Abstract　With the growing popularity of mobile health (mHealth) devices, including smartphones and wearable devices, information and communications technology has gained high importance in healthcare settings. This study aimed to summarize the current trends in physical activity research wherein mHealth devices are used and provide perspectives for future research. Until recently, questionnaire surveys were primarily used to evaluate physical activity. While questionnaire surveys are effective for subjective evaluation, the use of mHealth devices enables large-scale, real-time, objective evaluation of physical activity. In addition, mHealth devices automatically collect and aggregate data. This allows researchers to perform retrospective analysis of a wide range of indicators of physical activity and health. Particularly, the use of smartphones is highly likely to contribute to large-scale monitoring and health interventions because of their ubiquity. Even though there are fewer users of wearable devices (wrist-worn devices) than those of smartphones, using wearable devices allows for the evaluation of 24-hour movement patterns. The use of wearable devices helps perform further precise analysis that focuses not only on the total amount of physical activity but also on the quality, including measures of intensity, duration, frequency, type, and time. Moreover, some wrist-worn devices measure physiological information such as heart rate and may also provide location information. Combining such data with information from an accelerometer associated with a device may allow for further specific and detailed evaluation of physical activity. The validity of physical activity assessment using major mHealth devices has been confirmed in several studies and is comparable to that of pedometers and accelerometers developed for research purposes. Evaluation of physical activity using mHealth devices involves issues related to the representativeness of the target population and continuity of data, as well as the need for ethical considerations based on privacy policies. While mHealth devices may be used by individuals as a health management tool, it is also expected that the evaluation of physical activity using mHealth devices will be performed in various settings such as epidemiological and clinical studies on physical activity, as well as community services wherein indicators of physical activity are used.

Objectives　The COVID-19 pandemic spread rapidly across the globe during the first half of 2020. In Japan, a state of emergency was declared on April 7, 2020, which had a significant impact on the life of citizens. This study focused on behaviors like avoiding going out or coming in contact with others and frequent hand-washing to prevent the infection and the spread of COVID-19 among people living in Tokyo. We also examined the factors associated with these behaviors during the declaration of emergency.

Methods　An online survey was conducted from April 26 to 29, 2020, approximately 20 days after the declaration of the emergency, among men and women aged 20-69 years living in Tokyo. The study framework was based on the protection motivation theory, which explains the risk-reducing behaviors, and focus theory of normative conduct, which explains the effect of others' behavior on one's own behavior. The frequency of behaviors like avoiding going out or coming in contact with others and frequent hand-washing, as well as the perception of the risk of COVID-19 during the week preceding the survey, were assessed. Each preventive action was evaluated based on the following factors: perceived effectiveness (response efficacy), perceived practicability (self-efficacy), necessary cost (response cost), and perceptions of how much should be done (injunctive norm) and how well others are doing it (descriptive norm). Hierarchical multiple regression analysis with these behaviors as outcomes were performed.

Results　This study included 1,034 participants (50.3% male, mean age 44.82 years, standard deviation 14.00 years). The analyses of the frequency of avoiding going out or coming in contact with others showed that the injunctive norm was positively associated with the behavior (standardized partial regression coefficient (β)=0.343, P<0.001), while the descriptive norm was negatively associated with the behavior (β=−0.074, P=0.010). Furthermore, the two-way interaction between risk perception, response efficacy, and self-efficacy was significant (β=0.129, P<0.001), indicating that risk perception was positively associated with the behavior only when either response efficacy or self-efficacy was low. A similar analysis conducted for hand-washing behavior revealed that injunctive norm (β=0.256, P<0.001) and response efficacy (β=0.132, P<0.001) were positively associated with the behavior, while the response cost (β=−0.193, P<0.001) was negatively associated with the behavior.

Conclusion　Some variables in the protection motivation theory and the focus theory of normative conduct were related to the behavior for the prevention of COVID-19. The results suggest that the application of these theories is useful in future studies.

Objectives　By targeting the public health nurses (PHNs) who are expected to be actively involved in the implementation of community DOTS practices, we evaluated the quality of the regional DOTS practices based on the three aspects of “enhancing tuberculosis (TB) treatment adherence,” “patient-centered support other than treatment,” and “coordination with related organizations.” We examined the individual and organizational factors that affect the quality of these practices. Further, we clarified the challenges related to the abilities of PHNs.

Methods　A self-report questionnaire survey of 958 PHNs from local governments with a TB incidence rate of 15 or more was administered in 2015. This resulted in there being 410 valid responses with a valid response rate of 42.8%.

　The quality of the community DOTS practices was evaluated based on the three aspects by reviewing the literature on expert PHNs for TB patient support. After a preliminary survey, each was evaluated based on a scale of 10 points. A multiple regression analysis was conducted to understand the relationship between these and the TB control implementation system (organizational factors), the experience and motivation of PHNs to support tuberculosis patients, and the learning situation (individual factors).

Results　The quality of the community DOTS practices was 7.54±1.69 for “enhancing TB treatment adherence,” was 6.91±1.63 for “coordination with related organizations,” and was 6.68±1.53 for “patient-centered support.” The scores for the first factor were higher than those for the latter two factors (P<0.05). With regard to “patient-centered support,” one-fourth of the surveyed PHNs rated their practices as low. Each predictor showed a strong relationship with the quality of community DOTS practices, especially “coordination with related organizations” and “patient-centered support” (r=0.787). The significant organizational factors associated with the quality of the community DOTS practices in terms of each aspect were “making an individual support plan for TB patients” (β=0.112-0.270), “reporting own practices at the DOTS conference as a responsible PHN” (β=0.113-0.173), “attending cohort study meetings” (β=0.129-0.167), and the individual factor of “many years of experience as a PHN” (β=0.210-0.316). Additionally, in the model of “coordination with related organizations,” “reading specialized books and journals” (β=0.108) was found to be significant and positively related.

Conclusion　To improve the quality of the community DOTS practices based on the self-evaluation of PHNs, “patient-centered support” with a low score and high relevance to other aspects is a priority. It was also suggested that it would be useful if the PHNs participated in DOTS evaluations, developed individual patient support plans, presented support plans, and participated in performance evaluations to improve the quality of DOTS practices.

Objectives　This study aims to develop a dietary consciousness scale and examine its reliability and validity, as well as investigate the changes in psychological aspects that influence diet among Japanese adults during the COVID-19 pandemic and clarify its related factors.

Methods　An online survey was conducted from July 1, 2020 to July 3, 2020. Participants were adults aged between 20 and 69 years selected from 13 prefectures where the government declared the state of emergency from April to May 2020. All selected participants were shopping or cooking foods for more than 2 days a week at the time of the survey. A total of 2,299 participants were included in the analysis. Dietary consciousness was measured using 12 items, and the construct was examined using factor analysis. Cronbach's alpha was examined as an indicator of internal validity, and the criterion-referenced validity was confirmed using the Kruskal-Wallis test. To determine changes in dietary consciousness, we calculated total scores based on changes in each item of the Dietary Consciousness Scale as follows: no change (0 points), improved (+1 point), and worsening (−1 point). The associations between the changes in dietary consciousness and characteristics or socioeconomic factors of the participants were examined using the chi-squared test and residual analysis.

Results　Exploratory and confirmatory factor analyses demonstrated that a model consisting of two factors fitted the data (GFI = 0.958, AGFI = 0.938, CFI = 0.931, RMSEA = 0.066). Cronbach's alpha of the first factor (importance of diet) was 0.838 and 0.734 for the second factor (precedence of diet), and the reliability was confirmed at 0.828 for the entire scale. In the examination of criterion-related validity, the higher the stage of change, the higher the total score of the scale, and a significant difference was observed (P<0.001). The percentage of participants whose precedence worsened was higher than the importance. Significant differences were observed regarding gender, age group, marital status, employment status, household annual income, and income change during the COVID-19 pandemic considering changes in both the importance and precedence of diet. Those who were in the “worsening tendency” group in both the importance and precedence were men, 20-29 years old, unmarried, full-time employees, with a household income of 4-6 million yen during the past year.

Conclusion　During the COVID-19 pandemic, the precedence of diet worsened, compared to its importance, and men, young, or unmarried persons show a worsening of dietary consciousness.

Objectives　Social security costs related to the healthcare and long-term care of patients with cardiovascular diseases is a national burden that is expected to grow as Japan's population ages. Nutritional policies for improving the nation's diet could prevent cardiovascular diseases, but scientific evidence on their costs and outcomes is limited. This study gives an overview of health economic evaluation studies on population-wide dietary salt-reduction policies that have been instituted for the purposes of cardiovascular disease prevention. Thus, this study provides background information for the development of evaluation methods that can be utilized in Japan for analyzing the effects of nutritional policies on public health and social security cost containment.

Methods　We extracted representative health economic simulation models that are used for predicting the effects of cardiovascular disease-related interventions: Cardiovascular Disease Policy Model, IMPACT Coronary Heart Disease Policy and Prevention Model, US IMPACT Food Policy Model, Assessing Cost-Effectiveness (ACE) approach to priority-setting, and Prevention Impacts Simulation Model (PRISM). Next, we collected original articles on studies that used these models for assessing the costs and effects of national population-wide dietary salt-reduction policies. We then outlined the background, structure, and applied studies associated with each model.

Results　The five models utilized Markov cohort simulation, microsimulation, proportional multistate life tables, and system dynamics to predict the effect of dietary salt-reduction policies on blood pressure reduction and cardiovascular disease prevention. The models were applied to countries such as Australia, England, and the United States to simulate long-term (10 years to lifetime) costs and effects. These applied studies examined policies that included health promotion campaigns, sodium labels on the front of food packages, and mandatory or voluntary reformulation by the food industry to reduce the salt content of processed foods.

Conclusion　Health economic simulation modeling is actively being used to evaluate scientific evidence on the costs and outcomes of national dietary salt-reduction policies. Similarly, leveraging simulation modeling techniques could facilitate the evaluation and planning of dietary salt-reduction policies and other nutritional policies in Japan.