Alcohol consumption and abstention among pregnant Japanese women.

BACKGROUND: In order to clarify the alcohol consumption status of pregnant women in Japan and the characteristics of pregnant women who abstained from alcohol after their pregnancy had been confirmed, a nationwide questionnaire-based study of alcohol consumption behavior was performed. We also examined the factors associated with alcohol consumption during pregnancy and abstention after the confirmation of pregnancy. METHODS: After random sampling, 260 institutions participated in the survey; these were selected from a list of survey points fixed by the Japan Association of Obstetricians and Gynecologists. The study was conducted on pregnant women with confirmed pregnancies by using self-administered anonymous questionnaires during the period from February 1 through 14, 2002. RESULTS: Alcohol consumption during pregnancy was reported in 11.1% of the study participants, and abstention after the confirmation of pregnancy, in 76.9%. Significant associations were recognized between higher education and both alcohol consumption during pregnancy and abstention after pregnancy confirmation. Furthermore, alcohol consumption was significantly associated with parity, smoking, and shorter sleep duration, whereas abstention was significantly associated with less frequent alcohol consumption and knowledge regarding the risk of alcohol consumption. CONCLUSION: The results clarified the factors associated with alcohol consumption during pregnancy and abstention after the confirmation of pregnancy in Japan.

Smoking trends before, during, and after pregnancy among women and their spouses.

BACKGROUND: Pregnancy and childbirth can act as strong factors motivating parents to spontaneously quit smoking. The aim of the present survey was to establish smoking cessation guidelines for this group. The objectives were to clarify the smoking status of parents before, during and after pregnancy, as well as the factors associated with continuous smoking during pregnancy and post-partum smoking relapse among women who had stopped smoking during pregnancy. METHODS: A cross-sectional survey with self-administered questionnaires was conducted for the parents of the 908 infants who participated in the official medical and dental examination for 18-month-old infants in Itabashi ward, Tokyo, Japan. RESULTS: The prevalence of smoking among women before, during pregnancy, and at post-partum 18 months at 95% confidence intervals was 29.3% (23.3-35.3%), 9.8% (3.0-16.6%), and 23.1 (16.8%-29.4%), and among their spouses it was 64.3% (60.0-68.6%), 58.1% (53.4-62.7%), and 58.2% (53.5-62.8%), respectively. The positive factors associated with smoking among pregnant women were marriage to a smoker, less education, under stress, and part-time employment rather than unemployment. The positive factors associated with smoking relapse after childbirth among women were breast-feeding <6 months and age under 30 years. CONCLUSION: Compared with Western countries, the rate of smoking cessation during pregnancy was relatively high in Japan. It is necessary that smoking cessation intervention and support for men be initiated at the early stages of their spouses' pregnancies. These observations could influence the targeting and design of maternal smoking intervention.

Prevalence of smoking and associated factors among pregnant women in Japan.

OBJECTIVE: This study was conducted to estimate the prevalence of smoking among pregnant women living in Japan and to analyze the factors associated with their smoking behavior. METHOD: Five hundred institutions with maternity services were randomly sampled from a list of the Japan Association of Obstetricians and Gynecologists. Of these institutions, 260 participated in the survey which was conducted in February 2002. Using a self-reported anonymous questionnaire, a survey on smoking behavior, drinking behavior and sleep status was conducted on pregnant women. Chi-square tests and logistic regression analyses were used to examine the factors associated with their smoking behavior. RESULTS: Data were obtained from a total of 16,414 pregnant women. The prevalence of smoking during pregnancy was 9.9% [95% confidence interval (CI) 9.4%, 10.4%]. The quit rate of smoking among pregnant woman was 61.9% [95% CI 60.4%, 63.4%]. The odds ratios for smoking during pregnancy were significantly higher in women with relatively young age, less schooling, multiparous, exposure to passive smoking, short sleep duration and in women who drank. CONCLUSION: Smoking among pregnant women remains an important public health problem in Japan. It is necessary to promote antismoking measures based on the results of this study.

Factors associated with exclusive breast-feeding in Japan: for activities to support child-rearing with breast-feeding.

BACKGROUND: Benefits of breast-feeding are not only limited to nutrition and sanitation in developing countries but also extend to cost-saving health care and alleviation of anxiety related to childrearing in developed countries. This study aims to elucidate factors associated with exclusive breast-feeding in Japan and use this information to achieve child-rearing support worldwide by promoting breast-feeding. METHODS: This cross-sectional study used data from a survey conducted by Ministry of Health, Labour and Welfare of the Japanese government, the First Longitudinal Survey of Babies in 21st Century. All subjects were infants (n=53,575) born in Japan in 2001 between January 10 and 17 and between July 10 and 17. According to the data, the exclusive breast-feeding rate in Japan during the first 6 months of life was 21.0%. We examined the factors associated with exclusive breast-feeding using univariate and multivariate logistic regression analyses. RESULTS: Among the factors examined, the adjusted odds ratio (OR) for exclusive breast-feeding was low for late childbearing, low birth weight infants, multiple births, smoking parents, living with grandparents, and feeling burdened by childrearing. The adjusted OR was high for factors that included sufficient childcare leave and consultation about childrearing with the spouse, a birth attendant and/or nurse, and a peer in a child-rearing circle. CONCLUSIONS: Exclusive breast-feeding is associated not only with medical factors but also with social factors. This study clarifies the necessity of social support to reduce the child rearing burden and a political system to promote paternal participation in childrearing and to improve the childcare leave system.

The relationship between depression and sleep disturbances: a Japanese nationwide general population survey.

OBJECTIVE: Among the existing epidemiologic studies that have examined the relationship between depression and sleep disturbances, there are few nationwide studies that have been conducted on subjects representing the general population. The present study was therefore conducted to clarify the relationship between depression and sleep disturbances, in particular the relationship between depression and both sleep duration and subjective sleep sufficiency, using a large sample representative of the general population. METHOD: The survey was conducted in June 2000, using self-administered questionnaires, targeting a population that was selected randomly from among 300 communities throughout Japan. Among the respondents, data from 24,686 individuals aged 20 years or older were analyzed. The Center for Epidemiologic Studies Depression Scale was used to assess the presence of depression. Sleep status, including sleep duration, subjective sleep sufficiency, and the presence or absence of insomnia symptoms, was evaluated. RESULTS: Those whose sleep duration was less than 6 hours and those whose sleep duration was 8 hours or more tended to be more depressed than those whose sleep duration was between 6 and 8 hours. Thus, sleep duration exhibited a U-shaped association with symptoms of depression. As subjective sleep sufficiency decreased, symptoms of depression increased, indicating a linear inverse-proportional relationship. CONCLUSION: The fact that sleep duration and subjective sleep sufficiency exhibited different relationships with symptoms of depression indicates that these 2 sleep parameters each have their own significance with regard to depression. These findings may be useful in the medical management of mental diseases.

Epidemiological study on passive smoking among Japanese infants and smoking behavior of their respective parents: a nationwide cross-sectional survey.

BACKGROUND: Passive smoking is a well-known health hazard for infants. This study was conducted to: (1) estimate the prevalence of passive smoking among Japanese infants and (2) clarify the prevalence of indoor smoking and associating factors among parents having infants. METHODS: Subjects were all 53,575 infants born throughout Japan on January 10-17, 2001 or July 10-17, 2001. When the infants reached 6 months of age, the questionnaires were mailed to the homes. Family members answered questions that included information about the current smoking behavior of the parents. RESULTS: A total of 44,562 questionnaires (83.2%) were analyzed. The prevalence of smoking among the mothers and the fathers were 17.1% and 63.5%. The percentages of mothers and fathers who smoked indoors were 12.1% and 36.2%. The percentage of households where mothers and/or fathers smoked indoors was 37.5%. Multivariate logistic analysis indicated that young age, having a spouse who was a smoker, infants having many siblings, the mother not breast-feeding, and lower annual incomes had significantly higher odds ratios for both the mother's and the father's indoor smoking. CONCLUSIONS: Passive smoking is common among Japanese infants. To protect Japanese infants from passive smoking, further public health measures must be taken.

Daytime sleepiness, sleep habits and occupational accidents among hospital nurses.

AIM: This paper reports a study to determine the prevalence of excessive daytime sleepiness and sleep habits among hospital nurses and to analyse associations between excessive daytime sleepiness and different types of medical error. BACKGROUND: It has been reported that sleep disorders, and the tiredness and sleepiness brought about by sleep disorders may be associated with occupational accidents. However, to our knowledge, there has so far been no report on associations between sleep disorders, excessive daytime sleepiness in particular, and occupational accidents among hospital nurses. METHODS: The study was a cross-sectional study targeting 4407 nurses working in eight large general hospitals in Japan. An anonymous self-administered questionnaire was used to investigate their sleep patterns and experience of occupational accidents. The data were collected in 2003. RESULTS: The prevalence of excessive daytime sleepiness among hospital nurses in the present study was 26.0%. A statistically significant relationship was observed between having or not having occupational accidents during the past 12 months and excessive daytime sleepiness. Multiple logistic regression analyses on factors leading to occupational accidents during the past 12 months showed statistically significant associations between (1) drug administration errors and (2) shift work and age, between (1) incorrect operation of medical equipment and (2) excessive daytime sleepiness and age, and between needlestick injuries and age. CONCLUSIONS: Excessive daytime sleepiness is an important occupational health issue in hospital nurses. It is possible that occupational policies and health promotion measures, such as a provision of sleep hygiene advice and social support at worksites, would be effective in preventing occupational accidents among hospital nurses.

Relation of smoking and drinking to sleep disturbance among Japanese pregnant women.

BACKGROUND: Pregnant women suffer from sleep disturbance, which may be aggravated by smoking and/or drinking. We investigate here the joint effect of smoking and drinking with respect to sleep disturbance during pregnancy. METHODS: Survey of about 16,000 pregnant women in Japan, conducted in 2002 using a self-administered questionnaire. RESULTS: Both smoking and drinking increased the odds of sleep disturbances, such as subjective insufficient sleep, difficulty in initiating or maintaining sleep, early-morning awakening, short sleep duration, excessive daytime sleepiness and restless legs syndrome. The joint odds ratios for smoking and drinking corresponded more or less to the products of the odds ratio for smoking or drinking. CONCLUSION: Smoking and drinking are independently associated with increased sleep disturbance during pregnancy, in addition to their other well-known side-effects.

Excessive daytime sleepiness among the Japanese general population.

BACKGROUND: Excessive daytime sleepiness is one of the principal symptoms of sleep disturbances, and is often associated with serious consequences including traffic and industrial accidents, decreased productivity, and interpersonal problems. However, there are few epidemiologic studies on excessive daytime sleepiness in a large scale sample targeting Japanese general population. METHODS: The survey was performed using a self-administered questionnaire in June 2000, targeting a population randomly selected from among 300 communities throughout Japan. This questionnaire included information about sleep habits and sleep problems. Excessive daytime sleepiness measured according to a question "Do you fall asleep when you must not sleep (for example when you are driving a car)?" RESULTS: A total of 28,714 subjects completed the questionnaire. The prevalence of excessive daytime sleepiness was 2.5% (male=2.8% and female=2.2%). Backward elimination analysis showed that the following were associated with excessive daytime sleepiness: male sex, young age, short sleep duration, subjective insufficient sleep, loss of deep sleep, disagreeable sensations in the legs, interruption of sleep by snoring or dyspnea, and feeling psychological stress. Interruption of sleep by snoring or dyspnea was the strongest associated factor (adjusted odds ratio=2.46, 95% confidence interval=1.76-3.43) of excessive daytime sleepiness. CONCLUSIONS: These results suggest that excessive daytime sleepiness in Japanese is associated with several sleep problems. These findings may be useful in attempts to prevent excessive daytime sleepiness in the general population of Japan.

Smoking among Japanese nursing students: nationwide survey.

AIM: This paper reports a study estimating the nationwide prevalence of and attitudes towards smoking among Japanese nursing students. BACKGROUND: The World Health Organization established "World No Tobacco Day" in 1987, and has been promoting antismoking measures worldwide since then, with annual themes. It has emphasized that health care professionals, including nurses, as role models for healthy living, should not smoke, and that as promoters of health education they should not seem to justify or condone their patients' smoking. To promote antismoking measures among nurses, it will be necessary to scrutinize the smoking habits and behavior of nursing students and associated factors, and to conduct effective antismoking education and health education before they acquire the smoking habit. METHODS: A cross-sectional survey was carried out through self-administered, closed-ended, structured questionnaires. Questionnaires were mailed to 4169 nursing students at 27 randomly selected vocational nursing schools nationwide. Smoking status, history, and attitudes towards smoking were examined. RESULTS: Smoking prevalence among female nursing students was 23.5%, which was higher than that among the Japanese general female population aged 20-29 (21.9%). Smoker-students were significantly more positive toward smoking than non-smokers in all opinions about health care professionals' smoking. Multiple logistic regression analysis showed that smoking statuses of the people around the participants, dissatisfaction with being a nursing student, and living alone were associated with participants' smoking behaviour. CONCLUSIONS: The results of the present study suggest an urgent necessity to provide effective antismoking measures for nursing students.

Mental health status, shift work, and occupational accidents among hospital nurses in Japan.

A questionnaire survey was conducted with questions from the 12-item General Health Questionnaire, among others, targeting 4,407 nurses in 8 general hospitals in Japan, in the hope of improving the work environment of nurses and to provide data that will allow a discussion of the measures necessary for preventing medical errors, thus improving occupational health. For each type of accident, the percentage of those who had made medical errors was significantly higher for the "mentally in poor health" group than for the "mentally in good health" group (p<0.0001). The percentage of nurses in the "mentally in good health" and "mentally in poor health" groups who had experienced occupational accidents over the past 12 months (i.e., whether they were "with errors" or "without errors") was calculated for each of the following four types of medical accident: (1) drug-administration errors, (2) incorrect operation of medical equipment, (3) errors in patient identification, and (4) needlestick injuries. For each type of accident, the percentage of those who had made medical errors was significantly higher for the "mentally in poor health" group than for the "mentally in good health" group (p<0.0001). Multiple logistic regression analyses revealed significant associations between experience of medical errors in the past 12 months and being mentally in poor health, with night or irregular shift work, and age.

An epidemiologic study of self-reported sleep problems among Japanese adolescents.

STUDY OBJECTIVE: To examine the prevalence and correlates of sleep problems in Japanese adolescents. DESIGN AND SETTING: The survey was designed as a cross-sectional sampling. The targets of the survey were junior and senior high schools throughout Japan. Sample schools were selected by stratified cluster sampling. Self-reported anonymous questionnaires were sent to sample schools for all students to fill out. PARTICIPANTS: A total of 107,907 adolescents responded, and 106,297 questionnaires were subjected to analysis. MEASUREMENTS AND RESULTS: The overall prevalences of sleep problems in the month preceding the questionnaire were difficulty initiating sleep (boys: 15.3%, girls: 16.0%); nocturnal sleep duration less than 6 hours (boys: 28.7%, girls: 32.6%); excessive daytime sleepiness (boys: 33.3%, girls: 39.2%), and subjectively insufficient sleep (boys: 38.1%, girls: 39.0%). Multiple logistic regression analysis showed that female sex, being a senior high-school student, and having an unhealthy lifestyle (psychological stress, smoking, and drinking alcohol) were risk factors for sleep problems. CONCLUSION: Self-reported sleep problems in Japanese adolescents were common and were associated with multiple factors. There is a need for health education directed at solving sleep problems in Japanese adolescents.

The prevalence of restless legs syndrome among pregnant women in Japan and the relationship between restless legs syndrome and sleep problems.

STUDY OBJECTIVES: To clarify the prevalence of restless legs syndrome (RLS) in pregnant women living in Japan and to analyze the relationship between sleep problems and RLS, in order to discuss ways for pregnant women to obtain comfortable sleep and to improve the health of both the mother and child. DESIGN: A cross-sectional questionnaire survey. SETTING: 500 clinical institutions with maternity services were randomly sampled from a list of organizations identified in a survey by the Japan Association of Obstetricians and Gynecologists. Of these 500 institutions, 260 participated in the survey. PARTICIPANTS: 16,528 pregnant women living in Japan. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: In this survey of pregnant women, the prevalence of RLS was found to be 19.9%. An analysis was conducted on the relationship between RLS and other factors such as subjective evaluation of sleep, difficulty initiating sleep, difficulty maintaining sleep, early morning awaking, and excessive daytime sleepiness. The result of this analysis suggested that women with these sleep-related problems were more likely to have RLS than those without. In addition, RLS was more prevalent in the later stages of pregnancy. CONCLUSION: In the pregnant women in our survey, the prevalence of RLS was found to be 19.9%, which is higher than the prevalence of RLS that has been found in the general public in a previous study. This suggests that RLS-related sleep problems may be an important public health issue among pregnant women in Japan. This finding may have implications for attempts to improve sleep hygiene in this group.

[An epidemiological study of sleep problems among the Japanese pregnant women].

OBJECTIVE: The objective of the study was to identify: 1) what kinds of sleep problems that pregnant women experience in Japan; and 2) the relationships between sleep problems and month of pregnancy, sleep problems and the number of pregnancies, and sleeping hours, by means of a questionnaire given to pregnant women in Japan. Conditions to assure good quality sleep were studied. METHODS: Of 500 obstetric facilities which were randomly selected from areas surveyed by the Japan Association of Obstetricians and Gynecologists, 260 finally agreed to participate in this study. Women who had their pregnancy confirmed and were on a revisit to the 260 obstetric facilities were enrolled. These pregnant women completed anonymous self-administered questionnaires during the waiting time for treatment and submitted them to the obstetric facilities in sealed envelopes. The questionnaire covered personal attributes such as age and highest level of education, pregnancy status, working status, and patterns of smoking and alcohol drinking. Sleep-related items such as 1) subjective sleep quality, 2) difficulty in getting to sleep, 3) frequent awakenings, 4) waking up too early, 5) sleeping hours and 6) daytime drowsiness were also included. RESULTS: The month of pregnancy was significantly related to four sleep-related items, including difficulty in getting to sleep and waking up too early. With respect to the relationship between the number of pregnancies and sleep problems, significance was found for five sleep-related items, including subjective sleep quality and waking up too early. Poor subjective sleep quality was significantly related to sleeping less than seven hours and whether or not pregnant women had a regular job. It was also suggested that the greater the number of pregnancies, the shorter the sleeping hours. When responses to each sleep-related item were compared between pregnant women and the general population, the former were more likely to have sleep problems. CONCLUSION: These findings suggest that as well as the number of pregnancies and month of pregnancy with sleeping hours may be factor intimately related to sleep problems during pregnancy. A good quality sleep during pregnancy is vital for normal maternal health and fetal growth and sufficient sleeping hours are therefore needed. Attention should therefore be paid to the finding that pregnant women were more likely to have sleep problems than the general population.