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

Objectives　Given the growing shortage of public health physicians in local governments in Japan, this study aimed to characterize lectures and practical training in public health at medical schools and to assess career orientation and interest in public health among senior medical students.Methods　Between October 2024 and January 2025, a self-administered questionnaire developed using Google Forms was distributed through the academic affairs offices of all 82 medical schools. Responses were obtained from departments responsible for public health education and from fifth-year medical students.Results　Valid responses were obtained from 66 departments across 58 universities. Lectures were most frequently delivered in the third year, whereas practical training most commonly occurred in the fourth year. Primary training sites included public health centers, hospitals, and long-term care facilities; however, 22 universities did not include public health centers. Only seven universities (12.1%) required public health center training during clinical clerkship. The student analysis included 363 fifth-year students from 40 universities (56.5% male, 10.5% with prior enrollment at another university, and 32.5% with geographic ties to their current institution). Regarding career preferences (multiple responses allowed), 93.9% intended to pursue clinical practice in Japan, whereas 5.2% expressed interest in public health physician roles in local governments, and 2.8% each in governmental agencies and international organizations. Overall, 62.8% reported interest in public health.　After adjustment for participating universities using a modified Poisson regression model with robust variance estimators, selecting epidemiology and biostatistics as a lecture of interest was the only factor significantly associated with interest in public health (adjusted risk ratio [aRR], 1.251; 95% confidence interval [CI], 1.078-1.453; P＝0.003). Additionally, having a local connection to the university (aRR, 1.150; 95% CI, 0.979-1.351; P＝0.090) and interest in the healthcare system (aRR, 1.151; 95% CI, 0.982-1.350; P＝0.090) were suggestively associated at P＜0.10.Conclusion　Educational strategies that strengthen interest in core public health disciplines, particularly epidemiology and biostatistics, may contribute to broader workforce development efforts.

Objective　Focusing on novice public health nurses with prior work experience, this study aimed to identify the characteristics of human resource development systems related to career development, and to examine the importance of achievement levels in home visits within such systems.Methods　A web-based survey was conducted targeting all public health nurses newly employed by prefectural and municipal governments across Japan in fiscal years 2023 and 2024. In this study, we analyzed data from individuals with prior work experience. The survey items included demographic characteristics, the Comprehensive Career Development Scale for public health nurses (career score), the human resource development system, and levels of achievement during home visits for basic cases (home-visit achievement). Using hierarchical multiple regression, the career score was set as the dependent variable. In Model 1, all independent variables except home-visit achievement were entered; in Model 2, home-visit achievement was added. The adjusted coefficient of determination (R²) and its change were calculated to examine the contribution of home-visit achievement.Results　A total of 1,679 questionnaires were returned, of which 1,572 were valid, and 734 respondents had prior work experience. In the hierarchical multiple regression analysis, the adjusted R² values were 0.095 for Model 1 and 0.114 for Model 2, indicating a significant increase of 0.02. In Model 2, variables significantly associated with the career score were workplace consultation (β＝0.19), experience in presenting at academic conferences (β＝0.08), reading journals/books purchased by the workplace (β＝0.14), self-purchased journals/books (β＝0.08), and home-visit achievement (β＝0.15).Conclusion　The adjusted R² of Model 2 was 0.114, indicating that the career development of novice public health nurses with prior work experience could not be explained sufficiently by the variables examined in this study alone. However, workplace consultation, presentation experience, journal and book reading, and home-visit achievements were significantly associated with career score, with the inclusion of home-visit achievements further improving the explanatory power of the model. These findings suggest that, even for novice public health nurses with prior work experience, human resource development that provides systematic instruction and ensures achievement levels during home visits, together with well-developed consultation systems and learning opportunities, is important for supporting career development during the initial employment period.

Objectives　Food is taken in through the mouth, making the development and maintenance of oral function essential for promoting Shokuiku (food and nutrition education). However, the nationwide status of oral health promotion within Shokuiku has remained unclear. Therefore, we surveyed local governments throughout Japan. This paper examines the status of planning for oral health and Shokuiku in local governments and evaluates the interrelationship of their goals.Methods　The survey targeted oral health and Shokuiku departments in prefectures and municipalities across Japan. An email containing a Microsoft Excel survey form was sent to both departments. Oral health departments were asked about oral health promotion plans, and Shokuiku departments were asked about Shokuiku promotion plans. Survey items included the existence of these plans, the presence of nutrition- and Shokuiku-related goals in the oral health promotion plan, and the inclusion of oral health-related goals in the Shokuiku promotion plan. A descriptive statistical analysis assessed the status of plan formulation and interrelated goal setting. Differences by population size and prefecture were also examined for municipalities.Results　The response rate was 93.6% for oral health departments and 95.7% for Shokuiku departments at the prefectural level. At the municipal level, response rates were 57.8% and 54.5%, respectively. All prefectures had established oral health promotion plans and Shokuiku promotion plans. At the municipal level, 79.4% had oral promotion plans and 92.4% had Shokuiku promotion plans. Goals related to Shokuiku and nutrition were included in 36.4% of prefectural oral health promotion plans and 47.1% of municipal plans. Meanwhile, oral health-related goals were included in 46.7% of prefectural Shokuiku promotion plans and 39.6% of municipal plans. Regarding municipal population size, both cooperation and plan formulation rates decreased as population decreased. Significant regional differences were also observed when comparing municipal survey item across prefectures.Conclusion　A proportion of local governments incorporated goals addressing both oral health and Shokuiku in their respective promotion plans, although notable regional differences persisted. These findings may contribute to future efforts to promote oral health and Shokuiku.

Objective　This study investigated whether self-rated parent-child relationships are associated with self-esteem among elementary and junior high school students, after statistically adjusting for family economic status and young carer status.Methods　In 2024, 893 anonymous questionnaires were administered among fifth-grade elementary and second-grade junior high school students in Yurihonjo City, Japan. Exposure-defined as a "poor parent-child relationship"-was determined based on responses indicating "somewhat does not apply" or "does not apply" to one or more of six relevant items. Self-esteem was measured using the total score ranging from 3 to 12 on the Tokyo version of the Self-Esteem Scale. "Financial difficulties" were defined as responses indicating that the household's living conditions were "somewhat difficult" or "very difficult." Young carers were defined as children who provided care to family members in a manner that affected their daily lives. A linear regression model was used to examine the association between parent-child relationships and self-esteem. The total score on the self-esteem scale was treated as the dependent variable, whereas parent-child relationship (reference: good), household economic status (reference: sufficient), young carer status (reference: non-carer), and additional covariates were included as independent variables. Regression coefficients representing differences in self-esteem scores relative to the reference categories were estimated along with their 95% confidence intervals (CIs).Results　Among the participants, 49% were female, 52% were fifth-grade elementary school students, and 17% lived in single-parent households. A total of 23% participants reported poor parent-child relationships, 10% reported economic difficulties, 2% were young carers, and the median self-esteem score was 9.5. Regarding basic characteristics, children who reported poor parent-child relationships when compared to those with good relationships, exhibited the following features: a higher proportion of females, poorer self-rated health, and limited household economic status, while a lower proportion had someone to consult. After adjusting for covariates, the difference in self-esteem scores was -0.98 (95% CI: -1.19 to -0.77) for poor parent-child relationships. In addition, the total self-esteem scale score was -0.21 (95% CI: -0.50 to 0.09) among those experiencing poorer household economic status and 0.25 (95% CI: -0.26 to 0.75) among those identified as young carers.Conclusion　These findings suggest that parent-child relationships may serve as a key factor in fostering self-esteem among elementary and junior high school students.

Objectives　The aim of this study was to analyze the association between employment status, family structure, and nutrient adequacy in working-age Japanese adults (aged 20-64 years).Methods　Data from the 2019 National Health and Nutrition Survey and the Comprehensive Survey of Living Conditions, conducted by the Ministry of Health, Labour and Welfare, were used to examine the associations between nutrient adequacy and employment status (full-time, part-time, unemployed, or not applicable) and family structure (single, couple only, two-parents and child [parent, child], single parent and child [parent, child], three-generations [parent, child], and other family structures). Logistic regression analysis was performed with nutrient deficiency as the dependent variable and employment status and family structure as independent variables, controlling for age, municipality size, and prefecture of residence.Results　The association between employment status and nutrient adequacy, as assessed by the chi-squared test, showed statistically significant differences in the percentage of nutrient inadequacy across employment status categories among women for three nutrients, but not among men. The chi-squared test between family structure and nutrient adequacy showed statistically significant differences for 10 nutrients for men and 14 nutrients for women. Among men, parents in three-generation families had higher inadequacy rates; among women, those living alone showed higher inadequacy rates. Logistic regression revealed that, compared with those in full-time employment, men in part-time employment had statistically higher inadequacy in total fiber, folic acid, potassium, and magnesium. For women, employment status was associated with inadequacy of n-6 fatty acids, total fiber, vitamin A, vitamin C, salt equivalents, and magnesium. Furthermore, nutrient inadequacy differed significantly by family structure for 14 nutrients in men and 16 nutrients in women. For men, single individuals, and parents in three-generation families showed statistically higher inadequacy rates for some nutrients, while for women, of the 16 nutrients showing statistically significant differences, children in "two-parent and child families" and women in "couple-only families" showed lower rates of nutrient inadequacy for 9 and 8 nutrients, respectively.Conclusion　Nutritional disparities among working-age adults are associated with employment patterns and family structure. In addition, nutrient excesses and deficiencies were identified in groups previously overlooked, such as parents in two-parent and child households and three-generation households, highlighting the need for policies that address these diverse factors.

Objectives　This project aimed to introduce Health Impact Assessment (HIA) into urban redevelopment planning in Japan to promote health-conscious urban environments and support wider HIA implementation. We applied HIA to the "University of Tokyo Nishi-Chiba Campus Redevelopment Project" in Chiba City, Japan, to examine potential effects on residents' health and well-being.Methods　Among the three HIA types (comprehensive, rapid, and desktop), we selected the rapid HIA because of time limitations. The project carried out the initial four HIA steps: screening, scoping, appraisal, and reporting, excluding monitoring. We developed an HIA assessment matrix tailored to Japanese urban development by adapting the "HIA Screening Tool" of the Japanese Society of Public Health and consulting international HIA resources. Using this matrix, we organized three workshops that included local government officials, developers, and academic experts. The workshops evaluated potential health impacts of the redevelopment from multiple stakeholder perspectives.Results　Each indicator in the matrix was examined, and consensus on judgments was reached during the workshops. Based on these judgments, we identified necessary improvements and formulated recommendations. Pre-development recommendations included creating a green-space map with resident involvement, enhancing information sharing with nearby medical facilities, and implementing transportation and mobility measures. Post-development recommendations included establishing an area-management organization, hosting community events to support interaction between existing and incoming residents, and strengthening collaboration with local businesses. Our research group compiled these recommendations into a final report and provided it to the developers and the local government.Conclusion　This HIA project enabled a systematic evaluation of the health impacts of an urban redevelopment initiative and generated actionable recommendations. Workshops involving diverse stakeholders improved the credibility and practical value of the assessment. Nevertheless, challenges remain, including limited public participation, a compressed schedule, and constrained influence on major design elements because HIA was introduced at an advanced project stage. We expect that the "HIA Checklist for Urban Planning in Japan" developed through this study will be incorporated into future redevelopment efforts and contribute to the broader adoption of HIA and the advancement of healthier urban environments in Japan.

Objectives　In most Japanese municipalities, the Questionnaire for Medical Checkup of Old-Old (QMCOO) is administered during annual health checkups for older adults aged ≥75 years to screen for frailty, whereas the Kihon Checklist (KCL) is used within the long-term care (LTC) system to identify individuals who may be eligible for services aimed at preventing loss of independence. Few studies have examined whether the combination of these two tools is associated with subsequent LTC certification. We examined the association between coexisting health risks identified by both tools and the onset of LTC certification.Methods　This retrospective cohort study used data from Chiyoda-ku, Tokyo, Japan. Fiscal year (FY) 2020-2021 data from the National Health Insurance's "Kokuho Database" were linked with FY2020 data from a postal survey that incorporated the KCL. The participants comprised individuals aged ≥75 years with no LTC certification at baseline, who had completed the annual health checkup (including the QMCOO) in FY 2020, and who had responded to the postal survey. Frailty risk was defined as ≥4 of 12 frailty-related QMCOO items, and individuals eligible for LTC prevention services were identified using the KCL's standard criteria. Participants were classified into four groups (QMCOO + or - /KCL + or -). Incident LTC certification cases were identified from the health checkup date until March 31, 2022. Cox proportional hazards analysis was performed to calculate the hazards for LTC certification across groups, with the QMCOO-/KCL- group as the reference.Results　Among the 527 participants (mean age: 80.6 years; men: 41.9%), 50 (9.5%) received LTC certification during the 1013.5 person-years of follow-up. The LTC certification incidence rate per 1000 person-years was 33.1 in the QMCOO-/KCL- group and 85.7 in the QMCOO+/KCL+ group (log-rank P = 0.006). Cox proportional hazards analysis that adjusted for covariates (sex, age groups, living arrangement, years of education, and medical history) showed that the hazard of incident LTC certification in the QMCOO+/KCL+ group was significantly higher than that of the QMCOO-/KCL- group (hazard ratio: 2.55, 95% confidence interval: 1.21-5.38). Neither the QMCOO+/KCL- nor QMCOO-/KCL+ groups were significantly associated with LTC certification.Conclusions　Using both tools to identify older adults at high risk of LTC certification may help improve the efficiency of preventive interventions within Japan's healthcare system for older adults.

Objectives　In Japan, many females primarily use sanitary napkins during menstruation. However, growing awareness of environmental concerns and increasingly diverse lifestyles has led to the introduction of various menstrual products. Particularly, tampons, which are inserted intravaginally, are becoming more common; however, the prevalence of tampon use among Japanese females, the psychological and social factors influencing their use, and awareness of tampon-related adverse events remain unclear. Therefore, this study used an internet survey to examine tampon use among Japanese females.Methods　An internet survey was conducted in March 2024 through an online platform targeting 14,000 females aged 18-54 years in Japan. The primary survey assessed tampon use with the options "currently using," "previously used," or "never used," and explored the reasons underlying these responses. Additionally, 1,000 females from each usage category were randomly selected for a secondary survey that assessed menstrual symptoms and economic status. Among current tampon users, we also evaluated tampon-use practices and awareness of toxic shock syndrome (TSS), an adverse event linked to tampon use.Results　A total of 13,983 participants were included in the primary survey analysis after excluding inappropriate respondents. Among the respondents, 13.0% (95% CI: 12.4-13.5) were currently using tampons, 28.8% (95% CI: 27.7-29.2) had previously used tampons, and 58.2% (95% CI: 57.8-59.5) had never used tampons. The most common reason for current use was reduced risk of blood staining on underwear (51.7%). Among current users, 25.4% did not practice hand hygiene before tampon insertion, and 16.3% were aware of TSS. The current-use group reported more menstrual symptoms than the other two groups (Mean: 3.58, 3.26, 2.96; P < 0.001). The current-use group was more likely to have experienced economic difficulties that prevented purchasing menstrual products (16.9%, 6.8%, 3.6%; P < 0.001).Conclusion　Although the proportion of current tampon users in Japan remains lower than that in Western countries, these findings indicate the need to consider motivations for tampon use and related social factors to promote awareness of safe tampon practices in Japan.

Objectives　The purpose of this study was to clarify smoking status and quit attempts among cigarette smokers after the release of heated tobacco products.Methods　We used data from the 2016, 2018, 2020, and 2022 waves of the Japan "Society and New Tobacco" Internet Survey (JASTIS), which aims to facilitate a better understanding of the current situation regarding new tobacco products in Japan. Participants were aged between 20 and 69 years in each wave and were regular cigarette smokers. Survey items included basic characteristics, smoking status, types of tobacco products smoked in the past year, and quit attempts and methods. We calculated the frequencies of basic characteristics, smoking status, and quit attempts for each survey year. Frequencies of quit attempt methods and overlapping status were also calculated. Chi-square tests were applied to each item, and significant differences were compared with the results from the previous year. The Cochran-Armitage trend test was applied to smoking status and quitting attempts.Results　There were 934 participants in 2016, 1,717 in 2018, 1,348 in 2020, and 4,117 in 2022. Most participants were in their 40s and 50s, and approximately 70% were male. The rate of cigarette-only smokers was 94.5% in 2016, dropping sharply to 60.3% in 2018 (P < 0.001). Conversely, the number of smokers who used cigarettes in combination with either heated tobacco products or e-cigarettes increased sharply from 4.0% to 37.3% within the same period (P < 0.001). The quit attempt rate was 16.0% in 2016, increasing annually and reaching 40.1% by 2022 (P < 0.001). The most common quit attempt method in 2016 was self-help, accounting for 71.8%, decreasing to 41.7% in 2018 (P < 0.001), while the use of heated tobacco products/e-cigarettes increased during the same period from 28.9% to 64.3% (P < 0.001). In 2016, smoking cessation treatments and nicotine preparations from pharmacies accounted for 18.1% and 26.2%, respectively, with both increasing since 2020.Conclusion　Since the launch of heated tobacco products, the number of smokers using cigarettes has decreased, whereas the number of smokers using heated tobacco products and/or e-cigarettes in combination with cigarettes has increased. Simultaneously, the rate of quit attempts has been steadily increasing, with growing preference for heated tobacco products/e-cigarettes as cessation methods. Emerging evidence indicates that heated tobacco products pose health risks and may also lower the success rate of quitting smoking, while increasing the relapse rate, making them an unsuitable cessation option.

Objectives　This study aimed to investigate the relationship between intra- and intergenerational exchanges and mental health among adults living in rural mountainous areas, with particular emphasis on younger adults aged 20-49 years.Methods　A cross-sectional questionnaire survey was conducted in September 2023 among 980 residents aged 20-74 years in Nagatoro Town, Saitama Prefecture. Mental health was evaluated using the Japanese version of the WHO-5 Well-Being Index. A total score <13 or any item score ≤1 indicated poor mental health. Participants were categorized as younger adults (20-49 years) and middle-to-older adults (50-74 years). Intragenerational exchange was defined as interaction with peers outside family, relatives, or workplace relationships. Intergenerational exchange referred to interaction with individuals from different generations. Exchange patterns were classified into four groups: no exchanges, intragenerational only, intergenerational only, and both. The dependent variable was mental health status. Independent variables included the presence and patterns of intra- and intergenerational exchanges. Adjusted variables were sex, age, educational attainment, cohabitation with children, subjective economic status, participation in community activities, employment status, and self-rated health. Multivariable logistic regression analyses were conducted.Results　Among 302 valid responses (30.8% response rate), 135 participants (44.7%) had good mental health, including 75 younger adults (41.9%). Among younger adults, 74.3% reported intragenerational exchanges and 78.2% reported intergenerational exchanges. In younger adults, the presence of intragenerational exchange was significantly associated with better mental health compared with no intragenerational exchange. In contrast, the presence of intergenerational exchange was not significantly associated with better mental health compared with no intergenerational exchange. Regarding exchange patterns, compared with intragenerational-only exchange, no exchange and intergenerational-only exchange were associated with poorer mental health among younger adults. Having both types of exchange was not significantly associated with mental health.Conclusion　Among adults living in rural mountainous areas, intragenerational exchanges were positively associated with good mental health among younger adults, whereas intergenerational exchanges showed no positive association. Absence of exchanges or intergenerational-only exchanges was negatively associated with mental health. These findings suggest that intragenerational exchange may contribute to better mental health among younger adults in rural communities.