly training to improve his fitness and skills. Oh, by the way, he also smokes a cigar.

Ten Top-Selling Manga (in order of popularity)
1. One Piece Epic saga about a band of ragtag youths with special powers (akin to the X-men) aspiring to be the best pirate band ever. A runaway number one selling manga in Japan.
2. Naruto A story about young ninjas in training in an imaginary world with some similarities to Japan.
3. Fairly Tale A fantasy about girls growing up to be sorceresses in one of many sorcery guilds in the world.
4. Bleach A fantasy about a boy who is accidentally turned into a death god destined to battle evil spirits.
5. Kimi Ni Todoke (Let It Reach You) A story about a high school girl who comes of age through friendship and love.
6. Gintama A science fiction set in the Edo Period, about a boy maturing into a samurai in a world dominated by extraterrestrials.
7. Bakuman A story of a young boy aspiring to become a manga creator.
8. Hunter x Hunter A story of a boy training to be a “hunter,” a licensed professional who specializes in fantastic pursuits such as locating rare or unidentified animal species, treasure hunting, or hunting down lawless individuals.
9. Shingeki No Kyojin (Attacking Giants) Future dystopia in which humans must protect themselves against marauding cannibalistic giants.
10. Toriko A fantasy about food fighters with supernatural powers.

Turn the pages of any manga, and you will probably notice scenes after scenes of what you rarely see in American comics—characters lighting up a smoke. It’s not limited to anti-heroes like Golgo. Another long-running manga, Cooking Papa, about a family that loves to cook, depicts the big, burly matriarch warning her expecting daughter-in-law about the perils of eating too many eggplants while pregnant—while she puffs away on a cigarette right in front of her. Neither of these manga is widely read here. So, it really doesn’t matter what the comic readership across the Pacific Ocean is exposed to. Or does it?

Cigarette smoking among children and adolescents is one of the top United States government health concerns, because the majority of new smokers are children and adolescents. It is a significant public health problem, because smoking causes more preventable deaths than any other hereditary and behavioral risks. Previous studies provide clear and strong evidence that children and adolescents are more likely to view smoking favorably and to begin smoking as a result of exposure to smoking in the media.

However, most of these studies have been done with TV and movies. Little data exist regarding the depiction of smoking in comics. It is notable, however, that when Joe Quesada was editor-in-chief of Marvel Comics from 2000 to 2011, he had banned major characters (e.g., Wolverine of the X-Men series) from smoking, citing the death of his relatives from smoking-related diseases as the reason.

Similar steps have not been taken in the manga world, however. Indeed, a preliminary study from the University of Tokyo showed that, of the top four selling boy’s comic magazines (each magazine typically carrying 20 titles of serialized manga stories) in Japan, smoking depictions appeared in 20 of the 87 titles, and teenage smokers accounted for 17.6% of the smoking depictions. Thus, there is a significant concern that the Japanese children and adolescents receive greater exposure to smoking depictions than their American counterparts.

Not that no one has tried to put a stop to it. In 2006, the Japan Society for Tobacco Control filed an official complaint to the creator, the publisher, and the TV production of Nana, a manga about a group of aspiring musicians in late teens and early 20s that was turned into TV anime, with a wide audience consisting of teenage girls and women in early 20s. In it, virtually every character smokes real brands of cigarettes, leading the tobacco control society to insist that it would lead to impressionable youth following suit. The creator, the publisher, and the TV production all politely wrote back, saying essentially, “Tough luck.”

The increasing popularity of the manga as a form of entertainment among the American children and adolescents raises concerns that they are exposed more often to smoking depictions than their counterparts who do not read them. There may be some safeguards, such as cutting out the smoking scenes or substituting a cigarette with lollipop. (That’s what’s being done in anime, due to fairly strict censorship laws.)

Ten Top-Selling American Comics (in order of popularity)
1 Amazing Spider-man 6 Uncanny X-Force
2 Batman 7 Ultimate Comics Spider-man
3 Green Lantern 8 Batman and Robin
4 Uncanny X-Men 9 Detective Comics (Batman)
5 Action Comics (Superman) 10 Fantastic Four

Thanks to a generous grant from the Center for Japanese Studies, we were able to launch a content analysis study. Multiple search engines (e.g., Google, Yahoo) were used to determine the 10 top-selling manga in Japan and the United States, respectively, in 2011. Similar methodology was employed to identify the 10 top-selling American non-manga comics in the United States in 2011. Ultimately, we decided to compare the 10 top-selling manga in Japan and the 10 top-selling non-manga comics in the United States, because the manga popular here were generally the ones popular in Japan.

We are currently reviewing 2011 issues of Japanese manga and American non-manga comics. Two coders are independently examining the presence of tobacco related events, including smoking (e.g., getting out and holding an unlit tobacco product or packet; lighting, consuming, stubbing, and discarding a tobacco product), paraphernalia (ashtrays, and cigarette packets not held by smokers), and conversations about smoking; type of tobacco products; smoker characteristics (gender, estimated age, and role); and how smoking was depicted (positively, negatively or neutrally). Smokers will be considered to be teens only if clear indication of their age, such as being a high school student, was described. When two or more smokers are depicted in one panel, each smoker will be counted as one depiction. We plan to utilize both descriptive and statistical analyses.

We are in midst of accumulating data, so no official conclusions have been reached yet. But one thing is clear—the depiction of smoking is prevalent in manga. And, they are not censored here. Look at the cover of One Piece translated in English at a local comic store: one of the major protagonists, Sanji, a French cook and an expert in French kicking martial arts, savate, is in all his smoking glory. Once we get the final results, we hope to present and publish in primary care and public health arenas. What comes after that? Advocate for regulatory oversight on smoking scenes in manga? In the first place, why are there so many smoking scenes in manga?

Contrary to what one may assume from reading manga, the contemporary Japanese are not overly excessive smokers. True, 36.6% of the Japanese men smoked in 2010, a much higher percentage than American men (21.5%). But the Japanese women actually smoke less than the American women (12.1% vs. 17.3% in 2010). And the percentage continues to decline over the years.

There are no official figures, but there is anecdotal evidence that a high percentage of the Japanese manga creators smoke. Perhaps that is where the problem begins. But that will be another research project.

About the Author

Dr. Masahito Jimbo is a native of Japan and obtained his MD and PhD from Keio University School of Medicine in Tokyo, Japan. After completing his internal medicine residency there, he finished his family medicine residency at Thomas Jefferson University in Philadelphia. While practicing in rural North Carolina, he obtained MPH in Public Health Leadership from the University of North Carolina at Chapel Hill. He then served as a faculty at Thomas Jefferson University for five years before being recruited to the University of Michigan, where he is currently Associate Professor of Family Medicine and Urology.

Dr. Jimbo divides his clinical and teaching time between the family medicine clinic at Domino’s Farms and hospital medicine. In research, he has been pursuing two inter-related lines of inquiry: “How does having a Japanese cultural background affect one’s health behavior?” and “What behavioral interventions can help improve communication and decision making between the physician and the patient for a better health outcome?” Having spent half of his life each in Japan and the United States, he has great interest in cultural and educational issues related to Japan, and has lectured and taught extensively in his native country.