[Management of healthy food environment improvement through restaurants and other settings by prefectures and cities of cabinet order].

Objectives　In Japanese nutrition policy, emphasis is placed on healthy food environment improvement through restaurants and other settings by prefectures and cities of cabinet order (cities). This study aimed to clarify the actual status of management implementation by prefectures and cities.Methods　A mail survey of 47 prefectures and 106 cities throughout Japan was conducted in October 2020. Management implementation, including the existence of a healthy food environment improvement system (system) for restaurants and other settings, was confirmed. Local governments that had implemented the system were asked about the scope, dissemination efforts, process evaluation, and improvement of the system.Results　Of the local governments that responded, 39/42 prefectures (92.9%) and 57/82 cities (69.5%) implementing the system were included in the study. A total of 84.6% of prefectures and 14.0% of cities assessed the nutrient intake of local residents within the past five years. The median number of dietitians in the main office of the department in charge of healthy food environment improvement was two in both prefectures and cities. A target for healthy food environment improvement was set by 69.2% of prefectures and 54.4% of cities. The scope of the system was restaurant meals for 94.9% of prefectures and 100.0% of cities as well as ready-made meals for 87.2% of prefectures and 93.0% of cities. A total of 69.2% of prefectures and 66.7% of cities collaborated internally or with other local governments, while 15.4% of prefectures and 15.8% of cities entrusted system dissemination to external organizations. A total of 87.2% of prefectures and 89.5% of cities assessed the number of registered stores/companies, while 17.6% of prefectures and 21.6% of cities assessed the number of restaurants and other settings in the entire jurisdiction. A total of 33.3% of prefectures and 40.4% of cities established a renewal system, while 71.8% of prefectures and 33.3% of cities improved the system.Conclusion　Although underreporting due to the COVID-19 pandemic is possible, in local governments that had implemented the system, few cities assessed nutrient intake, and approximately 50-70% of prefectures and cities set targets for healthy food environment improvement. While approximately 90% of each local government assessed the number of registered stores/companies, those that assessed the number of stores/companies in the entire jurisdiction as a population size were approximately 20%. Approximately 30-40% of each local government has established a renewal system.

Examining and Comparing the Validity and Reproducibility of Scales to Determine the Variety of Vegetables Consumed: Validation Study.

BACKGROUND: Previous studies have reported that vegetable variety reduces the risk for noncommunicable diseases independent of the amount consumed. OBJECTIVE: This study aimed to examine and compare the validity and reproducibility of several scales to determine vegetable variety. METHODS: In total, 23 nutrition students in Japan reported their vegetable intake over the past month using a self-administered questionnaire between July and August 2021. Specifically, four scales were used: (1) a single question regarding the number of vegetables consumed (scale A); (2) a scale containing 9 vegetable subgroups included in the brief-type self-administered diet history questionnaire (scale B); (3) a scale containing 19 vegetable items included in a self-administered diet history questionnaire (scale C); and (4) a scale containing 20 vegetable items from the Ranking of Vegetable Consumers in Japan, which was analyzed based on a report on the National Health and Nutrition Survey in Japan (scale D). Scale validity was assessed by correlation with the number of vegetables consumed, which was collected from dietary records for 7 consecutive days. Reproducibility was assessed by test-retest reliability. RESULTS: Regarding the validity of the 4 scales, significant correlations were found between scales C (ρ=0.51) and D (ρ=0.44) with vegetable variety based on dietary records, but scales A (ρ=0.28) and B (ρ=0.22) were not significantly correlated. Reproducibility showed a significant correlation in scale B (ρ=0.45) and strong correlations in scales C (ρ=0.73) and D (ρ=0.75). CONCLUSIONS: The scales for vegetable items have acceptable validity and reproducibility compared to the scales that used a single question or vegetable subgroup and, therefore, may determine the variety of vegetables consumed.

[Survey of obesity and underweight among inpatients with schizophrenia in psychiatric hospitals throughout Japan].

AIM: Many studies have reported a high prevalence of obesity in patients with schizophrenia compared to the general population. However, no nationwide survey of schizophrenic inpatients has been conducted in Japan. The aims of this study were to conduct a large-scale survey of BMI among hospitalized patients with schizophrenia in Japan, identify the prevalence of obesity and underweight, and examine its associated factors. METHODS: This was a cross-sectional study. The subjects were 14,591 schizophrenic inpatients (7,645 males and 6,946 females) with complete data from 89 facilities in Japan that agreed to participate in this study. Survey items included age, gender, height, weight, BMI, length of hospital stay, antipsychotic agents, and types of hospital ward, and the survey took place between July to December 2010. RESULTS: When the BMI distribution was compared between the general adult population and patients, the rate of obesity was 26.1% in the general adult population and 21.9% in the patients, being lower among the patients, and the rate of underweight was 7.0% in the general adult population and 19.5% in the patients, being 2.8 times higher among the patients. Subsequently, logistic regression was used to examine factors associated with obesity and underweight. As the results, the obesity odds ratio was 1.32 times higher in patients in their 30s than in their 20s, 1.31 times higher in females than males, 0.62 times higher with a > or = 1-year hospital stay than < 3-month stay, 1.42 times higher in patients receiving > or = 4 antipsychotic agents than those receiving single typical agents, and 0.58 times higher in patients kept in a locked ward than those in an open ward. The underweight odds ratio was 2.03 times higher in patients in their > or = 70s than in their 20s, 1.18 times higher in females than males, 1.47 times higher with a 3-month < 1-year hospital stay than < 3-month stay, 0.7 times higher in patients receiving > or = 4 antipsychotic agents than those receiving single typical or atypical agents, and 1.81 times higher in patients kept in a locked ward than those in an open ward. CONCLUSIONS: Obesity in Japanese schizophrenic inpatients was associated with < 3-month hospitalization, antipsychotic polypharmacy, and an open ward, whereas underweight was associated with > or = 3-month hospitalization, the administration of single typical or atypical antipsychotic agents, and a locked ward, independent from age and gender.

Associations between Cooking at Home and Nutrient and Food Group Intake among Female University Students: A Cross-Sectional Analysis on Living Arrangements.

This cross-sectional study examined the association between cooking frequency and nutrient and food group intake among female university students with different living arrangements in Japan. Nutrient and food group intakes were assessed using a validated, brief, self-administered diet history questionnaire. Cooking frequency was measured using a single question on a five-point scale. The questionnaire also asked about living arrangements. Of the 91 respondents, 75 females were analyzed. Regarding cooking frequency, cooking at least 1-2 days a week was classified as cooking, and the "cooking yet living with families" group was compared with the "not cooking and living with families" and "cooking and living alone" groups. Based on the intakes of the "cooking yet living with families" group, the "not cooking and living with families" group consumed more total fat (29.5% energy vs. 33.0% energy, p = 0.010) and fewer cereals (224.8 g/1000 kcal vs. 179.6 g/1000 kcal, p = 0.007), and the "cooking and living alone" group consumed more confectionaries (21.0 g/1000 kcal vs. 34.5 g/1000 kcal, p = 0.023). This study showed that female university students who cook at least once a week and live with their families may have better diet quality than those who do not cook and live with their families and those who cook and live alone.

Individual Learning Needs of Japanese Public Health Dietitians by Years of Experience in Health Promotion.

Lifelong education for dietitians in Japan is based mainly on competencies according to years of experience. Because learning content differs depending on the desired position and specialty, training programs that reflect the individual learning needs of public health dietitians are needed. This study aimed to assess the individual learning needs of public health dietitians via years of experience in health promotion. In 2021, an online survey of public health dietitians involved in health promotion in prefectures, designated cities, and other municipalities throughout Japan was conducted. Years of experience in health promotion were categorized as early (<10 years), mid-career (10-19 years), and leadership (≥20 years) periods. To ascertain individual learning needs, the survey asked about respondents' desired final position, career path, and skills they felt they needed to improve in the future. Of the 1649 public health dietitians analyzed, all administrative categories preferred to work as public health generalists in mid-career or leadership periods rather than in the early period. In municipalities, more public health dietitians across all experience categories selected "professional competence", such as knowledge in specialized areas and nutritional guidance techniques. It was suggested that public health dietitians in the mid-career and leadership periods have individual learning needs, in both nutrition specialists and public health generalists.

[Assessment of the validity and reliability of the processes of change scale based on the transtheoretical model of vegetable consumption behavior in Japanese male workers].

OBJECTIVES: A core construct of the Transtheoretical model is that the processes and stages of change are strongly related to observable behavioral changes. We created the Processes of Change Scale of vegetable consumption behavior and examined the validity and reliability of this scale. METHODS: In September 2009, a self-administered questionnaire was administered to male Japanese employees, aged 20-59 years, working at 20 worksites in Niigata City in Japan. The stages of change (precontempration, contemplation, preparation, action, and maintenance stage) were measured using 2 items that assessed participants' current implementation of the target behavior (eating 5 or more servings of vegetables per day) and their readiness to change their habits. The Processes of Change Scale of vegetable consumption behavior comprised 10 items assessing 5 cognitive processes (consciousness raising, emotional arousal, environmental reevaluation, self-reevaluation, and social liberation) and 5 behavioral processes (commitment, rewards, helping relationships, countering, and environment control). Each item was selected from an existing scale. Decisional balance (pros [2 items] and cons [2 items]), and self-efficacy (3 items) were also assessed, because these constructs were considered to be relevant to the processes of change. The internal consistency reliability of the scale was examined using Cronbach's alpha. Its construct validity was examined using a factor analysis of the processes of change, decisional balance, and self-efficacy variables, while its criterion-related validity was determined by assessing the association between the scale scores and the stages of change. RESULTS: The data of 527 (out of 600) participants (mean age, 41.1 years) were analyzed. Results indicated that the Processes of Change Scale had sufficient internal consistency reliability (Cronbach's alpha: cognitive processes=0.722, behavioral processes=0.803). The processes of change were divided into 2 factors: "consciousness raising, emotional arousal, environmental reevaluation, self-reevaluation, commitment, rewards, helping relationships, and social liberation" and "countering and environment control" in the factor analysis. Moreover, each construct--the processes of change, decisional balance, and self-efficacy--could be classified into different factors. The scores for cognitive processes were higher in the contemplation and preparation stages than in the precontemplation stage (P<0.05). Scores for behavioral processes increased from the precontemplation stage to the preparation stages (P<0.05), and were higher in the action + maintenance stage than in the precontemplation stage (P< 0.05). CONCLUSION: For male workers, the Processes of Change Scale has sufficient validity and reliability, as demonstrated by the internal fitness and the construct and criterion-related validity of the scale found in this study.

Number of Days Required to Estimate Habitual Vegetable Variety: A Cross-Sectional Analysis Using Dietary Records for 7 Consecutive Days.

The aim of this cross-sectional study was to examine the number of days required to estimate habitual vegetable variety by conducting a multiday, dietary record. Sixty respondents from three groups in Japan (rural residents, general students, and nutrition students) participated in the study using a self-administered questionnaire in September 2018. To measure vegetable variety, the number of different vegetables consumed was extracted from the dietary records of seven consecutive days. Differences in the number of vegetables consumed and the capture proportion over seven consecutive days between groups were examined using repeated measures analysis of variance and one-way analysis of variance. The vegetable variety between each day was also compared using Pearson's correlation coefficient. The vegetable variety based on dietary records for seven consecutive days confirmed the differences between groups by repeated measurements (p = 0.013). However, there was no significant difference among groups in the capture proportion per survey day based on seven consecutive days. Furthermore, there were significant correlations between the number of vegetables consumed over seven consecutive days and that consumed on two or more days (r > 0.50, p < 0.01) and especially three or more days in all groups (r > 0.70, p < 0.001). The present study suggested that a dietary survey over two or more days could provide an estimate of habitual vegetable variety.

The Influence of Food Production Experience on Dietary Knowledge, Awareness, Behaviors, and Health among Japanese: A Systematic Review.

This study aimed to reveal the influence of food production experience on dietary knowledge, dietary awareness, dietary behaviors, and health among Japanese populations. We conducted a systematic review of articles published between January 2000 and September 2018 (PROSPERO registration number: CRD42019117163) using the following four databases: PubMed, Web of Science, CiNii, and ICHUSHI. The search formulas were created by combining search terms "agricultural experience," "garden," "diet," "food," "physical activity," "health," and "well-being." The articles were identified by titles, abstracts, and whole texts. We evaluated the content of the articles that met the adoption criteria. We included original articles from peer-reviewed scientific journals, articles written in Japanese or English, observational or interventional studies with statistical analyses, and articles targeting general Japanese people (except for those targeting patients or disabled) to examine the relationship according to the purpose of this review. Nineteen articles met the study criteria, including 10 cross-sectional studies, one retrospective study, seven pre-post studies, and three non-randomized controlled trials. Two studies combined multiple research designs. Thus, food production experiences were suggested to have a positive influence on dietary knowledge, dietary awareness, food preference, dietary behaviors, and mental health among the Japanese. However, the overall quality of the included studies was low. Further verification with randomized controlled trials and prospective cohort studies is required.

Eating Alone at Each Meal and Associated Health Status among Community-Dwelling Japanese Elderly Living with Others: A Cross-Sectional Analysis of the KAGUYA Study.

This cross-sectional study investigated the association between eating alone at each meal and health status, including functional capacity among community-dwelling Japanese elderly living with others. A self-administered questionnaire was mailed to all 8004 residents aged 65 or older, residing in the same Japanese town in March 2016. Eating alone was assessed by first asking whether participants ate three separate meals each day (i.e., breakfast, lunch, and dinner), and those who answered affirmatively were then asked how many people were usually present at each meal. Health status was assessed in terms of subjective health, medical history, care needs, body mass index, depression, and functional capacity. Data from 2809 respondents were analyzed. Those who reported not being in good subjective health and a history of hypertension were significantly more likely to eat alone at breakfast (odds ratio 1.27; 95% confidence interval 1.01-1.61, and 1.26; 1.06-1.49). Depressive symptoms and many subscales of functional capacity were also significantly associated with eating alone at breakfast, lunch, and dinner (p < 0.05). Many health status indicators were related to eating alone at each meal, especially breakfast.

Associations of self-efficacy, social support, and knowledge with fruit and vegetable consumption in Japanese workers.

BACKGROUND AND OBJECTIVES: Previous studies have suggested that self-efficacy, social support, and knowledge are primary psychosocial predictors of dietary behavior in adults. The present study aimed to investigate the associations of self-efficacy, social support, and knowledge with fruit and vegetable consumption in Japanese workers. METHODS AND STUDY DESIGN: From September to November 2014, a self-administered questionnaire was completed by Japanese workers at 8 workplaces in Niigata, Japan. Self-efficacy and social support for fruit and vegetable consumption were measured using a 3-item Likert scale across particular situations. Knowledge was measured using a single item about the recommended guidelines for fruit and vegetable consumption in Japan. Fruit and vegetable consumption was assessed using a validated, brief-type self-administered diet history questionnaire. RESULTS: Of the 457 respondents, 395 participants' data were analyzed. Scores in self-efficacy and social support showed a significant and positive association with fruit (p<0.001, p=0.002) and vegetable consumption (p=0.001, p=0.015). Knowledge was significantly and positively associated with vegetable consumption (p=0.015) but did not statistically differ in fruit consumption (p=0.645). CONCLUSIONS: The findings of this study suggest that selfefficacy and social support are positively associated with fruit and vegetable consumption in Japanese workers.

Effects of environmental intervention in workplace cafeterias on vegetable consumption by male workers.

OBJECTIVE: To assess the effects of an environmental intervention based on the transtheoretical model to increase access to nutritional information about vegetable consumption in workplace cafeterias. DESIGN: Nonrandomized controlled trial. SETTING: Sixteen workplaces with cafeterias in Niigata, Japan, were assigned to intervention (n = 8) or comparison sites (n = 8). PARTICIPANTS: A total of 349 Japanese male workers aged 20-59 years, who visited the cafeterias ≥ 3 times/wk. INTERVENTION: For the intervention group, 12 types of table tents containing information on increasing vegetable consumption, based on the transtheoretical model stages and processes of change, were distributed to cafeterias for 24 weeks in 2009. Information was presented according to the sequence suggested by the stages of change. MAIN OUTCOME MEASURES: Vegetable consumption in the cafeteria and per day and stage of change were assessed using self-administered questionnaires. ANALYSIS: Differences between groups were tested using a generalized linear model adjusted for age, work environment, and position. RESULTS: The difference in the stage of change was not statistically significantly different (P = .05), but the intervention group (n = 181) had increased vegetable consumption in the cafeteria (+0.18 servings; P = .01) and per day (+0.32 servings; P = .01) vs the comparison group. CONCLUSIONS AND IMPLICATIONS: The findings suggest a beneficial effect of providing access to nutrition information about vegetable consumption as an environmental intervention in workplace cafeterias.