Background: In Japan, students with health impairments who are in hospitals can take part in school education through in-hospital classes and hospital-visit education. However, previous studies have demonstrated that a certain percentage of elementary and junior high students do not receive learning support. The problems involved with the provision of school education through in-hospital classes and hospital-visit education should be addressed, to facilitate students’learning in hospitals.

Objective: This study aimed to clarify the reasons for the unavailability of in-hospital classes or hospitalvisit education from the perspective of head nurses in pediatric internal medicine and surgery departments, and explore issues arising due to the absence of in-hospital classes and hospital-visit education.

Methods: The Japan Hospital Association, Japanese Association of Children’s Hospitals and Related Institutions, and 576 hospitals with pediatric internal medicine or surgery wards were included in our study. The respondents were head nurses in the pediatric internal medicine or surgery wards. This questionnaire survey was conducted as a postal survey from mid-June, 2018 to mid-November, 2018. The questions for the selection formulas were tabulated and statistical analysis was performed. Subsequently, the card arrangement of the KJ method was used to identify themes and categorize them based on similarities.

Results: We collected data from 252 hospitals, and the final sample comprised 245 hospitals. The most common reasons given for not making use of in-hospital classes and hospital-visit education when these were available were “The families of the elementary/junior high school students in the hospital do not insist on education” When in-hospital classes and hospital-visit education were not available, there were issues, mainly in terms of returning to school and learning.

Conclusion: There were also two types of access issues for elementary and junior high school students: some hospitals had no venues for in-hospital classes and hospital-visit education, while other hospitals had venues for in-hospital classes and hospital-visit education that were unavailable to elementary and junior high school students. In hospitals with venues for in-hospital classes and hospital-visit education, the present findings revealed that several elementary and junior high school students in hospitals did not receive in-hospital classes or hospital-visit education, and that their learning mainly depended on the efforts of others, such as their parents and their original school teachers.

Background: Although many health-risk behaviors among adolescents have improved in the past several decades, the coronavirus disease 2019 (COVID-19) pandemic might have a significant impact on adolescent health and health-risk behaviors.

Objective: This study aimed to explore trends in the prevalence of health-risk behaviors among Japanese adolescents between 2002 and 2021 and to assess whether the COVID-19 pandemic period is associated with those changes.

Methods: A repeated cross-sectional study was conducted using data from prefecture-wide surveys of public high schools in Okinawa Prefecture, Japan, in 2002, 2005, 2008, 2012, 2016, and 2021. The study included 16,562 students in grades 10 to 12 (15-18 years). The behaviors studied included injury-related behaviors, cigarette use, alcohol use, sexual behaviors, dietary behaviors, and physical activity. Logistic regression models were performed separately for boys and girls, treating the survey year as a continuous independent variable and adjusting for grade, school type and region.

Results: During the 20-year period, there were significant improvements in multiple health-risk behaviors, such as traffic risk behaviors, cigarette and alcohol use, vegetable intake, TV watching, and sexual behaviors. On the other hand, persistent sad feelings, suicidal ideation and fasting in girls, fruit consumption and physical activity in boys, and video game/computer use among both sexes have worsened over time. In particular, during the COVID-19 pandemic, physical activity and video game/ computer use in both sexes and persistent sad feelings and suicidal ideation in girls worsened significantly.

Conclusion: Many health-risk behaviors among adolescents improved between 2002 and 2021. Meanwhile, the COVID-19 pandemic might contribute to deteriorated physical activity and video game/ computer use and worsened mental health and suicidality among girls.