Association and dose-response relationship between exposure to alcohol advertising media and current drinking: a nationwide cross-sectional study of Japanese adolescents.

BACKGROUND: Underage drinking is a public health concern. However, few studies have examined the association between alcoholic beverage advertising and underage drinking, particularly in countries with low underage drinking rates, such as Japan. Therefore, we aimed to investigate the relationship between exposure to advertising in various media and alcohol drinking among Japanese adolescents. METHODS: We conducted a cross-sectional study involving 15,683 adolescents (51% girls) using data from a nationwide lifestyle survey in 2021 among junior and senior high schools across Japan. Media types were websites, stores, and public transportation. We defined current drinking as alcohol consumption of ≥1 day in the 30 days preceding the survey. Multivariable logistic regression was used to examine the association between exposure to alcohol advertisements and current drinking, adjusting for sex, grades, school area, lifestyle (bedtime and having fun at school), and addictive behaviors (smoking status and parents' alcohol consumption). RESULTS: The prevalence of current drinking was 2.2% (2.3% of boys and 2.0% of girls). Students who were exposed to any alcohol advertising media had higher odds of current drinking compared with those who were not (odds ratio, 1.48; 95% confidence interval [CI], 1.18-1.87). Students who were exposed to web, in-store, and public transportation advertisements had odds ratios of 1.44 (95% CI, 1.14-1.81), 1.62 (1.28-2.05), and 1.45 (1.06-1.98) of current drinking, respectively, compared with those who were not. The association of exposure to alcohol advertising media with the prevalence of current drinking was similar among boys and girls (all p for sex interaction >0.1), except for that of exposure to web advertisements; its association with current drinking was more pronounced in girls (p for sex interaction = 0.046). Exposure to a larger cumulative number of different alcohol advertising media was independently associated with a higher prevalence of current drinking among all students, boys, and girls (p-values for trend <0.001, 0.031, and <0.001, respectively; p for sex interaction = 0.085). CONCLUSIONS: We found an association with a dose-response relationship between exposure to alcohol advertisements and current drinking among adolescents in junior and senior high schools across Japan. Our findings highlight the need for further advertising regulations to prevent underage drinking.

Effectiveness of nurse-delivered screening and brief alcohol intervention in the workplace: A randomized controlled trial at five Japan-based companies.

BACKGROUND: Excessive alcohol use is a leading cause of global morbidity and premature mortality. This study evaluated the effectiveness of two types of nurse-delivered interventions to reduce excessive alcohol consumption among screened participants using the alcohol use disorders identification test (AUDIT) in the workplace. METHODS: A randomized controlled trial involving AUDIT-positive employees of five Japan-based companies was conducted. A total of 351 participants were randomized into groups that received a patient information leaflet (PIL), 5 min of brief advice, or 15 min of brief advice and counseling. Outcomes (weekly alcohol consumption and drinking and binge drinking frequency in the previous 30 days) were evaluated at 6 and 12-month follow-up. RESULTS: The follow-up rates were 96.3% (n = 338) and 94.9% (n = 333) at 6 and 12 months, respectively. At 6 months, the mean change in weekly alcohol consumption was -38.1 g (-1.64 US fluid oz/week) in the 15-min brief advice and counseling group, which differed significantly from the PIL group. The reduction in the advice and counseling group persisted at 12-month follow-up but was no longer significantly different from the PIL group. There was no significant change in alcohol consumption observed in the 5-min brief advice group. Improvement in drinking and binge drinking frequency was observed in all three groups. CONCLUSIONS: Nurse-delivered 15-min brief advice and counseling was effective over a 6-month period in reducing alcohol consumption in a workplace setting. This finding suggests that the implementation of workplace screening and brief intervention could play a useful role in preventing the burden of harmful alcohol use.

Problem drinkers and high risk-taking behaviors under the stay-at-home policy of the COVID-19 emergency declaration.

BACKGROUND: To the best of the authors' knowledge, this is the first study to examine whether problem drinkers have had high risk-taking behaviors during the stay-at-home policy (e.g., dining out at a bar) under the COVID-19 emergency declaration. METHODS: We investigated data from Japan COVID-19 and Society Internet Survey(JACSIS)study-a web-based nationwide survey, conducted from August to September 2020. From a total of 12,076 current drinkers, problem drinkers were detected by Cut, Annoyed, Guilty, and Eye-opener (CAGE) questions. A CAGE score of 4 showed potential alcohol use disorder and scores of 2 to3 showed potential alcohol abuse; individuals with these scores were regarded as problem drinkers compared to light-or-no-risk drinkers, with a CAGE score of 0 to 1. The outcome assessed the presence of 18 behaviors against the stay-at-home policy, such as dining out at a bar, meeting people, or going to crowded places. All these behaviors were limited in Japan during the first declaration of emergency between April and May 2020. RESULTS: Based on the multivariable logistic regression, the participants with potential alcohol use disorder demonstrated 16 out of the 18 risk-taking behaviors, such as dining out at a bar (adjusted odds ratio (aOR): 2.08; 95% confidence interval (CI): 1.56-2.79), dining out at a restaurant (aOR: 1.79; 95% CI:1.37-2.35), visiting friends (aOR: 1.81; 95% CI: 1.34-2.44), going to karaoke (1.97; 95% CI: 1.26-3.10), and riding on a crowded train (aOR: 1.46; 95% CI: 1.07-1.99), compared to light-or-no risk drinkers with a CAGE score of 0 to 1. Additionally, participants with potential alcohol abuse (CAGE score of 2 to 3) had 10 out of 18 behaviors against the stay-at-home policy: the corresponding aORs for the aforementioned behaviors were 1.45 (95% CI: 1.25-1.67), 1.27 (95% CI: 1.12-1.44), 1.17 (95% CI: 1.01-1.36), 1.49 (95% CI: 1.17-1.90), and 1.19 (95% CI: 1.03-1.38), respectively. Problem drinkers had a significant association with being men, a higher income and job position, smoking, sleep deprivation, depression, and other mental diseases. CONCLUSIONS: Overall, problem drinkers were more likely to have higher risk-taking behaviors against the stay-at-home policy, compared to light-or-no-risk drinkers.

Abstaining from annual health check-ups is a predictor of advanced cancer diagnosis: a retrospective cohort study.

BACKGROUND: Cancer prevention is a crucial challenge in preventive medicine. Several studies have suggested that voluntary health check-ups and recommendations from health professionals are associated with increased participation in cancer screening. In Japan, it is recommended that individuals aged 40-74 years should undergo annual health check-ups; however, the compliance to this recommendation is approximately <50%. According to the national survey, individuals who do not undergo annual health check-ups are at a higher risk for cancer. However, to the best of our knowledge, no previous study has investigated the association between the use of health check-ups and the incidence rate of cancer. We hypothesised that not undergoing periodic health check-ups and/or less use of outpatient medical services are predictors for advanced cancer. METHODS: To explore the relationship between health check-up or outpatient service utilisation and cancer incidence, this retrospective cohort study used data at two time points-baseline in 2014 and endpoint in 2017-from the National Health Insurance (NHI) claims and cancer registry. A multivariable logistic regression analysis was performed to investigate whether cancer diagnosis was associated with health check-up or outpatient service utilisation. RESULTS: A total of 72,171 participants were included in the analysis. The results of the multivariable logistic regression showed that individuals who skipped health check-ups had a higher risk of cancer diagnosis (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.40). Moreover, not undergoing health check-ups increased the risk of advanced-stage cancer (OR, 1.78; 95% CI, 1.29-2.44). Furthermore, increased rate of outpatient service utilisation was negatively associated with advanced cancer diagnosis. CONCLUSIONS: This is the first study reporting that not undergoing health check-ups is a predictor of cancer diagnosis and advanced cancer stage. Primary prevention strategies for NHI members who do not undergo health check-ups must be reassessed. Moreover, future research should examine secondary prevention strategies, such as health education and recommendations from health professionals to facilitate adequate utilisation of preventive health services.

Heated Tobacco Product Smokers in Japan Identified by a Population-Based Survey.

BACKGROUND: In this study, we aim to estimate the prevalence of heated tobacco product (HTP) smokers 3 years after the launch of HTPs in Japan. METHODS: Our study, performed in February 2018 in Japan, had a cross-sectional population-based design. A total of 4,628 adult participants (2,121 men and 2,507 women) were randomly sampled from all regions of Japan. The response rate was 57.9%. Interviews were conducted by trained investigators who visited participants' homes. A survey on current (past 30 days) and lifetime tobacco use (including e-cigarettes and HTPs), as well as numerous sociodemographic factors, was conducted. RESULTS: The age-adjusted rates and estimated number of lifetime-HTP smokers were 14.1% (95% confidence interval [CI], 12.5-15.6%; 7.11 million men) and 3.7% (95% CI, 2.9-4.4%; 1.99 million women). The age-adjusted rates for current HTP smokers were 8.3% (95% CI, 7.1-9.6%; 4.21 million men) and 1.9% (95% CI, 1.3-2.4%; 1.02 million women). Multiple variables were found to be associated with a higher prevalence of current HTP use, including being male, aged 20-39 years, a current Internet user, a risky drinker, or a heavy episodic drinker. HTP use was also higher among men with 10 years or more of education, women with 15 years or less of education, and men with middle- or high-level household incomes. CONCLUSION: We concluded that HTP use has increased substantially in Japan. However, regulations for HTPs are weaker than those for combustible cigarettes in Japan. Thus, HTPs should be subjected to the same regulations as combustible tobacco products.

Heat-not-burn tobacco, electronic cigarettes, and combustible cigarette use among Japanese adolescents: a nationwide population survey 2017.

BACKGROUND: From among the global public health concerns, smoking remains one of the most crucial challenges. Especially for adolescents, the increase in the use of electronic cigarettes is controversial, as its use may lead to established smoking. In Japan, where a unique tobacco regulation system exists, the heat-not-burn tobacco market has been growing. However, the prevalence and association of combustible cigarettes and new tobacco-related products have not yet been closely investigated among Japanese adolescents. This study aimed to clarify the prevalence of smoking among adolescents, including new types of tobacco-related products, and to compare the characteristics of their users. METHODS: The 2017 Lifestyle Survey of Adolescents is a nationally-representative survey collected in Japan. From the national school directory, 98 junior high schools and 86 high schools were randomly sampled throughout Japan. The students completed an anonymous questionnaire at school. We calculated the prevalence of use for each type of tobacco product. Then, the use of a combination of products and the characteristics of different types of products were examined. RESULTS: In total, 64,152 students from 48 junior high schools and 55 high schools were included the analysis (school response rate = 56%, Mage = 15.7 years, 53.9% boys). The age-adjusted rate of ever (current) use of electronic cigarettes was 2.1% (0.7%) in junior high school and 3.5% (1.0%) in high school; that of combustible cigarettes was 2.6% (0.6%) in junior high school and 5.1% (1.5%) in high school. The rate of heat-not-burn tobacco use was lower relative to other products: 1.1% (0.5%) in junior high school and 2.2% (0.9%) in high school. An examination of the combined use of the three products identified a high number of dual users. Comparisons between different types of users indicated different backgrounds for combustible cigarette users and new product users. CONCLUSIONS: The prevalence of new tobacco-alternative products is growing in popularity among Japanese adolescents. Dual use is common, and many adolescents use new products only. Moreover, e-cigarettes might attract a broader range of groups to smoking. Continuous monitoring and research are needed to investigate their influence as a possible gateway to tobacco smoking.

Changes in smoking behavior among victims after the great East Japan earthquake and tsunami.

BACKGROUND: In areas affected by the tsunami of the great East Japan Earthquake, smoking behavior may have deteriorated due to high stress and drastic changes in living environment. Surveys were conducted to reveal changes in smoking behaviors among victims. METHODS: A population-based random-sample home-visit interview survey of victims in Iwate and Miyagi Prefectures affected by the tsunami disaster was conducted in 2012 (n = 1978), while a population-based nationwide survey was conducted in 2013 (n = 1082). A panel survey in 2014 was conducted with respondents of the 2012 survey (n = 930). Multiple logistic regression analysis was performed to reveal factors related to smoking status after the disaster. RESULTS: There was high smoking prevalence of both sexes in the tsunami disaster area (current smoking rate in coastal area, 50.0% for male, 21.4% for female; inland area, 34.7% for male, 7.6% for female). Low prevalence of male quitters was observed (quitter rate in coastal area, 20.8% for male, 8.0% for female; inland area, 23.4% for male, 5.5% for female). The prevalence of nicotine-dependent people assessed by FTND (Fagerström Test for Nicotine Dependence) in the coastal area was also higher than in the inland area or other areas of Japan. Smoking behavior among victims worsened after the disaster and did not improve 3 years from the disaster. Post-disaster factors related to smoking were living in coastal area, complete destruction of house, and living in temporary housing. CONCLUSIONS: Smoking prevalence and the level of nicotine dependence of tsunami victims were still high even 3 years after the disaster. It is important to emphasize measures for smoking control in the disaster areas for an extended time period.

The Association Between Alcohol-Flavoured Non-Alcoholic Beverages and Alcohol Use in Japanese Adolescents.

AIMS: There are no legal regulations in Japan governing minors' consumption of alcohol-flavoured non-alcoholic beverages (AFNAB); therefore, we examined if their consumption could lead to increased alcohol use among adolescents in Japan. METHODS: This cross-sectional study used a nonclinical, nationally representative sample of 38,494 junior (19,662 boys) and 61,556 senior (31,925 boys) high school students recruited in 2012. We measured AFNAB consumption rates and the order that adolescents first consumed AFNAB and alcohol. RESULTS: The AFNAB consumption was strongly associated with alcohol use in high school students. Among all age groups, alcohol was more commonly consumed before AFNAB for both males and females. CONCLUSIONS: Consumption of AFNAB is more prevalent among minors than alcohol consumption and it has a strong association with alcohol consumption. However, concerns that AFNAB use would lead to increased alcohol use were not supported because AFNAB consumption usually started after adolescents began consuming alcohol. SHORT SUMMARY: Consumption of AFNAB is more prevalent among high school students than alcohol consumption and it has a strong association with alcohol consumption. However, concerns that AFNAB use would lead to increased alcohol use were not supported because AFNAB consumption usually started after adolescents began consuming alcohol.

Prevalence and Trends in Alcohol Dependence and Alcohol Use Disorders in Japanese Adults; Results from Periodical Nationwide Surveys.

AIMS: Nationwide surveys to clarify the characteristics and trends of the drinking behavior of Japanese adults were carried out in 2003, 2008, and 2013. METHODS: These were periodical cross-sectional surveys. Subjects were chosen through a stratified two-stage random sampling method. The surveys included drinking frequency and amount, ICD-10 alcoholism diagnostic standards, questionnaire for the determination of harmful alcohol use ( AUDIT: Alcohol Use Disorders Identification Test). In 2003, the surveys obtained responses from 2547 people (73% response rate); in 2008, 4123 people (55% response rate); and in 2013, 4153 people (59% response rate). RESULTS: The proportion of lifetime experience of alcohol dependence diagnosed by ICD-10 was 1.9% for male and 0.2% for female, and the estimated number of patients was 1.07 million. The declining trends were observed in the percentage of daily drinkers and the amount of alcohol consumed per week for male. The lowering of the age for consuming their first alcoholic drink and their first drunken experience was observed among female. The gender difference of prevalence of problem drinking is getting smaller. The binge drinking and heavy episodic drinking were observed especially younger generation. The only small proportion of patients with alcohol dependence had received specialized medical care, whereas the many of these visited medical institutions and health screening. CONCLUSIONS: The survey observed many hidden alcoholic patients, and showed the possibility that the healthcare facilities and health screening became the place of screening and intervention for alcohol dependence.

[Epidemiology of addictive disorders and behaviors in Japan].

Nationwide surveys to clarify the characteristics and trends of the addictive disorders and behaviors including alcohol dependence, nicotine dependence, internet addiction and pathological gambling among Japanese adults were carried out in 2003, 2008, and 2013. At the part of the surveys on addictive behaviors in disaster stricken area by the Great East Japan Earthquake, the nationwide survey on benzodiazepine dependence was conducted in 2013. Epidemiological features of prevalent addictive disorders and behaviors were described. We observed large number of estimated patients with addictive disorders or behaviors in Japan, and the considerable proportion of them was not connect to appropriate medical services.

Lifestyle factors associated with presenteeism among city government office workers: a cross-sectional study.

OBJECTIVES: Presenteeism is a critical issue in occupational health. This study aimed to examine the association between presenteeism and subjective sleep quality, smoking status, and alcohol consumption. METHODS: Anonymous data of 777 workers in a Japanese city were retrospectively obtained from City Government Office A. They included variables like absolute presenteeism scores (measured using the Japanese version of the World Health Organization Health and Work Performance Questionnaire short form), gender, age, family status, subjective sleep quality, smoking status, and alcohol consumption. A binary logistic regression analysis was performed with gender, age, family status, subjective sleep quality, smoking status, and alcohol consumption as the independent variables, and absolute presenteeism scores equal to or below 40 as the dependent variable. A gender-stratified binary logistic regression analysis was also performed. RESULTS: The logistic regression analysis results revealed that absolute presenteeism was positively associated with poor subjective sleep quality among all respondents (odds ratio [OR], 1.70; 95% CI, 1.18-2.44) and men (OR, 1.85; 95% CI, 1.12-3.05) and with current drinkers among women (OR, 3.49; 95% CI, 1.36-8.92); it was negatively associated with age among those who were ≥50 years old (OR, 0.50; 95% CI, 0.27-0.93) and with current drinkers among men (OR, 0.43; 95% CI, 0.20-0.92). CONCLUSIONS: The factors associated with presenteeism differed between men and women office workers, suggesting that gender differences need to be considered when working toward improving workers' productivity.

Association between multimorbidity and utilization of medical and long-term care among older adults in a rural mountainous area in Japan.

Objective: With the accelerated population aging, multimorbidity has become an important healthcare issue. However, few studies have examined multimorbidity and its impact on the use of medical and long-term care services in Japan. Therefore, this study aimed to examine the association between multimorbidity and the use of medical and long-term care services among older adults living in the depopulated mountainous areas of Japan. Patients and Methods: A cross-sectional study was conducted using insurance claims data from late-stage medical insurance and long-term care insurance (April 2017 to March 2018) for older adults ≥75 years residing in a mountainous area in the Tottori prefecture. In addition to the descriptive analysis, multiple generalized linear regressions with family gamma and log-link functions were used to examine the association between the number of morbidities and total annual medical and long-term care expenditures. Results: A total of 970 participants ≥75 years were included in the analysis. Participants who had two or more morbidities constituted 86.5% of the total sample. Furthermore, participants with mental disorders were found to have more comorbidities. The number of comorbidities is associated with higher medical and long-term care expenditures. Conclusion: Multimorbidity was dominant among late-stage older adults living in depopulated mountainous areas of Japan, and the number of morbidities was associated with higher economic costs of medical and long-term care services. Mitigating the impact of multimorbidity among older adults in depopulated regions of Japan is an urgent challenge. Future research should investigate the degree and effectiveness of social protections for vulnerable older adults living in remote areas.

Spatial and Economic Proximity of Cigarette Sales to School Children in Mongolia.

Background: The Western Pacific Region has the highest rate of cigarette smoking in the world. In this region, Mongolia has ratified the WHO FCTC treaty and, as part of treaty implementation, has monitored school tobacco use in children using the 2014 Global Youth Tobacco Survey (GYTS) and 2019 GYTS. Our objective was to examine the spatial and economic factors associated with cigarette use in schoolchildren of Mongolia. Methods: The 2014 and 2019 GYTS are the most recent and comprehensive national surveys of tobacco use in schoolchildren in Mongolia and are cross-sectional, stratified, multi-stage cluster surveys of 13-15 year-old schoolchildren (7,298 in 2014, 4,146 in 2019) selected from urban and rural schools. For each survey, we conducted logistic regression modelling to examine whether spatial (proximity of cigarette sales to schools), economic (pocket money available to school children), and other environmental/contextual factors were predictors of cigarette use (all, single sticks) in schoolchildren. Results: We found that 1)the prevalence of vendors selling cigarettes near schools increased from 65% in the 2014 GYTS to 94% in the 2019 GYTS, 2) sales of cigarettes near schools were associated with increased current smoking of all cigarettes and this effect increased from a marginal 31% increase in odds in 2014 (OR [95% confidence interval(CI)]=1.31 [0.99, 1.73]) to a 416% increase in odds in 2019 (OR [95% CI]=5.16[3.31, 8.05]), 3) sales of cigarettes near schools were associated with a substantial increase in odds of smoking single cigarettes in 2014 (OR [95% CI]=1.87 [1.14,3.06]) and in 2019 (OR[95% CI]=2.70 [1.42, 5.12]). We also found that smoking of all cigarettes was higher when student pocket money exceeded the price of the cigarette pack (approximately 1.8 USD) and also when parents and/or peers were smokers. Conclusions: Despite the 2012 National Tobacco Laws banning sales of cigarettes and single cigarettes to schoolchildren near schools, the most recent national surveys (2014-2019) have shown that these sales are increasing. We provide new findings indicating that despite the higher pricing of cigarette packs (relative to the region), illicit sales of single cigarettes are targeting schoolchildren near their schools.

Did Depression, Schizophrenia, and Alcohol Use Increase During the COVID-19 Pandemic Even in Low-Risk Regions? An Analysis of the 2017-2020 National Health Insurance Data in Tottori Prefecture.

Background: This study aimed to determine whether the COVID-19 pandemic increased the number of medical consultations for depression, schizophrenia, and alcohol dependence in low-risk regions. Methods: National Health Insurance enrolments from March 2017 to March 2021 in Tottori Prefecture, Japan, where there were minimal COVID-19 cases in 2020, were included in this study. The all-cause mortality and proportion of National Health Insurance members with depression, schizophrenia, and alcohol dependence in the financial years (FY) 2017, 2018, 2019, and 2020 were calculated. The proportion in FY 2020 was compared with the average proportion from FY2017 to FY2019 and the proportion in FY2019. Results: The all-cause mortality for men aged 80-99 years and women aged 70-89 years decreased in FY2020. The proportion of men aged 20-29 years with depression increased to 4.1% in FY2020 compared with 3.0% in FY2019, while the proportion of women aged 20-29 years with depression was 4.4% in FY2017, 4.8% in FY2018, 4.8% in FY2019, and 5.5% in FY2020, confirming an increasing trend from before the COVID-19 pandemic. The proportion of men aged 30-39 years and 60-69 years with schizophrenia increased and that of women aged 40-49 years, 60-69 years, and 90-99 years with schizophrenia also increased, even before the pandemic. The proportion of people with alcohol use disorder has not changed significantly since FY2017. Conclusion: The pandemic has led to an increased proportion of men aged 20-29 years with depression, even in low-risk regions.

Alcohol's harm to others in Japan: Different rates for different relationships to the drinker in a 2018 national survey.

INTRODUCTION: No study in Japan has investigated alcohol's harm to others (AHTO). Therefore, this study aimed to reveal the situation of AHTO in Japan and examine the factors associated with it based on the relationship with the drinker. METHODS: A cross-sectional population-based survey was performed in 2018 with 2121 men and 2507 women. Respondents were asked questions about factors such as verbal or physical aggression, being forced to drink alcohol, sexual harassment and their relationship with the drinker. Binomial logistic regression was performed to quantify the associations of AHTO with participants' socio-demographic status and drinking patterns. RESULTS: The lifetime experience of AHTO was 24.7% for men and 19.3% for women. AHTO from the father and co-workers were the most common in and outside the home, respectively. The frequency of AHTO from the spouse or co-workers showed no significant difference for abstainers and drinkers. However, AHTO from the father was more commonly reported among drinkers and those with Alcohol Use Disorders Identification Test scores ≥8 points than abstainers. Of those who experienced AHTO, 24.5% of men and 27.6% of women, and 6.1% of men and 12.9% of women were profoundly affected by it in and outside the home, respectively. DISCUSSION AND CONCLUSIONS: One in five Japanese residents experienced AHTO in their life, and the characteristics associated with AHTO differed according to the affected individual's relationship with the drinker. Continued monitoring of AHTO and measures aimed at reducing alcohol-related harm that include AHTO should be promoted.

Comparison of the responses of cross-sectional web- and paper-based surveys on lifestyle behaviors of Japanese adolescents.

Objective: In Japan, paper-based surveys are currently more effective than web-based surveys. This study compared the response rates and lifestyle behaviors between paper- and web-based surveys conducted among Japanese junior and senior high schools. Methods: In total, there were 42 and 64 junior and senior high schools, respectively, for the web-based surveys and 20 and 27 junior and senior high schools, respectively, for the paper-based surveys. The questionnaire covered lifestyle behaviors (e.g., alcohol consumption, smoking, exercise, eating, and sleep status), mental health, and plans to attend college. School- and student-level response rates by survey method were assessed, and so was the effect on the reporting of each lifestyle behavior using logistic regression models. Results: The school response rates were 16.0% and 38.3% for web- and paper-based surveys, respectively. The student response rates were 88.7% and 77.2%, respectively. The web-based group had significantly more female participants and lower response rates for higher grades in senior high schools. The odds of lifetime and current alcohol consumption and poor mental health were lower, whereas those of lifetime use of conventional cigarettes, shorter sleep duration, and plans to continue attending college were higher among web-based (vs. paper-based) participants. Conclusions: The school response rate was poor in the web-based survey. However, whether the differences in lifestyle behavior are attributed to selection bias or the survey method remains unclear.

Secondhand Smoke Exposure and Smoking Prevalence Among Adolescents.

Importance: Secondhand smoke is a substantial risk factor for youth health globally, including in Japan, where tobacco control policies should be reassessed. Objective: To assess trends in the prevalence of secondhand smoke exposure among Japanese adolescents from 2008 to 2017 and to examine the association between its frequency and smoking during the study period. Design, Setting, and Participants: This study comprised a nationally representative, self-administered, school-based, cross-sectional survey focusing on tobacco and alcohol use and related factors among students in grades 7 to 12 (ages 12-18 years) in Japan. This random sampling survey used single-stage cluster sampling. Using the national school directory, junior and senior high schools throughout Japan were randomly extracted from each regional block. All students enrolled in the sampled schools were included as participants, and school-based surveys were completed in 2008, 2012, and 2017. Data analysis was performed from January 1 to March 15, 2023. Main Outcomes and Measures: Prevalence of secondhand smoke exposure among adolescents in Japan from 2008 to 2017 and changes in the association between secondhand smoke exposure frequency and prevalence of smoking were examined using multiple logistic regression analysis. Results: Data were analyzed for 95 680 adolescents in 2008 (50.7% boys), 100 050 in 2012 (51.6% boys), and 64 152 in 2017 (53.9% boys). At baseline, 42.0%, 38.5%, and 34.6% of the participants were junior high school students in 2008, 2012, and 2017, respectively. Based on the 2008 surveys, 51.0% of adolescents in grades 7 to 12 were exposed to secondhand smoke in any place (≥1 day during the past 7 days), 37.2% were exposed at home, and 36.5% were exposed in public places. In 2017, 36.3% of participants were exposed to secondhand smoke in any place, 23.8% were exposed at home, and 27.0% were exposed in public places. An association between secondhand smoke exposure frequency and prevalence of smoking was observed consistently regardless of survey year, location, or pattern of exposure (adjusted odds ratios ranged from 2.29 [95% CI, 1.81-2.91] for 1-2 days at home to 11.15 [95% CI, 8.50-14.62] for 7 days in public places). Stratified analysis by higher education intention indicated that the prevalence of smoking and secondhand smoke exposure decreased but remained higher among adolescents who did not intend to pursue higher education. The association between secondhand smoke and smoking did not differ substantially between groups. Conclusions and Relevance: In this cross-sectional study, the prevalence of secondhand smoke exposure among adolescents in Japan decreased but remained at high levels overall. There may not be a hazard-free threshold for smoking. Enhancing comprehensive tobacco control strategies is Japan's first step toward achieving smoke-free environments to protect youths. Implementation and verification of the effectiveness of smoke-free legislation should be considered.

Validation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) based on the clinical diagnosis of IGD in Japan.

Background and aims: Although the Ten-Item Internet Gaming Disorder Test (IGDT-10) has been translated into Japanese and widely used, the Japanese version has not previously been validated. We used the clinical diagnosis of IGD as a gold standard for validating the test. Methods: The Japanese version was validated using 244 gamers drawn from the general young population in Japan. Expert interviews using the Japanese version of the Structured Clinical Interview for Internet Gaming Disorder evaluated diagnoses of Internet gaming disorder (IGD). This resulted in a diagnosis of IGD for eight individuals, categorized as the gold standard group. The screening performance of the two Japanese versions with different scoring conditions was examined: the scoring method proposed by the original study (original version) and a less stringent scoring method where responses of either "often" or "sometimes" were regarded as affirmative (modified version). Results: The results of the sensitivity and specificity analyses, the Cronbach's alpha and the receiver operating characteristics analysis revealed a higher screening performance for the modified versus the original version. The optimum cutoff for the modified version was 5 or more - the sensitivity, specificity, and Youden's index were 87.5, 85.2, and 72.7%, respectively. The rate of probable IGD using the original and modified versions were 1.8% and 11.3%, respectively. Discussion and conclusion: A less stringent scoring method for the Japanese version of IGDT-10 showed a higher screening performance than the original scoring method. Future studies comprising different ethnic groups and gaming cultures should further examine the suggested scoring method.

Loneliness and Increased Hazardous Alcohol Use: Data from a Nationwide Internet Survey with 1-Year Follow-Up.

We aimed to examine the association between loneliness and developing alcohol dependence or hazardous alcohol use. A cohort study was conducted utilizing data from a nationwide internet survey in 2021 and 2022 in Japan. A total of 15,854 follow-up participants (55% men, with a mean age of 52.8 years) were divided based on AUDIT scores: nondrinkers (AUDIT: 0), low-risk drinkers (AUDIT: 1-7), medium-risk drinkers (AUD: 8-14), high-risk drinkers (AUDIT: 15-19), and probable alcohol dependence (AUDIT: 20-40). The University of California, Los Angeles Loneliness Scale (Version 3), a short-form three-item scale, was used to assess loneliness (high loneliness score of ≥6). The prevalence of high loneliness was higher in nondrinkers than that in low- and medium-risk drinkers, i.e., 22%, 18%, and 17%, respectively, as well as in high-risk drinkers (32%) and those with probable alcohol dependence (43%) compared to non-high-risk drinkers (19%). After adjusting for various factors (sociodemographic, social isolation, psychological distress, and smoking), non-high-risk drinkers (AUDIT: 0-14) with high loneliness were more likely to become high-or-over-risk drinkers (AUDIT: 15-40) than those without high loneliness, with adjusted risk ratios of 1.45 (95% confidence interval: 1.08-1.96) through multivariable binary logistic regression. Among non-high-risk drinkers, people with high loneliness scores at baseline were associated with increased high-risk drinking patterns with probable alcohol dependence.

Risk Factors of Free Flap Complications in Reconstruction for Head and Neck Cancer.

Background: Although head and neck reconstruction using free flaps has become a common procedure, flap complications remain a concern. This study aimed to analyze the risk factors of free flap complications and to identify the causes of these complications. Methods: We studied 97 patients with head and neck cancer with intraoral defects who underwent reconstruction using free flaps at Tottori University Hospital between 2011 and 2020. We used a retrospective cohort study design to investigate whether flap complications, including flap necrosis (total and partial) and flap dehiscence, were related to various factors, including the underlying disease condition, treatment status, and surgical factors. Results: Of the 97 patients analyzed, total flap necrosis was observed in one patient (1.0%). The incidence rate of flap complications, including flap necrosis and flap dehiscence, was 29.9%. When the time taken to perform one vascular anastomosis, including preparation of the recipient vessel and flap vessel, exceeded 30 min, the incidence rates of flap necrosis (total and partial) (odds ratio, 8.30; 95% confidence interval, 1.91-36.00; P = 0.005) and flap dehiscence (odds ratio, 3.46; 95% confidence interval, 1.05-11.36; P = 0.041) increased significantly. Conclusion: The time taken to perform one vessel anastomosis was the factor that contributed the most to the incidence of flap complications. Reconstructive surgeons should reduce the incidence of flap complications by keeping the known risk factors of the surgery in mind and by aiming to complete a vascular anastomosis time, including the time taken for the preparation of vessels, of ≤ 30 min per vessel during surgery.