Purpose: The purposes of this study were 1) to grasp a general picture of the health promoters' selfreliant attitude and behavior toward their activities to develop an assessment index of the acquiring process of self-reliant attitude and behavior, and 2) to make a comparative study on the process among health promoters with different backgrounds by using the assessment index.
Method: We first interviewed 14 health promoters about the current status of their activities and their changing awareness toward them. Based on the interview, a questionnaire concerning the health promoters' acquiring process of self-reliant attitude and behavior was formed. The questionnaire was used for a survey that was conducted for 354 health promoters. The survey findings were further utilized to develop an ‘assessment index of the health promoters’ acquiring process of self-reliant attitude and behavior.’ Using the index, we studied how the health promoters’ different backgrounds were reflected on their acquiring process of self-reliant attitude and behavior toward their activities.
Results: The questionnaire was distributed to 354 health promoters, of whom 226 replied to the survey, the returning rates being 63.8%. As a result of the factor analysis, the questionnaire was rearranged to include 39 items in total which were further classified into the following 5 factors: 1) organizational development as community organizations/groups engaged in health promotion, 2) personal development as health promoters, 3) expanded network of human relationship, 4) improved connection between health promoters' activities and their personal lives, and 5) enhancement of health promoters' community-oriented attitudes. We call these 5 factors comprising 39 question items, the ‘assessment index of the health promoters' acquiring process of self-reliant attitude and behavior.' Since the index proved to be reliable and valid enough, it was used to make a comparative study in A city on the acquiring process of selfreliant attitude and behavior among health promoters with different backgrounds. The following observations were obtained from the comparison: 1) the experienced health promoters showed a higher score of the assessment index than the newcomers, 2) health promoters' attitudes in general seemed still passive, and community groups were not effectively interrelated with each other, and 3) the leaders of community groups tended to have more selfreliant attitude and behavior.
Conclusion: The index consisted of 5 factors and 39 items was developed to assess the acquiring process of health promoters' self-reliant attitude and behavior. The index proved to have sufficient reliability and validity. A comparative study using the index found that the experienced health promoters and leaders of community groups showed a higher score of the assessment index than the newcomers, and that the community groups were not effectively interrelated with each other.

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Objective: Using a buffet-style school lunch with the Lunch Box Diet Method, a nutrition education program was implemented for elementary school children. The purpose of the study was to identify the improvement of food choices among children through the program.
Methods: Sixty-one students in the sixth grade (30 boys and 31 girls) in a public elementary school in Setagaya, Tokyo participated in the study in autumn 2003. Buffet-style lunches using the Lunch Box Diet Method were provided twice at the beginning and at the last of the nutrition education program. We examined the changes of children's food choice between the two buffet-style lunches at nutrient, food, and dish levels. We also analyzed children's descriptive contents in class worksheets to identify their awareness of food choice changes.
Results: At nutrient level, the fat energy ratio was significantly decreased from 41% to 33% among boys, and from 42% to 29% among girls. At the same time, the carbohydrates energy ratio was significantly increased from 40% to 51% among boys, and from 41% to 55% among girls. At food level, quantities of rice were significantly increased from 108g to 192g among boys, and from 82g to 186g among girls. Green vegetable and overall vegetable were also significantly increased. At dish level, the average servings of grain and vegetable dishes were increased, while those of fish and meat dishes were decreased. From an analysis of worksheets written by students at the class, most of the children had appropriate awareness for well-balanced diet.
Conclusion: It was suggested that children gained the knowledge and skills on how to choose a balanced diet through this program.

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Objectives: The purpose of this study was to elucidate: 1) How health handbooks are used at elementary and junior high schools, and 2) Whether the retrospective use of health handbooks at elementary and junior high schools has an influence on students' current attitudes regarding health handbooks and their health-related habits.
Methodology: A group survey was conducted with 340 first-to third-year students at two senior high schools in Tokyo using anonymous questionnaires. The questionnaire contained questions regarding attribution, the use of health handbooks at elementary and junior high school, attitudes regarding the use of health handbooks in senior high school, and health-related habits.
Results: The usage rate of health handbooks at elementary and junior high school was approximately 80%. Approximately 50% of students responded that their teacher recorded medical check-up results in their health handbook, and approximately 70% of students responded that their handbooks were kept at school. When asked whether they still had the records of medical check-up results, approximately 40% of the students responded that they still had them at home, while 50% were unsure. Approximately 40% of the students answered that it was necessary for them to have had their elementary and junior high school checkup results stored, and 30% of students stated that they would like to use their senior high school health handbooks in the future. A significant relationship was observed between senior high school students' willingness to use health handbooks, the experience of using health handbooks at elementary and junior high school, and the belief that it is necessary to store records of elementary and junior high school medical check-up results. However, no discernable link was observed between the use of health handbooks at elementary and junior high school and current health-related habits.
Conclusion: The survey suggests that the use of health handbooks at elementary and junior high schools may not have an effect on subsequent health-related habits. The students' willingness to use their senior high school health handbooks was related to their having used them in elementary and junior high school, as well as to recognize the importance of medical check-up results recording. These results indicate that it is necessary to revise and improve the ways in which health handbooks can be utilized. Moreover, it was suggested that it is important to offer school health education that encourages the consideration of one's own health and continued use of health handbooks.

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