Joint Roles of Oxytocin- and Dopamine-Related Genes and Childhood Parenting Experience in Maternal Supportive Social Network.

How genes and parenting determine maternal social support availability, an important preventive factor of postpartum depression, has been little studied. Our study aimed to examine the interaction effects of maternal sociality-related gene and parenting on maternal social support. We analyzed data of 115 triads of Japanese grandmothers, mothers, and their infants. An interaction between parenting and cumulative genetic risk, calculated on the sociality-related genes (OXTR rs53576, rs2254298, rs1042778; COMT rs4680), was found. Mothers with high genetic risk received less social support if received poorer parenting (B = - 0.02, 95%CI = - 0.04 to - 0.01), while no association among low-risk mothers. Poorer social support was associated with severer depression in high-risk mothers (B = - 0.88, 95%CI = - 1.45 to -0.30). Our results suggest that mothers carrying risk alleles of sociality-related genes are particularly sensitive to childhood parenting, underscoring the importance of childhood parenting and genetic risk to understand maternal help-seeking behavior.

Interplay between social isolation and loneliness and chronic systemic inflammation during the COVID-19 pandemic in Japan: Results from U-CORONA study.

In the face of the global coronavirus disease 2019 (COVID-19) pandemic, billions of people were forced to stay at home due to the implementation of social distancing and lockdown policies. As a result, individuals lost their social relationships, leading to social isolation and loneliness. Both social isolation and loneliness are major risk factors for poor physical and mental health status through enhanced chronic inflammation; however, there might be an interplay between social isolation and loneliness on the association with chronic inflammation. We aimed to clarify the link between social relationships and inflammation in the context of the COVID-19 pandemic by distinguishing whether social isolation only, loneliness only, or both were associated with chronic inflammation markers among community-dwelling adults. The data of 624 people (aged 18-92 years, mean 51.4) from the Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) study, which targeted randomly sampled households in Utsunomiya city, Japan, were analyzed. Social isolation was assessed as a structural social network by asking the number of social roles they have on a daily basis. Loneliness was measured with the UCLA loneliness scale. As chronic inflammation biomarkers, neutrophil-to-lymphocyte ratio (NLR) and the concentration of high-sensitivity C-reactive protein (CRP) were measured. Generalized estimating equations method was employed to take into account the correlations within households. Isolated-Lonely condition (i.e., being both socially isolated and feeling lonely) was associated with higher NLR among men (B = 0.141, 95%CI = -0.01 to 0.29). Interestingly, Nonisolated-Lonely condition (i.e., not socially isolated but feeling lonely) was associated with lower CRP among women (B = -0.462, 95%CI = -0.82 to -0.10) and among the working-age population (B = -0.495, 95%CI = -0.76 to -0.23). In conclusion, being both socially isolated and feeling lonely was associated with chronic inflammation. Assessing both social isolation and loneliness is critical for proper interventions to mitigate the impact of poor social relationships on health, especially in the context of the COVID-19 pandemic.

Is Japan's child allowance effective for the well-being of children? A statistical evaluation using data from K-CHILD study.

BACKGROUND: Child allowance payment is one form of social security policy that aims to mitigate the child poverty gap by providing financial support to families. This study aimed to explore the impact of the child allowance on children's physical and mental health (BMI, problem behavior, depression, and self-rated health), and parental investment in child health (children's material goods, family events, extracurricular activities, interaction with children, and involvement in child maltreatment). METHODS: We used cross-sectional data from the 2016 Kochi Child Health Impact of Living Difficulty (K-CHILD) study. Participants were 1st, 5th and 8th grade children living in Kochi prefecture in Japan (N = 8207). Caregivers reported children's child allowance status, BMI and behavior problems, while children filled out a self-assessment on depression and health condition. Propensity score matching analysis regarding potential confounders was used. RESULTS: We found that children in families that received child allowance showed a smaller total difficulties score by 1.29 points (95% CI: - 2.32 to - 0.25) and a lower risk of overweight (OR: 0.51, 95% CI: 0.29 to 0.91) although there is no association with underweight, prosocial behavior, depressive symptoms and self-rated health. Parental investment did not differ by child allowance status (p > 0.05). CONCLUSIONS: Child allowance was found to be potentially beneficial in decreasing behavior problems and reducing child overweight. Further longitudinal studies are needed to elucidate how child allowance is used by family members and associated with children's well-being. (230/350 words).

Association of lifestyle and flourishing during the COVID-19 pandemic in Japan.

Introduction: COVID-19 have changed our lifestyle and little is known how our lifestyle associated with flourishing during COVID-19. This study examined the association between lifestyle, including sleep time, drinking, and smoking, and flourishing during the COVID-19 pandemic in Japan. Methods: We used the population-based study, Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) survey conducted in November 2021 to examine the association between lifestyle such as sleeping time, drinking and smoking, and flourishing (n = 473). Flourishing was assessed with the flourishing index, a 10-item multidimensional scale with five domains. Multivariate linear regression analysis was performed adjusted for sex, age, income, and education. Results: We found that the flourishing index was significantly lower in the group that slept less than 6 h than in the group that slept 6-8 h (coef = -0.49, SE = 0.17, p < 0.01). We also found that drinking once to several times/week showed higher flourishing than those who almost never drink (coef = 0.57, SE = 0.19, p < 0.01). Smoking was not associated with flourishing. Discussion: Sleep duration and drinking habit, but not smoking, may be important for flourishing during the COVID-19 pandemic.

Competitiveness, country economic inequality and adolescent well-being: Analysis of 60 countries.

INTRODUCTION: Competitiveness might impact on adolescent well-being considering the social salience distinct from the other age groups. However, there is only sizable research on competitiveness and well-being. Also, most previous studies did not distinguish between individual-level and country-level competitiveness and lacked consideration of contextual effects such as country inequality. METHODS: Using cross-sectional data from the Program for International Student Assessment (PISA), we analyzed individual- and country-level competitiveness and its interaction with country inequality in relation to well-being (life satisfaction and purpose of life) in approximately 350,000 adolescents from 60 countries. Competitiveness and well-being were assessed via questionnaires. The Gini index retrieved from the World Bank was used for country inequality. A multilevel model was applied. RESULTS: Individual-level competitiveness was positively associated with both life satisfaction (ß = 0.087, 95%CI = 0.084 to 0.091) and purpose of life (ß = 0.214, 95%CI = 0.211 to 0.217), while country-level competitiveness was not. Although adolescents in the least unequal countries were satisfied with life the most and those in the most unequal countries reported the strongest purpose of life, there observed a nonlinear effect modification as a stronger association in middle unequal countries (p for interaction <0.05) compared to both less and more unequal countries. DISCUSSION: Individual-level competitiveness was positively associated with life satisfaction and purpose of life. The stronger association between competitiveness and well-being in middle unequal countries suggested that encouraging adolescents to compete within their activities or competition may work to mitigate the impact of country inequality.

"What Did You Do in the War, Daddy?": Paternal Military Conscription During WWII, Economic Hardship and Family Violence in Childhood, and Health in Late Life in Japan.

Childhood adversity is a risk factor for poor health in late life and includes economic hardship and family violence, whose prevalence is high among offspring of military conscripted father. We assessed the association between paternal military conscription (PMC) and paternal war death (PWD) during Second World War and self-rated health (SRH) among older adults in Japan. Data were obtained from a population-based cohort of functionally independent people aged 65 years or older from 39 municipalities across Japan in 2016. Information on PMC and SRH was obtained through a self-report questionnaire. A total of 20,286 participants were analyzed with multivariate logistic regression to investigate the association between PMC, PWD, and poor health. Causal mediation analysis was performed to see whether childhood economic hardship and family violence mediated the association. Among participants, 19.7% reported PMC (including 3.3% PWD). In the age- and sex-adjusted model, older people with PMC showed higher risk of poor health (odds ratio [OR]: 1.16, 95% confidence interval [CI] [1.06, 1.28]), while those with PWD were not associated (OR: 0.96, 95% CI [0.77, 1.20]). Causal mediation showed a mediation effect of childhood family violence exposure on the association between PMC and poor health (proportion mediated: 6.9%). Economic hardship did not mediate the association. PMC, but not PWD, increased the risk of poor health in older age, which was partially explained by the exposure to family violence in childhood. There appears to be a transgenerational health impact of war which continues to affect the health of offspring as they age.

Poverty from fetal life onward and child brain morphology.

Poverty is a risk factor for impaired child development, an association possibly mediated by brain morphology. Previous studies lacked prospective poverty assessments during pregnancy and did not stratify by majority/minority status. We investigated the association of household poverty from fetal life forward with brain morphological differences at age 10 years, in 2166 mother-child dyads. Overall, the results showed no associations between any poverty exposure early in life and brain volumes. However, there was the evidence of timing effects: children exposed to poverty in utero had smaller amygdala volumes (B = - 0.18, 95%CI - 0.30; - 0.07, pFDR-adjusted = 0.009). There were also differences in associations by majority/minority status (cerebral white matter: p for interaction = 0.04). Dutch children exposed to childhood poverty showed smaller cerebral white matter volumes than their control (B = - 0.26, 95%CI - 0.45; - 0.06, pFDR-adjusted = 0.035). This association was not observed in the minority population (B = - 0.05, 95%CI - 0.23; 0.12, pFDR-adjusted = 0.542). The smaller cerebral white matter volume mediated the association between childhood poverty and poorer school performance in Dutch children. Our findings point to the importance of poverty exposure in the fetal period and suggest different mechanisms and vulnerabilities across majority/minority groups.

Association of parental dissatisfaction and perceived inequality of post-disaster recovery process with child mental health.

INTRODUCTION: Unequal distribution of access to resources would often be highlighted after disasters, and may have impact on child mental health. We aimed to elucidate the association between perception of recovery process (dissatisfaction and perceived inequality) and child mental health. METHOD: Data from the Great East Japan Earthquake Follow-up for Children (GEJE-FC) study targeting children (aged 4-6 years at the time of the disaster) and their siblings and parents from three affected prefectures (Miyagi, Fukushima and Iwate) in Japan, from August 2012 to January 2018, were analyzed. Dissatisfaction and perceived inequality of recovery process, parental mental health (Kessler Psychological Distress Scale (K6) and happiness) and social capital, and child mental health (Depression Self-Rating Scale for Children) were assessed via self-rated questionnaires. Longitudinal associations of dissatisfaction and perceived inequality and mental health were examined with the linear mixed modeling and structural equation modeling (n = 168 parent-child dyads). RESULT: Dissatisfaction and perceived inequality predicted lower parental happiness and more child depressive symptoms. Structural equation modeling revealed that parental mental health was associated with perceived inequality via lower social capital. Interestingly, perceived inequality was associated with child depressive symptom directly and indirectly through parental mental health and social capital. CONCLUSION: Dissatisfaction and perceived inequality of post-disaster recovery process were important predictors of child mental health. To mitigate the impact of disaster and to avoid damage on child mental health in the recovery process, policy makers should take into account survivors' dissatisfaction and perceived inequality of recovery process.

Association between subjective degree of influence in class and thinness among adolescents in Japan.

Social status in school, measured by subjective degree of influence in class (DOI), may influence thinness among adolescents. This study examined the association between subjective degree of influence in class and thinness among Japanese adolescents. Data were obtained from the Kochi Child Health Impact of Living Difficulty (K-CHILD) study in 2016, which Was a population-based study targeting 5th, 8th and 11th grade adolescents living in Kochi Prefecture, Japan (N = 9,998). DOI was assessed by adolescents via questionnaire. Weight and height were given by caregivers for 5th grade adolescents, whilst they were self-reported for 8th and 11th grade adolescents. Collected data on weight and height were used to calculate body mass index z-scores of WHO standards. Models included grade, gender, number of friends, household income, location of school and depressive symptoms as covariates. The results showed that both high and low DOI were positively associated with thinness after adjustment for other individual covariates (high DOI, OR = 1.59, 95% CI 1.05-2.43; low DOI, OR = 2.04, 95% CI 1.36-3.06). Further stratification by gender revealed that low DOI was positively associated with thinness (OR = 2.14, 95% CI 1.34-3.44) among boys, but there was no association among girls. Both high and low DOI were associated with the risk of being thin in adolescents. Focusing on DOI for adolescents may be important to address thinness among adolescents. Further studies are needed to examine the causality between DOI and thinness in adolescents.

Association between Social Engagements and Stigmatization of COVID-19 Infection among Community Population in Japan.

In the face of unknown risks, including the coronavirus disease 2019 (COVID-19) pandemic, we tend to have stigmatized perceptions. The current study aimed to examine the association of social engagements with the level of stigmatization of COVID-19 infection among the general population. The data of 429 participants of the Utsunomiya COVID-19 seroprevalence neighborhood association (U-CORONA) study, a population-based cohort study conducted in Utsunomiya City, Japan, were analyzed. Their stigmatized perception of people with COVID-19 infection was evaluated via a questionnaire for the situation if they or others in their community were to get infected. The association between social engagements (community social capital, social network diversity, and social network size) and stigmatization were analyzed by a multiple linear regression model with generalized estimating equations. Overall, females reported a higher stigmatized perception of people with COVID-19 than males. Lower education and depressive symptoms were also positively associated with higher stigmatization, while age, household income, and comorbidities were not. People with higher community social capital reported lower stigmatization (B = -0.69, 95% CI = -1.23 to -0.16), while social network diversity and social network size did not show an association with stigmatization. We found an association between community social capital and stigmatization, suggesting that enhancing their community social capital, but not social network diversity and size, has the potential to mitigate the levels of stigmatization.

Association between adverse childhood experiences and brain volumes among Japanese community-dwelling older people: Findings from the NEIGE study.

BACKGROUND: Adverse childhood experiences (ACEs) can affect later-life health outcomes via brain structural differences. However, there is no sufficient empirical evidence about whether brain morphological differences remain until old ages. OBJECTIVE: We examined the association between ACEs and brain volumes among older individuals. PARTICIPANTS AND SETTING: Residents aged 65-84 years in Tokamachi City, Japan, were randomly recruited, and 491 participants were included in the analysis. METHODS: ACEs were assessed with a self-reported questionnaire. The volumes of seven brain regions of interests were evaluated via structural magnetic resonance imaging. RESULTS: In total, 143 (27.1%) participants experienced one ACE and 33 (6.7%) two or more ACEs. Participants with two or more ACEs had a larger anterior cingulate cortex volume (B = 0.346, 95% confidence interval [CI] = 0.04 to 0.66) and smaller hippocampal (B = -0.287, 95% CI = -0.58 to 0.001) and amygdala (B = -0.313, 95% CI = -0.59 to -0.03) volumes. Interestingly, we observed a distinct association between deprivation and threat. That is, deprivation was associated with a smaller amygdala volume (B = -0.164, 95% CI = -0.32 to -0.01) and threat with a larger anterior cingulate cortex volume (B = 0.401, 95% CI = 0.11 to 0.70). CONCLUSIONS: ACEs were associated with the volumes of brain regions such as anterior cingulate cortex, hippocampus, and amygdala, which are responsible for emotion and self-regulation in older population. The effect of ACEs on the amygdala was commonly driven by deprivation experiences and that on the anterior cingulate cortex by threat.

Heart rate variability in 2014 predicted delayed onset of internalizing problems in 2015 among children affected by the 2011 Great East Japan Earthquake.

Experience of natural disaster was related to an increased risk of long-term child internalizing problems. Initial traumatic experiences are hypothesized to work as disaster-related stresses and sensitize neural circuitry, leading to heightened reactivity to subsequent stressful experiences, which in turn results in delayed onset of internalizing problems. However, empirical evidence is lacking. Thus, we aimed to examine the association between heart rate variability (HRV) and internalizing problems among children exposed to the disaster. The Great East Japan Earthquake Follow-up for Children (GEJE-FC) study followed children aged 4-6 years old and their siblings and parents from three affected prefectures (Miyagi, Fukushima, and Iwate) and one unaffected prefecture (Mie) in Japan over four periods: from August 2012 to June 2013 (= T1), August 2013 to April 2014 (= T2), July 2014 to December 2014 (= T3), and August 2015 to December 2015 (= T4) (n = 155). HRV was assessed at T2 and T3 as a biomarker of autonomic nervous system activity. Child internalizing problems were assessed by caregivers at T3 and T4, using the Child Behavior Checklist. HRV measurements at T2 were not associated with child internalizing problems at T3. However, HRV in low frequency domains at T3 showed an inverse association with child internalizing problems at T4 (B = -1.72, 95% CI = -3.12 to -0.31). The findings indicated that later exacerbation of internalizing problems could be predicted by dysfunction of autonomic nervous system measured by HRV.

Association between gratitude, the brain and cognitive function in older adults: Results from the NEIGE study.

OBJECTIVES: Having gratitude is associated with reduced social isolation and depression, which are risk factors for dementia. However, it is unknown whether gratitude is directly associated with cognitive function. This study aimed to determine associations between gratitude and cognitive function and to elucidate the underlying biological mechanism by testing the mediating role of brain regions among healthy older people. METHODS: We used cross-sectional data from the 2017 Neuron to Environmental Impact across Generations (NEIGE) study of community-dwelling older adults aged ≥ 65 years (n = 478). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Levels of gratitude were assessed using the two-items of Gratitude Questionnaire. Volumes of brain regions associated with emotional processing and social interaction were measured by magnetic resonance imaging. Linear regression models and structural equation models were used to examine associations between level of gratitude, brain volume, and cognitive function. RESULTS: The mean gratitude score was 6.3 (SD=0.9) and the mean MMSE score was 27.1 (SD=2.5). Regression analysis showed that higher levels of gratitude were associated with better cognitive function (coefficient=0.25, 95% CI: 0.01, 0.49), adjusting for age, sex, education, marital status, and depressive symptoms. Higher levels of gratitude were associated with larger volumes of right amygdala and left fusiform gyrus. Structural equation model analysis showed that amygdala volumes mediated the association between gratitude and cognitive function. CONCLUSION: Higher levels of gratitude were positively associated with cognitive function, partially mediated through the amygdala, which is involved in processing emotion and memory.

The impact of public assistance on child mental health in Japan: results from A-CHILD study.

Public assistance is one option for providing a safety net to protect the health of children, but assistance may also generate feelings of shame that impact self-esteem. This study aims to elucidate the impact of public assistance on child mental health. We used cross-sectional data on 6920 first graders from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study. We found children living in relative poverty had more behavioral problems, low resilience, and were likely to refuse to go to school. After propensity-score matching among low-income households, the likelihood of children refusing to go to school was larger in the families receiving assistance as compared to non-recipients (OR 4.00, 95% CI 0.85-18.84) although there were no significant differences between recipients and non-recipients in low-income households. Our study produced insufficient evidence to indicate that social assistance is associated with child mental health, resilience, or school refusal.

Do Social Ties Moderate the Association between Childhood Maltreatment and Gratitude in Older Adults? Results from the NEIGE Study.

BACKGROUND: Childhood maltreatment can impede gratitude, yet little is known about the older population and its moderators. The aim of this study is to clarify the association between childhood maltreatment and levels of gratitude of the older population, and the moderating effect of social ties on the association. METHODS: We analyzed the data of 524 community-dwelling older adults aged 65-84 years without functional disabilities in Tokamachi City, Niigata, Japan, collected for the Neuron to Environmental Impact across Generations (NEIGE) study in 2017. Using a questionnaire, the participants rated three types of childhood maltreatment before the age of 18 (physical abuse, emotional neglect, and psychological abuse), level of gratitude, and social ties. RESULTS: We found an inverse association between emotional neglect and gratitude. Furthermore, emotional neglect was inversely associated with gratitude only for those with lower levels of social ties. CONCLUSIONS: Promoting social ties may mitigate the adverse impact of emotional neglect on the level of gratitude.

Association between Social Integration and Face Mask Use Behavior during the SARS-CoV-2 Pandemic in Japan: Results from U-CORONA Study.

Face mask use is a critical behavior to prevent the spread of SARS-CoV-2. We aimed to evaluate the association between social integration and face mask use during the COVID-19 pandemic in a random sample of households in Utsunomiya City, Greater Tokyo, Japan. Data included 645 adults in the Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) study, which was conducted after the first wave of the pandemic, between 14 June 2020 and 5 July 2020, in Utsunomiya City. Social integration before the pandemic was assessed by counting the number of social roles, based on the Cohen's social network index. Face mask use before and during the pandemic was assessed by questionnaire, and participants were categorized into consistent mask users, new users, and current non-users. Multinomial logistic regression analysis was used to examine the association between lower social integration score and face mask use. To account for possible differential non-response bias, non-response weights were used. Of the 645 participants, 172 (26.7%) were consistent mask users and 460 (71.3%) were new users, while 13 (2.0%) were current non-users. Lower social integration level was positively associated with non-users (RRR: 1.76, 95% CI: 1.10, 2.82). Social integration may be important to promote face mask use.

Degree of influence in class modifies the association between social network diversity and well-being: Results from a large population-based study in Japan.

BACKGROUND: Social network diversity can be associated with physical and mental health among adolescents, which might be modified by their perceived degree of influence in class. We aimed to examine the association between social network diversity and physical and mental health, and to elucidate its effect modification by perceived degree of influence in class. METHODS: Data were obtained from the Kochi Child Health Impact of Living Difficulty (K-CHILD) study in 2016, which targeted 5th, 8th and 11th grade children living in Kochi Prefecture in Japan (N = 9998). Social network diversity accounted for the number of social roles in which adolescents had regular contact. Degree of influence in class, depression (using Depression Self-Rating Scale for children (DSRS)) and self-rated health were assessed by children, and behavior problem and prosocial behavior (using Strengths and Difficulties Questionnaire (SDQ)) was assessed by caregivers. RESULTS: Significant association of social network diversity with depression (Coefficient (B) = -0.59, 95% confidence interval (CI) = -0.68 to -0.50), self-rated health (B = 0.09, 95% CI = 0.07 to 0.11), behavior problem (B = -0.71, 95% CI = -0.82 to -0.61) and prosocial behavior (B = 0.06, 95% CI = 0.02 to 0.11) were found. The association with depression and self-rated health was stronger among children with perceived low degree of influence (both p for interaction < 0.001). A similar trend was observed for behavior problem (p for interaction = 0.053), but effect modification was not found for the association between social network diversity and prosocial behavior. CONCLUSIONS: Social network diversity was beneficial for adolescent physical and mental health, especially for children with perceived lower degree of influence in class.

Association of parental social network diversity with behaviour problems and resilience of offspring in a large population-based study of Japanese children.

OBJECTIVES: The current study aimed to elucidate the impact of parental social network diversity on the behaviour problems and resilience of offspring. DESIGN: We used cross-sectional data from the Kochi Child Health Impact of Living Difficulty study in 2016. SETTING AND PARTICIPANTS: Participants were first, fifth and eighth grade children living in Kochi prefecture, Japan (N=9653). We calculated parental social network diversity by counting the number of people with whom parents connected on a daily basis (ie, structural social network diversity) and by assessing perceived psychosocial support (ie, functional social network diversity). PRIMARY OUTCOME MEASURES: Child behaviour problems and resilience were respectively assessed using the Strengths and Difficulties Questionnaire (SDQ) and the Child's Resilient Coping Scale (CRCS), as rated by caregivers. RESULTS: Diversity in parental structural and functional social networks showed an inverse association with SDQ total difficulties score (B=-0.16 (95% CI -0.25 to -0.07) and -0.20 (95% CI -0.27 to -0.13), respectively), and a positive association with prosocial behaviour score (B=0.11 (95% CI 0.08 to 0.15) and 0.09 (95% CI 0.06 to 0.12), respectively) and CRCS score (B=0.75 (95% CI 0.46 to 1.05) and 1.12 (95% CI 0.88 to 1.35), respectively) in the adjusted model. Parental mental health accounted for 36% and 43% of the total effects of structural and functional social network diversity respectively on the total difficulties score. For prosocial behaviour score, parental involvement accounted for 31% of the effects of functional social network diversity. CONCLUSION: The results shed light on new strategies to enhance child mental health that do not directly involve children but rather focus on parental social networking.

Impact of Alcohol Outlet Density on Reported Cases of Child Maltreatment in Japan: Fixed Effects Analysis.

Background: Parental drinking habits or binge drinking are a known risk factor of child maltreatment. Though drinking habits are affected by alcohol outlet density, the direct association between alcohol outlet density and child maltreatment is still controversial. Purpose: This study aimed to examine the impact of off-premises alcohol outlet density on child maltreatment cases reported to Child Guidance Centers in Japan. Methods: A fixed effects model was used to investigate the association between a change in off-premises alcohol outlet density and a change in child maltreatment cases in each unit. Time-series of cross-sectional ecological data collected from across Japan over 16 years (2000 to 2015) was used, and maltreatment cases were further sub-grouped by type of maltreatment (physical, sexual, psychological abuse and neglect) and by perpetrators (father, stepfather, mother, and stepmother). Results: The association between alcohol outlet density and total cases of child maltreatment was not observed (coefficient = 0.98, 95% confidence interval: -6.30, 8.25). However, alcohol outlet density was shown to be positively associated with neglect (coefficient = 3.08, 95% confidence interval: 0.54, 5.62), which indicates that 1 alcohol outlet per 1,000 adults increase would lead to 3 more neglect cases per 10,000 children. Also, a negative association was observed between a change in the incidence of total child maltreatment by father and a change in alcohol outlet density (coefficient = -3.03, 95% confidence interval: -5.78, -0.28). Conclusion: The findings suggest that off-premises alcohol outlet density may have a causal effect on the increasing cases of neglect and decrease in maltreatment by father in Japan.