[Nihon koshu eisei zasshi] Japanese journal of public health最新文献

Objectives　Japan's "Healthy Japan 21 (Third Phase)" highlights the need for environments that naturally support health, yet, few studies have assessed health outcomes in community-dwelling older adults based on the area of residence. This study compared long-term care (LTC) risk scores and projected medical and LTC costs for older adults who lived in the Kashiwanoha Campus area, a district developed under the concept of a healthy, secure, and publicly-privately-academically managed community, and older adults who lived in other parts of Kashiwa City.Methods　We analyzed data of the 2022 Health and Lifestyle Survey in Kashiwa City, part of the Japan Gerontological Evaluation Study, including 5,895 community-dwelling adults aged ≥65 years who were certified to not need support or LTC. Differences in LTC risk scores between Kashiwanoha and other areas were assessed using multivariable linear regression accounting for school district clusters. Based on prior studies, we estimated three-year cumulative medical and LTC costs and six-year cumulative LTC costs. Sensitivity analyses included income-stratified analyses, propensity score matching, a nine-year longitudinal analysis of changes in LTC risk scores, and item-level analyses using risk ratios for each of the 10 LTC risk score components.Results　Living in the Kashiwanoha area was associated with 0.32 points lower LTC risk scores than in other areas (95% CI: －0.45 to －0.19). Sensitivity analyses showed differences of 0.25 to 0.81 points across income strata, consistently lower point estimates in propensity score matching, and a 0.58-point difference in the nine-year longitudinal analysis, although the latter two were not statistically significant. Among the 10 LTC risk items, "walking continuously for 15 minutes" was more common among Kashiwanoha residents. Based on the main analysis and the nine-year longitudinal analysis, the three-year cumulative medical and LTC costs in the Kashiwanoha area were estimated to be ¥18,208 to ¥33,002 lower per person, and the six-year cumulative LTC costs were estimated to be ¥10,112 to ¥18,328 lower per person.Conclusions　In the main and some sensitivity analyses, older adults in Kashiwanoha had significantly lower LTC risk than those in other areas. The projected three-year reduction in medical and LTC costs was ¥18.208 to ¥33.002 million per 1,000 persons. Multifaceted urban development in Kashiwanoha may have contributed to residents health promotion. Further studies are warranted to clarify the environmental factors that contribute to the health and functioning of residents.

Objectives　We sought to identify the reasons for concerns and stress, and help-seeking behaviors among fathers of preschool-aged children, and to provide data for developing support systems targeting fathers.Methods　This cross-sectional study used health and household survey data from the 2022 Comprehensive Survey of Living Conditions. Participants were divided into two groups (those with and without concerns or stress), and their background characteristics, including fathers' age and educational attainment, were compared. Residual analyses were performed for statistically significant variables. Subsequently, we presented the distribution of causes of these concerns or stress. Finally, binary logistic regression analysis was performed between the outcome of help-seeking behavior and background characteristics, and we calculated odds ratios (OR) and 95% confidence intervals (Cis), with "not seeking help" coded as 1 and "seeking help" coded as 0.Results　Forty-seven percent of fathers reported concerns or stress; 26% of them did not seek counseling, and 16% scored ≥10 points on the K6 scale. Main reasons for concerns and stress among fathers were: "own work" (52%), "income, family finances, debts, etc." (18%), and "childcare" (6%). Regarding help-seeking behaviors, older fathers, fathers having mood or anxiety disorders (OR 1.48, 95% CI: 1.24-1.75), and fathers working ≥11 hours per day were more likely not to seek help than those working 8 hours per day (OR 1.24, 95% CI: 1.02-1.51). Conclusion　Approximately half of fathers reported concern or stress due to "own work," "income, household finances, debt, etc.," and "childcare." Supporting fathers extends beyond childcare support, but requires a support system to improve their workplace environments, consciously encouraging supporters to create an atmosphere conducive to consultation, and checking fathers' concerns and stress levels, including the necessity of mental health screening. Further studies on concrete approaches to support fathers should be conducted, and support providers should be trained accordingly.

Objective　To develop a checklist for utilizing information and communication technology (ICT) in community-workplace collaboration programs implemented by local government, based on a consensus among municipal personnel responsible for these programs in organizations utilizing multiple ICT tools.Methods　Using data from a questionnaire and interview surveys conducted in 2022-2023, a checklist comprising seven domains was drafted: online meetings (eight items), e-mail newsletters (seven items), websites (eight items), live online seminars (eight items), on-demand online seminars (eight items), health-related applications (nine items), and common foundational items across ICT utilization (eight items). The expert panel was selected from a nationwide survey conducted in June 2024 among prefectures and public health centers with community-workplace collaboration councils. Personnel responsible for community-workplace collaboration programs were invited from 54 organizations in which five or more ICT tools were utilized. A two-round Delphi study was conducted using an initial checklist based on the findings of the questionnaire and interview surveys. Participants rated the importance of items on a five-point scale, reported their implementation status, and provided open-ended comments. Consensus was defined as an agreement rate ≥70%, a median importance score ≥4, and an interquartile range ＜1.5.Results　Responses were obtained from 39 of 54 organizations (72.2%) in the first round, and 35 of 39 (89.7%) in the second round. The items were revised after the first round. In the second round, 55 items had an agreement rate ≥70%, and 53 items had an agreement rate ≥80%. The final checklist comprised 55 items across the seven domains: online meetings (eight items), e-mail newsletters (seven items), websites (eight items), live online seminars (eight items), on-demand online seminars (seven items), health-related applications (nine items), and common foundational items across ICT utilization (eight items).Conclusion　Using the Delphi method, a checklist was developed that encompasses the preparation, organizational and operational systems, implementation strategies, and evaluation components necessary for ICT utilization in community-workplace collaboration programs. Organizations can assess their Internet infrastructure and organizational readiness using the common foundational items before selectively applying the domain-specific checklists based on the ICT tools being implemented. The checklist may also assist organizations that are already using ICT, to periodically evaluate its effectiveness. Despite achieving consensus for all checklist items, several items related to budget, operational systems and evaluation had low implementation rates, indicating a necessity for strategies to enhance effective ICT utilization.

Objectives　When large-scale natural disasters occur, the Japan Dietetic Association-Disaster Assistance Team (JDA-DAT) dispatches dietitians to disaster-affected areas, where they collaborate with the affected local governments to provide nutrition and dietary support. Recognizing local government needs may result in more effective support. Therefore, this study aimed to identify the types of tasks that local government officials expect from JDA-DAT as aid providers. The findings of this study will contribute to the development of a more comprehensive disaster support system.Methods　A nationwide survey was conducted targeting officials in the nutrition-related and disaster management departments of local governments nationwide. The survey investigated the priority of tasks expected of the JDA-DAT in disaster-affected areas and the types of tasks the recipients would like the JDA-DAT to undertake outside the disaster area (backup support). The priorities of tasks expected of the JDA-DAT in disaster-affected areas were classified as follows: ratings of 4 and 5 were considered high priority, 3 as medium priority, and 1 and 2 as low priority.Results　The tasks in disaster-affected areas expected of the JDA-DAT, ranked in order of highest priority, were as follows: "tailored nutritional counseling for individuals necessitating special consideration who require nutrition and dietary support", "identification of residents requiring nutrition and dietary support (nutritional assessment) at evacuation shelters", "assessment of meal conditions at evacuation shelters and proposals for provided meals based on nutrient adequacy or deficiency (e.g., menu planning)", "management of stockpiled food and relief supplies (special dietary products): sorting special dietary products from general food items", and "support for coordination of provided meals (soup kitchens and boxed meal distribution): hygiene guidance". The items with high priority were similar in prefectural government offices and ordinance-designated cities/special wards, whereas some items were assigned high priority in municipalities (cities, towns, and villages).Conclusions　The local government officials anticipate a wide range of support activities from the JDA-DAT. In particular, identifying individuals requiring special consideration and providing individualized support have received high priority. Furthermore, our findings suggest that the priority of requested support varies according to the type of municipality, underscoring the significance of supporters in understanding the roles of different local governments when engaging in disaster support activities.

Objective　Effort is defined as engagement in goal-directed activities and may contribute to well-being (WB). However, only a few studies have directly examined this association. This study aimed to develop the effort scale for academic advancement (ESAA), a multidimensional scale for assessing effort in studying for university entrance examinations, and to examine its reliability and validity (Study 1). Moreover, we examined the association between effort related to academic advancement and WB (Study 2).Method　In Study 1, we developed the initial ESAA items based on a three-dimensional effort framework comprising intensity, persistence, and direction. We conducted a web-based survey of individuals aged 18-34 years who had undergone university entrance examinations and assessed their efforts. We used an exploratory factor analysis to examine the factor structure of the ESAA, and we assessed its internal consistency using Cronbach's alpha coefficient. Furthermore, we examined criterion-related validity by testing the correlations between each subscale score and the external criteria. Moreover, we examined the associations between the ESAA scores and background variables, including age, sex, and first-choice admission status. In Study 2, we conducted a follow-up survey of participants from Study 1. We assessed factorial validity using confirmatory factor analysis and examined test-retest reliability using correlations between corresponding subscale scores across the two surveys. We finally examined the associations between effort and life satisfaction, an indicator of WB, using multiple regression analyses while controlling for covariates.Results　In Study 1, we included 534 participants, and exploratory factor analysis yielded a three-factor structure. Cronbach's alpha coefficients ranged from 0.92 to 0.93, supporting internal consistency. Each subscale score significantly correlated with the external criteria, and associations with background variables differed across the subscales. We included 295 participants in Study 2. Confirmatory factor analysis showed an acceptable model fit. Correlations between the corresponding subscale scores ranged from 0.77 to 0.81, indicating sufficient test-retest reliability. In multiple regression analyses, each subscale score was positively associated with life satisfaction when entered individually. However, only intensity remained positively associated when all the subscale scores were entered simultaneously.Conclusion　These findings indicate that the ESAA has acceptable reliability and validity for assessing efforts related to academic advancement. Moreover, effort intensity was associated with WB even after controlling for goal attainment, that is, whether participants were admitted to their first-choice university. Future studies should extend these findings to other contexts.

Objective　Homelessness has a profound impact on health and is often framed as an extreme form of social exclusion. In Japan, policies and support programs have promoted stable housing as a pathway to independence, contributing to a marked decline in the number of individuals experiencing homelessness. Nevertheless, the homeless population has aged, and homelessness has become prolonged; among this population, the avoidance of support services and return to street homelessness remain notable challenges. While previous studies have emphasized structural factors and formal outcomes, such as facility entry, reasons for discharge, and housing acquisition, the subjective experiences of individuals transitioning into housing remain underexplored. The objective of this study was to qualitatively describe how individuals experiencing long-term homelessness perceive homelessness and obtaining housing within the context of their relationships with others in society.Methods　This was an exploratory qualitative study. Participants were recruited through a support organization in the Tokyo metropolitan area. The study included four men who had experienced homelessness for more than 10 years and had been living in apartments for at least 1 year at the time of the interviews. Semi-structured interviews were conducted between July and August 2023. The interview transcripts were analyzed using a phenomenological approach, focusing on lived experiences, context, and meaning through an iterative interpretive process.Results　Three major themes were identified. "Becoming 'no one'" described experiences of disengaging from social roles and expectations tied to family, work, and community, resulting in the loss of a socially defined sense of self. "Living as oneself while being accepted" referred to practices through which participants sustained their lives during homelessness by finding specific spaces or relationships in which they were not judged based on their social status or roles. "Being required to become 'someone' again" captured the experience of obtaining housing, in which institutional rules, social expectations, and relationships re-entered daily life, destabilizing previously viable ways of living.Conclusions　Experiencing homelessness and obtaining housing were not defined by the presence or absence of housing; rather, they involved relationships with others and shifts in those relationships. In providing support, it is necessary to recognize that relational changes accompanying housing acquisition may create new difficulties. Support should therefore be attentive to individual experiences, accompanying individuals in accepting such changes and building new relationships. This study suggests directions for homelessness support that extend beyond the provision of physical housing.

Abstract　In rapidly aging Japan, supporting older adults in maintaining meaningful social roles is an important public health priority for extending healthy life expectancy and preventing the need for long-term care. In response, the Work-like Activity (Shuro-teki Katsudo) Support Coordinator Placement Program was introduced in 2020 to promote role-based social participation among older adults. Within this policy framework, this paper clarifies the concepts of work-like activities and work-like activity support. By reviewing diverse definitions and practices and examining their alignment with documents issued by the Ministry of Health, Labour and Welfare, we identify key conceptual issues related to work-like activities and emphasize their significance as meaningful forms of social participation, particularly regarding paid activities outside formal employment. Two central perspectives on work-like activity support are highlighted: (1) aligning activities with older adults' preferences and functional conditions and (2) developing and expanding opportunities that accommodate diverse health and functional states. This conceptual framework may support the planning and implementation of municipal programs while providing a common foundation for future research on the prevalence and effects of work-like activities.