The Association Between Alcohol-Flavoured Non-Alcoholic Beverages and Alcohol Use in Japanese Adolescents.

AIMS: There are no legal regulations in Japan governing minors' consumption of alcohol-flavoured non-alcoholic beverages (AFNAB); therefore, we examined if their consumption could lead to increased alcohol use among adolescents in Japan. METHODS: This cross-sectional study used a nonclinical, nationally representative sample of 38,494 junior (19,662 boys) and 61,556 senior (31,925 boys) high school students recruited in 2012. We measured AFNAB consumption rates and the order that adolescents first consumed AFNAB and alcohol. RESULTS: The AFNAB consumption was strongly associated with alcohol use in high school students. Among all age groups, alcohol was more commonly consumed before AFNAB for both males and females. CONCLUSIONS: Consumption of AFNAB is more prevalent among minors than alcohol consumption and it has a strong association with alcohol consumption. However, concerns that AFNAB use would lead to increased alcohol use were not supported because AFNAB consumption usually started after adolescents began consuming alcohol. SHORT SUMMARY: Consumption of AFNAB is more prevalent among high school students than alcohol consumption and it has a strong association with alcohol consumption. However, concerns that AFNAB use would lead to increased alcohol use were not supported because AFNAB consumption usually started after adolescents began consuming alcohol.

A prescription for sustaining community engagement in malaria elimination on Aneityum Island, Vanuatu: an application of Health Empowerment Theory.

BACKGROUND: Community engagement has contributed to disease control and elimination in many countries. Community engagement in malaria elimination (ME) on Aneityum Island has been sustained since its introduction in the early 1990s. Capacity developed within this population has led to a health empowered community response. Health Empowerment Theory (HET) can account for the innovative community actions and capacity development efforts taken to realize and sustain meaningful changes in well-being. This study used the HET framework to investigate participant perceptions of ME efforts on the island focusing on two HET elements, personal and social-contextual resources. The purpose of this study was to explore the role of empowerment as a critical element of community engagement. METHODS: Six focus group discussions, ten key informant interviews and 17 in-depth interviews were conducted in July 2012 on Aneityum. Both deductive and inductive approaches to qualitative content analysis were used to identify themes, which were condensed, coded and classified based on the HET elements above. RESULTS: Awareness and use of personal and social-contextual resources played an important role in ME efforts. Most participants shared their knowledge to prevent malaria reintroduction. Many participants reported their skills needed for behavioral maintenance, problem-solving or leadership. Participants who perceived a threat took preventive actions even in the dry season. Community leaders focused on second generation capacity development. A local health coalition provided ME services. Members of networks were sources of information and assistance. Face-to-face was the preferred method of communication. Barriers to engagement (e.g., financial difficulties, health literacy issues and underdeveloped infrastructure) were minimized through active collaboration and mutual assistance. CONCLUSIONS: In the community engagement continuum, health empowerment develops incrementally overtime as people gain their knowledge and skills, form coalitions and develop collaborative networks (social capital) to make decisions and take action for change. Community engagement, which facilitates local personal and social-contextual resource development, has potential for ME and multilevel empowerment through community-based capacity development processes. These self-empowered communities have written and will continue to write a 'prescription' for sustaining high levels of engagement.

Determinants of the use of insecticide-treated bed nets on islands of pre- and post-malaria elimination: an application of the health belief model in Vanuatu.

BACKGROUND: Insecticide-treated nets (ITNs) are an integral piece of any malaria elimination strategy, but compliance remains a challenge and determinants of use vary by location and context. The Health Belief Model (HBM) is a tool to explore perceptions and beliefs about malaria and ITN use. Insights from the model can be used to increase coverage to control malaria transmission in island contexts. METHODS: A mixed methods study consisting of a questionnaire and interviews was carried out in July 2012 on two islands of Vanuatu: Ambae Island where malaria transmission continues to occur at low levels, and Aneityum Island, where an elimination programme initiated in 1991 has halted transmission for several years. RESULTS: For most HBM constructs, no significant difference was found in the findings between the two islands: the fear of malaria (99%), severity of malaria (55%), malaria-prevention benefits of ITN use (79%) and willingness to use ITNs (93%). ITN use the previous night on Aneityum (73%) was higher than that on Ambae (68%) though not statistically significant. Results from interviews and group discussions showed that participants on Ambae tended to believe that risk was low due to the perceived absence of malaria, while participants on Aneityum believed that they were still at risk despite the long absence of malaria. On both islands, seasonal variation in perceived risk, thermal discomfort, costs of replacing nets, a lack of money, a lack of nets, nets in poor condition and the inconvenience of hanging had negative influences, while free mass distribution with awareness campaigns and the malaria-prevention benefits had positive influences on ITN use. CONCLUSIONS: The results on Ambae highlight the challenges of motivating communities to engage in elimination efforts when transmission continues to occur, while the results from Aneityum suggest the possibility of continued compliance to malaria elimination efforts given the threat of resurgence. Where a high degree of community engagement is possible, malaria elimination programmes may prove successful.

Incidence of sexually transmitted diseases in Hokkaido, Japan, 1998 to 2001.

The objective of this study was to provide precise data on the incidence of sexually transmitted diseases (STDs) in Hokkaido. The goal of this prospective surveillance, study was to clarify the STD incidence between 1998 and 2001 in Hokkaido, Japan. The incidence of gonococcal infection in men was found to be 127-199 per 100000 people per year, which was three or four times higher than that for women. Female genital chlamydial infection had an incidence of 300-400 with a female to male ratio of two or three to one. Younger adults had higher incidences of gonococcal and chlamydial infections than older people. In conclusion, the current study of STDs revealed high incidences of gonococcal and chlamydial infections in the Hokkaido area, and there was no decreasing trend in STD incidence during these 4 years.

Clarification of the factor structure of the 12-item General Health Questionnaire among Japanese adolescents and associated sleep status.

If the factors affecting the mental health status of adolescents and their association with sleep status could be clarified, this information would be helpful for formulating lifestyle and healthcare guidance for the promotion of healthy growth and the prevention of mental problems in these individuals. The purpose of this study was to clarify (1) the factor structure of the 12-item General Health Questionnaire (GHQ-12), and (2) the associations between the factors extracted from this questionnaire and lifestyle, in particular sleep status, by using a representative sample population of Japanese adolescents. One hundred three thousand sixty hundred fifty self-administered questionnaires were collected from students enrolled in junior high and high schools in Japan. Of these questionnaires, 99,668 were analyzed. Sleep duration, subjective sleep assessment, bedtime, and insomnia symptoms of these students over the past month were studied to investigate sleep status. The factor analyses yielded two factors: depression/anxiety and loss of positive emotion. Sleep duration of less than 7h was found to be associated with both depression/anxiety and loss of positive emotion, whereas sleep duration of 8h or more was associated only with loss of positive emotion. Subjective sleep assessment and insomnia symptoms were associated with both depression/anxiety and loss of positive emotion. It was demonstrated that two underlying factors of mental health status were associated with differences in sleep status. In order to improve the mental health status of adolescents, it is important to provide guidance about sleep and lifestyle habits according to the mental health status of the individual.

Decrease in the prevalence of adolescent alcohol use and its possible causes in Japan: periodical nationwide cross-sectional surveys.

BACKGROUND: Trends in alcohol drinking prevalence were assessed among Japanese adolescents, and possible reasons for a decrease in drinking prevalence observed in 2004. METHODS: Cross-sectional nationwide surveys were conducted periodically. High schools were randomly sampled from throughout Japan in 1996, 2000, and 2004. All enrolled students in sampled schools were subjects of the surveys. Self-reporting anonymous questionnaires were collected from 115,814 students in 1996, 106,297 in 2000, and 102,451 in 2004. Questions about drinking prevalence of students and family members, proportion of students who have no friends, and sources of alcohol were included. Students who drunk at least one day of the 30 days preceding the survey were defined as the current drinkers. RESULTS: The drinking prevalence in 2004 was decreased in comparison to that in 1996 and 2000 in both sexes and in all school grades. The current drinking rate (monthly drinker) among junior high school boys was 29.4% in 1996, 29.0% in 2000, and 20.5% in 2004, while that among senior high school boys was 49.7%, 48.7%, and 36.2%, respectively. The respective prevalence among junior and senior girls was 24.0%, 25.5%, and 20.0% and 40.8%, 42.1%, and 34.1%. The prevalent sources of alcohol beverages were searching in home, stores (convenience store, supermarket, or gas-stand), liquor shops, and bars. An analysis of the reasons for this decrease identified a decrease in drinking prevalence in students' families, especially by fathers and older brothers, and an increase in the proportion of students who had no friends. CONCLUSIONS: A decrease in drinking prevalence of male family members and a limitation of sources of alcoholic beverages may contribute to the decrease in adolescent drinking prevalence.

Is passive smoking associated with sleep disturbance among pregnant women?

STUDY OBJECTIVE: Pregnant women suffer from sleep disturbance, which may be aggravated by passive smoking. In this study we investigated the effects of passive smoking on sleep disturbance during pregnancy. DESIGN: Two cross-sectional questionnaire surveys conducted in 2002 and 2006. SETTING: Clinical institutions specializing in obstetrics and gynecology that participated in the nationwide surveys: 260 in the 2002 survey and 344 in the 2006 survey. PARTICIPANTS: 16,396 and 19,386 pregnant women in Japan surveyed in 2002 and 2006, respectively. INTERVENTION: N/A. MEASUREMENTS AND RESULTS: Pregnant women exposed to passive smoking were likely to have sleep disturbances, such as subjective insufficient sleep, difficulty in initiating sleep, short sleep duration, and snoring loudly/breathing uncomfortably. Smoking pregnant women had the same sleep disturbances and also experienced excessive daytime sleepiness and early morning awakening. The prevalence of 5 types of sleep disturbance (insufficient sleep, difficulty in initiating sleep, short sleep duration, excessive daytime sleepiness, and snoring loudly/breathing uncomfortably) among nonsmokers with environmental tobacco smoke showed a mean value intermediate between that of active smokers and that of nonsmokers without environmental tobacco smoke. CONCLUSION: Passive smoking is independently associated with increased sleep disturbance during pregnancy.

[Decreases in Japanese adolescent drinking in 1996, 2000 and 2004 national surveys of Japanese junior and senior high school students].

We conducted three national surveys to clarify the drinking status of Japanese junior and senior high school students in 1996, 2000 and 2004. The total numbers of subjects in each survey were about 50 thousands junior high school students and 70 thousands senior high school students. The present study compares drinking status and alcohol related problems of the subjects of the three surveys. The results were as follows. First, drinking experiences of the subjects decreased over the three surveys. Those of junior high school students dropped from 60% to 40%, and those of senior high school students from 75% to 60%. Second, drinking behavior of the subjects has changed, e.g., the amount of drinking on each occasion has decreased, failures due to drunkenness have also decreased, compliance with the Law Prohibiting Minors Drinking has increased, their buying alcoholic drinks has decreased and experiences of being offered alcohol by parents have decreased. Third, male problem drinkers among the subjects decreased slightly but female problem drinkers did not decrease. We discussed the reasons why Japanese adolescent drinking has decreased. Over the past 10 years, Japanese society started to prohibit adolescent drinking, by revising the Law Prohibiting Minors Drinking, penalties for driving while intoxicated became more severe and Japanese alcohol consumption started to decrease.

Insomnia among Japanese adolescents: a nationwide representative survey.

STUDY OBJECTIVES: Although a number of previous studies have examined the prevalence of insomnia among adolescents, there have been very few nationwide studies. The objectives of this nationwide study were to clarify the prevalence of insomnia, its symptoms, and associated factors among Japanese adolescents. DESIGN AND SETTING: This study was designed as a cross-sectional sampling survey. The targets were junior and senior high schools throughout Japan. Sample schools were selected by cluster sampling. Self-reported anonymous questionnaires were sent to schools for all students to fill out. PARTICIPANTS: A total of 103,650 adolescents responded, and 102,451 questionnaires were subjected to analysis. INTERVENTION: N/A. MEASUREMENTS AND RESULTS: The prevalence of difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening was 14.8%, 11.3%, and 5.5%, respectively. Insomnia was defined as the presence of one or more of these three symptoms. The prevalence of insomnia was 23.5%. Multivariate analyses revealed that, among junior high school students, male sex, poor mental health, skipping breakfast, drinking alcohol, smoking, not participating in extracurricular activities, and late bedtime had significantly higher odds ratios for insomnia. Among senior high school students, the same characteristics were associated with a significantly higher odds ratio for insomnia, as was the additional factor of having no intent to study at university. CONCLUSION: Insomnia in Japanese adolescents is common and associated with multiple factors. The results of this study suggest the need for comprehensive program to prevent insomnia in Japanese adolescents.

Unhealthy lifestyle, poor mental health, and its correlation among adolescents: a nationwide cross-sectional survey.

OBJECTIVES: The objective was to study the relationship between mental health and lifestyles of adolescents using samples representative of Japanese adolescents nationwide. METHOD: The survey was conducted between December 2004 and January 2005 among students enrolled in randomly selected junior and senior high schools. Self-administered questionnaires addressed lifestyles, sleeping habits, and mental health status. Of 103 650 questionnaires collected, 85 158 were analyzed. RESULTS: Population characteristics associated with poor mental health were being female, being a senior high school student, skipping breakfast, not participating in extracurricular activities, not consulting parents about personal matters, parental smoking, students' smoking or alcohol use, poor subjective sleep assessment, and short or long sleeping duration. CONCLUSION: Smoking and anxiety disorders are associated with an elevation in acculturative stress in adolescents. Prepossessing adolescents are in subclinical depression. Results suggest that lifestyles approaches in preventions that target students can be effective in reaching high-risk populations.

An epidemiologic study of self-reported sleep problems among Japanese adolescents.

STUDY OBJECTIVE: To examine the prevalence and correlates of sleep problems in Japanese adolescents. DESIGN AND SETTING: The survey was designed as a cross-sectional sampling. The targets of the survey were junior and senior high schools throughout Japan. Sample schools were selected by stratified cluster sampling. Self-reported anonymous questionnaires were sent to sample schools for all students to fill out. PARTICIPANTS: A total of 107,907 adolescents responded, and 106,297 questionnaires were subjected to analysis. MEASUREMENTS AND RESULTS: The overall prevalences of sleep problems in the month preceding the questionnaire were difficulty initiating sleep (boys: 15.3%, girls: 16.0%); nocturnal sleep duration less than 6 hours (boys: 28.7%, girls: 32.6%); excessive daytime sleepiness (boys: 33.3%, girls: 39.2%), and subjectively insufficient sleep (boys: 38.1%, girls: 39.0%). Multiple logistic regression analysis showed that female sex, being a senior high-school student, and having an unhealthy lifestyle (psychological stress, smoking, and drinking alcohol) were risk factors for sleep problems. CONCLUSION: Self-reported sleep problems in Japanese adolescents were common and were associated with multiple factors. There is a need for health education directed at solving sleep problems in Japanese adolescents.

[Japanese national survey of adolescent drinking behavior: comparison between 1996 and 2000 surveys].

This report shows Japanese adolescent drinking behavior from the national surveys conducted in 1996 and 2000. We randomly selected 120 junior high schools and 100 senior high schools nationwide. We requested the cooperation of the principals of these schools and sent questionnaires to each school. Students answered anonymously the questionnaires during school time, and sealed in envelopes by themselves; then teachers collected the envelopes. The questionnaire focused on adolescent drinking behavior. Valid responses numbered 42,798 (1996) and 47,246 (2000) from the junior high schools and 73,016 (1996) and 59,051 (2000) from the senior high schools. The number of students surveyed represented about 1% of all Japanese junior high school students, and about 2% of all senior high school students. This report covers only students who gave answers on both drinking frequency and drinking quantity. It compares adolescent drinking behavior between the 1996 and 2000 surveys, such as drinking frequency, drinking quantities, drinking occasions, methods of obtaining alcohol, kinds of alcohol drunk, alcohol-related problems, opinions on the law that prohibits minors under 20 years of age from drinking alcohol, and distribution of drinking status of the subjects by the Quantity-Frequency Scale (QF scale). In a comparison of adolescent drinking behavior between the 1996 survey and 2000 survey, non-drinkers among junior high school students increased from 45% to 55%, and those among senior high school students increased from 27% to 33%. On the other hand, ratios of female students in both junior and senior high schools who drank 1 or more times per week were higher in the 2000 survey than in the 1996 survey. Comparison of the 1996 survey and 2000 survey did not indicate that Japanese adolescent drinking has increased or decreased.

Decrease in the prevalence of smoking among Japanese adolescents and its possible causes: periodic nationwide cross-sectional surveys.

OBJECTIVES: To assess trends in smoking prevalence among Japanese adolescents and to analyze possible causal factors for the decrease in smoking prevalence observed in a 2004 survey. METHODS: Nationwide cross-sectional surveys were conducted in 1996, 2000 and 2004. Survey schools, both junior and senior high schools, considered to be representative of the whole of Japan were sampled randomly. Enrolled students were asked to complete a self-reporting anonymous questionnaire on smoking behavior. The questionnaires were collected from 115,814 students in 1996, 106,297 in 2000, and 102,451 in 2004. School principals were asked about the policy of their respective school on smoking restrictions. RESULTS: Cigarette smoking prevalence (lifetime, current, and daily smoking) in 2004, based on the completed questionnaires, had decreased relative to previous years in both sexes and in all school grades. The most important trends were: a decrease in smoking prevalence among the fathers and older brothers of the students; an increase in the proportion of students who did not have friends; a decrease in the proportion of current smokers who usually bought cigarettes in stores decreased in 2004, in particular for the oldest boys. An association was found between a lower smoking rate at a school and a smoke-free school policy. CONCLUSIONS: Japan has experienced a decrease in the prevalence of smoking among adolescents. A decrease in smoking prevalence among the fathers and older brothers, limitations to minors' access to tobacco, an increase in the proportion of students without friends, and a school policy restricting smoking may have contributed to this decreasing trend.

Association between mental health status and sleep status among adolescents in Japan: a nationwide cross-sectional survey.

OBJECTIVE: Previous epidemiological studies on relationships between mental health status and sleep status of adolescents have not been sufficiently representative. In the present study, using samples representative of Japanese adolescents nationwide, associations between mental health status and various sleep statuses were examined. METHOD: The survey was conducted in December 2004 and January 2005 among students enrolled in randomly selected junior and senior high schools throughout Japan, using self-administered questionnaires that addressed lifestyle, sleep status, mental health status, and personal data. Of 103,650 questionnaires collected, 99,668 were analyzed. Sleep status was assessed according to sleep duration, subjective sleep assessment, bedtime, and insomnia symptoms. The Japanese version of the 12-item General Health Questionnaire was employed for assessment of mental health status. RESULTS: Mental health status of subjects whose sleep duration was less than 7 hours, and those who slept 9 hours or more, was poorer than that of subjects who slept for 7 hours or more but less than 9 hours. A U-shaped association was observed between mental health status and sleep duration. Furthermore, a linear association was observed between subjective sleep assessment and mental health status; the worse the subjective sleep assessment, the poorer the mental health status. Mental health status was also inversely proportional to the frequency of insomnia symptoms. CONCLUSION: The fact that sleep duration and subjective sleep assessment showed different patterns of association with mental health status indicates that these 2 sleep parameters have independent significance. Considering these associations, it is important to promote mental health care and sleep hygiene education for adolescents.

Cigarette brand preferences of smokers among university students in Japan.

BACKGROUND: A survey on smoking behavior and relating factors among university students is necessary for establishing antismoking measures toward younger generation. To determine brand preferences of young smokers, we conducted a cross-sectional survey for students in a university. METHODS: An anonymous questionnaire was completed by the students at their annual health examinations. A total of 5688 students out of 7136 responded this survey (79.7%). The questionnaire included questions about smoking status, number of cigarettes smoked, brand preference, etc. RESULTS: Smoking prevalence was 55.2% for males and 12.0% for females. Estimated consumption of Japanese-brand cigarettes was 46.8% for males and 36.1% for females, whereas that of American-brand cigarettes was 36.3% for males and 45.1% for females. These values are much higher than the market share of imported cigarettes in Japan (17.1% in 1992). Five American brands ranked in the top 10 brands among these university students, whereas only one American brand was ranked in the top 10 brands in the Japanese market in 1992. Smokers who prefer cigarettes with higher nicotine ratings were more likely to have a higher consumption rate than otherwise. CONCLUSIONS: Cigarette brand preference is an important aspect to realize the smoking behavior among young smokers.

Relationship between a high mortality rate and extreme heat during the summer of 1999 in Hokkaido Prefecture, Japan.

In order to describe the relationship between mortality rate and extreme heat during the summer of 1999 in Hokkaido, we calculated the monthly age-adjusted death rates, average monthly mean temperature and average monthly high temperature for the years 1995 to 1999 in Hokkaido. The materials were derived from Statistics and Information Department, Minister's Secretariat, Ministry of Health, Labour and Welfare of Japan, Statistical Bureau Management and Coordination Agency Government of Japan and the Japan Meteorological Agency. Trends in the monthly age-adjusted death rates and temperature changes in the same period were analyzed. The highest average monthly high temperature for August and September (28.8 degrees C and 23.8 degrees C, respectively) occurred in 1999; the similar trend was observed in the highest average monthly mean temperature. In August 1999, there were 14 days with highest temperatures of 30 degrees C and over. The age-adjusted rate in August 1999 was significantly higher compared with those for the years 1995 to 1998 (p<0.01). We concluded that an unusually hot spell in 1999 was followed by a high mortality rate in Hokkaido.

A cohort study on cerebrovascular disease in middle-aged and elderly population in rural areas in Jiangxi Province, China.

To clarify the risk factors of CVD deaths in rural areas in Jiangxi Province, China, a cohort study was carried out from September 1, 1994 through December 31, 2000 involving 50,252 participants aged 40 years or older in 4 counties. Among the 3,429 deaths, 671 cases (398 males and 273 females) died of CVD. In addition, excluding 183 cases with a previous history of CVD, 632 CVD deaths out of 50,069 subjects were analyzed using Cox proportional hazard models. The multivariate hazard ratio (HR) for CVD mortality significantly increased in parallel with age, blood pressure and degree of liking for salty foods (p for trend < 0.01). The multivariate HR for CVD mortality of ex-drinkers was 1.55 (95% CI: 1.04, 2.31) compared with non-drinkers. The multivariate HR for CVD mortality of subjects who ate meat once or twice per month was 0.75 (95% CI: 0.62, 0.91) compared with those who never ate meat or seldom. There was no significant relationship between smoking and CVD mortality. Our results indicated that the main risk factors for CVD mortality were advancing age, high-normal blood pressure and hypertension. The risk in these areas was lower in subjects who disliked salty foods and those who ate meat once or twice per month.

Risk of adverse reproductive outcomes associated with proximity to municipal solid waste incinerators with high dioxin emission levels in Japan.

BACKGROUND: Great public concern about health effects of dioxins emitted from municipal solid waste incinerators has increased in Japan. This paper investigates the association of adverse reproductive outcomes with maternal residential proximity to municipal solid waste incinerators. METHODS: The association of adverse reproductive outcomes with mothers living within 10 km from 63 municipal solid waste incinerators with high dioxin emission levels (above 80 ng international toxic equivalents TEQ/m3) in Japan was examined. The numbers of observed cases were compared with the expected numbers calculated from national rates adjusted regionally. Observed/expected ratios were tested for decline in risk or peak-decline in risk with distance up to 10 km. RESULTS: In the study area within 10 km from the 63 municipal solid waste incinerators in 1997-1998, 225,215 live births, 3,387 fetal deaths, and 835 infant deaths were confirmed. None of the reproductive outcomes studied here showed statistically significant excess within 2 km from the incinerators. However, a statistically significant peak-decline in risk with distance from the incinerators up to 10 km was found for infant deaths (p=0.023) and infant deaths with all congenital malformations combined (p=0.047), where a "peak" is detected around 1-2 km. CONCLUSION: Our study shows a peak-decline in risk with distance from the municipal solid waste incinerators for infant deaths and infant deaths with all congenital malformations combined. However, due to the lack of detailed exposure information to dioxins around the incinerators, the observed trend in risk should be interpreted cautiously and there is a need for further investigation to accumulate good evidence regarding the reproductive health effects of waste incinerator exposure.