The effect of breathing relaxation to improve poor sleep quality in adults using a huggable human-shaped device: a randomized controlled trial.

PURPOSE: To examine whether or not breathing relaxation, using a huggable human-shaped device, improves poor sleep quality in adults. METHODS: We conducted a randomized controlled trial using outpatients with sleep problems from two clinics in Japan. The intervention group conducted three minutes of breathing relaxation using a huggable human-shaped device before going to bed every night for four weeks. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), at pre-intervention, mid-intervention (2 weeks after pre-intervention), and post-intervention (4 weeks after pre-intervention). We employed intention-to-treat analysis. RESULTS: A total of 68 participants (mean [SD] age, 41.7 [11.4] years; 64 female [95%]) were randomly assigned to the intervention group (n = 29, mean [SD] age, 43.6 [9.5] years; 28 female [97%]) and the control group (n = 36, mean [SD] age, 40.3 [12.7] years; 36 female [95%]). The intervention group showed a significant decrease in the PSQI score compared to the control group (F = 3.81, p = 0.025, effect size (η2) = 0.057). Furthermore, we found the intervention to be more effective in participants without suicide risk and with a lower number of adverse childhood experiences (effect size (η2) = 0.080 and 0.160, respectively). CONCLUSIONS: A novel psychological intervention, breathing relaxation using a huggable human-shaped device, may be effective to improve sleep quality among people with sleep problems, especially those without severe psychological symptoms. TRIAL REGISTRATION: UMIN000045262. (Registration Date: September 28th, 2021).

Association of maternal pre-pregnancy body mass index with resilience and prosociality of the offspring aged 6-7 years old: a population-based cohort study in Japan.

The association between maternal pre-pregnancy obesity and child behavior problems has been widely researched, leaving a gap in understanding the positive aspects of children's mental health. The present study aimed to investigate the association between maternal pre-pregnancy body mass index (BMI) and resilience and prosociality among 6-7 year-old children in Japan. A retrospective cohort study was conducted using data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, a population-based study in 2017 and 2019 including all first-grade students in public schools in Adachi, Tokyo, Japan (n = 7328, response rate = 84.7%). Resilience and prosociality were measured by the Children's Resilient Coping Scale and the Strength and Difficulties Questionnaire, respectively. Maternal pre-pregnancy weight and height were reported based on the Mother and Child Health Handbook, and BMI was categorized as underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), and obesity (BMI ≥ 30). Linear regression models were employed to control for covariates. Maternal pre-pregnancy obesity was found to be negatively associated with child resilience (coefficient: - 3.29; 95% CI - 6.42--0.15), while maternal underweight was negatively associated with child prosociality (coefficient: - 0.12; 95% CI - 0.24--0.005) compared to mothers of pre-pregnancy normal BMI. Perinatal factors, such as gestational weight gain, gestational age, and birth weight, did not mediate the association. Our findings suggest that maternal pre-pregnancy obesity is linked to decreased resilience and maternal underweight is linked to decreased prosociality in children aged 6-7 years. Maintaining an appropriate BMI range before pregnancy may be crucial for enhancing resilience and prosociality of offspring.

Impact of exposure to secondhand smoke on the risk of obesity in early adolescence.

BACKGROUND: Exposure to secondhand smoke (SHS) might be associated with obesity in children. This study aimed to evaluate whether continuous, quit, or start exposure to SHS was associated with obesity risk in early adolescents. METHODS: We used population-based longitudinal data of primary school students in Adachi City, Tokyo, Japan, in 2018 (4th grade) and 2020 (6th grade) and studied 3605 students. The association between continuous, quit, start, or never exposed to SHS from 4th to 6th grade and BMI categories (underweight or normal weight, overweight, obesity) in 6th grade was investigated using ordinal logistic regression models. RESULTS: Continuous SHS group showed a higher risk of being in the high BMI category than no SHS group (OR = 1.51, 95% CI 1.16-1.96). The stratified analyses by sex showed a similar association in boys (OR = 1.74, 95% CI 1.25-2.44) but not in girls (OR = 1.14, 95% CI 0.74-1.76). Quitting SHS group did not show a higher risk of being in the high BMI category than no SHS group (OR = 1.11, 95% CI 0.75-1.66) and the same was true for boys (OR 1.46, 95% CI 0.88-2.41). CONCLUSIONS: Continuous SHS was a risk factor for obesity in boys in early adolescence; however, quitting SHS may help prevent it. IMPACT: Continuous secondhand smoke (SHS) was not associated with a higher risk of obesity in early adolescence in girls. Continuous SHS can be a risk factor for obesity in early adolescence in boys. Quitting SHS may help to prevent obesity in early adolescence in boys.

Being Left Alone at Home and Dental Caries of Children Aged 6-7 Years.

BACKGROUND: Leaving children alone at home is considered child neglect in some countries but is not prohibited in Japan. We investigated the association between being left alone at home and dental caries of children aged 6-7 years in Japan. METHODS: The data on first graders in all 69 public elementary schools in Adachi, Tokyo, obtained from repeated cross-sectional surveys in 2015, 2017, and 2019 were analyzed. Caregivers answered the questionnaire, and the data were linked to the information on children's dental caries evaluated in school dental health checkups (N = 12,029). Poisson regression analysis with propensity score matching (PSM) was applied to account for confounders. RESULTS: Leaving children alone at home for ≥1 hour during the weekdays was reported by 46.4% of the caregivers, which did not vary across years. The PSM analysis showed that, compared with children never being left alone at home, children being left alone at home for ≥1 time per week had more dental caries (mean ratio [MR] 1.11; 95% confidence interval (CI), 1.02-1.21; P = 0.016), while <1 time per week was not associated (MR 0.97; 95% CI, 0.92-1.03; P = 0.345). The difference between those being left alone at home for <1 time per week and those being left alone for ≥1 time per week was not significant after applying Bonferroni correction (MR 1.12; 95% CI, 1.00-1.26; P = 0.041). CONCLUSION: Leaving children alone at home for ≥1 hour every week might be a risk factor for dental caries of children aged 6-7 years.

Number of Siblings and Social Capital Among Parents Rearing Schoolchildren: Results From the A-CHILD Study.

BACKGROUND: Having siblings may foster sociality; however, little is known about whether sibling number determines social capital, the resources obtained through social networks. We examined the association between sibling number and social capital among Japanese parents rearing schoolchildren. METHODS: We used cross-sectional data from the 2018 and 2019 Adachi Child Health Impact of Living Difficulty (A-CHILD) study, targeting all primary and junior high school students and their parents in Adachi, Tokyo, Japan (n = 8,082). Individual-level social capital was evaluated by assessing caregivers' social cohesion, social support, and group affiliation. All analyses were adjusted for age and sex. RESULTS: An inverse U-shaped association was found between sibling number and social capital. Adults who grew up with one or two, but not three or more siblings had greater social support (coefficient = 0.23; 95% confidence interval [CI], 0.06-0.40 and coefficient = 0.46; 95% CI, 0.29-0.64, respectively) than those who grew up as an only child, after covariate adjustment. Adults who grew up with two or three, but not one or four or more siblings had greater group affiliation (coefficient = 0.09; 95% CI, 0.03-0.16 and coefficient = 0.09; 95% CI, 0.01-0.18, respectively) than those who grew up as an only child, after covariate adjustment. Sibling number was not associated with social cohesion. CONCLUSION: Growing up with one to three siblings was associated with higher social capital in adulthood than being an only child. Having siblings may provide an opportunity to foster social capital.

Association between poor parent-daughter relationships and the risk of hyperglycemia in pregnancy: a hospital-based prospective cohort study in Japan.

BACKGROUND: Adverse child experiences (ACEs), childhood maltreatment and household dysfunction, are risk factors of hyperglycemia in pregnancy (HIP), including diabetes before pregnancy, gestational diabetes (GDM), and overt diabetes in pregnancy, through increased risk of unhealthy behaviors, obesity, and stress response system dysfunction. While ACEs are often difficult to be assessed in hospital settings, parent-daughter relationship, that is, pregnant women's relationship with their parents can be considered as a measurable maker for ACEs that may be associated with HIP. The purpose of this study is to examine the association between poor parent-daughter relationship and HIP. METHODS: Hospital-based prospective cohort study was conducted in Japan (N = 6,264). Women visiting participating 58 facilities for delivery between April 2019 and March 2020 were included. Parent-daughter relationship was assessed by a questionnaire asking whether participants were satisfied with their relationship with their parents. HIP was diagnosed based on the criteria used in Japan. A multiple logistic regression model was applied to adjust for covariates. RESULTS: Pregnant women who were not very satisfied and not satisfied at all with the relationship with their parents, and HIP were 343 (5.5%), 74 (1.2%), and 274 (4.4%), respectively. Pregnant women who were not very satisfied with their parent-daughter relationship showed a significant positive association with HIP in the crude model (odds ratio (OR): 1.71, 95% confidence interval (CI): 1.11-2.63). When stratified by psychiatric disease history, we found a significant positive association among those without psychiatric disease history (OR: 1.77, 95% CI: 1.11-2.84), but not among those with psychiatric disease history (OR: 0.61, 95% CI: 0.16-2.28). CONCLUSIONS: Poor parent-daughter relationship was associated with the risk of HIP among pregnant women without psychiatric disease history, suggesting that this simple question could be used to estimate the risk of HIP when it was challenging to inquire directly about ACEs. Further research is needed to elucidate the mechanism of the association.

Interventions to change parental parenting behaviour to reduce unintentional childhood injury: a randomised controlled trial.

OBJECTIVE: The previous study has shown the impact of paternal involvement in childcare on unintentional childhood injury; yet the causality is unknown. The purpose of this study is to investigate whether the intervention of an educational video on paternal involvement in childcare can prevent unintentional injury among young children. METHODS: A randomised controlled trial of parents of children born at two obstetrics wards in Japan (n=451, intervention group: 223, control group: 228) was conducted. Parents in the intervention group watched an educational video that promote paternal involvement in childcare, while parents in the control group watched an educational video on the prevention of shaken baby syndrome. The participants were followed for up to 18 months after the birth of their child. The primary outcome of this study was unintentional injury at 3, 6, 12 and 18 months. The secondary outcome was paternal involvement in childcare based on maternal observation. Unintentional injury-free rates over time were assessed using the Cox proportional hazard model. RESULTS: Children in the intervention group were less likely to have unintentional injury, such as burn (HR: 0.29 (95% CI: 0.09 to 0.87)) and caught by a door (HR: 0.66 (95% CI: 0.48 to 0.91)) compared with the control group. Fathers in the intervention group showed higher frequency of taking their children for a walk (coefficient: 0.19 (95% CI: 0.05 to 0.32)). CONCLUSIONS: Educational videos promoting paternal involvement in childcare is effective to prevent unintentional childhood injury.

School- and community-level protective factors for resilience among chronically maltreated children in Japan.

PURPOSE: Few studies have investigated how school- and community-level modifiable factors might enhance resilience, defined as an ability to recover from and cope with adversity, among chronically maltreated pre-adolescent children. This study aims to investigate school and community factors that can increase children's resilience following maltreatment. METHODS: We used data from the Adachi child health impact of living difficulty (A-CHILD) Study, a population-based prospective longitudinal study starting with first-grade children in all public elementary schools in Adachi City, Tokyo, Japan in 2015. Children who experienced chronic maltreatment while in 1st and 4th grades and whose resilience scores were available at those grades were included in the analysis (N = 789). Crude and multiple regressions were used to examine associations of child-reported school factors (i.e., school social capital, number of friends to consult with) and community factors (i.e., having a non-parental role model and supportive adult, having a third place, which is defined as a place other than home to spend time after school) with parent-reported resilience at 4th grade. These regressions were also performed stratified by sex. RESULTS: School social capital and having a non-parental role model at 4th grade were positively associated with resilience after adjusting covariates, including resilience at 1st grade [coefficient = 3.63, 95% confidence intervals (CI) 2.26-4.99; coefficient = 2.52, 95% CI 0.57-4.38, respectively]. Analysis by sex revealed that having a supportive adult, but not a role model, was associated with resilience among girls (coefficient = 5.50, 95% CI 0.20-10.8). CONCLUSIONS: The findings suggest that school and community factors can promote resilience following child maltreatment, and these factors are different between boys and girls.

Child Maltreatment and Mental Health in Middle Childhood: A Longitudinal Study in Japan.

Toxic stress caused by child maltreatment can lead to adverse mental health outcomes in later life, yet unmeasured confounding has been a major issue in many previous studies. To examine the association between child maltreatment and resilience and behavior problems among early elementary school-age children, we used data from a population-based longitudinal survey targeting all first-grade children in 2015 in Adachi City, a ward in Tokyo, Japan. Children whose caregivers provided valid responses during the 2015 (first grade; ages 6-7 years), 2016 (second grade; ages 7-8 years), and 2018 (fourth grade; ages 9-10 years) waves of the study were included in the analysis (n = 2,920). Fixed-effects regression models revealed that child maltreatment was inversely associated with resilience (ß = -0.89, 95% confidence interval (CI): -1.05, -0.72) and prosocial behavior (ß = -0.03, 95% CI: -0.05, -0.003) and positively associated with behavior problems (ß = 0.32, 95% CI: 0.27, 0.37) over 4 years of follow-up (2015-2018), after controlling for all time-invariant confounders and measured time-varying confounders and survey year. These associations were consistent across sex. Child maltreatment may hamper the development of resilience and prosocial behavior and induce behavior problems in early elementary school children over time. Future researchers should identify modifiable protective factors for better mental health among maltreated children.

Impacts of the COVID-19 Pandemic Exposure on Child Dental Caries: Difference-in-Differences Analysis.

The impact of the coronavirus disease 2019 (COVID-19) pandemic on dental caries is unknown. We investigated the effect of the pandemic on child dental caries in Japan by comparing the increase in dental caries from fourth to sixth grade between two cohorts, COVID-19 exposed cohort and COVID-19 unexposed cohort, using difference-in-differences analysis. Longitudinal data that followed elementary school children in Adachi City, Tokyo, were analyzed. The analysis consisted of two cohorts: those who were in fourth grade in 2016 and sixth grade in 2018 (COVID-19 unexposed cohort, N = 399) and those who were in fourth grade in 2018 and sixth grade in 2020 (COVID-19 exposed cohort, N = 3,082). Children's dental caries were examined by school dentists. A difference-in-differences analysis, adjusting for time-variant variables, i.e., household socioeconomic status, children's oral health behavior, and caregivers' psychological distress, was performed. In fourth grade, the number of Decayed, Missing, and Filled permanent Teeth (DMFT) was not different between the COVID-19 unexposed and exposed cohorts (mean = 0.241 and 0.242, respectively). In sixth grade, DMFT increased by 0.067 in the COVID-19 unexposed cohort and 0.180 in the COVID-19 exposed cohort. The interaction term of grade and cohorts for caries by difference-in-differences analysis showed that dental caries among the COVID-19 exposed cohort showed a significant increase in the number of dental caries by 0.116 (95% confidence interval 0.015, 0.216) compared to the COVID-19 unexposed cohort. Child dental caries slightly increased after the pandemic. Studies with longer follow-ups are needed to evaluate the impact of the pandemic on child dental caries.

Adachi Child Health Impact of Living Difficulty (A-CHILD) Study: Research Protocol and Profiles of Participants.

BACKGROUND: The Adachi Child Health Impact of Living Difficulty (A-CHILD) study has been conducted since 2015 to clarify the associations between socioeconomic factors and child health, as well as to accumulate data for political evaluation of the child-poverty agenda. This paper describes the purpose and research design of the A-CHILD study and the baseline profiles of participants, together with the future framework for implementing this cohort study. METHODS: We have conducted two types of continuous survey: a complete-sample survey started in 2015 as a first wave study to target first-grade children in all public elementary schools in Adachi City, Tokyo, and a biennial fixed grade observation survey started in 2016 in selected elementary and junior high schools. Questionnaires were answered by caregivers of all targeted children and also by the children themselves for those in the fourth grade and higher. The data of A-CHILD also combined information obtained from school health checkups of all school-grade children, as well as the results from blood test and measurement of blood pressure of eight-grade children since 2016. RESULTS: The valid responses in the first wave were 4,291 (80.1%). The number of households in "living difficulties", such as low household income or material deprivation, stood at 1,047 (24.5%). CONCLUSIONS: The A-CHILD study will contribute to the clarification of the impact of poverty on children's health disparities and paves the way to managing this issue in the community.

Association between maternal adverse childhood experiences and mental health problems in offspring: An intergenerational study.

The aim of this study is to examine the association between maternal adverse childhood experiences (ACEs) and mental health problems in adolescent offspring. Data were obtained from the population-based Kochi Child Health Impact of Living Difficulty (K-CHILD) study in 2016, and participants were 10,810 children in the fifth grade (3,144 pairs), eighth grade (3,497 pairs), and eleventh grade (4,169 pairs) living in Kochi Prefecture, Japan. Mothers of participating children were asked about their ACEs, childhood social economic status, current mental and physical health, current social economic status, positive parenting behaviors, child maltreatment, marital status, and child behavior problems using the Strength and Difficulty Questionnaire. Children reported their depressive symptoms using the Depression Self-Rating Scale. Children of mothers with a larger number of ACEs showed higher levels of behavior problems (p for trend <.001) and depressive symptoms (p for trend <.001), adjusting for potential confounders. In particular, maternal psychological distress mediated the association between maternal ACEs and child mental health. The adverse effects of maternal ACEs may have a direct intergenerational impact on behavior problems and depressive symptoms in adolescent offspring. Further studies to elucidate possible mediators are needed.

Association of home cooking with caregiver-child interaction and child mental health: results from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study.

OBJECTIVE: To examine the associations of home cooking with caregiver-child interaction and child mental health in Japan. DESIGN: Cross-sectional data collected in 2018. Frequency of home cooking was assessed by a questionnaire among 4126 caregivers and classified as high (almost every day), medium (4-5 d/week) or low (≤3 d/week). Caregiver-child interaction was evaluated by assessing frequency of talking and playing together (per week). Behaviour problems and prosocial behaviour were assessed by the Strengths and Difficulties Questionnaire, and resilience was assessed using the Children's Resilient Coping Scale. SETTING: Japan. PARTICIPANTS: Children aged 9-10 years and their caregivers in Adachi, Tokyo, Japan. RESULTS: Low and middle frequency of home cooking were associated with lower frequencies of talking about school life, talking about news with the child, talking about television shows with the child and helping with the child's homework. Children with low and/or middle frequency of home cooking had more behaviour problems (low frequency: ß = 3·95, 95 % CI 1·30, 6·59 and medium frequency: ß = 3·38, 95 % CI 2·07, 4·70), lower prosocial behaviour (low frequency: ß = -5·85, 95 % CI -10·04, -1·66) and lower resilience (low frequency: ß = -6·56, 95 % CI -9·77, -3·35 and medium frequency: ß = -4·11, 95 % CI -5·71, -2·51), compared with children with high frequency of home cooking after adjusting covariates including socio-economic status. These associations were mediated by child's eating behaviours and/or caregiver-child interaction. CONCLUSIONS: Creating an environment that encourages caregivers to cook at home may be important for children's mental health.

The association of community and individual parental social capital with behavior problems among children in Japan: results from A-CHILD longitudinal study.

PURPOSE: The purpose of this study was to determine the association of individual-level and community-level parental social capital with childhood behavior problems using population-based longitudinal data in Japan. METHODS: We analyzed data from a population-based longitudinal survey study which followed first-grade elementary school children (6-7 years old) in Adachi City, Tokyo, Japan. At baseline, the parents of first-grade students from all 69 elementary schools in Adachi City were asked to respond to a questionnaire assessing behavior problems and prosocial behavior (using the Strengths and Difficulties Questionnaire) and parental social capital in the community (N = 5494). Data on follow-up questionnaires on behavior problems were collected when children were second grade. Among both surveys, 3656 parents returned valid responses. The association between individual-level and community-level parental social capital and children's behavior problems were analyzed using multilevel analyses adjusting for covariates. RESULTS: Community-level social capital was positively associated with prosocial behaviors, but not for total difficulties, after adjustment for covariates (coefficient = 0.19, 95% CI 0.03 to 0.36). Individual-level parental social capital was also positively associated with prosocial behaviors (coefficient = 0.27, 95% CI 0.12 to 0.41) and negatively associated with total difficulties (coefficient = - 0.54, 95% CI - 0.89 to - 0.19). CONCLUSIONS: This study showed that greater community-level social capital can benefit children with increased prosocial behaviors. Individual-level parental social capital can be protective of youth by increasing prosocial behaviors and reducing difficult behaviors. Boosting both community and individual social capital can be a promising means to enhance children's well-being.

The association between mobile devices use and behavior problems among fourth grade children in Japan.

AIM: Previous studies showed mixed evidence on the association between duration of mobile devices usage and behavior problems among children. We aimed to examine this association using a large population-based sample of fourth grade children (i.e. aged 9-10 years old), stratified by gender. METHODS: Questionnaires with anonymous unique identifiers were distributed to 4th grade students (aged 9-10 years old) at all public schools in Adachi City, Tokyo (n = 4,105). Duration of mobile devices usage was self-reported, and behavior problems were assessed by the Strengths and Difficulties Questionnaire by caregivers. Multiple regression analyses were performed, adjusting for potential confounders such as socioeconomic status, family social capital, and number of friends. RESULTS: Among boys, U-shape association was found between duration of mobile devices usage and behavior problems; boys with usage time of less than 1 h showed 0.88 [95% confidence interval (CI) -1.50 to -0.27] point lower total difficulty score in comparison with boys who do not use mobile devices, and total difficulty score among boys with usage time of 1 h or more was not different with non-users. Among girls, dose-response positive association was found between duration of mobile devices usage and total difficulty score (P for trend: <0.001). CONCLUSION: Among children aged 9-10 years old, mobile devices usage time of less than 1 h was a protective factor for behavior problems in boys, while usage time of 1-h or more was a risk factor in girls. Further longitudinal study is warranted to confirm the findings.

Preventing postpartum depressive symptoms using an educational video on infant crying: A cluster randomized controlled trial.

BACKGROUND: The aim of this study was to examine the impact of watching an educational video on infant crying within 1 week of age after delivery at maternity wards to reduce the prevalence of postpartum depressive symptoms at 1 month after giving birth. METHODS: The study design was a cluster randomized controlled trial. The intervention hospitals were randomly assigned, stratified by area and function of the hospital. Participants included 47 obstetrics hospitals or clinics out of 150 hospitals or clinics in Osaka Prefecture, Japan. In total, 44 hospitals or clinics completed the trial and 2,601 (intervention group = 1,040, control group = 1,561) caregivers responded to the questionnaire on postpartum depression (response rate: 55.1%). Mothers in the intervention group watched an educational video, within 1 week of age, during hospitalization at maternity wards. Primary outcome in this study was postpartum depression assessed by the Edinburgh Postnatal Depression Scale as 9+ and assessed via questionnaire at a 1-month health checkup. RESULTS: In the intervention group, 142 (13.7%) mothers reported postpartum depression compared to 250 (16.0%) in the control group. Intention-to-treat analysis showed no significant difference in the prevalence of postpartum depression between the groups. However, among young mothers (<25 years), the analysis showed a 67.0% reduction in postpartum depression (odds ratio: 0.33, 95% CI: 0.15-0.72). CONCLUSIONS: Watching an educational video on infant crying within 1 week after delivery at maternity wards did not reduce postpartum depression at 1 month after giving birth, but it was effective for young mothers aged <25 years.

Is Japan's child allowance effective for the well-being of children? A statistical evaluation using data from K-CHILD study.

BACKGROUND: Child allowance payment is one form of social security policy that aims to mitigate the child poverty gap by providing financial support to families. This study aimed to explore the impact of the child allowance on children's physical and mental health (BMI, problem behavior, depression, and self-rated health), and parental investment in child health (children's material goods, family events, extracurricular activities, interaction with children, and involvement in child maltreatment). METHODS: We used cross-sectional data from the 2016 Kochi Child Health Impact of Living Difficulty (K-CHILD) study. Participants were 1st, 5th and 8th grade children living in Kochi prefecture in Japan (N = 8207). Caregivers reported children's child allowance status, BMI and behavior problems, while children filled out a self-assessment on depression and health condition. Propensity score matching analysis regarding potential confounders was used. RESULTS: We found that children in families that received child allowance showed a smaller total difficulties score by 1.29 points (95% CI: - 2.32 to - 0.25) and a lower risk of overweight (OR: 0.51, 95% CI: 0.29 to 0.91) although there is no association with underweight, prosocial behavior, depressive symptoms and self-rated health. Parental investment did not differ by child allowance status (p > 0.05). CONCLUSIONS: Child allowance was found to be potentially beneficial in decreasing behavior problems and reducing child overweight. Further longitudinal studies are needed to elucidate how child allowance is used by family members and associated with children's well-being. (230/350 words).

[Factors related to the passive attitude of caregivers on dental care visit when elementary and junior high school children are diagnosed with dental caries].

Objectives　Early diagnosis and treatment are particularly important for children who have dental caries. It has been reported that some children are not taken to a dental clinic even though they are diagnosed with dental caries at school dental check-ups. The purpose of this study is to investigate factors related to the passive attitude of caregivers regarding dental care visits when elementary and junior high school children are diagnosed with dental caries.Methods　A cross-sectional study was conducted utilizing data from the 2016 Adachi Child Health Impact of Living Difficulty (A-CHILD) study. A questionnaire was administered to 1,994 parents of 4th and 6th grade students in elementary school, and 8th grade students in junior high school. Out of the 1,994 parents, 1,652 (83%) responded. Caregivers were asked whether they take their child to the dental clinic immediately if their child is diagnosed with dental caries. Those who answered "cannot take immediately" were defined as caregivers with a passive attitude towards dental care visits. Their reasoning was further probed by the questionnaire. The validity of the answer (i.e., taking their child to the dental clinic) was assessed with the child's untreated dental caries obtained from the results from the school dental health checkup. The number of children excluded in the analysis due to a lack of information on dental caries and/or the attitude of the parents was 1,613. A logistic regression analysis was performed to investigate the association between passive attitude on dental care visit and demographic factors (e.g., child's sex, grade, number of siblings, and household members), lifestyle (e.g., time home for caregiver, grandparent co-residence, skipping breakfast, snacking habits, sugar-sweetened beverage intake, frequency of teeth brushing, and parent-child relationship), and socioeconomic status (e.g., annual household income, educational attainment of caregiver, employment status of caregiver).Results　In total, 269 (16.7%) caregivers reported a passive attitude for the dental care visit of their child. The most frequent reason was "I don't have time to take my child to the dental clinic" (172 people, 55.8%). The passive attitude by the caregivers was associated with untreated decay for the child (P<0.001). The passive attitude of the caregiver on the dental care visit was associated with lower maternal educational attainment, skipping breakfast for the child, and lower frequency of brushing teeth. In elementary school children, the passive attitude of the caregiver on the dental care visit was also significantly associated with maternal employment, later time of getting home by the mother and a lack of interaction with children by the caregiver.Conclusion　The passive attitude of the caregiver as pertaining to the dental care visit of the child was associated with maternal socioeconomic background. Health promotion activities considering maternal socioeconomic background is needed.