The term behavioral science was coined in 1946 by a research group at the University of Chicago led by Miller. It is defined as “science that systematically reveals the rules of human behavior”. To elucidate human behavior, they proposed combining biological science and social science. In Japan, achievements in behavioral science research have accumulated and have been applied in health education and health policy. In this paper, we describe the current status and future approaches in social medicine through an overview of behavioral science research in Japan with regard to the following five points: 1) representative theories and techniques in health behavior, 2) differences in health awareness, 3) a new approach of behavioral science based on the dual process theory, behavioral economics, and zero-order prevention, 4) diversity in behavioral changes and 5) experimental research in behavioral science.

Objectives: In this multicity study, we aimed to elucidate the city-specific factors affecting the association of high ambient temperature with ambulance dispatches due to acute illnesses.

Methods: We used the data of ambulance dispatches in 27 cities in Japan with more than 500,000 population excluding Tokyo, from May to September from 2012 to 2015. We included patients 20 years and older (≥20 years) and stratified them into three age groups (20–59, 60–79, and ≥80 years). We explored the city-specific pattern of the daily relative temperature (in temperature percentiles) and the risk of ambulance dispatches for each age group using a distributed lag nonlinear model and estimated the city-specific relative risks of ambulance dispatches at the 95/99 percentile temperature compared with the 77.6 percentile temperature defined as the reference temperature (T_ref). Then, the estimates were combined by performing meta-analyses for each age group. We also applied meta-regression models to explore whether the city-specific characteristics modified the association of temperature with ambulance dispatches.

Results: The relative risks of the 95th percentile with respect to T_ref were 1.14 (95% confidence interval (CI): 1.12, 1.16), 1.16 (95% CI: 1.13, 1.20), 1.13 (95% CI: 1.10, 1.16), and 1.13 (95% CI: 1.00, 1.16), for all-age (≥20) and age-stratified groups (20–59, 60–79, and ≥80 years), respectively. We observed a higher relative risk for the ≥20 years age group in the cities with higher proportions of single-elderly, single-mother, and single-father households. We also found that the relative risk for the 20–59 years age group was higher in the cities with a higher proportion of blue-collar workers.

Conclusions: The present study provides insights into city-specific characteristics modifying heat-related health effects.

Asian dust is a phenomenon involving the long-range transport of atmospheric pollutants originating from the desert areas of China and Mongolia. In recent years, the health effects of Asian dust have raised public concerns. Numerous studies on the health effects of Asian dust have been published since the last review in 2010. Thus, a literature review was conducted to shed light on the latest epidemiologic findings. PubMed and Science Direct databases were used for the review of epidemiologic studies published between June 2009 and April 2018. We identified 53 epidemiologic studies. Mortality, ambulance transportation, hospitalization/medical examination, changes in symptomatic, functional, and examination findings, as well as birth outcomes have been reported as outcomes. When the outcomes were categorized by disease, the effects of Asian dust on respiratory, cardiovascular, and allergic diseases raised concerns. The common evidences of causation between Asian dust and these diseases were the consistency of findings and temporal sequence of association. As results of research on dose-response relationships have become available, and the possibility that the health effects of Asian dust may vary depending on its chemical composition has been pointed out, further research using the exposure level indicators of Asian dust or its chemical composition should be conducted. Furthermore, with focus on the crucial issue of reducing exposure, research related to prevention and raising awareness should be further promoted.

Objectives: The purpose of this study was to confirm the association of the status of implementation of nonsmoking at eating and drinking establishments with the prevalence of persons with subjective symptoms, the prevalence of persons with diseases under treatment, medical expenses, and mortality rate using prefectural data.

Methods: The prefectural rate of eating and drinking establishments implementing nonsmoking (hereafter, nonsmoking rate) was calculated using the data from “Tabelog^®”. The variables of interest were the prevalence of persons with subjective symptoms, the prevalence of persons with diseases under treatment, medical expenses (total, hospitalization and nonhospitalization expenses), and the mortality rates of malignant neoplasms (lung cancer, stomach cancer, and colon cancer), heart disease, acute myocardial infarction, cerebrovascular disease, cerebral infarction, and pneumonia in each prefecture. The partial correlation coefficient was estimated between the nonsmoking rate and the variable of interest using the smoking rate by prefectural as the control variable.

Results: The nonsmoking rate showed a significantly negative correlation with the medical expenses. When eating and drinking establishments were divided into “restaurant”, “café”, and “bar”, the nonsmoking rate also indicated a significantly negative correlation with the medical expenses in any category. It was negatively related to the mortality rates of cerebrovascular disease, cerebral infarction, and pneumonia. The negative correlation was stronger in females than in males.

Conclusions: These results suggest that the implementation of nonsmoking at eating and drinking establishments may reduce the mortality rates of diseases, such as cerebrovascular disease, cerebral infarction, and pneumonia, and medical expenses. Thus, it is important to implement nonsmoking at eating and drinking establishments in line with the Revised Health Promotion Act.

Objective: The Organisation for Economic Co-operation and Development (OECD) pointed out the deterioration of the performance of health systems (performance) in Japan. To correct this, we evaluated the performances in different prefectures.

Methods: By the OECD method, we set 27 indicators concerning “health status (HS)”, “ risk factors (RFs)”, “ access to care (AC)”, “ quality of care (QC)”, and “ health care resources (HRs)”. Next, the relative value (RV, ±4 standard deviation) from the average value of each indicator in each prefecture was obtained. On the basis of this RV, the prefectures were divided into A, B, and C by cluster analysis. Then, the 27 indicators of the three groups were subjected to multiple comparison tests and the performances were evaluated.

Results: A included Hokkaido, Ishikawa, Kyoto, Shimane, Okayama, Hiroshima, Yamaguchi, Tokushima, Kagawa, Ehime, Kochi, Fukuoka, Saga, Nagasaki, Kumamoto, Oita, Miyazaki, Kagoshima, and Okinawa, B included Aomori, Iwate, Akita, Fukushima, Ibaraki, Tochigi, Saitama, Tokyo, Osaka, and Wakayama, C included Miyagi, Yamagata, Gunma, Chiba, Kanagawa, Niigata, Toyama, Fukui, Yamanashi, Nagano, Gifu, Shizuoka, Aichi, Mie, Shiga, Hyogo, Nara, and Tottori. The multiple comparison test results showed that HS and RFs were not significantly different between A and C. In A, AC and QC were poor, but HRs were excessive, and the local allocation tax was high. RFs, AC, QC, HRs, and the local allocation taxes were not significantly different between B and C, but HS was poor in B.

Conclusions: The performance of health systems was deteriorating in the 19 prefectures included in A, and correction is necessary in these prefectures.

Recently, the main air pollutant has been fine particulate matter (PM_2.5), which is taken up by the whole body with severe adverse health effects. The main chemical components of PM_2.5 are salts of sulfate (and nitrate) and carbons. However, it remains unknown which components are toxic. Here, the author reviewed the literatures to determine which components are toxic and the main mechanisms underlying their toxicity. Many epidemiological studies have shown that sulfate concentration is strongly related to mortality. However, there is no experimental evidence showing that sulfate at environmental concentrations of PM_2.5 causes cardiovascular disease or other disease. On the other hand, carbon components such as elementary carbon (EC) produces high concentrations of reactive oxygen species (ROS) via its phagocytosis by macrophages, and organic carbon (OC) also produces high concentrations of ROS during its metabolic processes, and the ROS cause acute and chronic inflammation. They cause many diseases including cardiovascular disease, asthma and cancer. Furthermore, there are many lines of evidence showing that epigenetic changes such as DNA methylation or microRNA expression induced by particulate matters also induce the development of many diseases such as those mentioned above. It has been reported that carbon components are incorporated into the brain and produce ROS, and that the ROS cause damage to brain cells and Alzheimer’s disease and cognitive disorders in the elderly.

From these lines of evidence, the author would like to emphasize that the main toxicity of PM_2.5 is due to carbon components, and it is important to take countermeasures to decrease the concentration of carbon components in ambient air.

Objectives: In our previous study in which we aimed to clarify the factors related to salt intake in women aged 40–59 years, salt intake was found to be not related to salt-reduction cognizance. The aim of this research was to clarify factors related to salt intake in those who were cognizant of the importance of reducing their salt intake.

Methods: Two hundred and forty-seven female guardians (effective rate, 32.2%) in a medical university, aged 40–59 years old, participated in this study. The participants were divided into three groups according to their salt-reduction cognizance.

Results: There was no significant difference in salt intake between the three groups who were salt-reduction cognizant. Intakes of potassium (mg/1,000 kcal), vegetables, and fruits were higher in those who were cognizant of the importance of reducing their salt intake. The frequencies of consuming stewed foods, miso soup, and vinegared and marinated dishes were also higher. Those who were salt-reduction cognizant were knowledgeable about salt consumption, had experienced making low-salt dishes, used low-sodium seasoning, and made light-tasting dishes by regulating ingredients when cooking. However, when it came to eating, there was no difference in the percentage of those who left most of the broth when eating noodle soups and the frequency with which they added seasoning in terms of salt-reduction cognizance.

Conclusion: Salt-reduction cognizant women aged 40–59 years made conscious efforts to use less salt at the time of cooking, but made no efforts when eating, even though they were cognizant of the importance of reducing their salt intake.

Objectives: In academia, harassment may often occur and remain unrevealed in Japan, which discourages young researchers from pursuing their career. It is necessary to estimate and improve the perception of “academic harassment” among university faculties. Therefore, in this study, we aim to develop a scale of perception of academic harassment.

Methods: Prior to a quantitative survey, a task team consisting of medical doctors, researchers, nurses, hospital workers, and managers in general affairs division identified 36 items related to academic harassment. In February 2016, we sent a self-administered questionnaire to 1,126 academic faculty members who worked in a medical university located in Tokyo, Japan. We instructed them to score the extent to which they consider each item as related to academic harassment based on a Likert scale. We carried out maximum likelihood factor analyses with promax rotation and computed Cronbach’s alpha to develop a scale and investigate the reliability of the scale.

Results: In total, 377 returned the questionnaires (response rate, 33.5%; male, 73.8%). In factor analyses, we removed 17 items owing to low factor loadings, and four factors were eventually extracted. The first factor was termed “Harassment in organization (7 items)” because it included conditions of forcing a particular person to work on chores or lectures for students that may prevent one’s academic research outputs. The second factor was termed “Violence and denying personal character (4 items)”. The third factor was termed “Research misconduct (5 items)” including conditions of excluding a particular person from the coauthor list of research outputs or pressuring a person to fabricate, falsify, or plagiarize research outputs. The fourth factor was termed “Research interference (3 items)” including a condition of interference with conference attendance. Cronbach’s alpha values of these four factors ranged from 0.83 to 0.91, suggesting that the scale had high reliability. The means of these factors did not differ according to gender but were higher in participants aged 50 or older than in younger participants.

Conclusions: The results suggest that the scale of perception on academic harassment consisting of four factors with 19 items is valid and reliable to some extent.

Objectives: To clarify the performance of health systems (performance), the state of prefectures was investigated.

Methods: Using the method developed by the Organisation for Economic Co-operation and Development, we conducted the study using 27 indicators. To evaluate the performance, we examined the signal-to-noise ratio of transcription (η) by integrating indicators using the Mahalanobis-Taguchi method. The η was separated by a median. The ratio of prefectures in East or West Japan and the presence or absence of ordinance-designated cities were studied using the chi-square test. Furthermore, the correlation among the total component η (T-η), each component η, and expenditures, and the correlation between T-η and life expectancy, were studied.

Results: The T-η positively correlated with the risk factors (RF)-η and the resources (R)-η, and negatively correlated with the health status (HS)-η. The number pf prefectures without ordinance-designated cities where the T-η and RF-η exceeded the median was large. The number of prefectures with ordinance-designated cities where the HS-η exceeded the median was also large. In addition, there were many prefectures where the T-η was in the top 25% in West Japan. There were positive correlations between the total expenditures and the T-η, the expenditures and the RF-η, and the expenditures and the R-η. There was a negative correlation between the expenditures and the HS-η, and the T-η and the life expectancy.

Conclusions: For life expectancy, prefectures with too good performance were recognized. In these prefectures, correction of resources is necessary.

Objectives: In this study, we aimed to examine the possible association between liver fibrosis and loss of skeletal muscle mass (SM) in community-dwelling older adults with no history of liver diseases.

Methods: A total of 2,028 older adults (mean age, 69.8 ± 5.2 years) who had not received any treatment for liver diseases and had participated in a comprehensive health survey for community residents in Wakayama, Japan were included in this study. We carried out bioelectrical impedance analysis to estimate the SM of the whole body including the arms, legs, and trunk of the subjects. Liver fibrosis was evaluated by calculating the Fib4 index based on the subject’s age, AST level, ALT level, and platelet counts.

Results: The subjects were divided into three groups according to cutoff values of the Fib4 index (low: <1.30, medium: 1.30–2.66, high: ≥2.67). The SM index (kg/m²) was the lowest among subjects in the high-Fib4-index category, followed by the medium- and low-Fib4-index categories. This dose–response reduction in the SM index was more pronounced among individuals with lower blood albumin level (low nutrition) and in those with more sedentary behavior (physical inactivity). Among the selected 262 subjects who underwent SM measurement twice with an interval of 3 years, the subjects with a high Fib4 index showed greater reduction in the SM index than those with medium and low Fib4 indices. Multiple regression analysis revealed that the Fib4 index was significantly associated with the SM index, independent of age, sex, albumin level, sedentary behavior, diabetes mellitus, alcohol intake, and smoking status.

Conclusions: The present findings suggest that the potential progression of liver fibrosis is associated with the excessive loss of SM among apparently healthy older adults without any treatment for liver diseases.

Objectives: To investigate the associations between dietary patterns and mental health status of female university students.

Methods: Self-administered questionnaires consisting of measures of food intake frequency and mental health status were completed by 320 female university students. Food intake frequency was assessed using the Food Frequency Questionnaire (FFQ). Then, dietary patterns were identified by cluster analysis. The 28-item General Health Questionnaire (GHQ-28) was used to evaluate students’ mental health status. Relationships between the dietary patterns and the mental health status were analyzed.

Results: We identified three dietary patterns. “The Japanese foods pattern in youth” was a representative food intake pattern of this generation. “The light eating pattern” had lower intakes of most items but higher intakes of soft drinks, and was not interested in nutrition balance. “The dairy products pattern” had higher intakes of dairy products and sweets, and were significantly associated with high scores of GHQ-28 subscale anxiety and insomnia.

Conclusion: The dietary patterns are associated with the mental health status of female university students.

Objectives: In this study, we aimed to categorize the actions of occupational physicians in health committees leading to solutions of occupational health problems.

Methods: We conducted two focus group discussions among experienced occupational physicians. The discussions addressed the following question: what had they and others said and done that had led to the development of solutions to occupational health problems. We used a qualitative content analysis approach developed by Berelson, and created a draft of the categories of actions. Subsequently, an online questionnaire survey was then used to evaluate the external validity of the draft. The questionnaire asked physicians whether they had experience of each item in the draft. They were also asked whether they had experienced any other items not included in the draft. If so, they were asked to provide a description of their experience. These descriptions were discussed by three researchers. Any suggested new items considered to fall under any of the original items in the draft were excluded, and any new items proposed by two or more participants were added as additional items. Finally, we corrected words and phrases and reviewed the items to ensure that they clearly conveyed the required meaning, and described actions leading to solutions to occupational health problems.

Results: The content analysis revealed six basic actions, and 32 items were categorized in the draft. The six basic actions were “participate”, “gather information”, “make a place that allows communication with key people and health committee members”, “make arrangements”, “speak at a health committee”, and “pay attention”. In total, 67 physicians responded to the questionnaire survey. At least 40% of participants answered that they had experience of the draft items. All items in the draft had also been experienced by groups of occupational physicians other than those involved in the focus groups. Three additional items proposed by two or more participants were added. “Pay attention” was deleted following the final review.

Conclusions: We categorized the actions of occupational physicians in health committees into five basic actions, and 32 items. Being aware of types of actions used in groups may encourage occupational physicians to be more involved in workplace health committees and contribute to the promotion of occupational health activities in the workplace.

Objectives: The aim of this study was to clarify the current status of stockpiling of oral care hygiene materials in case of a disaster and to determine methods to support stockpiling during disaster preparation.

Methods: We conducted an Internet questionnaire survey on stockpiling and disaster prevention measures among 300 adults. For statistical analysis, the χ² test, Mann–Whitney U-test and Spearman rank test were employed. Logistic regression analysis was conducted to review factors related to stockpiling.

Results: Among the questions on stockpiling and disaster prevention (14 of 15 items), seven items on disaster prevention measures and two on disaster prevention experiences significantly differed. Analysis of disaster prevention knowledge revealed that disaster prevention measures and disaster experiences significantly differed in terms of the presence or absence of stockpiling, albeit a positive correlation was noted with stockpiling. Logistic regression analysis was conducted with stockpiling as a dependent variable. As a result, the items ‘I am aware about the hazard map of the residential area’, ‘I am aware about the type of oral care hygiene materials prepared for emergency’ and ‘Devising the living environment such that large furnitures and cupboards do not collapse during disasters’ were effective.

Conclusions: Stockpiling at home is considered necessary for self-sufficiency during a disaster on the basis of the experiences in disaster management, disaster prevention knowledge and disaster prevention measures. Hence, stockpiling is a strong measure against disaster prevention along with provision of appropriate knowledge about the necessity of oral care in daily life. Disaster prevention education that empowers a population to prepare itself by implementing disaster prevention measures, such as improving the home environment, is considered effective. In addition, considering that relying on stockpiling at an individual level is ineffective, it is necessary to create mechanisms and systems that jointly manage disaster situations according to local circumstances.

Objetives: As the first step forward building a supporting system for the Parents of Children with Profound Intellectual and Multiple Disabilities (PIMD) at home, we developed a new resilience scale that can be used by multiple professionals to understand the situation of those parents and to provide the necessary support.

Methods: First, we collected scale items on the basis of our previous study as well as related reports in the literature. These items were then screened by the research team with knowledge and experience in supporting those parents, finally, 37 items were generated. Then, we asked the parents of children with PIMD who were of elementary school age and above in the Kanto-Shinetsu area to complete a questionnaire. Out of 477 questionnaires sent, 193 were refused, and the data were statistically analyzed.

Results: Exploratory factor analysis revealed that the scale was made up of the following seven factors. 1) Understanding and awareness of the child, 2) Empowerment by the child, 3) Use of specialists, 4) Interest and concern in something other than the child, 5) Emotional adjustment, 6) Maintenance of lifestyle balance, and 7) Request for assistances. Cronbach’s alpha coefficient of each factor was calculated. The validity was also confirmed by determining the relationship of resilience with parents’ well-being.

Conclusions: The results suggest that the new resilience scale for parents of children with PIMD developed in this study can be a reliable instrument for assessing resilience in Japanese parents of a child with such disabilities

In this study, we examined the changes in the demographic characteristics of foreign residents in Japan (FRJ) and the current status of FRJ from a global health perspective. We also considered child maltreatment that occurred in FRJ families and language problems in child welfare. Japan’s official statistics in the end of 2017 indicated that there were more than 2.56 million FRJ from over 190 countries. This population was diverse with heterogeneous characteristics, such as age structure, dwelling place, marital status, and childbirth. At the end of 2017, there were 219,982 FRJ children aged 0–14 of various nationalities, including Chinese, Brazilian, South Korean, North Korean, Filipino, Vietnamese, Peruvian, Nepalese, and Indian. In 2010, we conducted our first survey of child maltreatment in FRJ families, targeting 219 child protection centers across Japan. Between April 2007 and August 2010, 1,639 child maltreatment cases were reported from 56% of these centers. Details of 1,111 cases were collected and descriptive analyses were conducted. The male-to-female ratio was 0.88 and the median age was 8 years: however, the age distribution showed that females were significantly older than males (P < 0.01). The proportions of physical abuse, child neglect, emotional abuse, and sexual abuse were 38%, 33%, 21%, and 7%, respectively. Native language problems created numerous challenges and required a large amount of effort from child welfare practitioners. However, most solutions to identified problems were still at the beginning stage and some were found to be ineffective. More interdisciplinary and integrated researches are needed targeting child welfare of FRJ. An ethical framework for good counseling practices should be developed.

There is mounting concern about the effects of early-life exposure to chemical substances on children’s health and development. We summarize the past and ongoing birth cohort studies carried out worldwide on the association between environmental exposure and children’s health. Our PubMed search with the keywords ‘birth cohort’ revealed that the number of articles jumped from 200–300 in the 1980s to over 1,000 in the 1990s. Many of these articles reported elevated risks to children’s health posed by chemical exposure owing their vulnerability. At the same time, policies implemented to reduce exposure to lead and dioxins were successful in the past few decades. Research also demonstrated that intervention to reduce exposure to certain chemicals whose exposure routes were well documented was also successful. We summarize the effects of early-life exposure to chemical substances on children’s health and development. Our findings will hopefully help safeguard the environment in which future generations grow and live.