Has the double burden of malnutrition reached pupils in rural western Kenya?

BACKGROUND: Undernutrition and overnutrition have been considered separate challenges caused by the distinct factors in distinct settings. The double burden of malnutrition is defined as the coexistence of both undernutrition and overnutrition, which has now spread globally, especially in low- and middle-income countries. In Kenya, the double burden of malnutrition is present in the capital city but the situation in rural areas currently remains unknown. The aim of this study was therefore to analyze nutritional status in rural Kenya. METHODS: Data from height and weight measurements conducted by teachers in the third term of school year 2013 were collected from primary schools. Teachers were trained by experts before starting the measurements. The Z-scores of height-for-age, weight-for-age, and body mass index-for-age were calculated using AnthroPlus, and nutritional status was defined according to the World Health Organization guidelines. RESULTS: Data analyzed from 7,447 pupils (3,763 boys and 3,684 girls) showed that 12.4% were stunted and 7.8% were underweight among those ≤120 months old, and 11.7% were thin among those >120 months old. Boys were more likely to be stunted than girls. Boys were more likely to be underweight and girls were more likely to be overweight in the older age group. CONCLUSION: The double burden of malnutrition was not found, and undernutrition was still common among schoolchildren in the study area. However, it is important to monitor nutritional status due to adverse effects of rapid urbanization. Height and weight measurements in schools may be useful for monitoring the nutritional status of schoolchildren.

Factors enabling systematized national school health services in Japan.

BACKGROUND: Japan has provided nationwide school health services since 1872. However, the system used and the factors enabling this provision have not been fully and systematically explored. This study aimed to provide an overview of the system and identify enabling factors for the provision of school health services in Japan, to support successful implementation in developing countries. METHODS: We reviewed research papers and related documents and identified factors likely to support successful provision of school health services in developing countries. RESULTS: The following six key factors were identified that support systematized, nationwide school health service provision in Japan: (i) existence of a legal basis for school health services provision, (ii) partnership between the education and health sectors, (iii) a systematized supervision system at all administrative levels, (iv) clear definition of essential services and stakeholders' responsibilities, (v) utilization of skilled human resources for school health services at school level, and (vi) regular assessment of children's health issues. CONCLUSION: Five factors were proposed as essential for successful provision of school health services in developing countries: (i) formulation of national school health policies and guidelines with clear definitions of essential health services and stakeholders' responsibilities, (ii) strengthening partnerships within and between health and education sectors at all administrative levels, (iii) building cooperation between school and health professionals and at the community and school levels, (iv) establishing sustainable development of personnel for school health in the education sector, and (v) developing systems for collecting children's health data, assessing their health issues, and monitoring and evaluating the implementation.

Lessons on health promotion from Japanese early childhood development.

Early childhood development (ECD) has received increasing attention in both developed and developing countries since the 1990s. In Japan, ECD facilities have pursued integrated practices of education and health care to provide appropriate services to promote children's welfare. This ECD approach appears to embody objectives of health promotion in young children. Therefore, information about Japanese practices may help to support ECD in other countries, especially developing countries. In this context, the present study discussed the potential application of health-related ECD practices in Japan for developing countries by reviewing an outline of Japanese ECD, along with a case study describing practices in ECD facilities in Japan. We identified four main points: (i) distinct legal grounds including a legal basis for allocating health specialists; (ii) outlines of activities based on national standards and flexible practices at the facility level; (iii) teachers' attitudes that respect children's initiative, and explicit and independent activities embedded in children's daily lives that reflect the child's developmental status; and (iv) various useful practices to enhance the effect of health-related activities, such as cooperation with parents, lesson study and hoiku- (teachers) conference. As these practices are based on the Japanese context, it is essential to consider both the Japanese context and potential risks of transplanting such concepts, to enable optimum use of these lessons in other countries.

Lessons learned from health education in Japanese schools.

INTRODUCTION: A qualitative improvement in school health education is required to improve health for school-aged children in developing countries. This study aimed to clarify the factors that enable the provision of comprehensive and consistent health education in Japan. METHODS: We reviewed health education in Japanese schools and the feature of curriculum revision, and clarified the factors that enable the provision of comprehensive and consistent health education. RESULTS: We identified nine points as enabling factors: (i) clear description of the purpose of health education; (ii) clear provision of teaching content and adequate time allocation; (iii) comprehensive school health framework and clarification of the position of the health education; (iv) systems for surveying and screening children's health problems; (v) regular revising of the Courses of Study; (vi) well trained teachers responsible for health education; (vii) health education specialists in higher education facilities; (viii) various materials related to health education; and (ix) collaboration with related health workers. CONCLUSIONS: We proposed measures to enhance health education in developing countries: (i) clarifying the role of health education toward achieving goals set out in laws and policies related to education; (ii) providing appropriate learning content and time allocation; (iii) establishing a comprehensive school health framework; (iv) establishing a system that continuously monitors children's health issues; (v) identifying the person responsible for health education in a school and establishing a training system; (vi) providing a teacher's guide and teaching materials to facilitate child participatory learning, and (vii) collaborating with guardians, community members, and local health workers.

Health screening system to ensure children's health and development in Japan.

BACKGROUND: The establishment of health screening systems for children is important, however, such systems are not always well-established in developing countries. This study aimed to improve child health screening systems in developing countries by analyzing the factors that contribute to enabling continuous and proper screenings at various governmental levels in Japan. METHODS: We reviewed the history of child health and development screening systems in Japan and examined factors that enabled their regular and nationwide implementation. RESULTS: We identified the six enabling factors: (i) the existence of relevant laws and regulations in health and education systems for health checkups, (ii) mandated and detailed conditions for health checkups within both school and community health, (iii) the provision of guidelines and manuals for health checkups, (iv) a sufficient number of professionals to carry out the health checkups, (v) clear criteria for evaluating and interpreting the checkup results, and (vi) understanding among teachers, children, and guardians of the importance of health checkups. CONCLUSION: We proposed the following six requirements to the governments in developing countries for establishing their own health screening programs: (i) a clear description of the need for regular and continuous health checkups in the relevant laws, regulations, and policies, (ii) mandate as essential activity and detailed requirements of the screening activities, (iii) provision of relevant manuals for health workers and teachers, (iv) provision of enough well-trained professionals and a training system, (v) studying growth and development curves for children, and (vi) promoting understanding among stakeholders about the importance of health checkups.

Introducing Ecohealth education in a Teacher Training Institute in Lao PDR: a case study.

This paper argues the effectiveness of Ecohealth education for improving the quality of health and environmental education and for achieving sustainable development in developing countries. To illustrate the need for Ecohealth education, we review the transitions in health education, environmental education and Education for Sustainable Development (ESD) in various developing countries. Moreover, we discuss issues relating to these disciplines and consider the possible roles that Ecohealth education can play. Then, drawing on a case study conducted in Lao PDR, we propose a concrete example of the teaching content of Ecohealth education. We conclude that Ecohealth education can embody the concepts of ESD with respect to health and environmental issues, and thus can contribute to improvements in the quality of health and environmental education, and of ESD. In addition, we propose the following five actions for implementing Ecohealth education in developing countries: (i) promote research based on the approaches of public health and anthropology, and develop teaching materials that use the research results, (ii) empower school-aged children, (iii) encourage the active involvement and sharing of problems among communities, (iv) strengthen participatory teaching and learning methodology and (v) build a training system and train relevant teachers.

[Factors related to plateauing among Yogo teachers].

Objectives　The purpose of this study was to identify the factors related to plateaus to support the career development of Yogo teachers (school nurses).Methods　In March 2017, 1,000 elementary, junior high, and high schools in Tokyo, Kanagawa, Saitama, and Chiba prefectures were stratified and randomized. Questionnaires were sent to 1,000 Yogo teachers in each school. Plateaus among Yogo teachers were analyzed by hierarchical multiple regression analysis and path analysis by creating a conceptual framework that leads to plateauing through work engagement from professional autonomy (innovative behavior), social support in the workplace, and work-related stressors.Results　Data from 335 Yogo teachers were included in the analysis. The path analysis indicated that the factors that influenced content plateau among Yogo teachers were work engagement, self-learning of professional autonomy (innovative behavior), and years of experience. Work engagement was influenced by self-learning, pursuit of better practice, informational support, instrumental support, emotional support, role ambiguity, and job position. The developed model was a substantial fit to the data: CFI=1.00, RMSEA=0.00, SRMR=0.01. The coefficient of determination was R2=0.41 for the content plateau phenomenon and R2=0.45 for work engagement. Factors that influenced hierarchical plateau among Yogo teachers were work engagement, self-learning, education, job position, and the absence of a school counselor. Work engagement was influenced by self-learning, pursuit of better practice, informational support, instrumental support, emotional support, role ambiguity, and job position. The model was a substantial fit to the data: CFI=1.00, RMSEA=0.00, SRMR=0.01. The coefficient of determination was R2=0.25 for the hierarchical plateau phenomenon and R2=0.45 for work engagement.Conclusions　This study found that the low plateau phenomenon among Yogo teachers was associated with high self-learning of professional autonomy (innovative behavior) and work engagement. To prevent the plateau phenomenon, it is necessary to support them to enhance self-learning, create a conducive work environment, and consider training for Yogo teachers that takes into account their years of experience.

Sustainable human resource training system for promoting school health in Japan.

BACKGROUND: It is essential to develop relevant human resources and sustainable training systems to promote school health. METHODS: This paper reviewed the structure of human resources and relevant training systems for school health in Japan and identified current strengths and challenges. RESULTS: Our review identified seven key points: (i) a legal basis for the allocation of human resources to schools; (ii) established training systems for school health human resources; (iii) uniformity and quality of teacher training curricula; (iv) establishment of teacher-training institutions; (v) education centers in every prefecture; (vi) allocation of supervisors for Yogo teachers to every prefectural and municipal education board; and (vii) various study group activities at the district and school levels. CONCLUSIONS: Based on these results, we proposed some useful ideas for developing human resources to promote school health in countries outside Japan, especially for developing countries. First, it is necessary to clarify the required competencies for school health among school staff and establish teacher-training systems based on the required competencies in each country. It is also necessary to consider possible collaboration with existing community health workers, such as doctors, nurses, midwives, nutritionists, and community health workers by providing short-term training on school health. Second, it is important to train and assign specialists to teacher-training institutions that can provide education and conduct research on school health. Third, it is helpful to enhance the functions of in-service training at the prefectural or district level and introduce lesson study on school health.

Participation of children in school health in Japan.

BACKGROUND: The importance of promoting child participation in school health has been emphasized internationally. This study examined ways in which Japan's school health system involves children, and factors enabling child participation in this system. It also suggests strategies to promote child participation in school health in developing countries. METHODS: We conducted a document review to clarify the importance of, and recent trends in, child participation in school health. We summarized the system of child participation in school health in Japan and examined factors enabling child participation. RESULTS: We identified the following four factors that enable child participation in school health in Japan: (i) having an explicit legal basis for participatory activities at the national level; (ii) having clear notification, in relevant administrative documents at the prefectural and municipal levels, of the necessity for children's voluntary participation; (iii) establishing a system for teachers to provide support for participatory activities at the school level, and (iv) having a shared understanding among stakeholders about the pedagogical importance of participatory activities in school health. CONCLUSIONS: To promote child participation in school health activities in developing countries, it is necessary to describe clearly the importance, benefits, impacts, and purposes of child participation in relevant legal and administrative documents at relevant administrative levels. Schools should also ensure that stakeholders have a common understanding of the educational benefits of child participation considering the cultural context of each country. It is helpful to conduct appropriate training for teachers to enable them to facilitate child participation.

Implementation of Kenyan comprehensive school health program: improvement and association with students' academic attainment.

There is growing evidence supporting the effectiveness of a comprehensive school health program. However, implementation in developing countries is a challenge. Furthermore, the available information on the association between a comprehensive school health program and students' academic attainment is limited. In Kenya, a project to verify the effects of a comprehensive school health program was carried out in Mbita sub-county, Homa Bay County from September 2012 to August 2017. This study aimed to clarify the improvement of school health during the project years and the association between school health and students' academic attainment. Primary schools in Mbita sub-county were selected as study sites. We assessed 44 schools' scores on a school health checklist developed from the Kenyan Comprehensive School Health Program, the students' mean score on the Kenya Certificate of Primary Education (KCPE), and absenteeism during the project years (2013-16). The mean school health checklist score (n = 44 schools) was 135.6 in 2013, 169.9 in 2014, 158.2 in 2015 and 181.3 in 2016. The difference of the mean score between 2013 and 2016 was significant. In addition, correlation analysis showed a significant association between mean KCPE score in the project years and school health checklist score (Pearson's coefficient was 0.43, p = 0.004). The results of this study suggest improvements of school health by the implementation of the Kenyan Comprehensive School Health Program and students' academic attainment.

The ecosystem approach to health is a promising strategy in international development: lessons from Japan and Laos.

BACKGROUND: An ecological perspective was prominently present in the health promotion movement in the 1980s, but this seems to have faded. The burden of disease the developing world is facing cannot be addressed solely by reductionist approaches. Holistic approaches are called for that recognize the fundamentally interdependent nature of health and other societal, developmental, and ecosystem related factors in human communities. An ecosystem approach to human health (ecohealth) provides a good starting point to explore these interdependencies. DISCUSSION: Development assistance is often based on the assumption that developed countries can serve as models for developing ones. Japan has provided lavish assistance to Laos for example, much of it going to the development of transport networks. However, there is little sign that there is an awareness of the potentially negative environmental and health impacts of this assistance. We argue that the health consequences of environmental degradation are not always understood, and that developing countries need to consider these issues. The ecohealth approach is useful when exploring this issue. We highlight three implications of the ecohealth approach: (1) The WHO definition of health as a state of complete physical, mental and social well-being emphasized that health is more than the absence of disease. However, because this approach may involve an unattainable goal, we suggest that health should be defined in the ecosystem context, and the goal should be to attain acceptable and sustainable levels of health through enabling people to realize decent livelihoods, and to pursue their life purpose; (2) The increasing interconnectedness of ecosystems in a globalizing world requires an ethical approach that considers human responsibility for the global biosphere. Here, ecohealth could be a countervailing force to our excessive concentration on economy and technology; and (3) If ecohealth is to become a positive agent of change in the global health promotion movement, it will have to find a secure place in the educational curriculum. This article presents a brief case study of Japan's development assistance to Laos, and its environmental and health implications, as an illustration of the ecohealth approach. We highlight three implications of the ecohealth perspective.

Path Model of Reality Gap on the Mental Health of Novice School Nurses in Japan.

Introduction: Mental health is a serious concern among novice school nurses in Japan. Numerous novice school nurses with various health problems experience high stress levels, affecting their mental health. They may be experiencing reality shock, a known risk factor for burnout and turnover, or its factor, the "reality gap." Objective: This study aimed to examine the hypothetical model by which the reality gap affects the mental health of novice school nurses. Methods: This cross-sectional study conducted a self-administered questionnaire survey, and responses were obtained from 102 novice school nurses. A path model was created based on a hypothetical model. Results: After several revisions on the hypothesis model, a modified path model was generated (CFI = .98, TLI = .93, RMSEA = .06). The path model showed that reality gaps negatively affected work engagement, work engagement positively affected intention to stay, and intention to stay positively affected mental health. Reality gap was also directly negatively associated with mental health. Having various support networks reduced the effects of reality gaps on mental health. Additionally, social support in the workplace boosted work engagement. Conclusion: Unique from other studies, this study contributed to understanding the effects of reality gaps on mental health. School managers and administrators should establish a support system that enables school nurses to receive various supports from within and outside the school. In addition, novice school nurses should take advantage of networks and support inside and outside school to reduce reality gaps and grow as professionals.

A Sense of Belonging and Help Seeking: Examining Factors Related to the Mental Health of High School Students with High Autistic Traits without Diagnosis.

Certain individuals are clinically undiagnosed for Autism Spectrum Disorder (ASD) but exhibit strong ASD characteristics. This study examined the differences between a control group and a "high autistic traits" group involving individuals who scored 9 or higher on the Autism-Spectrum Quotient-16 Japanese Version, based on their sense of belonging, help-seeking style, and relationship with mental health. The participants were 608 Japanese public high school students. Of them, 129 (21.2%) and 479 (78.8%) were in the high autistic traits and control groups, respectively. A multiple regression analysis was performed using the General Health Questionnaire (GHQ) as the dependent variable for the groups. The analysis revealed no differences between the two groups regarding grade, gender, physical illness, insomnia, or mental health status; however, they differed regarding avoidant help-seeking style and teacher acceptance. Moreover, avoidant help-seeking scores in the high autistic traits group and teacher acceptance showed a significantly positive and significantly negative association with GHQ, respectively. The results indicated that children with autistic traits internally suppress them, experiencing distress. Teachers are aware that these students seek support from them, but the students seem reluctant to ask them for help. This can negatively impact the mental health of children with high autistic traits.

[Neighborhood environment quality, individual-level social capital, and depressive symptoms among adolescents].

OBJECTIVES: We aimed to develop measures to assess features of neighborhood quality and individual social capital, as well as their associations with depressive symptoms among early adolescents. To determine whether relations of depressive symptoms with neighborhood quality might be contingent upon the level of individual cognitive social capital, neighborhood-by-cognitive social capital interaction terms were examined. METHODS: A qualitative study was conducted to elicit the perceptions of early adolescents about their neighborhood environment. Subsequently, we recruited 2,002 eighth graders and asked for responses to a self-administered questionnaire. The variables analyzed in this study were the Center for Epidemiologic Studies-Depression scale (10 items), features of neighborhood quality, cognitive and structural individual social capital, and demographics. We adopted a generalized estimating equation regression model for the multivariate analysis. The analytic sample was 1,786 with no missing variable in the models. RESULTS: Seven subscales were devised to assess quality features of neighborhood environments with an examination of validity and reliability: "availability of services," "good neighborhood relations," "spaces for recreation," "insecurity and danger of accidents," "dirty-looking, squalid, unclean," "civic communities," and "aesthetic look." We also developed a scale of individual cognitive social capital, which consisted of three constructs: "social trust," "reciprocity," and "social norms." Additionally, the number of social activities in which subjects participated was counted as an indicator of the structural aspect of individual social capital. On examination with the generalized estimating equation regression model, "availability of services," "insecurity and danger of accidents," "dirty-looking, squalid, unclean," and cognitive social capital were significantly associated with the CES-D scores controlling for demographics. We also found a significant interplay between "dirty-looking, squalid, unclean" and the cognitive social capital for estimating scores of depressive symptoms. CONCLUSION: Improvement in features of neighborhood quality such as availability of services, cleanliness, and security and social order in terms of public policy as well as civic activities could contribute to promotion of mental health in adolescents. Individual cognitive social capital accumulated through experiencs of good social relationshisp in a community could also play important roles in maximizing mental health.

The Impact of Changes in Professional Autonomy and Occupational Commitment on Nurses' Intention to Leave: A Two-Wave Longitudinal Study in Japan.

This study aimed to investigate changes in nurses' attitudes toward professional autonomy and occupational commitment over time, and their effect on nurses' intentions to leave, using a two-wave longitudinal design. Anonymous, self-report questionnaires were distributed to all nurses working at 28 hospitals in western Japan on two separate occasions (n = 1778). Multivariate analysis using a generalized estimation equation was conducted, with the intention to leave at Time 2 as the dependent variable, and the changing secular trends in all subscales of attitudes toward professional autonomy and occupational commitment as the independent variables. Age, sex, education, and intention to leave at Time 1 were control variables. Results showed that increasing changing secular trends in control over work conditions, which is a subscale of attitudes toward professional autonomy, increased intention to leave at Time 2, while increasing changing secular trends in all subscales of occupational commitment decreased intention to leave at Time 2. Nurses with a progressive attitude toward discretion of control over work conditions may have higher intentions to leave. Therefore, increasing control over their work conditions may reduce this intention. Additionally, it is necessary to continually enhance nurses' occupational commitment by offering professional development programs.

Health indicators as moderators of occupational commitment and nurses' intention to leave.

AIM: This study examined the hypothesis that health indicators moderate the relationship between occupational commitment and intention to leave among nurses, using a large sample in Japan. METHODS: A self-administered questionnaire was distributed to all registered nurses (N = 11,171) working in group hospitals in western Japan in 2014. The questionnaire evaluated intention to leave, occupational commitment, psychological distress, cumulative fatigue, and demographic variables. After a preliminary analysis of the bivariate and multivariate associations between variables and intention to leave, we tested the interactions between occupational commitment and health indicators on intention to leave. RESULTS: Of the 5,768 returned questionnaires, data from 5,505 (49.3%) participants were analyzed. Participants' mean age was 36.27 years (SD = 10.37). Most (95.14%) were women. According to a generalized estimating equation, the interaction of continuance occupational commitment and cumulative fatigue was significantly related to intention to leave (b = -0.0055). Additionally, the interaction of affective occupational commitment and psychological distress was significantly related to intention to leave (b = 0.0079). CONCLUSIONS: This study clarified that the relationship between occupational commitment and intention to leave was robust for nurses in good health. Interventions aimed at reducing fatigue and improving psychological distress should be implemented to prevent the protective effects of occupational commitment on nurses' intention to leave from being compromised.

Effective school-based preventive interventions for alcohol use in Africa: a systematic review.

BACKGROUND: Despite recognition of the risks of alcohol use and importance of prevention from an early age, the effectiveness of school-based interventions in Africa has not been clarified. OBJECTIVE: We aimed to identify effective school-based alcohol use prevention interventions in Africa. METHODS: We searched eight databases for peer-reviewed articles published until February 3, 2019 that reported on randomized controlled trials, cluster randomized controlled trials, controlled clinical trials, pre-post quasi-experimental studies, cohort studies, and case-control studies. The full-texts of relevant studies were searched. RESULTS: Four of 2797 papers met our eligibility criteria. All reported interventions targeted secondary school students in South Africa and were incorporated in the school curriculum. The interventions comprised multi-component activities with participatory and peer educational methods, and applied modified programs originally developed in the US. However, intervention effects were inconsistent among studies, although the interventions tended to have a positive effect on non-drinkers at baseline, with stronger effects in girls. CONCLUSION: interventions had positive effects on students that were non-drinkers at baseline, especially girls. Although we could not find robust evidence that school-based interventions changed attitudes, frequency/quantity of drinking, and intentions to use alcohol, one intervention showed an increase in students' alcohol refusal self-efficacy.

Examining the appropriateness and reliability of the strategy of the Kenyan Comprehensive School Health Program.

The Kenyan government established the Kenyan Comprehensive School Health Program (KCSHP) on the basis of Kenyan National School Health Policy. A KCSHP pilot project was carried out in eight primary schools in Mbita Sub-County of Homa Bay County in the Nyanza Region from 2012 to 2017. This pilot project provided health facilities and support for evaluation with a school health checklist, and organized teacher training on health education, a child health club, and school-based health check-ups. The present study aimed to examine the appropriateness and reliability of the strategy of the second KCSHP pilot project in Kenya. We analyzed data from self-administered questionnaires targeted at pupils in seventh-grade in the eight primary schools. The questionnaire consisted of questions on health-related knowledge, attitudes and practices, self-evaluated physical and mental health status, self-awareness of health control, subjective happiness, recognition on the importance of learning about health in school, absenteeism, and sense of school belongingness. The project contributed to improving health-related knowledge, attitudes and practices, self-evaluated health status, sense of school belongingness, recognition on the importance of learning about health in school, self-awareness of health control, and absenteeism. On the contrary, subjective happiness did not improve significantly.

Returning to the "homeland": work-related ethnic discrimination and the health of Japanese Brazilians in Japan.

OBJECTIVES: We investigated whether self-reported ethnic discrimination in the workplace was associated with well-being among Japanese Brazilians who had returned to Japan. Further, we examined interactions between discrimination and education on well-being. METHODS: We obtained data from a cross-sectional survey of Japanese Brazilian workers (n = 313) conducted in 2000 and 2001. Outcomes were self-rated health, psychological symptoms as measured by the 12-item General Health Questionnaire (GHQ-12) score, and a checklist of somatic symptoms. RESULTS: Reports of ethnic discrimination were associated with increased risk of poor self-rated health and psychological symptoms (GHQ-12 score), after we controlled for self-assessed workload, supportive relations at work, physically dangerous working conditions, workplace environmental hazards, shift work, number of working hours, age, gender, marital status, income, education, Japanese lineage, length of residence, and Japanese language proficiency. Further, the relationship between discrimination and self-rated health and somatic symptoms was most robust for those with the least education. CONCLUSIONS: Ethnic discrimination appears to be a correlate of morbidity among Japanese Brazilian migrants. Future research should investigate how educational and workplace interventions may reduce discrimination and possibly improve health.

Generation-Common and -Specific Factors in Intention to Leave among Female Hospital Nurses: A Cross-Sectional Study Using a Large Japanese Sample.

An understanding of the conditions that determine the factors affecting nurses' intention to leave is important for countries suffering from nurse shortage. AIM: to examine factors influencing intention to leave among female hospital nurses in a large Japanese sample, classified into four generations by age and considering economic conditions. METHODS: a cross-sectional survey with convenience sampling was conducted. Anonymous self-administered questionnaires were distributed to all nurses in 30 hospitals. To assess intention to leave, basic attributes, life conditions, work characteristics, and factors of psychosocial work environment were addressed. After classifying data into four generations based on age cohorts, we conducted multivariate logistic regression analysis using the completed data (N = 5074, mean age = 36.24 years). RESULTS: regardless of the generational characteristics influenced by economic conditions, effort and monetary reward were generation-common factors. Over-commitment, social support, and the presence of a role model were generation-common factors in three generations. While having children increased intention to leave in the generation born in 1965⁻1979, having family members in need of caregiving other than children decreased the risk in the generation born in the 1980s. CONCLUSION: generational countermeasures considering factors of psychosocial work environment and life conditions are needed to avert female nurse turnover.