Association between socioeconomic status and prolonged television viewing time in a general Japanese population: NIPPON DATA2010

BACKGROUND@#It has been pointed out that prolonged television (TV) viewing is one of the sedentary behaviors that is harmful to health; however, the association between socioeconomic status (SES) and prolonged TV viewing time has not been sufficiently investigated in Japan.@*METHODS@#The study population are the participants of NIPPON DATA2010, which is a prospective cohort study of the National Health and Nutrition Survey 2010 in Japan. They were residents in 300 randomly selected areas across Japan. This study included 2752 adults. SES was classified according to the employment status, educational attainment, living status, and equivalent household expenditure (EHE). Prolonged TV viewing time was defined as more than or equal to 4 h of TV viewing per day. Multivariable logistic regression analyses were conducted to examine the association of SES with prolonged TV viewing time.@*RESULTS@#The mean TV viewing time was 2.92 h in all participants. Of 2752 participants, 809 (29.4%) prolonged TV viewing, and the mean TV viewing time of them was 5.61 h. The mean TV viewing time in participants without prolonged TV viewing time was 1.81 h. The mean TV viewing time was prolonged as age classes increased and significantly longer in aged ≥60 years. Prolonged TV viewing time was associated with not working for all age classes and sexes. Only among women, education attainment and living status were also associated with prolonged TV viewing time. For education attainment, the lower the received years of education, the higher odds ratios (OR) of prolonged TV viewing time. For living status, in women aged <60 years, living with others had a significantly higher OR compared to living with spouse. On the other hand, in women aged ≥60 years, living alone had a significantly higher OR. EHE did not have any significant associations with prolonged TV viewing time.@*CONCLUSIONS@#In a general Japanese population, it should be noted that the association between SES and prolonged TV viewing time differed by age and sex. Particularly, it must draw attention to the prolonged TV viewing in elderly. The intervention in order to shorten TV viewing time needs to consider these attributes.

Socioeconomic and lifestyle factors associated with depressive tendencies in general Japanese men and women: NIPPON DATA2010

BACKGROUND@#The gender-specific characteristics of individuals at an increased risk of developing depression currently remain unclear despite a higher prevalence of depression in women than in men. This study clarified socioeconomic and lifestyle factors associated with an increased risk of subclinical depression in general Japanese men and women.@*METHODS@#Study participants were residents not receiving psychiatric treatments in 300 sites throughout Japan in 2010 (1152 men, 1529 women). Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95%CIs) for socioeconomic factors and lifestyle factors were calculated using a logistic regression analysis.@*RESULTS@#Risk of depressive tendencies was significantly higher in men who were single and living alone (OR, 3.27; 95% CI, 1.56-6.88) than those married. The risk was significantly lower in women who were not working and aged ≥ 60 years (OR, 0.39; 95% CI, 0.22-0.68) and higher in men who were not working and aged < 60 years (OR, 3.57; 95%CI, 1.31-9.72) compared with those who were working. Current smoking was also associated with a significantly increased risk of depressive tendencies in women (OR, 2.96; 95% CI, 1.68-5.22) but not in men.@*CONCLUSIONS@#Socioeconomic and lifestyle factors were associated with an increased risk of depressive tendencies in general Japanese. Related factors were different by sex.

Having few remaining teeth is associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese individuals: findings from the NIPPON DATA2010

BACKGROUND@#Oral health is thought to be associated with diet quality, and socioeconomic status (SES) affects both oral health and diet. The aim of this study was to investigate the association between the number of teeth and dietary intake as well as nutritional biomarker, considering the subjects' SES.@*METHODS@#We conducted a cross-sectional analysis of data from 2049 individuals aged ≥ 50 years from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010. The number of remaining teeth was categorized into age-specific quartiles (Q1 to Q4). We assessed the adjusted means and 95% confidence intervals for dietary variables by the number of teeth using analysis of covariance. Stratified analyses by SES were also conducted.@*RESULTS@#The intake of grain products was 31 g higher, and those of vegetables and meat were 30 g and 8 g lower, respectively, in Q1 (fewer teeth) than in Q4 (more teeth). Carbohydrate intake was higher whereas protein, minerals (potassium, magnesium, and zinc), vitamins (vitamins A, E, B, B, β-carotene, and folic acid), and dietary fiber intakes were lower among individuals with fewer teeth. Adjusted mean serum albumin levels were low in Q1. The associations between the number of teeth and dietary intake were more evident in individuals with a low SES.@*CONCLUSIONS@#Having few remaining teeth was associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese adults, and these associations were more evident in individuals with low SES.

A validation study on food composition tables for the international cooperative INTERMAP study in Japan

<p><b>OBJECTIVE</b>The INTERMAP Study is an international cooperative study on the relationship between macro- and micro-nutrient intakes and blood pressure. The present study-ancillary to INTERMAP-is to evaluate validity of the INTERMAP Tables of Food Composition in Japan (ITJ) formulated by modifying the Standard Tables of Food Composition in Japan (STJ), including factoring in changes in weight and nutrient composition of individual foods due to cooking.</p><p><b>METHODS</b>With chemical analytical values of 96 meals prepared in two university hospitals in Japan as the "gold standard", validity of calculated values based on the ITJ was examined for six major components (energy, protein, lipid, carbohydrate, sodium, potassium) by comparison of mean values, correlation, and linear regression analysis.</p><p><b>RESULTS</b>Although both the ITJ-based and STJ-based calculated values for all six components were significantly higher than the analytical values, differences from the analytical values were generally less marked for the ITJ-based values than for the STJ-based values. The STJ-based values were significantly higher than the ITJ-based values for protein and potassium. Analytical values showed slightly stronger correlations with the ITJ-based calculated values (r=0.876 for total energy, r=0.789 for lipid, r=0.832 for potassium) than with the STJ-based calculated values, except for carbohydrates.</p><p><b>CONCLUSIONS</b>The ITJ was considered to have greater validity than the STJ. To obtain more accaurate data in nutritional surveys, food composition tables in which changes in nutrient compositions due to cooking methods are taken into consideration should be used.</p>

A Validation Study on Food Composition Tables for the International Cooperative INTERMAP Study in Japan

Objective: The INTERMAP Study is an international cooperative study on the relationship between macro- and micro-nutrient intakes and blood pressure. The present study—ancillary to INTERMAP—is to evaluate validity of the INTERMAP Tables of Food Composition in Japan (ITJ) formulated by modifying the Standard Tables of Food Composition in Japan (STJ), including factoring in changes in weight and nutrient composition of individual foods due to cooking. Methods: With chemical analytical values of 96 meals prepared in two university hospitals in Japan as the “gold standard”, validity of calculated values based on the ITJ was examined for six major components (energy, protein, lipid, carbohydrate, sodium, potassium) by comparison of mean values, correlation, and linear regression analysis. Results: Although both the ITJ-based and STJ-based calculated values for all six components were significantly higher than the analytical values, differences from the analytical values were generally less marked for the ITJ-based values than for the STJ-based values. The STJ-based values were significantly higher than the ITJ-based values for protein and potassium. Analytical values showed slightly stronger correlations with the ITJ-based calculated values (r=0.876 for total energy, r=0.789 for lipid, r=0.832 for potassium) than with the STJ-based calculated values, except for carbohydrates. Conclusions: The ITJ was considered to have greater validity than the STJ. To obtain more accaurate data in nutritional surveys, food composition tables in which changes in nutrient compositions due to cooking methods are taken into consideration should be used.

Non-pharmacological intervention study of hypercholesterolemia among middle-aged people

Middle-aged people with a serum total cholesterol of more than 220 mg/dl at the latest health examination (n=197) at a chemical company were invited to join a health education program for 6 months. Participants meeting inclusion criteria were randomly assigned to an intervention (n=96) and a control group (n=92). Periodical interviews and blood tests were performed every 2 months for both groups. The intervention group was educated by health professionals in the factories through programs developed for hypercholesterolemia. After a 6-month intervention, the reduction of cholesterol levels and the differences between the groups were analysed.The mean total cholesterol (TCH) levels at the baseline measurement were 239.7 mg/dl in the intervention group and 236.5 mg/dl in the control group. During the intervention period, decreased levels of TCH were 27.1 mg/dl for the intervention group and 18.5 mg/dl for the control group. Declines in body weight, TCH and triglyceride levels in the intervention group were significantly larger than those in the control group. The decline of apoprotein-B was also significantly larger in the intervention group while high-density lipoprotein cholesterol levels essentially did not change.The health education by health professionals proved to be useful in reducing the risk factor levels for coronary heart disease. These results suggest that health education would also be useful against other major risk factors in cardiovascular diseases.

Effectiveness of annual interventions for smoking cessation in an occupational setting in Japan

<p><b>OBJECTIVE</b>To examine the effectiveness of a small-scale smoking cessation intervention program conducted annually for ten years in an occupational setting in Japan.</p><p><b>METHODS</b>We conducted an annual intervention program promoting smoking cessation in male smokers from 1993 to 2002 in an occupational setting in Hyogo, Japan. Trends in smoking prevalence in this worksite were compared with a control group from two similar worksites of the same company. The intervention program was carried out by medical students (the fourth year of a six-year course) who received training on the protocol prior to the intervention. This protocol consisted of one initial group session, followed by periodical correspondence for two months. Successful cessation of smoking was determined by self-declaration of abstinence for longer than four weeks after intervention, confirmed by an expiratory carbon monoxide concentration of less than nine ppm. Smoking prevalence was determined by a self-administered questionnaire provided at the annual health checkup.</p><p><b>RESULTS</b>The proportion of smokers who participated in the program was 3.47% on average. Abstinence rates following each intervention ranged from 13.3% to 60.0%, with the prevalence of male smokers at the intervention worksite decreasing from 56.2% in 1993 to 47.0% in 2002. In contrast, the smoking prevalence of the control worksites remained largely unchanged, being 60.2% in 1995 and 57.6% in 2002. At the end of the study, the intervention worksite had a significantly lower prevalence of smokers in either the crude or age-adjusted rate.</p><p><b>CONCLUSION</b>A small-scale but repeated smoking cessation intervention program at a worksite can reduce smoking prevalence more efficiently than the natural trends.</p>

Effects of stage-matched repeated individual counseling on smoking cessation: A randomized controlled trial for the high-risk strategy by lifestyle modification (HISLIM) study

<p><b>OBJECTIVE</b>The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking.</p><p><b>METHODS</b>We conducted a multisite randomized controlled trial that enrolled smokers unselected for their readiness to quit. There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and randomly allocated to the intervention or control group. Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20-30 minute follow-up sessions. Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia.</p><p><b>RESULTS</b>The point prevalence abstinence rate at 6 months, validated by carbon monoxide testing, in the intervention group (13.6%) was 5.4 times higher (p<0.001) than that in the control group (2.5%). When the data were analyzed based on the baseline stage of change, there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives. The odds ratio was 6.4 (p<0.001) in precontemplators, 6.7 (p<0.001) in contemplators, and 6.2 (p<0.01) in preparators. There was a positive, consistent effect of the intervention regardless of study site (worksite or community) or the presence of hypertension or hypercholesterolemia.</p><p><b>CONCLUSIONS</b>We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit. This result suggests that stage-matched individual counseling, based on the transtheoretical model, is effective in smokers with a lower motivation to quit as well as those ready to quit.</p>

The evaluation of materials to provide health-related information as a population strategy in the worksite: The high-risk and population strategy for occupational health promotion (HIPOP-OHP) study

<p><b>OBJECTIVE</b>To examine the effectiveness of newly developed materials for providing health-related information to the worksite population, we compared the amount of attention that employees paid to the materials.</p><p><b>METHODS</b>Study subjects were 2,361 employees in six companies participating in an intervention program between 2002 and 2003. Three kinds of media were used as tools for providing health information: [1] Point Of Purchase advertising menus (POP menus) were placed on all tables in company restaurants, [2] posters were put on walls and [3] leaflets were distributed at health-related events. One year or more after the introduction of these media, we compared the amount of attention paid to each type of medium.</p><p><b>RESULTS</b>Amongst the three types of media, the POP menu drew the most attention, although results were not consistent in all gender and company groups. Every piece of information provided by the POP menus was "always" or "almost always" read by 41% of the men and 51% of the women surveyed. The corresponding rate for posters was 30% in men and 32% in women. For leaflets, only 16% of men and 22% of women read almost all of the leaflets. More attention was paid to the POP menu when the sample was women, older, and ate at the company restaurant at least three times a week.</p><p><b>CONCLUSION</b>The POP menu may provide health-related information to a broader range of people than posters and leaflets, therefore, it is an effective material for population strategy.</p>

Methodological issues for a large-scale intervention trial of lifestyle modification: Interim assessment of the high-risk and population strategy for occupational health promotion (HIPOP-OHP) study

<p><b>OBJECTIVE</b>To clarify the methodological issues for the High-risk and population Strategy for Occupational Health Promotion Study (HIPOP-OHP study), which is a 4-year non-randomized control trial, an interim assessment of male participants was performed 3 years after the baseline survey.</p><p><b>METHODS</b>We had approximately 2,500 and 4,000 participants in the intervention and control groups, respectively. The population measures and prevalence of risk factors at each year, and between the baseline and 4th examinations were compared between the two groups. The personal trends of returning participants who were in the study at the 1(st) and 4(th) examinations were also evaluated.</p><p><b>RESULTS</b>During the 3 years, an increase in serum HDL cholesterol (2.7 mg/dl), and a reduction in the prevalence of hypertriglycemia detected with fasting blood samples (3.6%) and current smokers (5.4%) were observed in the intervention group. The mean HDL cholesterol level was significantly higher in the intervention group than in the control group at the 4th examination, reversed from the baseline survey. The serum non-HDL cholesterol level was significantly increased only in the control group. There was also a significant increase in the prevalence of hypertriglycemia nad high plasma glucose detected with fasting blood samples in the control group. The return participation rate after 3 years was 72.2% for the intervention group and 74.9% for the control group. The above-mentioned changes for risk factors were mainly due to returning participants at each examination.</p><p><b>CONCLUSION</b>These interventional methods may be effective in improving overall cardiovascular risk factors in the population. However, the low return participation rate will dilute the effect of the intervention.</p>

Methodological Issues for a Large-Scale Intervention Trial of Lifestyle Modification: Interim Assessment of the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) Study

Objective: To clarify the methodological issues for the High-risk and Population Strategy for Occupational Health Promotion Study (HIPOP-OHP study), which is a 4-year non-randomized control trial, an interim assessment of male participants was performed 3 years after the baseline survey. Methods: We had approximately 2,500 and 4,000 participants in the intervention and control groups, respectively. The population measures and prevalence of risk factors at each year, and between the baseline and 4th examinations were compared between the two groups. The personal trends of returning participants who were in the study at the 1st and 4th examinations were also evaluated. Results: During the 3 years, an increase in serum HDL cholesterol (2.7 mg/dl), and a reduction in the prevalence of hypertriglycemia detected with fasting blood samples (3.6%) and current smokers (5.4%) were observed in the intervention group. The mean HDL cholesterol level was significantly higher in the intervention group than in the control group at the 4th examination, reversed from the baseline survey. The serum non-HDL cholesterol level was significantly increased only in the control group. There was also a significant increase in the prevalence of hypertriglycemia and high plasma glucose detected with fasting blood samples in the control group. The return participation rate after 3 years was 72.2% for the intervention group and 74.9% for the control group. The above-mentioned changes for risk factors were mainly due to returning participants at each examination. Conclusion: These interventional methods may be effective in improving overall cardiovascular risk factors in the population. However, the low return participation rate will dilute the effect of the intervention.

The Evaluation of Materials to Provide Health-Related Information as a Population Strategy in the Worksite: The High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) Study

Objective: To examine the effectiveness of newly developed materials for providing health-related information to the worksite population, we compared the amount of attention that employees paid to the materials. Methods: Study subjects were 2,361 employees in six companies participating in an intervention program between 2002 and 2003. Three kinds of media were used as tools for providing health information: [1] Point Of Purchase advertising menus (POP menus) were placed on all tables in company restaurants, [2] posters were put on walls and [3] leaflets were distributed at health-related events. One year or more after the introduction of these media, we compared the amount of attention paid to each type of medium. Results: Amongst the three types of media, the POP menu drew the most attention, although results were not consistent in all gender and company groups. Every piece of information provided by the POP menus was “always” or “almost always” read by 41% of the men and 51% of the women surveyed. The corresponding rate for posters was 30% in men and 32% in women. For leaflets, only 16% of men and 22% of women read almost all of the leaflets. More attention was paid to the POP menu when the sample was women, older, and ate at the company restaurant at least three times a week. Conclusion: The POP menu may provide health-related information to a broader range of people than posters and leaflets, therefore, it is an effective material for population strategy.

Effects of Stage-matched Repeated Individual Counseling on Smoking Cessation: A Randomized Controlled Trial for the High-risk Strategy by Lifestyle Modification (HISLIM) Study

Objective: The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking. Methods: We conducted a multisite randomized controlled trial that enrolled smokers unselected for their readiness to quit. There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and randomly allocated to the intervention or control group. Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20-30 minute follow-up sessions. Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia. Results: The point prevalence abstinence rate at 6 months, validated by carbon monoxide testing, in the intervention group (13.6%) was 5.4 times higher (p<0.001) than that in the control group (2.5%). When the data were analyzed based on the baseline stage of change, there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives. The odds ratio was 6.4 (p<0.001) in precontemplators, 6.7 (p<0.001) in contemplators, and 6.2 (p<0.01) in preparators. There was a positive, consistent effect of the intervention regardless of study site (worksite or community) or the presence of hypertension or hypercholesterolemia. Conclusions: We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit. This result suggests that stage-matched individual counseling, based on the transtheoretical model, is effective in smokers with a lower motivation to quit as well as those ready to quit.

Effectiveness of Annual Interventions for Smoking Cessation in an Occupational Setting in Japan

Objective: To examine the effectiveness of a small-scale smoking cessation intervention program conducted annually for ten years in an occupational setting in Japan. Methods: We conducted an annual intervention program promoting smoking cessation in male smokers from 1993 to 2002 in an occupational setting in Hyogo, Japan. Trends in smoking prevalence in this worksite were compared with a control group from two similar worksites of the same company. The intervention program was carried out by medical students (the fourth year of a six-year course) who received training on the protocol prior to the intervention. This protocol consisted of one initial group session, followed by periodical correspondence for two months. Successful cessation of smoking was determined by self-declaration of abstinence for longer than four weeks after intervention, confirmed by an expiratory carbon monoxide concentration of less than nine ppm. Smoking prevalence was determined by a self-administered questionnaire provided at the annual health checkup. Results: The proportion of smokers who participated in the program was 3.47% on average. Abstinence rates following each intervention ranged from 13.3% to 60.0%, with the prevalence of male smokers at the intervention worksite decreasing from 56.2% in 1993 to 47.0% in 2002. In contrast, the smoking prevalence of the control worksites remained largely unchanged, being 60.2% in 1995 and 57.6% in 2002. At the end of the study, the intervention worksite had a significantly lower prevalence of smokers in either the crude or age-adjusted rate. Conclusion: A small-scale but repeated smoking cessation intervention program at a worksite can reduce smoking prevalence more efficiently than the natural trend.

Non-pharmacological Intervention Study of Hypercholesterolemia among Middle-Aged People

Middle-aged people with a serum total cholesterol of more than 220 mg/dl at the latest health examination (n=197) at a chemical company were invited to join a health education program for 6 months. Participants meeting inclusion criteria were randomly assigned to an intervention (n=96) and a control group (n=92). Periodical interviews and blood tests were performed every 2 months for both groups. The intervention group was educated by health professionals in the factories through programs developed for hypercholesterolemia. After a 6-month intervention, the reduction of cholesterol levels and the differences between the groups were analysed. The mean total cholesterol (TCH) levels at the baseline measurement were 239.7 mg/dl in the intervention group and 236.5 mg/dl in the control group. During the intervention period, decreased levels of TCH were 27.1 mg/dl for the intervention group and 18.5 mg/dl for the control group. Declines in body weight, TCH and triglyceride levels in the intervention group were significantly larger than those in the control group. The decline of apoprotein-B was also significantly larger in the intervention group while high-density lipoprotein cholesterol levels essentially did not change. The health education by health professionals proved to be useful in reducing the risk factor levels for coronary heart disease. These results suggest that health education would also be useful against other major risk factors in cardiovascular diseases.