[Developing a Japanese version of the Digital Health Literacy Instrument].

Objectives　The Internet has made it possible to search for, obtain, transmit, and share information. Accordingly, the ability to use health information and skills related to interactivity taken from the Internet have become important in the medical and health fields. However, there is no scale to evaluate these abilities. Therefore, this study was conducted to assess the validity and reliability of the Digital Health Literacy Instrument (DHLI) and examine the association of digital health literacy (DHL) with the characteristics of the study participants.Methods　The Japanese version of the DHLI was developed using the basic guidelines for scale translation. The participants included 2,000 Japanese adults (men: 50.0%, mean age: 40.7±12.0 years) who responded to an Internet-based cross-sectional survey. The Japanese version of the DHLI, attributes, sources of health information, contents of health information taken from the Internet, and eHealth Literacy Scale (eHEALS) scores were obtained using a questionnaire. Confirmatory factor analysis and correlation with eHEALS scores were used to assess construct and criterion validities. Cronbach's alpha and correlation coefficients were computed for internal consistency and test-retest reliability. Differences in DHLI scores for each attribute and variables related to health information were examined using the analysis of variance and t-test.Results　Confirmatory factor analysis revealed a goodness-of-fit index of .946, a comparative fit index of .969, and a root mean square error of approximation of .054, confirming that the Japanese version has the same seven-factor structure as the original version does. A significant positive correlation was found between DHLI and eHEALS scores (r=.40, P<.001). Cronbach's alpha was .92, and test-retest reliability was r=.88 (P<.001). DHLI scores were mainly associated with household income, health status, frequency of information searches on the Internet, and devices used. The subscale scores found difficulties in evaluating reliability, determining relevance, and adding self-generated content. Differences in DHL were observed among some sources and contents of health information on the Internet.Conclusion　The Japanese version of the DHLI was a sufficiently reliable and valid instrument for assessing DHL among Japanese adults. Our results suggest that low DHL may lead to health information disparities. Therefore, it is necessary to consider support strategies for individuals who need to improve their DHL and for skills that need to be strengthened.

Development of a partnership between academia, community, and government in response to the 2022 mpox outbreak in Japan.

Objectives　In response to the steady rise in the number of cases of mpox in nonendemic countries, starting with an outbreak in the United Kingdom in May 2022, the World Health Organization declared a public health emergency of international concern on July 23, 2022. As of November 13, 2022, seven cases of mpox have been reported in Japan.Methods　A community engagement approach was applied to prevent the spread of mpox in Japan.Results　A tripartite partnership between academia, community, and government (ACG) was established to promote multisectoral communication between vulnerable communities, medical personnel involved in diagnosis and treatment, public health specialists at public health centers, epidemiologists at the National Institute of Infectious Diseases (NIID), and government and public administration. Through information sharing, this ACG partnership can translate accurate information into effective infection control measures.Conclusion　By developing and maintaining the ACG partnership, an environment will be created that allows an immediate response to future public health crises affecting vulnerable communities. This Practice Report describes the process of establishing an ACG partnership.

Cultural Tightness-Looseness: How Was It Related to Vaccination Behavior among University Students in Japan, the United States, and India?

As a next step to better understand the role of cultural tightness-looseness (CTL), this study aimed to examine whether CTL is associated with COVID-19 vaccination behavior among university students, taking into consideration sociocultural perceptions of vaccination across countries. A global online survey was conducted. University students from Japan, the US, and India participated. The average CTL score, three sociocultural perceptions related to COVID-19 vaccination, side effects, infection experience of themselves and family members, and other demographic variables were used to identify the model and to explain the second vaccination status using stepwise logistic regression methods with Akaike Information Criterion (AIC) scores which was for both the total, with the country as a variable, and for each country. Analyses of data from 1289 respondents who received the first vaccine revealed the essential role of CTL in individuals getting the second vaccine, while also revealing differences between countries. Regardless of the limitations, this study adds knowledge about CTL's roles in the COVID-19 vaccination behavior among young generations and provides insights into public health communication practices for issues like COVID-19.

Effect of digital messages from health professionals on COVID-19-related outcomes: A systematic review of randomized controlled trials.

Effectiveness of health professionals' messages via digital tools on COVID-19-related outcomes remains unknown. In this systematic review, we examined this issue by searching randomized controlled trials in six databases until August, 2022 (PROSPERO, CRD 42022350788). Risk of bias was assessed using revised Cochrane risk-of-bias tool. Primary outcomes were COVID-19 infections, preventive behaviors, and factors that support behavioral change. Seven trials with 16 reports (some reported two or more outcomes) were included. One trial showed that physician videos distributed by Facebook ads significantly reduced COVID-19 infections. Five of 6 reports showed that interventions can promote non-pharmaceutical preventive behaviors, vaccination, or information-seeking behaviors and half of the results were significant. Interventions improved the factors that support behavioral change. 14 reports had some concerns of bias risk and 2 had high risk of bias. Our findings suggest that digital messages by health professionals may help reduce COVID-19 infections through promoting behavioral change.

[Current issues related to education in the five core disciplines of public health at the school of public health in a private university].

Objectives　In Japan, schools of public health (SPH) have engaged in professional education focusing on five core disciplines: epidemiology, biostatistics, social and behavioral science, health policy and management, and occupational and environmental health. However, empirical information is lacking regarding the current state of this education and its associated challenges in Japan. In this article, we showcase this issue, using the master of public health (MPH) course at Teikyo University Graduate School of Public Health (Teikyo SPH) as an example.Methods　We summarized the current objectives and classes required to complete the MPH course at Teikyo SPH, using the course guideline published in 2022. Current issues and possible future directions in the course were summarized based on the opinions of Teikyo SPH faculty members.Results　For epidemiology, lectures and exercises were designed to focus on how to formulating public health issues, collecting and evaluating data, and causal inference. Issues related to the design included ensuring that students had the necessary skills to apply epidemiology to emerging issues, and catching the course up with evolving techniques. For biostatistics, lectures and exercise classes focused on understanding data and statistics, as well as performing analyses. Issues included the understanding of theories, setting the course level, and a lack of appropriate education materials for emerging analytical methods. For social and behavioral science, lectures and exercise classes focused on understanding human behaviors and actions for problem solving. Issues included learning various behavioral theories in a limited timeframe, the gap between the lectures and various needs, and nurturing professionals who had the skills to perform in practical settings. For health policy and management, lectures, exercise classes, and practical training classes focused on identifying and solving problems in the community and around the world, and on integrating the disparate viewpoints of health economics and policy. Issues included few alumni who actually found work globally, a lack of students working in local or central administrations, and insufficient perspectives on rational/economic thinking and macro-economic transitions. For occupational and environmental health, lectures, exercise classes, and practical training classes focused on learning the occupational and environmental impacts of public health issues, and their countermeasures. Challenges included enriching the topics with regard to advanced technologies, environmental health, and socially vulnerable populations.Conclusion　Through these reflections on MPH education at Teikyo SPH, the following recommendations are considered essential in order to prepare improvements to the program: reorganizing the curriculum to meet the needs of the day, accepting students with various backgrounds, addressing the increasing knowledge and skills that need to be acquired by the students, and enhancing the powers of professors to implement changes.

Association between watching wide show as a reliable COVID-19 information source and preventive behaviors: A nationwide survey in Japan.

INTRODUCTION: Current pandemic prompted a surge in the television (TV) news watching. However, its influence is poorly understood. In Japan, wide show, a major genre of soft news TV programs, broadcasted COVID-19 for long hours, and was pointed out that it broadcasted COVID-19 sensationally, arousing fear and anxiety, and that it criticized individuals gathering in closed places. Thus, wide show may promote preventive behaviors but also produce fear or anxiety and aggressiveness towards others not engaging in preventive behaviors. We examined this issue using large-scale nationwide data. METHODS: We analyzed the cross-sectional data of 25,482 individuals from the Japan COVID-19 and Society Internet Survey conducted in 2020. Participants reported the type of COVID-19 information sources including TV news and wide show, and their trustworthiness. We calculated multivariable-adjusted prevalence ratios (PRs) of engaging in recommended preventive behaviors strictly (defined as always engaging in hand washing, mask wearing, and attempting to keep physical distancing) and alerting others not engaging in preventive behaviors, respectively. RESULTS: About 72.4% of the participants obtained information from TV news with reliance, while corresponding values were 50.3% for wide show. Overall, 32.8% engaged in recommended preventive behaviors strictly, and 9.6% alerted others. Watching wide show both with and without reliance were significantly associated with alerting others (adjusted PRs: 1.48 and 1.34, respectively) but not associated with preventive behaviors. Watching TV news was neither associated with strict preventive behaviors nor alerting others. CONCLUSION: Watching TV news and wide show was not associated with strict preventive behaviors; watching wide show was associated with only alerting others. Although causality is unclear, actions may be needed for TV stations broadcasting wide show to understand own influences on society in a timely manner amid the health emergencies.

Health literacy and COVID-19-related beliefs and behaviors: a longitudinal study of the Japanese general population.

Since the outbreak of novel coronavirus disease-2019 (COVID-19), health communication has played a critical role in the process of disease prevention. Based on the concepts of health literacy and protection motivation theory, this study longitudinally examined the relationship between general health literacy measured immediately before the COVID-19 outbreak, and COVID-19-related information utilization, health literacy, beliefs and protective behaviors during the subsequent year in the Japanese general population. The participants were 767 Japanese residents who completed self-administered questionnaire surveys in January 2020 and February 2021. Based on the hypotheses, we constructed and tested a path model to predict the adoption of protective behaviors. Higher health literacy in 2020 was significantly related to higher COVID-19-related health literacy in 2021, which, in turn, was related to the adoption of recommended protective behaviors both directly and indirectly through threat and coping appraisal. Coping appraisal, but not threat appraisal, significantly differed by health literacy level. Generic health literacy skills for accessing, understanding and applying health information may enable people to better adapt to specific health risks. Our findings provide guidance for future health literacy education and health risk communication in populations with different health literacy levels.

Patterns of alcohol and alcohol-flavoured non-alcoholic beverage advertisements over Japanese free-to-air television networks.

BACKGROUND: Alcohol use is a serious public health challenge worldwide. Japan has no government regulations or legal penalties against advertising alcoholic beverages on television (TV). Instead, advertisements depend on the Japanese alcohol industry's self-regulation on airtime (no advertisements from 5 am to 6 pm) and the content of alcoholic beverages, which must not tempt minors. However, many adolescents (10 to 19 years old) watch TV from 6 pm to 11 pm. The aim of this study was to describe the pattern in the advertising of alcoholic beverages and alcohol-flavoured non-alcoholic beverages (AFNAB) in Japan during the popular TV viewing time for adolescents. METHODS: A secondary analysis of advertising airtime data from five free-to-air Japanese TV networks in the Greater Tokyo area that aired between 12 August and 3 November 2019, was performed. RESULTS: During the study period, 5215 advertisements for alcoholic beverages and AFNABs aired (1451.75 min). In total, 2303 advertisements (44.2%) were beer, low-malt beer, or beer-taste beverages, 277 (5.3%) were whisky, 2334 (44.8%) were local alcoholic beverages (shochu and seishu), and 301 (5.8%) were AFNAB. On average, more advertisements aired on weekends (67.6 advertisements) than on weekdays (59.3 advertisements) per day. Approximately 30% of advertisements for AFNABs were aired during the time restricted for alcohol advertising, although AFNABs are considered alcohol according to industry guidelines. During the popular television viewing time for young adolescents, about two to three times more advertisements were aired per hour than during the rest of the day, on both weekdays and weekends (p < 0.001). CONCLUSION: The number of alcohol advertisements aired at times when adolescents often watch TV is 2 to 3.2 times higher than that at other times of the day. Furthermore, despite the industry's self-imposed regulations, some alcoholic beverages are still advertised. Therefore, other methods to protect children and adolescents from exposure to advertisements for alcoholic beverages should be investigated and implemented.

The relationship between evaluation of shared decision-making by pet owners and veterinarians and satisfaction with veterinary consultations.

BACKGROUND: Communication skills are a necessary competency in veterinary medicine, and shared decision-making (SDM) between practitioners and patients is becoming increasingly important in veterinary practice as in human medicine. There are few studies that have quantitatively measured SDM in veterinary health care, and the relationship between SDM and consultation satisfaction is unknown. The purpose of this study was to investigate the status of SDM implementation in veterinary hospitals and the relationship between SDM implementation and consultation satisfaction among pet owners. We conducted a cross-sectional study using self-administered questionnaires among pet owners and veterinarians. In total, 77 pet owners who visited a veterinary clinic and 14 veterinarians at the clinics participated in this study. After a veterinary clinic visit, owners were asked to rate their decision-making preferences using the Shared Decision Making Questionnaire for patients (SDM-Q-9) adapted for veterinary medicine, as well as their satisfaction with the consultation. The corresponding veterinarians were asked to complete the veterinary version of the survey (SDM-Q-Doc). RESULTS: Most pet owners (64.9%) preferred SDM in veterinary consultations. Cronbach's alpha coefficient of 0.84 for the veterinary SDM-Q-9 and 0.89 for the veterinary SDM-Q-Doc both confirmed high reliability. The Spearman's correlation coefficient between the SDM-Q-9 and consultation satisfaction was 0.526 (p < 0.001), which was significant. The SDM-Q-Doc was not significantly correlated with either the SDM-Q-9 or pet owner consultation satisfaction. We conducted a sensitivity analysis of correlations among veterinarians; responses on the SDM-Q-Doc to examine the association between the SDM-Q-Doc and SDM-Q-9 and owner satisfaction; the results remained the same and no association was found. CONCLUSIONS: Our findings suggest that evaluation of SDM among pet owners was associated with their satisfaction with veterinary consultation. Veterinarians may be able to improve the satisfaction level of pet owners by adopting a consultation method that increases SDM. We did not consider the content of veterinary care or the number of visits to the veterinary clinic; future studies should be conducted to confirm the validity of our results.

Readability assessment of vaccine information: A systematic review for addressing vaccine hesitancy.

OBJECTIVE: Vaccine hesitancy is a problem attracting growing attention and concern. Communication can be an effective tool to counteract vaccine hesitancy and promote optimal vaccine uptake. Readability has been recognized as one of the more important aspects of health communication for achieving good health literacy. We reviewed studies of readability assessment in the area of vaccine communication. METHODS: We conducted a systematic literature search in September 2020, using four online databases (Medline, CINAHL, PsycArticles, and PsycINFO). We included studies that assessed the readability level of online and offline vaccine information materials. RESULTS: We found 12 articles that were appropriate for inclusion. Ten of the studies were published after 2016. The readability levels of the majority of the materials assessed were found to be difficult and higher than 8th-grade level. CONCLUSION: Readability assessments of vaccine information are scarce. The limited evidence shows that the readability level of vaccine information supplied by health care providers is more difficult to read than recommended. More studies on the readability of vaccine information are recommended. PRACTICE IMPLICATIONS: Difficulty reading vaccine information may influence attitudes toward acceptance of or hesitancy to take vaccines. It is recommended that health care professionals use guidelines and tools to create easy-to-read vaccine information.

Declines in health literacy and health-related quality of life during the COVID-19 pandemic: a longitudinal study of the Japanese general population.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, the importance of health literacy (HL) was addressed by public health researchers. We longitudinally examined the changes in general HL and health-related quality of life (HRQOL) between immediately before the COVID-19 outbreak and 1 year later, and how general HL before the outbreak was related to changes in HRQOL in the Japanese general population. METHODS: Among the Japanese residents aged 20-79 years who participated in our previous study in 2017, 826 were followed-up via self-administered questionnaires in January 2020 and February 2021, for the purposes of this study. The HRQOL was measured using the SF-8, a short version of the SF-36 Health Survey, and general HL was measured using the short form of the European Health Literacy Survey Questionnaire (HL-SF12) in the 2020 and 2021 surveys. RESULTS: The physical and mental dimensions of HRQOL as well as general HL declined significantly from immediately before the COVID-19 outbreak to 1 year later (p = .010, p < .001 and p < .001, respectively). The decline in HRQOL, especially the mental dimension, was more significant among women. A lower economic status was also related to a greater decline in HRQOL (p = .026 for the physical dimension and p = .012 for the mental dimension). Higher general HL before the COVID-19 outbreak was associated with a lesser decline in HRQOL in both the physical and mental dimensions (p = .040 and p < .001, respectively) after controlling for possible confounding variables such as gender and economic status. CONCLUSIONS: Healthcare support is crucial for vulnerable populations during and after the pandemic. General HL may be important for attenuating the decline in HRQOL, by enabling effective use of health information and adaptive behaviors toward health threats. Further studies are needed to better understand the association between HL and HRQOL.

Morphological identification in skull between spotted seal and harbor seal using geometric morphometrics.

The morphology of the skull contains considerable ecological information about a species, because the skull contains sensory organs that are used to look for food, compete for mates, or to migrate. Spotted seals (Phoca largha) and harbor seals (Phoca vitulina) are similar in body size and pelage color but differ in habitat use and reproductive biology. The current study aims to clarify differences in the shapes of skulls in the spotted and harbor seals using geometric morphometrics and to discuss whether ecological differences can explain morphological differences in skulls. First, we discovered that the age at which the shape of skulls stopped changing was 7 years in both species, using the linear-threshold model. Using a total of 75 landmarks, 54 individuals (25 spotted seals, 29 harbor seals) that were older than the age at which skulls stopped changing were correctly identified at a rate of 100%. The total of 75 landmarks was narrowed down to eight key landmarks that resulted in an identification accuracy rate of 100% using random forests. Of the eight landmarks, seven were related to feeding apparatus, indicated that the harbor seal had a broader mouth and mandible than the spotted seal. Because of both species were dietary generalists and classified as pierce feeders, we suggested that the different features in the shapes of their skulls were caused not only by differences in their feeding behavior but also other differences related to reproductive behavior.

Factors related to self-care drug treatment and medication adherence of elderly people in Japan.

Objectives: The number of home-dwelling elderly people who need drug treatment is increasing with the aging of the population. Elderly people are often suffering from various chronic diseases requiring treatment with multiple drugs, which makes self-care at home difficult. This study focused on medication adherence and aimed to identify the current state of self-care for drug treatment in home-dwelling elderly people and the factors that relate to self-care and medication. Study design: Cross-sectional study. Methods: Medication adherence was measured on a 12-item medication adherence scale for home-dwelling elderly people aged 65 and over who were taking medications. The present condition of medication self-care for home-dwelling elderly people was clarified in terms of medication adherence. Next, we clarified the relationship between medication adherence and other factors such as demographic and clinical characteristics, communication with doctors, and health literacy. Results: The average age was 73.7 (47.2% male). Functional health literacy and communicative health literacy were significantly associated with a high level of medication adherence. There was also a significant association between medication adherence and good communication with doctors. Conclusions: Medication adherence among home-dwelling elderly people was found to be related to the ability to obtain, understand, and communicate information, in addition to the basic literacy skills of health literacy. We also found that good communication with doctors was closely related to medication adherence. Our findings suggest that it is necessary to be consciously involved in promoting health literacy and communication when supporting self-care for medical treatment of home-dwelling elderly people in the future.

Influence of high versus low readability level of written health information on self-efficacy: A randomized controlled study of the processing fluency effect.

We investigated the relationship of processing fluency of written information about exercise to participants' perceived interest, safety, self-efficacy, outcome expectation, and behavioral intention regarding the exercise. We randomly assigned 400 men and women aged 40-69 years to control or intervention conditions. Perceived self-efficacy of performing the exercise in the intervention group (i.e. easy to read) was significantly higher than that in the control group (i.e. difficult to read) (p = 0.04). Easy-to-read written health information may be important not only for making written health information comprehensible but also for increasing readers' self-efficacy for adopting health-related behaviors.

[Transparency in relations between multinational R&D pharmaceutical companies' corporate social responsibility activities and patient organizations in the Europe, Japan, and the United States].

Objectives　Multinational R&D pharmaceutical companies operating in many countries and regions have deep ties with patient groups that are recipients of their corporate social responsibility (CSR). CSR activities are diverse and range from direct funding (including donations and sponsorships) to indirect funding (such as expenses associated with company-sponsored lectures); there are rewards for CSR requests for patient groups (writing, supervision, and surveys), and labor is provided by company employees. In developing pharmaceutical products, R&D companies can provide greater benefits to patients by listening to them. It is therefore important for all stakeholders to ensure transparency regarding the relationship between companies and patient groups. This study aimed to identify trends in information disclosure toward ensuring transparency of relations between CSR activities and patient groups based on industry groups regulations in Japan, the United States, and Europe.Methods　The contents described in regulations by the European Federation of Pharmaceutical Industries and Associations (EFPIA), Pharmaceutical Research and Manufacturers of America (PhRMA), and the Japan Pharmaceutical Manufacturers Association (JPMA) concerning such transparency were qualitatively and inductively analyzed in terms of four concepts: transparency, equal partnership, mutual benefit, and independence.Results　Most of the descriptions relate to transparency. The EFPIA regulation is the most detailed; it states that there should be no influence on patient groups' work or on events and activities organized by companies or patient groups. The rules of the three associations also impose the need to maintain records concerning the purpose and contents of financial support and activity items. However, information disclosure to secure transparency is not required in the PhRMA regulation. The JPMA regulation does not specify a clear update schedule; the EFPIA regulation requires disclosure information to be updated once a year. In terms of equal partnership, such terms as "mutual respect," "equal value," and "establishing a trust relationship" appeared in searches with all three regulations. None of the regulations referred to "mutual benefit." All the regulations either respected or validated the independence of patient groups.Conclusion　Each pharmaceutical association set its own regulations and recommended voluntary information disclosure by member companies; however, the extent of such disclosure differed with each association. The regulations of industry associations form the basis for the policies of member companies; thus, it is desirable that the contents and regulations related to mutual information disclosure be established in great detail worldwide.

Newspaper coverage before and after the HPV vaccination crisis began in Japan: a text mining analysis.

BACKGROUND: The human papillomavirus (HPV) vaccination coverage rate has fallen sharply in Japan since 2013, when newspapers began covering negative campaigns against the vaccination. We examined and compared contents from newspaper articles before and after the start of this HPV vaccination crisis. METHODS: We collected articles published between January 2005 and September 2017 in the four daily national Japanese newspapers with the highest domestic circulation. We then conducted text mining analysis to chronologically examine content distribution. RESULTS: From among the 1178 articles analyzed, 12 types of contents were identified. Contents related to cervical cancer prevention, such as on the risk of developing cervical cancer, causes of cervical cancer, and the effects of vaccination, were frequently conveyed until 2012. However, after March 2013, they were replaced with anti-vaccination contents, such as on adverse effects to vaccines, alleged victims, and related lawsuits. Meanwhile pro-vaccination contents, such as safety statements from the World Health Organization, scarcely received coverage. CONCLUSIONS: Newspaper contents changed profoundly before and after the start of the vaccination crisis. Those newspaper reports potentially had impact on readers' beliefs and actions. Journalists should strive for impartial coverage so readers can make more-informed decisions. Health professionals should be expected to work with journalists to help improve impartiality in newspaper coverage. The Ministry of Health, Labour and Welfare should discus benefits and risks of the HPV vaccination based on the scientific evidences, and consider to resume the proactive recommendation of HPV vaccination. Well-organized advocacy among medical societies, scientists and health professionals will also be needed to influence the government.

Japanese anti- versus pro-influenza vaccination websites: a text-mining analysis.

Anti-vaccination sentiment exists worldwide and Japan is no exception. Health professionals publish pro-influenza vaccination messages online to encourage proactive seeking of influenza vaccination. However, influenza vaccine coverage among the Japanese population is less than optimal. The contents of pro- and anti-influenza vaccination websites may contribute to readers' acceptance of one or the other position. We aimed to use a text-mining method to examine frequently appearing content on websites for and against influenza vaccination. We conducted online searches in January 2017 using two major Japanese search engines (Google Japan and Yahoo! Japan). Targeted websites were classified as 'pro', 'anti' or 'neutral' depending on their claims, with author(s) classified as 'health professionals', 'mass media' or 'laypersons'. Text-mining analysis was conducted, and statistical analysis was performed using a chi-squared test. Of the 334 websites analyzed, 13 content topics were identified. The three most frequently appearing content topics on pro-vaccination websites were vaccination effect for preventing serious cases of influenza, side effects of vaccination, and efficacy rate of vaccination. The three most frequent topics on anti-vaccination websites were ineffectiveness of influenza vaccination, toxicity of vaccination, and side effects of vaccination. The main disseminators of each topic, by author classification, were also revealed. We discuss possible tactics of online influenza vaccination promotion to counter anti-vaccination websites.

[Content analysis of newspaper reports on passive smoking regulations in Japan].

Objectives　Ever since Tokyo was awarded the privilege to host the 2020 Olympic Games, the Japanese Ministry of Health, Labour, and Welfare has worked toward implementing a ban on passive smoking. This study examined the present situation of passive smoking in Japan, and the coverage of passive smoking regulations in newspaper reports, based on a content analysis. This was followed by a comparison with the contents of the "White Paper on Tobacco," published by the Japanese Ministry of Health, Labour, and Welfare in August, 2016.Methods　In total, 182 articles published from September 7, 2013 to March 31, 2017 were collected from three major newspapers based in Tokyo (Asahi, Yomiuri, and Mainichi). The article search criteria included the presence of the following keywords in the title or main text: "passive smoking OR entire surface smoking cessation OR indoor smoking OR indoor smoking cessation OR smoking cessation in the site OR smoking cessation in the building." Online posts and articles that did not focus mainly on the regulation of passive smoking were excluded. The 37 coding categories that were developed were classified either as positive or negative (with respect to coverage of passive smoking regulations). The assessment of passive smoking in the White Paper on Tobacco informed the coding categories, to allow the evaluation of the extent to which the contents of the White Paper were reflected in newspaper reports.Results　Among the 182 articles examined, 107 addressed only the positive aspects of the regulations, while 7 addressed only the negative aspects. Further, 50 articles addressed both positive and negative aspects, while 18 addressed neither. Among those addressing both positive and negative aspects, 14 (28%) included counterarguments to the negative comments, which consistently reflected the contents of the White Paper on Tobacco.Conclusions　Majority of the articles reported only on the positive aspects of the regulations. Persuasive articles that presented both the positive and negative aspects of the issue, which included counterarguments to the negative opinions, were scarce. However, such articles were found to some degree in the editorials of newspapers. The influence of such editorials may increase if newspapers include the pros or cons of this issue, and present counterarguments. Additionally, some topics were not reported sufficiently. Thus, problems were observed in the newspaper reports regarding passive smoking regulations.

Amount of Narratives Used on Japanese Pro- and Anti-HPV Vaccination Websites: A Content Analysis

Background: HPV vaccination is an effective way in preventing cervical cancer. However, HPV vaccination coverage rate has fallen to only a few percent in Japan. Anti HPV-vaccination websites often use narratives of those who have experienced adverse reactions to HPV vaccine to enhance their persuasiveness. Scholars suggest using the same medium to promote HPV vaccination online; e.g., presenting narratives of those who have experienced cervical cancer. We examined the amount of narratives used on Japanese pro- and anti-HPV vaccination websites. Methods: We conducted online searches using two major search engines (Googl.jp and Yahoo!.jp). Identified websites were classified as "pro," "anti," or "neutral" depending on their claims. Two independent raters coded the pro and anti websites and counted the number of narratives of people who experienced side effects of HPV vaccine or cervical cancer. Results: A total 26% of anti websites posted narratives on side effects. No pro websites posted narratives about having cervical cancer. Conclusion: Pro-HPV vaccination websites is recommended to post narratives to enhance the persuasiveness of their arguments.