Paper-based versus digital-based learning among undergraduate medical, nursing and pharmaceutical students in Japan: a cross-sectional study.

OBJECTIVE: Since the emergence of COVID-19, university education has drastically transformed into digital-based learning (DBL). Online education has been well recognised as a promising mode of teaching; however, only a limited number of studies have reported the students' preferred format for academic learning. DESIGN: Cross-sectional. SETTING: The study was conducted in a university setting in Japan. A Google Forms online questionnaire was distributed to the participants between April and May 2022. PARTICIPANTS: A total of 939 undergraduate medical, nursing and pharmaceutical students in the pre-clinical grade were recruited, and 344 were included in the final analysis. PRIMARY AND SECONDARY OUTCOME: The questionnaire assessed students' format preferences between paper-based learning (PBL) and DBL as it pertained to academic performance and eyestrain. In terms of academic performance, comprehension, memory retention and absorption (concentration) were assessed. We also explored the association between students' daily time spent using DBL and their digital preference by the Cochran-Armitage trend test and logistic regression analysis. RESULTS: A total of 344 (191 medical, 73 nursing and 80 pharmaceutical) university students completed the questionnaire (response rate 36.6%). An even distribution was observed in the preferred learning format for comprehension: PBL (32.0%), both formats equivalent (32.8%) and DBL (35.2%; digital preference). Only few students preferred DBL for memory retention (6.1%), absorption (6.7%) and eyestrain (1.2%). Although a positive association was observed between daily time spent using DBL and digital preference for comprehension, there was no association for memory retention, absorption and eyestrain. CONCLUSION: Among university students, DBL was just as preferred as PBL for comprehension; however, only a few students reported that DBL was better in terms of memory retention, absorption and eyestrain. A learning environment where students can study using PBL should be continued.

A longitudinal study of the influence of work characteristics, work-family status, and social activities on problem drinking: the Japanese civil servants study.

Problem drinking causes a decline in labor productivity among working population. This study examined whether work characteristics, work-family status, and social activities are associated with future problem drinking behavior among Japanese civil servants. A total of 1,535 participants (men: 63.1%, women: 36.9%) with no problem drinking behavior were followed up from 2014 to 2019. A multivariable logistic regression analysis was performed to examine the factors associated with future problem drinking behavior. During the five-year follow-up period, the cumulative incidence of problem drinking was 9.6% and 5.8% in men and women, respectively. In both men and women, frequent drinking around three times a week or more and alcohol consumption of two units or more at baseline were associated with future problem drinking. In men, compared with low-grade employees, high-grade employees were less likely to become problem drinkers (OR: 0.56, 95% CI: 0.33-0.95). Shift workers were significantly associated with the incidence of problem drinking (OR: 2.96, 95% CI: 1.46-6.00). In women, poor own work performance was significantly associated with problem drinking (OR: 5.30, 95% CI: 1.57-17.86). In conclusion, disadvantaged work characteristics are associated with the development of problem drinking. To prevent problem drinking, attention should be paid to poor work characteristics.

Association between excessive screen time and school-level proportion of no family rules among elementary school children in Japan: a multilevel analysis.

BACKGROUND: Excessive screen time (ST) in children is a global concern. We assessed the association between individual- and school-level factors and excessive ST in Japanese children using a multilevel analysis. METHODS: A school-based cross-sectional study was conducted in Toyama, Japan in 2018. From 110 elementary schools in Toyama Prefecture, 13,413 children in the 4th-6th grades (boys, 50.9%; mean, 10.5 years old) participated. We assessed lifestyle, recreational ST (not for study use), psychological status, and school and family environment including family rules. We defined ≥3 hours ST as excessive. We calculated the school-level proportions of no family rules and divided them into four categories (<20%, 20% to <30%, 30% to <40%, and ≥40%). A modified multilevel Poisson regression analysis was performed. RESULTS: In total, 12,611 children were included in the analysis (94.0%). The average school-level proportion of those with no family rules was 32.1% (SD = 9.6). The prevalence of excessive ST was 29.9% (34.9% in boys; 24.8% in girls). The regression analysis showed that excessive ST was significantly associated with both individual-level factors, such as boys (adjusted prevalence ratio (aPR); 1.39), older grades (aPR; 1.18 for 5th grades and 1.28 for 6th grades), late wakeup (aPR; 1.13), physical inactivity (aPR; 1.18 for not so much and 1.31 for rarely), late bedtime (aPR; 1.43 for 10 to 11 p.m. and 1.76 for ≥11 p.m.), frequent irritability (aPR; 1.24 for sometimes and 1.46 for often), feelings of school avoidance (aPR; 1.17 for sometimes and 1.22 for often), infrequent child-parental interaction (aPR; 1.16 for rare and 1.21 for none), no family rules (aPR; 1.56), smartphone ownership (aPR; 1.18), and the school-level proportion of no family rules (aPR; 1.20 for 20% to <30%, 1.29 for 30% to <40%, and 1.43 for ≥40%, setting <20% as reference). CONCLUSION: Besides individual factors, a higher school-level proportion of no family rules seemed influential on excessive ST. Increasing the number of households with family rules and addressing individual factors, could be deterrents against excessive ST in children.

Work and Lifestyle Factors Influencing Job Satisfaction of Japanese Civil Servants: A 5-Year Longitudinal Study.

OBJECTIVE: Although work, family, and lifestyle factors were associated with job satisfaction, prospective studies are lacking. This longitudinal study clarified the predisposing factors for job satisfaction. METHODS: Datasets were obtained from the Japanese Civil Servants Study and included 1429 participants. We assessed the relationship between job satisfaction and specific work and lifestyle factors. Logistic regression analyses evaluated the association between deteriorating job satisfaction and poor work and lifestyle factors at baseline and changes in these factors at follow-up. RESULTS: Poor sleep quality and limited job control at baseline were associated with deterioration in job satisfaction. Furthermore, deterioration in job control and work-to-family conflict at follow-up was associated with job dissatisfaction. CONCLUSION: Work and lifestyle characteristics were associated with job dissatisfaction. Employees with limited job control and high work-to-family conflict at baseline were more likely to develop job dissatisfaction.

Examination of Factors Related to Problem Drinking Among the Working Population: The Japanese Civil Servants' Study.

Problem drinking affects not only the health of a population but also the productivity of a nation, especially if it is rampant among the working population. This study examines the association between problem drinking and work characteristics, work-family status, and social situation among the Japanese working population. Multivariable logistic regression analysis was performed on the basis of gender on 3136 participants (men: 65.1%, women: 34.9%), adopted from the Japanese Civil Servants Study in 2014 (response rate: 87.8%), to examine the factors related to problem drinking, after adjusting frequency and quantity of drinking. Problem drinking was assessed using the Cutdown, Annoyed, Guilty, and Eye-opener (CAGE) questionnaire. The prevalence of problem drinking was found in 24.3% of men and 10.3% of women. The analysis showed that in men, low work performance (OR: 1.34, 95%CI: 1.00-1.79), high family-to-work conflict (OR: 1.54, 95%CI: 1.14-2.09), and high work-to-family conflict (OR: 1.63, 95%CI: 1.14-2.34), were significantly associated with problem drinking, whereas in women, high work-to-family conflict (OR: 2.45, 95%CI: 1.21-4.95) was significantly associated with problem drinking. Although the number of close friends is negatively associated with problem drinking in women, the significance disappeared in the full adjusted model. It can be concluded that it is important for both men and women to strike a balance between work and family life. Moreover, owing to gender differences, work performance may be important for men, and the presence of close friends for women, in reducing the risk of problem drinking.

Association of Sleep, Work Environment, and Work-Life Balance With Work Performance: The Japanese Civil Servant Study.

OBJECTIVES: To explore differences in work performance based on the influence of sleep, work environment, and work-life balance. METHODS: The datasets for this study were obtained from the Japan Civil Servant Study, which included 3478 participants (2199 men and 1279 women). RESULTS: Belonging to the younger generation, high levels of support at work, fewer social contacts with friends, and a negative personality were independently associated with low work performance in both men and women. Poor sleep quality and job dissatisfaction were associated with low work performance in men but not in women. Work-to-family conflict was associated with work performance in women. CONCLUSION: Interventions that target not only the overall measure but also account for sex-specific characteristics are important for improving work performance.

Pathological Gaming and Its Association With Lifestyle, Irritability, and School and Family Environments Among Japanese Elementary School Children.

BACKGROUND: Pathological gaming (PG) has emerged as one of the major public health concerns worldwide. We aimed to assess PG and its associated factors among elementary school children in Japan. METHODS: We conducted a school-based observational study in Toyama, Japan in 2018. In total, 13,413 children in the 4th-6th grades (mean age, 10.5 years) participated in the study. We distributed questionnaires and inquired about their lifestyle, irritability, and school and family environments. Referring to criteria of gaming disorder in the International Statistical Classification of Disease (ICD-11), we asked about three core symptoms: impaired control over gaming, increasing priority given to gaming over other activities, and continuation of gaming despite the negative consequences. Children who had all three criteria in the questionnaire were defined as PG. RESULTS: The response rate was 97.6%, and 11,826 children were included in our analyses (88.2%). The prevalence of PG was 5.6% (7.8% in boys, 3.2% in girls). Besides sex, PG was significantly associated with lifestyles, including skipping breakfast (odds ratio [OR] 1.33; 95% confidence interval [CI], 1.05-1.68), physical inactivity (OR 2.23; 95% CI, 1.63-3.05 for rare), late bed time (OR 2.52; 95% CI, 1.96-3.25 for ≥11 p.m.), frequent irritability (OR 1.89; 95% CI, 1.47-2.43), frequent feeling of school avoidance (OR 1.92; 95% CI, 1.49-2.46), fewer close friends (OR 1.30; 95% CI, 1.08-1.56 for some), low academic performance (OR 1.53; 95% CI, 1.13-2.08), no child-parent interaction (OR 1.34; 95% CI, 1.02-1.75), and no rules at home (OR 1.21; 95% CI, 1.02-1.43). CONCLUSION: Unhealthy lifestyles, irritability, and low functioning in school and family environments were associated with PG. Besides having a healthy lifestyle, parental involvement appears to be an indispensable countermeasure for PG in children.

Prevalence of coronary heart disease and its risk factors by working environment among Japanese male workers.

Work is a major social determinant of health. We conducted a cross-sectional study to explore the association between coronary heart disease (CHD), its risk factors, and the working environment among Japanese male workers. We collected data from 10,572 workers (mean age 49.9 yr) who underwent annual medical check-ups in Toyama, Japan, in 2016. This study included data from health check-ups and questionnaires on medical history of CHD, hypertension, and diabetes, and the use of medication. The working environment included company size and industry categories. Company size was classified into 4 categories according to the number of full-time workers (1-20, 21-100, 101-300, 301-). The industry category was classified into 10 categories. Logistic regression analysis was performed to explore the association. In total, 1.5% of patients had a history of CHD and 31.5% and 11.0% of participants were suffering from hypertension and diabetes, respectively. Compared to workers in a large company, those in a smaller company were more likely to have CHD. Moreover, there was a significant association between CHD's risk factors and working in the transportation industry. Health providers, including medical doctors, should consider employee working environment as a potential risk factor for CHD.

Socioeconomic determinants of long sickness absence affected by work, family, and personal health-related characteristics: A longitudinal study of the Japanese civil servants.

OBJECTIVES: Sickness absence is increasingly affecting society at different levels. This study explores how work, family, and personal health-related characteristics will contribute to socioeconomic status (SES) differences in future long sickness absence (7 days or more) with respect to sex differences. METHODS: A total of 1562 civil servants worked for the Local Japanese government and were considered from 2003 to 2014 for this study. Logistic regression analyses were performed to examine whether there were employment-grade differences in long sickness absence after 11 years and whether such SES differences were associated with work, family, and personal health-related characteristics or sexes. RESULTS: Male low-grade employees had a significantly higher odds ratio (OR) for long sickness absence (age-adjusted OR = 1.75, 95% confidence interval (CI) [1.04-2.95]). However, after adjustment for work characteristics, the association of significance disappeared (OR = 1.65, [0.96-2.84]). Female low-grade employees had a significantly lower OR for long sickness absence after 11 years (OR = 0.26, [0.08-0.86]). Male employees working long hours and male and female employees in high job demand take less sickness absence. Meanwhile, male employees working short hours take longer sickness absence. CONCLUSIONS: This study showed that male employees at low grades take longer sickness absence than those at high grades; however, this was alleviated by work characteristics. Female employees at low grades take less sickness absence than those at high grades. Japanese female employees with low grades, male employees with long working hours, and both sexes with high job demands take less sickness absence, although they may be unhealthy because of work stress.

[Non-participation in social activities of rural older adults: Results from the Toyama dementia survey].

Objective　Social activities play an important role in the maintenance of health and well-being of the older adults. The aim of this study was to identify characteristics of the rural older adults who do not participate by type of social activities.Methods　This survey examined 1,537 older adults randomly selected at a sampling rate of 0.5% from among those living in Toyama prefecture of Japan, in 2014. Of the total, 947 ambulatory older adults living in their own homes were analyzed using Poisson regression. Results were presented as prevalence ratio (PR). The level of statistical significance was set at P<0.05 (two-sided test).Results　The participants included 426 men (mean age 73.9 ± 6.5 years) and 521 women (mean age 74.8 ± 7.0 years).　In terms of work, both men and women did not work at an older age (men PR 1.15 over 75 years old, women PR 1.11 over 70 years old). Men did not work during outpatient treatment (PR 1.09) and the Revised Hasegawa Dementia Scale (HDS-R) 21-25 points (PR 1.09) and 20 points or below. Women who did not drink alcohol did not work (PR 0.93).　Both men and women did not participate in residential activities at older ages (men PR 1.12 over 70 years old, women PR 1.11 over 80 years old). Men with 20 points or below on HDS-R (PR 1.16) and with work history of only physical labor (PR 1.12), and women living with family (PR 0.92) were less likely to participate in residential activities.　In the hobby group, both men and women with work history of only physical labor were less likely to participate (men PR 1.05, women PR 1.08). Men with education of 9 years or below (PR 1.05) and women living alone (PR 1.07) were less likely to participate. Hobby groups did not relate with age and cognitive decline.　In the senior citizens' club, men and women who did not drink alcohol were less likely to participate (men PR 0.91, women PR 0.89). Men who smoked (PR 1.06), men with psychological symptoms (PR 1.09), and women with 20 points or below on HDS-R (PR 1.13) were less likely to participate.Conclusion　Factors related to non-participation of older adults in rural cities depended on the type of social activities. In order to promote social activity among the older adults in rural cities, it is important to consider specific measures taking into account the type of social activities.

Work and family characteristics as socioeconomic determinants in long sickness absence: the Japanese civil servants study.

Long sickness absence is more common among low socioeconomic status (SES) groups than high SES groups. This study aimed to evaluate whether work and family characteristics contribute to SES and sex differences in long sickness absence (7 days or more). The participants were 3080 civil servants working for a local Japanese government. In both sexes, low-grade employees were likely to take long sickness absence, with a statistically significant association for men (age-adjusted OR of lowest-grade employees for long sickness absence: 2.30 (95% Confidence Interval (CI): 1.32-4.02)). After adjusting for all variables, SES differences in long sickness absence in men decreased to OR 1.98 (CI 1.10-3.55) but remained significant; in men, being without a spouse was significantly associated with long sickness absence. Employees working long hours had lower OR for long sickness absence after adjusting for all variables in both sexes. Conversely, poor sleep quality and longstanding illness significantly increased OR for long sickness absence. In conclusion, SES differences in sickness absence were explained partly by work and family characteristics, longstanding illness, and poor sleep quality; however, other factors that were not evaluated in this study may also be associated with SES differences.

Neighbourhood walkability and obesity among adults in rural Japan: results from a Japanese health database.

BACKGROUND: Walkable neighbourhoods promote physical activity and prevent obesity, but there is limited evidence to inform urban planning strategies for public health within the context of rural Japan. This study describes associations between neighbourhood walkability and obesity in Toyama, a regional municipality in Japan. METHODS: A cross-sectional analysis of the Toyama Prefecture National Health Insurance data (n = 3454) in 2016 using Analysis of Covariance (ANCOVA) and binary logistic regression. Walk Score® was used to estimate neighbourhood walkability. RESULTS: Residents from highly walkable neighbourhoods generally had lower mean body mass index (BMI), but significant associations between neighbourhood walkability and BMI and prevalence of obesity were only observed in women (adjusted OR: 0.46, 95% CI: 0.26-0.80). Men below 65 years old had higher obesity prevalence (adjusted OR: 1.76, 95% CI: 1.34-2.30). Daily alcohol consumption was associated with lower odds of being obese among men (adjusted OR: 0.72, 95% CI: 0.55-0.95). Hypertension, diabetes mellitus and dyslipidaemia were associated with higher obesity prevalence among residents, regardless of gender. CONCLUSIONS: Walkable environment may improve health outcomes for rural communities in Japan. Further studies are required to create equitable and inclusive living spaces for men and women to access healthier lifestyle choices.

Future projections of the prevalence of dementia in Japan: results from the Toyama Dementia Survey.

BACKGROUND: This study aimed to make future projections of the nationwide prevalence of dementia in Japan using the prevalence of dementia from the Toyama Dementia Survey and population projections. METHODS: We performed linear regression analysis using the prevalence of dementia by sex and age in 1985, 1990, 1996, 2001, and 2014 from the Toyama Dementia Survey to calculate the estimated future prevalence by sex and age. The estimated prevalence was then multiplied by the estimated future population of people aged 65 years and older by sex and age in each of the 47 prefectures from 2020 to 2045 and added together to calculate the total number of people with dementia. The estimated future prevalence of dementia was calculated by dividing the calculated number of people with dementia by the estimated future population of people aged 65 years and older in each of the 47 prefectures. In addition, the estimated future prevalence of dementia in each of the 47 prefectures from 2020 to 2045 was presented on a map of Japan and grayscale-coded in four levels. RESULTS: In 2020, the estimated future prevalence of dementia did not exceed 20% in any prefecture, but in 2025, five prefectures, mainly rural prefectures, had projected rates exceeding 20%. In 2030, the prevalence rate is projected to exceed 20% nationwide, and by 2035, the rate will exceed 25% in 42 prefectures. In 2045, all prefectures excluding Tokyo are projected to have a dementia prevalence rate exceeding 25%, and the rate will exceed 30% in 12 of 47 prefectures. CONCLUSIONS: Over the next 25 years, the prevalence of dementia in people older than 65 years is projected to exceed 25% nationwide, including metropolitan areas.

The Role of Facets of Job Satisfaction in the National and Socioeconomic Differences in Overall Job Satisfaction: A Comparison Between Studies of Civil Servants in Great Britain and Japan.

OBJECTIVE: To explore national and socioeconomic differences in overall job satisfaction, we examined whether those differences can be explained by what job-related factors. METHODS: Our datasets for this study are from the Whitehall II study and the Japan Civil Servant Study. Of the participants who were 5540 cases, with 3250 people from Great Britain and 2290 from Japan. RESULTS: The odds ratio for job dissatisfaction was more than double in Japan compared with Britain. However, after adjusting the related factors-especially the facets of job satisfaction variables-the difference was reversed. Also, regarding the occupational differences, lower occupational grades had lower risks of overall job dissatisfaction, after adjusting for related factors. CONCLUSIONS: The national and socioeconomic differences in overall job satisfaction were strongly related to facets of job satisfaction rather than job stress factors.

Association between marital status and cognitive function in Japan: results from the Toyama Dementia Survey.

BACKGROUND: This study aims to clarify the association between marital status and dementia in Japan, adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors. METHODS: Data from the Japanese Toyama Dementia Survey were used. Individuals aged ≥65 years living in Toyama Prefecture were randomly selected, and 1171 participants were analysed, with a sampling rate of 0.5%. The participants' marital status, socioeconomic status, lifestyle factors, and lifestyle-related diseases were assessed. The odds ratio (OR) of marital status for each lifestyle factor and medical histories were calculated by logistic regression analysis. The OR of marital status for dementia was also calculated by logistic regression analysis. RESULTS: The prevalence of dementia was 7.4% for married, and 20.6% for non-married participants. Non-married participants showed a higher prevalence of a history of stroke than married participants. The age- and sex-adjusted OR of marital status for dementia was 1.99 (95% confidence interval (CI) 1.24-3.18) for non-married compared with married participants. Following variable adjustments, the OR for dementia was higher for non-married participants (adjusted OR 1.71; 95% CI 1.03-2.85). CONCLUSIONS: Non-marital status was an independent risk factor for dementia in Japan even after adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors. Non-married people were more likely to have dementia because of their history of stroke.

Effect modification by workplace social capital on the association between depression and workplace and family stress: the Japanese civil servant study.

BACKGROUND: Mental health problems among workers have become an issue in Japan. The working environment for civil servants is becoming excessively stressful, and there is a need to prevent the onset of depression. In addition to stress at the workplace and at home, social capital has been reported as a factor associated with depression. This study examined whether workplace social capital reduces the association between depression and work-related stress or depression and home-related stress. METHODS: A total of 3015 Japanese civil servants (1867 men and 1148 women) from Toyama Prefecture were included in this study. Data on depression and workplace social capital, work status, work stress, work-life balance, and physical health were collected. RESULTS: The odds ratio for depression was higher for both men and women with low workplace social capital. For those with low workplace social capital, the adjusted odds ratio for depression was 2.93 (95% confidence interval [CI], 2.16-3.98) for men and 2.46 (95% CI, 1.74-3.49) for women. After adjusting for workplace social capital, the associations between depression and low job position, low job support, and moderate family-to-work conflict declined in men and were no longer significant. For women, the strength of the association between depression and unmarried status along with moderate control at work decreased and also lost significance. When the ORs for depression were stratified by high and low workplace social capital and compared with the ORs before stratification, the ORs for depression of long working hours and work-to-family conflict increased for both men and women in the low workplace social capital group. CONCLUSIONS: Workplace social capital mitigated the effect of workplace and family stress leading to depression in both men and women.

Lifestyle, psychological stress, and incidence of adolescent constipation: results from the Toyama birth cohort study.

BACKGROUND: We aimed to clarify the predisposing factors for adolescent constipation in a longitudinal study, because while factors associated with childhood constipation have been reported, prospective studies on the incidence of constipation are lacking. METHODS: We enrolled 5540 adolescents aged 12 to 13 years from the Toyama Birth Cohort Study-a community-based prospective study examining children's health. The incidence of constipation, defined as bowel movement frequency of less than once every 2 days, was surveyed during the three-year period from baseline (grade 4) to follow-up (grade 7). Multivariate logistic regression analyses were performed to explore the association between the incidence of adolescent constipation and their lifestyle variables. RESULTS: A total of 261 adolescents (4.7%) developed constipation during the three-year period. Female sex (odds ratio [OR] = 2.62,) overweight (OR = 0.60), and infrequent intake of fruits (OR = 1.50) at baseline were associated with the incidence of constipation. Furthermore, factors related to lifestyle changes and psychological status such as skipping breakfast (OR = 1.73), becoming physically inactive (OR = 1.55), and being persistently irritated (OR = 1.80) were significantly associated with the incidence of constipation. CONCLUSION: Our prospective study demonstrated that female sex, insufficient fruit intake, and deteriorating lifestyles such as skipping breakfast and becoming inactive during the 3-year period were associated with the incidence of adolescent constipation. Beyond anecdotal, maintaining a healthy lifestyle is recommended to reduce the incidence of adolescent constipation.

Prevalence and Associated Factors of Pathological Internet Use and Online Risky Behaviors Among Japanese Elementary School Children.

BACKGROUND: Little is known about pathological Internet use (PIU) and online risky behaviors among elementary school children. We aimed to investigate the prevalence and factors associated with PIU and online risky behaviors. METHODS: A school-based cross-sectional study was conducted in Toyama, Japan in 2018. The study included 13,413 children in the 4th-6th grades (mean, 10.5 years old) from 110 elementary schools (61.1% of elementary schools in Toyama). We assessed PIU using Young's Diagnostic Questionnaire (YDQ) and risky behaviors. Poisson regression analysis was conducted. RESULTS: Totally, 13,092 children returned questionnaires (response rate 97.6%). The prevalence of PIU was 4.2% and that of each risky behavior was as follows: 21.6% for spending money online, 6.6% for uploading personal movies, 5.2% for interpersonal issues, and 2.4% for having met strangers. PIU was significantly associated with boys (prevalence ratio [PR] 1.26; 95% confidence interval [CI], 1.04-1.52), skipping breakfast (PR 1.43; 95% CI, 1.14-1.79), Internet time (for 2∼3 h, PR 3.49; 95% CI, 2.63-4.65; for 3∼4 h, PR 4.45; 95% CI, 3.27-6.06; and for ≥4 h, PR 8.25; 95% CI, 6.45-10.55), physical inactivity (PR 2.63; 95% CI, 2.00-3.47), late bedtime (PR 1.86; 95% CI, 1.45-2.39 for ≥11 p.m.), no rules at home (PR 1.22; 95% CI, 1.01-1.46), no child-parent interaction (PR 1.37; 95% CI, 1.06-1.77), and no close friends in real life (PR 1.69; 95% CI, 1.30-2.19). CONCLUSIONS: PIU and risky behaviors were not rare among the elementary school children. Besides unhealthy lifestyles, social and family environments were associated with PIU. Having child-parent interaction and helping children develop close friendships in real life are effective deterrents to PIU.

Associations of socioeconomic status and lifestyle factors with dental neglect of elementary school children: the MEXT Super Shokuiku School Project.

BACKGROUND: Despite the fact that there are parents who do not take children with untreated dental caries to a dental clinic, few studies have been conducted to identify the responsible underlying social and family factors. The aim of this study was to investigate whether socioeconomic status and lifestyle factors are associated with dental neglect in elementary school children. METHODS: This study was conducted in 2016 with 1655 children from the Super Shokuiku School Project in Toyama. Using Breslow's seven health behaviors, the survey assessed: the grade, sex, and lifestyle of the children; parental internet and game use and lifestyle; socioeconomic status. The odds ratios (OR) and 95% confidence intervals (CIs) for having untreated dental caries were calculated using logistic regression analysis. RESULTS: Among the children participating, 152 (3.2%) had untreated dental caries. Among them, 53 (34.9%) had not been taken to a dental clinic despite the school dentist's advice. Dental neglect was significantly associated with children in higher grades (OR, 2.08; 95% CI, 1.14-3.78), father's Internet and game use ≥ 2 h/day (OR, 1.99; 95% CI, 1.02-3.88), not being affluent (OR, 2.78; 95% CI, 1.14-6.81), and non-engagement in afterschool activities (OR, 1.99; 95% CI, 1.10-3.62). CONCLUSIONS: Socioeconomic status was the strongest factor associated with dental neglect despite the fact that the children's medical expenses are paid in full by the National Health Insurance in Toyama, Japan. Future studies should investigate what factors prevent parents of non-affluent families from taking their children to dental clinics and how they can be socially supported to access adequate medical care.

Association between self-reported hearing loss and low socioeconomic status in Japan: findings from the Toyama dementia survey.

BACKGROUND: Age-related hearing loss reduces the quality of life in older adults. Low socioeconomic status (SES) has been reported as a risk factor for hearing loss, although this has not been verified in Japan. This study aimed to assess the association between low SES and hearing loss, excluding people with dementia, in Japan. METHODS: Data from the Toyama Dementia Survey, Japan, were used. Overall, 126 patients with hearing loss and 913 unimpaired controls were identified. Participants' presentation of dementia, self-reported hearing loss, history of medically diagnosed disease (hypertension, hyperlipidemia, diabetes, stroke, or angina pectoris/cardiovascular disease), lifestyle factors (alcohol consumption and smoking), and SES (educational attainment and occupation) were assessed. Any association between low SES and hearing loss was investigated using logistic regression analysis. RESULTS: The odds ratio (OR) for hearing loss was higher for participants with low educational attainment than for those with high educational attainment (age- and sex-adjusted OR 3.08; 95% confidence intervals [CI], 1.51-6.28). After adjusting the models for SES, lifestyle factors, and medical history, the OR increased from 2.90 (95% CI, 1.40-6.01) to 3.43 (95% CI, 1.62-7.27). The OR for hearing loss for participants with blue-collar jobs compared with that of participants with white-collar jobs was not significant (age- and sex-adjusted OR, 1.45; 95% CI, 0.93-2.25). Older age and a history of angina pectoris or cardiovascular disease were found to increase the risk of hearing loss. CONCLUSIONS: Low educational attainment was independently associated with hearing loss in older adults without dementia in Japan.