Adolescent smoking behaviour and cigarette brand preference in Japan.

OBJECTIVES: As part of efforts to develop a smoking control strategy for Japanese adolescents, the results of two nationwide surveys on adolescent smoking behaviour were compared. DESIGN: Descriptive study on smoking behaviour among high school students was conducted. Self-reporting anonymous questionnaires were administered to 115,814 students in 1996 and 106,297 in 2000 through randomly sampled junior and senior high schools throughout Japan. MAIN OUTCOME MEASURES: Smoking prevalence, proportion of smokers by usual sources of cigarettes, national estimated cigarettes consumed by minors, share of cigarette brands smoked by high school students. RESULTS: The experiment rate among junior high school boys decreased in 2000 compared with that in 1996, whereas current and daily smoking rates did not. Although prevalence among Japanese girls was much lower than that among boys, prevalence among girls increased in 2000. The main source of cigarettes among high school smokers was vending machines. The proportion of smokers who usually purchased cigarettes from vending machines increased in 2000, in spite of the 1998 introduction of restrictions on night-time operations. Japanese adolescents were more likely than adults to smoke American cigarette brands, and the adolescent market share of American brands has increased rapidly, especially for menthol brands. CONCLUSIONS: This survey revealed the seriousness of the problem of smoking behaviour among Japanese high school students, and suggested that this behaviour may be influenced by social environmental factors, including the marketing strategies of the tobacco industry. Action should be taken to reduce the prevalence and impact of pro-tobacco marketing messages and to abolish cigarette vending machines.

The influence of lifestyle and health status factors on sleep loss among the Japanese general population.

STUDY OBJECTIVE: To examine the relationship between lifestyle, health status factors and sleep loss. DESIGN: A cross-sectional questionnaire survey conducted by the Ministry of Health and Welfare, Japan. SETTING: N/A. PATIENTS OR PARTICIPANTS: Approximately 30,000 subjects selected from the general population in Japan. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: This study indicated that approximately 28% of the general population sleep less than 6 hours nightly and approximately 65% sleep less than 7 hours. However, approximately 80% of the population reported getting sufficient sleep. Multiple logistic regression analysis showed that being females, being of younger age, living in an urban environment, being unemployed, and having an unhealthy lifestyle (i.e., lack of exercise, poor health status, and irregular eating habits) were associated with sleep loss. CONCLUSION: In this study, sleep loss was found to be associated with having an unhealthy lifestyle and being in poor general health. These findings suggest that health education and promotion of a healthy lifestyle should be advocated.

Relation between smoking prevalence and various social factors in Japan.

Although the smoking prevalence among women is significantly low compared to that among men in Japan, the prevalence in young Japanese women has been steadily increasing recently. The relationship between the prevalence of smoking among the general population and various social factors was investigated with a special emphasis regarding the influence of household size on the smoking prevalence of young Japanese women. Thirty-one thousand and six hundreds twenty-seven subjects of 20 years and older were randomly selected from the general population of Japan. The Ministry of Health and Welfare, Japan planned and conducted the survey. Subjects were divided into male and female, and smoking prevalence was investigated in terms of age, place of residence, occupation and household size factors. Statistical analyses were performed using chi-square test and multiple logistic regression. Multiple logistic regression analyses suggested that for men there was a strong relationship between becoming a smoker and living in a municipality with a smaller population, and that for women who were living in a municipality with a larger population. For women, as the size of a household increased from living alone to a two- or three-generation household, the tendency to becoming a smoker decreased, but this tendency was not observed among men. As to reasons for quitting smoking, more women than men living in two- and three-generation households gave "family's advice" as a major reason (p < 0.01). The steady replacement of the traditional three-generation household by smaller households in Japan may lead to an increase in the number of young women who smoke.

Domain analysis and modeling to improve comparability of health statistics.

Health statistics is an essential element to improve the ability of managers of health institutions, healthcare researchers, policy makers, and health professionals to formulate appropriate course of reactions and to make decisions based on evidence. To ensure adequate health statistics, standards are of critical importance. A study on healthcare statistics domain analysis is underway in an effort to improve usability and comparability of health statistics. The ongoing study focuses on structuring the domain knowledge and making the knowledge explicit with a data element dictionary being the core. Supplemental to the dictionary are a domain term list, a terminology dictionary, and a data model to help organize the concepts constituting the health statistics domain.

[Smoking behavior of nurses in Mie Prefecture, Japan].

Nurses who work in hospitals and clinics belonging to a regional medical association in Mie prefecture were surveyed regarding their smoking behavior and several related factors. The results are summarized as follows: 1) Smoking prevalence in male and female nurses was 75.5% and 14.6% respectively. In the present study the rate of female nurses was almost equal to results reported in a national survey. 2) Smoking prevalence was higher among licensed practical nurses than registered nurses, and it was highest among psychiatric nurses. 3) Smoking prevalence among hospital and clinical nurses was 15.7% and 9.1% respectively. Smoking prevalence was lower among clinical nurses, even though, they have a higher number of licensed practical nurses. Also smoking prevalence was higher in hospitals with a smaller nursing staff than in hospitals with a larger nursing staff. 4) Among smokers, 44.5% seriously had attempted to quit smoking, and 34.1% had considered quitting but never tried. Therefore, the results suggest the importance of providing smoking cessation programs for nurses.

[Smoking behaviors among medical doctors in Fukui, Japan].

This study was conducted in order to identify the smoking prevalence among all doctors (N = 874) belonging to the medical associations in Fukui Prefecture and factors that might possibly indicate causal smoking habits. A survey was conducted from December of 1996 to February of 1997, using a self-administered questionnaire, and the response rate for the survey was 91%. The main results of this survey were as follows: The prevalence of smoking among male and female medical doctors was 28% and 8% respectively, which was lower than that of adults in the general population, but higher than that of doctors in the developed countries. The prevalence of smoking among doctors was almost highest when they were 20 to 29 years old, and that among medical practitioners with their own institution was higher than doctors employed by an institution. In particular, medical practitioners who did not smoke were more likely to restrict or ban smoking in their hospitals or clinics.

[A comparison of smoking habits between nursing school and nursing college students].

This study was conducted through anonymous questionnaires in order to compare the smoking habits of nursing school students with those of nursing college students, and to identify factors that might possibly indicate causes of smoking habits, among students of two major courses (a 3-year nursing school course and a 4-year nursing college course) for becoming nurses. The subjects were students in two nursing schools and two nursing colleges in the Tokyo Metropolitan area. The results showed that the smoking prevalence among nursing school students in the first to the third grades was 26%, and that among nursing college students of the same grades was 12%. As to factors related to smoking habits of the students the smoking patterns of mothers and friends were shown to largely influence those of the nursing students. Among nursing college students, 21% agreed to a smoking ban in their schools, compared with 14% of the nursing school students.

[Does disclosure of medical records to patients influence medical care?].

UNLABELLED: Disclosure of medical records to patients has been assessed, but the influence of disclosure on medical care has not been well researched. To address this situation, this study was conducted to test three hypotheses: 1) doctors think that the disclosure can influence medical care, 2) whether doctors think disclosure can influence medical care depends on how they rank medical records (for example, as evidence for diagnosis and treatment, a process to reach a diagnosis, a tool to communicate with other medical staff, etc), and on whether they think medical record disclosure could change the content of the record. Questionnaires were sent to 881 doctors who work at two hospitals affiliated with N Medical School and K Medical University. RESULTS: Four hundred eighty-eight doctors responded. The findings related to the hypotheses were as follows: 1) Those who answered that the disclosure could have an influence on medical care were 49.1% of the total. 2) There was no relation between how doctors ranked medical records and whether they thought disclosure could influence medical care. 3) Doctors who answered that there were things that they would not be able to write if medical records were disclosed accounted for 73.5% of the total. These doctors answered "yes" significantly higher to the question that the disclosure could influence medical care than others (Odds 3.6, P < 0.01). Doctors who thought they would not be able to enter the diagnosis, the name of the disease for insurance, self-evaluation, information that could be judged and subjective information answered that disclosure could influence on medical care (P < 0.05). It was assumed that disclosure of medical records to patients could change the content of the medical records and that could influence medical care. How to deal with information will become an important issue if records are disclosed.

[Smoking prevalence of nurses in national hospitals of Japan].

We surveyed nurses in 14 randomly sampled national hospitals about their smoking behavior and some relating factors. The main results were as follows: 1) The prevalence of smoking among male and female nurses was 67.8% and 18.5% respectively. These figures are higher than in the general population. 2) The smoking prevalence of female nurses was highest among those in their thirties and lowest among those in their twenties, and 56% of those who smoke daily started smoking between the age of 20 and 24. 3) Smoking was more prevalent among practical nurses than among registered nurses. 4) Smoking was more prevalent among nurses who where not satisfied with their career choice than those who stated that they were satisfied with being nurses. 5) Among smokers, 80% had considered quitting, 44% had seriously tried to quit smoking, and 80% wanted to quit smoking. For this reason, it is important to provide smoking cessation programs for nurses. 6) The nurses surveyed, 93% agreed with the opinion that women should not smoke for the sake of both their own and their infant's health. However only 30% agreed with the opinion that nurses should not smoke as medical professionals.

[Study of factors that influence the use of ambulances in Japanese prefectures].

PURPOSE: The objective of this study was to clarify the factors that influence the rate of patient-carriage by ambulances in Japanese Prefectures. METHOD: The study was conducted using data on cases of patients with mild conditions carried by ambulances in Japanese prefectures in 1993, concentrating the factors that influence the rate of usage. The cases were analyzed focusing on three major types of medical emergencies (accounting for 93.4% of the total): sudden illnesses, traffic accidents and general injuries. SPSS for Windows was used for statistical analysis. RESULTS AND DISCUSSION: Data analysis by age group and type of medical emergency showed a positive correlation (r > 0.7) for the rate of cases with mild conditions carried by ambulances in all age groups (early childhood, adolescence, adult and senior) and the three major types of medical emergencies. Particularly, a strong correlation (r > 0.9) was observed with regard to patients suffering from sudden illnesses and general injuries. Multiple regression analysis showed that the rate for patients with mild cases carried by ambulances was higher in prefectures where; (1) there were more cases of administrative litigation related to individuals' rights, and (2) there were many nuclear families that tended to lack the capacity for family care. In addition, it also became evident that the rate for patients with mild injuries from traffic accidents was higher in prefectures where; (1) the rate for male-driver license holders for small- and medium-size cars was higher, and (2) the ratio of numbers of vehicles to total roadway area was higher. CONCLUSIONS: The findings suggest that factors unrelated to medical emergencies have a major influence on use of ambulance. Reevaluation of policy in order to promote appropriate utilization is necessary.

[Estimating cost functions of cancer screening programs provided by municipalities].

OBJECTIVE: To estimate cost functions of cancer screening programs for stomach, lung, colorectal, cervical, and breast cancers provided by municipalities and to describe the relationship between the costs and the scale of cancer screening programs. METHODS: Subjects were all the municipalities in Japan. Questionnaires were sent to 3,182 subjects and 1,860 responses were received. Data obtained from questionnaires were the number of persons screened and the total cost of each program in the 1998 fiscal year. A cost function of each program was specified as a linear model, a power model, and a cubic model, and the fitness of each model was estimated. RESULTS: Long-run cost functions of all the cancer screening programs allowed better explanation of the relationship between the number of persons screened and the total cost than short-run cost functions. The average costs of stomach, colorectal, and cervical cancer screening programs increased and the average cost of the lung cancer screening program decreased, as the number of persons screened increased. The cost function of the breast cancer screening program could not be identified. CONCLUSIONS: It is necessary to estimate not only cost functions but also production functions of cancer screening programs using the data related to products, costs, and factors of production to evaluate the efficiency of cancer screening programs.

[The validity of repeated mail surveys concerning smoking habits for Japanese physicians].

PURPOSE: A cross-sectional study of smoking prevalence among medical doctors was performed using questionnaires. Mailing four times proved essential in order to obtain a reasonable number of responses from the subjects. The objective of the present study was to analyze the smoking characteristics of the subjects who returned the questionnaires after the second to fourth mailings. METHODS: A set of an anonymous questionnaire and a letter from the President of the Japan Medical Association (JMA) requesting cooperation was mailed with a return envelope with the subject's name and address written to 3,000 male and 1,500 female doctors randomly selected from the roster membership of the JMA. The survey was conducted between February and June 2000. RESULTS: The collection rate after the first mailing was 66%, while the subtotal collection rate for the second through fourth mailings was 21%, bringing the grand-total to 87%. The total prevalence of smoking among the subjects who had sent back the questionnaire on the second to fourth mailings was approximately 1.5 times higher than for those who had sent back the questionnaire after the initial mailing for both male and female subjects. As to other characteristics of the subjects who only responded after the second to fourth mailings were: working in hospitals (odds ratios; male: 1.39, female: 1.47), not giving smoking cessation guidance (odds ratio; male: 0.58), and not recognizing the idea that doctors should not smoke (odds ratio; female: 0.67). CONCLUSIONS: The results suggested that for future surveys on smoking to be conducted in academic institutions or work-places, efforts to obtain responses from those who do not answer the first attempt should take into consideration these points.

[The influence of lifestyle and night-shift work on sleep problems among female hospital nurses in Japan].

STUDY OBJECTIVE: In this study, by conducting a questionnaire survey, we aimed to clarify the situation regarding sleep disorders in female hospital nurses and their relation with night-shift work and lifestyle. METHODS: The subjects were female nurses working at 5 hospitals, each with more than 400 beds. The survey was carried out in July 2000. The questionnaire contained six items concerning sleep quality from the Pittsburgh Sleep Quality Index (PSQI), two new items on sleep drafted by ourselves, and some questions on lifestyle and shift-work status. RESULTS: Among all female nurses, statistically significant differences were observed between those working and those not working night shifts for 7 items regarding sleep (P < 0.05). Significant correlations were observed between sleep disorders and the following factors: (1) working night shift, (2) having anxiety or stress, (3) getting less than 6 hours of sleep, (4) working in cities, (5) having children, and (6) bathing more than 1 hour before going to bed. In addition, significant correlations were observed between getting less than 6 hours of sleep and the following factors: (1) being 40 years of age or older, (2) working in cities, and (3) having anxiety or stress. CONCLUSIONS: The results of this study suggest that sleep problems among nurses are associated not only with night-shift work but also with lifestyle. They also suggest that nurses who work night shifts, especially in Tokyo, should try to get sufficient hours of sleep to ensure good quality of sleep.

[Factors related to smoking behavior of nursing students revealed by a cohort study].

PURPOSE: Through a cohort study, changes in smoking behavior of nursing students and the factors related to their smoking behavior were examined. METHOD: Research through anonymous questionnaires concerning smoking behavior was conducted on nursing students in the first to third grades (as of 1997) at two vocational schools of nursing located in the Tokyo Metropolitan area. The same research was conducted in the same manner on the same subjects the following year. RESULTS: The smoking prevalence among nursing students of the first and second grades as of 1997 had increased by 10% in one year, and that of nursing students of the third grade (to graduate in 1998) had increased by 5%. The average degree of nicotine dependence of the subjects, who replied that they smoked every day in both surveys, increased from 4.25 to 5.00. As to factors related to smoking behavior, the smoking behavior of friends largely influenced that of the nursing students. CONCLUSIONS: Education to prevent nursing students from smoking should be started as soon as possible at vocational schools of nursing, because the research showed that more than 70% of the smokers had actually thought of quitting and that their views toward smoking influenced later smoking behavior.

Changes in smoking prevalence and attitudes to smoking among Japanese physicians between 2000 and 2004.

OBJECTIVES: To estimate smoking prevalence among Japanese physicians in 2004, clarify their attitudes towards smoking, and compare and examine the results of the 2004 survey with those of the 2000 survey. STUDY DESIGN: Cross-sectional study. METHODS: Among members of the Japan Medical Association, 3000 male and 1500 female physicians were selected at random, and mailed self-administered, anonymous questionnaires. The survey was conducted between February and July 2004. Data from 3633 respondents were analysed. RESULTS: Smoking prevalence among males in 2004 was 21.5% [95% confidence interval (CI) 19.9-23.1%], which was significantly lower than that found in 2000 (27.1%; 95%CI 25.4-28.8%). Smoking prevalence among females in 2004 was 5.4% (95%CI 4.1-6.7%), which was not significantly different from that in 2000 (6.8%; 95%CI 5.4-8.2%). For nicotine dependency, no significant differences were observed for male or female physicians between 2004 and 2000. The percentages of respondents who agreed that 'physicians should not smoke' and 'patients should not smoke' increased in both males and females. The proportion of physicians that actively encouraged smoking cessation also increased in 2004. CONCLUSIONS: There were some favourable changes in anti-smoking behaviour among Japanese physicians between 2000 and 2004. However, several problems still need to be resolved, and further anti-smoking measures are required.

Somatic and psychological complaints and their correlates with insomnia in the Japanese general population.

OBJECTIVE: This cross-sectional study was conducted to estimate the prevalence of somatic and psychological complaints (SPCs) and to investigate the association of SPCs with insomnia in a sample of the general adult population of Japan. METHODS: We randomly selected 4000 adult residents (-20 years old) from five areas of Japan using stratified sampling and conducted interviews using a structured questionnaire. The questionnaire solicited information about eight somatic symptoms, eight psychological symptoms, three sleep problems, and demographic and health-related information. A total of 3,030 subjects completed questionnaires, giving a response rate of 75.8%. RESULTS: Stiff neck/shoulder (45.3%), backache (35.1%), and fatigue (31.4%) were the most common complaints in this population. In general, SPCs were more prevalent in younger persons and in women. Logistic regression analyses, controlling for other factors, showed that insomnia was significantly associated with a number of SPCs: backache (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.1-1.6), epigastric discomfort (OR = 1.7, 95% CI = 1.3-2.2), weight loss (OR = 2.0, 95% CI = 1.2-3.3), headache (OR = 1.7, 95% CI = 1.3-2.2), fatigue (OR = 1.7, 95% CI = 1.4-2.1), worrying (OR = 1.6, 95% CI = 1.1-2.3), irritability (OR = 1.4, 95% CI = 1.1-1.7), and loss of interest (OR = 1.8, 95% CI = 1.2-2.7). CONCLUSIONS: SPCs were common and were largely associated with insomnia in the general adult population of Japan. Further study is needed to examine the causal links between SPCs and insomnia.

Smoking behavior and related factors among Japanese nursing students: a cohort study.

BACKGROUND: Although there have been several surveys on smoking behavior among Japanese nursing students, most have been cross-sectional studies. No longitudinal studies, such as a prospective cohort study, have ever been carried out. We therefore conducted a cohort study on, and analyzed smoking behavior and related factors among, Japanese nursing students. METHODS: A survey on smoking behavior using a confidential questionnaire was conducted on nursing students at two vocational schools of nursing and two nursing colleges/universities located in the Tokyo metropolitan area. Another survey was subsequently conducted in the same manner among the same subjects 1 year later. The surveys were conducted between 1997 and 1999. RESULTS: Over the 1-year period, the prevalence of smoking among nursing students increased by 10% for students at the vocational schools of nursing (n = 224) and by 3% for students at the nursing colleges/universities (n = 222). The average score for nicotine dependence for students who were daily smokers at both time points rose from 3.6 to 4.4 (P < 0.05). Two factors found to significantly predict smoking behavior were having friends who smoke and living alone. CONCLUSION: Smoking prevalence is increasing among Japanese nursing students. Smoking prevention and cessation interventions should be instituted in all nursing training programs.

Study of the smoking behavior of medical doctors in Fukui, Japan and their antismoking measures.

We conducted a survey on smoking among all members of the medical association in Fukui Prefecture, using a questionnaire to be filled in by the subjects. The survey was conducted from December of 1996 to February of 1997, and the return rate was 90.8%. The main results of this survey were as follows: the prevalence of current smoking among medical doctors was 26.0% (male: 27.8%, female: 5.2%), which was lower than that of adults in the general population. The prevalence of past smoking among doctors 20 to 34 years old by age cohort was highest and that among doctors 35 years old and higher declines as age cohort increased. Doctors' participation in activities for the prevention of smoking in the general society was also found to be at a low level.

Smoking behaviors and attitudes among school teachers in Mie, Japan.

We conducted a questionnaire survey of public kindergarten, elementary and high school teachers in Mie Prefecture, concerning smoking habits and attitudes from November 1995 to February 1996. A self-reporting questionnaire was sent to approximately 16,000 teachers and school employees. The questionnaires were collected in a way which took into consideration the privacy of the respondents. A total of 13,998 questionnaires were returned. The percentages of smokers among the teachers were 44.7% for males and 3.1% for females, percentages which are lower than those for the general Japanese population. Almost all of the men and women agreed that anti-smoking education is needed. Most of those who did not feel anti-smoking education was needed were smokers themselves. Seventy percent of both men and women responded that anti-smoking education was a teachers' duty, however, only thirty-six percent of the male and twenty-one percent of the female teachers had actual experience at such education. Finally, almost all teachers wish wish that schools were totally smoke-free or had a partial ban on smoking and believe that school anti-smoking policies in Japan should be introduced.

Smoking prevalence of female nurses in the national hospitals of Japan.

OBJECTIVE: To estimate the prevalence of smoking and the attitudes towards the restriction of smoking at work among female nurses in the national hospitals in Japan. DESIGN: Questionnaires mailed to 14 randomly selected national hospitals and sanitariums in Japan in 1993. SUBJECTS: 2207 female nurses. MAIN OUTCOME MEASURES: Smoking status and history, and attitudes towards the restriction of smoking at work. RESULTS: The prevalence of smoking among female nurses was 18.6%, which was higher than the age-adjusted prevalence of the general female population using this study's subjects as a standardised population. Banning smoking in the hospital in which they worked was supported by 15.0%, whereas 81.6% supported the restriction of smoking. CONCLUSIONS: The results showed that smoking is more common among female nurses than among the general female adult population. The survey suggested that nurses favour restriction, but not banning, of smoking.