Growing socioeconomic disparity is a global concern, as it could affect population health. The author and colleagues have investigated the health impacts of socioeconomic disparities as well as the pathways that underlie those disparities. Our meta-analysis found that a large population has risks of mortality and poor self-rated health that are attributable to income inequality. The study results also suggested the existence of threshold effects (ie, a threshold of income inequality over which the adverse impacts on health increase), period effects (ie, the potential for larger impacts in later years, specifically after the 1990s), and lag effects between income inequality and health outcomes. Our other studies using Japanese national representative survey data and a large-scale cohort study of Japanese older adults (AGES cohort) support the relative deprivation hypothesis, namely, that invidious social comparisons arising from relative deprivation in an unequal society adversely affect health. A study with a natural experiment design found that the socioeconomic gradient in self-rated health might actually have become shallower after the 1997–98 economic crisis in Japan, due to smaller health improvements among middle-class white-collar workers and middle/upper-income workers. In conclusion, income inequality might have adverse impacts on individual health, and psychosocial stress due to relative deprivation may partially explain those impacts. Any study of the effects of macroeconomic fluctuations on health disparities should also consider multiple potential pathways, including expanding income inequality, changes in the labor market, and erosion of social capital. Further studies are needed to attain a better understanding of the social determinants of health in a rapidly changing society.
A link between affective disturbances and physical disorders has been suggested since the Greco–Roman era. However, evidence supporting an association between mind and body is limited and mostly comes from North America and Europe. Additional local epidemiologic studies are needed so that more evidence can be collected on effective treatments and health management. Epidemiologic studies of Japanese with rheumatoid arthritis (RA) and those on chronic hemodialysis examined the association between psychosocial factors and patient quality of life (QOL). Strong associations among depression, social support, and patient QOL were confirmed, which supports the findings of studies performed in Western countries. In addition, disparities between the perspectives of patients with RA and their doctors were observed. Alexithymia, a personality construct that reflects a deficit in the cognitive processing of emotion, had a stronger independent association with increased risk of 5-year mortality than did depression among patients with chronic hemodialysis. Physiological, biological, and psychosocial factors are associated and independently and interactively determine our health. Epidemiology is a powerful tool for identifying effective points of intervention, after considering all possible confounders. Future studies must clarify how health can be improved by using a psychosocial approach.
Background: The objective of this study was to clarify the relationship between feeling upon awakening (FA) and time spent using information technology (IT) devices by children in kindergartens, elementary schools, and junior high schools in Shimane, Japan. Methods: In October 2008, a self-report survey was distributed to 2075 children in kindergartens (n = 261), elementary schools (n = 1162), and junior high schools (n = 652) in Shimane, Japan. The questionnaire gathered data on sex, school year, feeling upon awakening, and time spent using IT devices after school (television, videos on television, video games, personal computers, and cellular phones). After adjusting for sex and school year, data were analyzed by multivariate logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 2030 children completed this survey (response rate, 97.8%). Negative FA was associated with watching television more than 2 hours/day (OR = 1.51, 95% CI = 1.23–1.85), playing video games more than 30 minutes/day (1.50, 1.20–1.87), and using personal computers more than 30 minutes/day (1.35, 1.04–1.75). Conclusions: Time spent using IT devices affected the FA of children in kindergarten through junior high school. We propose the development of guidelines regarding the appropriate amount of time this population should spend using IT devices.
Background: Few studies have reported the factors associated with intention to quit smoking among Korean adult smokers. This study aimed to examine sociodemographic characteristics, smoking-related beliefs, and smoking-restriction variables associated with intention to quit smoking among Korean adult smokers. Methods: We used data from the International Tobacco Control Korea Survey, which was conducted from November through December 2005 by using random-digit dialing and computer-assisted telephone interviewing of male and female smokers aged 19 years or older in 16 metropolitan areas and provinces of Korea. We performed univariate analysis and multiple logistic regression analysis to identify predictors of intention to quit. Results: A total of 995 respondents were included in the final analysis. Of those, 74.9% (n = 745) intended to quit smoking. In univariate analyses, smokers with an intention to quit were younger, smoked fewer cigarettes per day, had a higher annual income, were more educated, were more likely to have a religious affiliation, drank less alcohol per week, were less likely to have self-exempting beliefs, and were more likely to have self-efficacy beliefs regarding quitting, to believe that smoking had damaged their health, and to report that smoking was never allowed anywhere in their home. In multiple logistic regression analysis, higher education level, having a religious affiliation, and a higher self-efficacy regarding quitting were significantly associated with intention to quit. Conclusions: Sociodemographic factors, smoking-related beliefs, and smoking restrictions at home were associated with intention to quit smoking among Korean adults.
Background: Both outdoor air pollution and extreme temperature have been associated with daily mortality; however, the effect of their interaction is not known. Methods: This time-series analysis examined the effect of the interaction between outdoor air pollutants and extreme temperature on daily mortality in Shanghai, China. A generalized additive model (GAM) with penalized splines was used to analyze mortality, air pollution, temperature, and covariate data. The effects of air pollutants were stratified by temperature stratum to examine the interaction effect of air pollutants and extreme temperature. Results: We found a statistically significant interaction between PM10/O3 and extreme low temperatures for both total nonaccidental and cause-specific mortality. On days with “normal” temperatures (15th–85th percentile), a 10-µg/m3 increment in PM10 corresponded to a 0.17% (95% CI: 0.03%, 0.32%) increase in total mortality, a 0.23% (0.02%, 0.44%) increase in cardiovascular mortality, and a 0.26% (−0.07%, 0.60%) increase in respiratory mortality. On low-temperature days (<15th percentile), the estimates changed to 0.40% (0.21%, 0.58%) for total mortality, 0.49% (0.13%, 0.86%) for cardiovascular mortality, and 0.24% (−0.33%, 0.82%) for respiratory mortality. The interaction pattern of O3 with lower temperature was similar. The interaction between PM10/O3 and lower temperature remained robust when alternative cut-points were used for temperature strata. Conclusions: The acute health effects of air pollution might vary by temperature level.
Background: The present study investigated the prevalence of refractive error, visual impairment, and eye diseases in school-aged children in western China. Methods: The survey was done in a representative county (Yongchuan District, Chongqing Municipality) of western China. Cluster random sampling was used to select children aged 6 to 15 years. We conducted door-to-door surveys and eye examinations including optometry, stereoscopic vision test, eye position and eye movement, slit lamp examination of the anterior segment, retinoscopy, and fundus examination after cycloplegia with 1% cyclopentolate. Results: Among 3469 children, data were available for 3079 (88.76%). The prevalences of eye diseases were, in descending order, refractive error (20.69%; 637/3079), conjunctivitis (11.76%; 362/3079), amblyopia (1.88%; 58/3079), color vision defect (0.52%; 16/3079), keratitis (0.36%; 11/3079), strabismus (0.29%; 9/3079), cataract (0.23%; 7/3079), pathologic myopia (0.19%; 6/3079), and ocular trauma (0.13%; 4/3079). The prevalence of corneal leucoma, corneal staphyloma, optic neuropathy, macular degeneration, and myelinated nerve fibers was 0.03% (1/3079) for each. The prevalence of visual impairment was 7.70% (237/3079), and the major causes of visual impairment were uncorrected refractive error (86.08%; 204/237), amblyopia (9.70%; 23/237), pathologic myopia (1.27%; 3/237), congenital cataract (0.42%; 1/237), and others (2.11%; 5/237). Conclusions: Among school-aged children in a less developed area of western China, refractive error was the most prevalent eye disorder, and uncorrected refractive error was the main cause of visual impairment.
Background: Fever is one of the most common symptoms among children and is usually caused by respiratory infections. Although Japanese health authorities have long recommended gargling to prevent respiratory infections, its effectiveness among children is not clear. Methods: The children in this observational study were enrolled from 145 nursery schools in Fukuoka City, Japan. Children in the exposure group were instructed to gargle at least once a day. The endpoints of this study were incidence of fever during the daytime and incidence of sickness absence. Differences among gargling agents for each endpoint were also analyzed. Results: A total of 19 595 children aged 2 to 6 years were observed for 20 days (391 900 person-days). In multivariate logistic regression, the overall odds ratio (OR) for fever onset in the gargling group was significantly lower (OR = 0.68). In age-stratified analysis, ORs were significantly lower at age 2 (OR = 0.67), 4 (OR = 0.46), and 5 (OR = 0.41) years. Regarding sickness absence, the overall OR was 0.92 (not significant) in the gargling group. In age-stratified analysis, ORs were significantly lower at age 4 (OR = 0.68), 5 (OR = 0.59), and 6 (OR = 0.63) years. In subgroup analysis, significantly lower ORs for fever onset were observed for children who gargled with green tea (OR = 0.32), functional water (OR = 0.46), or tap water (OR = 0.70). However, the ORs were not significant for sickness absence. Conclusions: Gargling might be effective in preventing febrile diseases in children.
Background: Previous studies have shown associations of sedentary behavior with cardiovascular risk, independent of moderate-to-vigorous physical activity (MVPA). However, few studies have focused on older adults. This study examined the joint associations of television (TV) viewing time and MVPA with overweight/obesity among Japanese older adults. Methods: A population-based, cross-sectional mail survey was used to collect self-reported height, weight, time spent in TV viewing, and MVPA from 1806 older adults (age: 65–74 years, men: 51.1%). Participants were classified into 4 categories according to TV viewing time (dichotomized into high and low around the median) and MVPA level (dichotomized into sufficient and insufficient by the physical activity guideline level of ≥150 minutes/week). Odds ratios (ORs) for overweight/obesity (body mass index ≥25 kg/m2) were calculated according to the 4 TV/MVPA categories, adjusting for potential confounders. Results: Of all participants, 20.1% were overweight/obese. The median TV viewing time (25th, 75th percentile) was 840 (420, 1400) minutes/week. As compared with the reference category (high TV/insufficient MVPA), the adjusted ORs (95% CI) of overweight/obesity were 0.93 (0.65, 1.34) for high TV/sufficient MVPA, 0.58 (0.37, 0.90) for low TV/insufficient MVPA, and 0.67 (0.47, 0.97) for low TV/sufficient MVPA. Conclusions: In this sample of older adults, spending less time watching TV, a predominant sedentary behavior, was associated with lower risk of being overweight or obese, independent of meeting physical activity guidelines. Further studies using prospective and/or intervention designs are warranted to confirm the presently observed effects of sedentary behavior, independent of physical activity, on the health of older adults.
Background: The necessity and readiness for smoking cessation intervention in dental clinics was assessed by investigating smoking status and stage of behavior change in patients and the attitudes of dentists toward the effects of smoking on their patients, respectively. Methods: A self-administered questionnaire was mailed to 1022 dentists randomly selected from the Japanese Dental Association database. The questionnaire survey consisted of 1 section for dentists and 1 for patients aged 20 years or older and was scheduled to be completed at the dentists’ clinics on a designated day in February 2008. Results: The response rate to the questionnaire was 78.2% from among target dental clinics and 73.7% and 74.7% for patient and dentist questionnaires, respectively. Data from 11 370 patients and 739 dentists were analyzed. The overall smoking prevalence among the patients (25.1%) was similar to that reported by the National Health and Nutrition Examination Survey, and young female patients had a markedly higher smoking prevalence. More than 70% of patients who smoked were interested in quitting. Although the prevalence of current smoking among dentists (27.1%) was significantly higher than that reported among Japanese physicians (15.0%), approximately 70% of dentists were concerned about the effects of smoking on patient health and prohibited smoking inside their clinic. Conclusions: Many smokers who were interested in quitting, particularly young women, visited dental clinics, and most dentists believed that smoking was harmful for their patients. These results indicate that smoking cessation intervention in dental settings is necessary and that dentists are ready to provide such interventions.
Background: X-ray cross-complementing group 1 (XRCC1) polymorphisms affect DNA repair capacity and may therefore be of importance in colorectal carcinogenesis. Alcohol consumption, an important risk factor for colorectal cancer, may induce carcinogenesis through DNA damage caused by the toxic effects of alcohol or its metabolites. Therefore, we examined the associations of XRCC1 Arg399Gln, Arg280His, and Arg194Trp polymorphisms with colorectal cancer and the impact of the association between alcohol consumption and colorectal cancer risk. Methods: This case-control study in Fukuoka, Japan including 685 cases and 778 controls. The cases were incident patients with histologically confirmed colorectal adenocarcinoma. The controls were randomly selected community subjects. Results: The XRCC1 399Gln/Gln genotype was significantly associated with colorectal cancer risk (adjusted odds ratio [OR] 1.57, 95% CI 1.01–2.42; relative to 399Arg/Arg genotype). The association was strongest in individuals with high alcohol consumption. The Arg280His polymorphism modified the association between alcohol consumption and colorectal cancer risk (interaction P = 0.049). The OR of colorectal cancer in individuals with the 280His allele was 0.45 (95% CI 0.26–0.78) as compared with the 280Arg/Arg genotype limited to the 399Gln allele (interaction P = 0.001). The adjusted ORs for 399Gln/Gln-280Arg/Arg-194Arg/Arg and 399Arg/Gln-280Arg/Arg-194Arg/Trp were 1.71 (95% CI 1.02–2.87) and 1.57 (95% CI 1.05–2.33), respectively, with 399Arg/Arg-280Arg/Arg-194Arg/Arg as reference (interaction P = 0.418). Conclusions: The findings are additional evidence that individuals with the XRCC1 399Gln/Gln genotype have an increased risk of colorectal cancer, and that XRCC1 polymorphisms have an important role in colorectal cancer risk associated with alcohol consumption or gene-gene interaction.
Background: Studies investigating the impact of breastfeeding on dental caries have produced contradictory results. This cross-sectional study investigated the relationship between breastfeeding and the prevalence of dental caries in young Japanese children. Methods: The study subjects were 2056 Japanese children aged 3 years. Information on breastfeeding was obtained by means of a questionnaire. Children were classified as having caries if 1 or more deciduous teeth were decayed, missing, or had been filled at the time of examination. Results: The prevalence of dental caries was 20.7%. As compared with breastfeeding for less than 6 months, breastfeeding for 18 months or longer was associated with a significantly higher prevalence of dental caries. The relation was J-shaped: the adjusted prevalence ratios for less than 6 months, 6 to 11 months, 12 to 17 months, and 18 months or longer were 1.0, 0.79 (95% confidence interval [CI]: 0.60–1.05), 0.86 (95% CI: 0.66–1.13), and 1.66 (95% CI: 1.33–2.06), respectively (P for linear trend <0.0001, P for quadratic trend <0.0001). Conclusions: Breastfeeding for 18 months or longer was positively associated with the prevalence of dental caries, while breastfeeding for 6 to 17 months was nonsignificantly inversely associated with the prevalence of dental caries.