Objective: The purpose of this study was to clarify the structural causal effects of socio-economic factors, subjective health, and lifestyle on future equivalent income of elderly urban-community dwellers.
Methods: A self-reported questionnaire was distributed to elderly aged over 65 years, city residents in September 2001. The response rate was 80.2% (13,915/16,915). A follow-up survey was conducted in September 2004. From these surveys, data from 8,162 respondents aged under 85 years were analyzed by pass analysis to clarify the possible causal relationships between responses reported in 2001, educational status, subjective health, lifestyles, and yearly equivalent income reported in 2001 and 2004. The theoretical model was formulated using SPSS18.0J and AMOS18.0J for Windows.
Results: Three years after equivalent income has been decreased significantly for both sexes correlated with the three years before equivalent income in 2001. The yearly equivalent income in 2004 was totally and directly affected by the yearly equivalent income reported 3 years earlier with largest scales, whereas 2004 equivalent income was indirectly correlated with the health practices and the subjective health with small effect based on the career for both sexes. It should be noted that educational status influenced the yearly equivalent income in 2001 with significance, rather than the yearly equivalent income in 2004. Goodness-of-fit indices were high level. Determination coefficients of equivalent income were 16%-45% for both sexes.
Conclusion: In the new supportive health education, we should have attention to the results that the yearly equivalent income tend to be affected by the 3 years prior equivalent income base on the carrier. Further study is necessary to develop a model that has higher internal and external validity.

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Objective: Purpose: To identify the effect of a leisure activity program with a walking program on the rate of applicants to the programs aged 40-59 and motivational readiness among those who had no intention to exercise.
Methods: This study is an interventional study, targeting registrants from a Japanese social research company. There was a baseline (T1) of 1,618 adult respondents (aged 40-59) at the precontemplation (PC) stage of the various stages of change in exercise behavior. After setting the ratio of control group to lower than other 2 groups, the respondents were randomly divided into three groups: walking (n = 683), leisure activity (n = 752), and control (n = 183). The intervention was applied for 8 weeks. Each intervention group received 16 messages via their mobile phones. Questionnaire surveys were conducted at T1 and 8 weeks (T2). The rate of applicants was compared between two intervention groups using a χ² test. Stage of change (PC, contemplation or upper stage) was compared among three groups at T2 using the χ² test.
Results: There was no significant difference in the rate of applicants (walking 18.4%, leisure-activity 21.4%). At T2, the proportion of those who had changed to the over contemplation stage was 24.5% (control), 49.6% (leisure-activity) and 71.3% (walking) (p < 0.001).
Conclusion: These results indicate that the leisure activity program attracted the same number participants compared with the walking program. They also suggest that the effect of the leisure activity program on the motivational readiness of exercise behavior was weaker than that of the walking program among those in PC stage.

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Objective: We evaluated the effectiveness of a 3-month intervention program for the prevention of Type 2 diabetes, conducted by screening, group education and a follow-up health check-up 1 year later, considering the personality traits of the subjects in a central region of Kyoto prefecture.
Methods: This study was conducted as a controlled trial. We carried out group education in a local region with 34 abnormal glucose metabolism subjects (average age 66.5, IQR 7.3) who were overweight at a physical examination in the years 2004, 2006-2008. We conducted 5 education sessions, focusing on nutrition and exercise, group discussions considering personality traits, and self-monitoring over a 3-month period. The control group consisted of 34 subjects who met the same diagnostics and were matched by sex, age and region with the intervention group, but who did not participate in the intervention program. The assessment compared the net differences between the intervention and control groups, or extrovert (n = 18) and introvert (n = 14) groups among the intervention group after adjustment for sex, age and baseline data.
Results: BMI (−1.3 kg/m², p = 0.02), systolic and diastolic blood pressure (−7.5, −6.0 mmHg, p = 0.05, < 0.01), and HDL-cholesterol (7.7 mg/dl, p < 0.01) values were improved in the intervention group, compared with the control group. Triacyl glycerol was improved in the extrovert group, compared with the introvert group (−34.5 mg/dl, p < 0.01).
Conclusion: These results suggested that community-based intervention programs considering personality traits can be effective.

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Objective: We developed the Decisional Balance Scale of vegetable consumption behavior, and examined the validity and the reliability of the scale.
Methods: In September 2009, a self-administered questionnaire was completed by Japanese male employees aged 20-59 years, working at 20 worksites of Niigata City in Japan. The scale about decisional balance of vegetable consumption behavior was composed of 6 items selected from an existing scale: 3 items assessing the potential benefits (pros) and 3 items assessing the potential costs (cons). The internal consistency of the scale was examined using Cronbach's alpha, construct validity was examined using confirmatory factor analysis, and criterion-related validity was determined by assessing the association between the scale scores and the stages of change.
Results: Of 600 respondents, the data of 527 participants (mean age, 41.1 years) were analyzed. By using item analysis, the newly developed scale was reduced to 4 items, 2 pros and 2 cons. Results indicated that the scale had sufficient reliability (Cronbach's alpha: pros = 0.76, cons = 0.74). Moreover, the scale provided the best data fit (χ² = 0.024, p = 0.878, GFI = 1.000, AGFI = 1.000, RMSEA = 0.000). The score for pros was higher in the preparation than in the precontemplation stage (p < 0.05). Conversely, the score for cons was lower in the preparation and action/maintenance than in the precontemplation stage (p < 0.05). Furthermore, it was lower in the action/maintenance than in the contemplation stage (p < 0.05).
Conclusion: The Decisional Balance Scale has sufficient validity and reliability for male workers, as demonstrated by the internal consistency of the scale, as well as by its construct and criterion-related validity.

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Objective: Health practitioners and popular mass media have unprecedented potential to come together social betterment. Popular media, guided by social science research, can serve as an advocacy for social change. The entertainment-education (E-E) communication strategy is very useful to achieve such win-win collaborations that can benefit society. This paper analyzes the E-E approach which, while relatively new in Japan, has been purposely utilized effectively with demonstrated results in many countries over the past three decades. We explore the possibilities of applying the E-E approach to the Japanese public health context.
Methods: This paper reports the definition of E-E, its history, recent trends, and research perspectives, drawing upon the literature on E-E, including Singhal's latest writings and on the topic, and conversation and discussion between the two authors.
Results: Simply put, E-E is about strategically utilizing the power of stories to change established social scripts. Over its history of more than 40 years since “Simplemete Maria” in Peru in early 1970s, the E-E practices and research have expanded and deepened with accumulated evidence.
Discussion: Considering the media environment, we conclude that the application of E-E in the Japanese context is possible, and that collaborating with local media and utilization of games might especially yield tremendous impacts. We hope that many scholars and practitioners in Japan get interested in E-E strategy that could create an environment of public discourse where complex social problems could find creative resolution, and that its research and practice can lead to the betterment of the society.

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Background: The Dental and Oral Health Promotion Law of Japan was passed in August 2011. Meanwhile, dental and oral health promotion laws at the prefectural level have been rapidly increasing in the past few years. This is in part due to the appearance of numerous research studies showing a strong relationship between oral and general health. This means that when planning and implementing healthcare policy, oral and general health must be considered in an integrated way. However, while the need for such integration is widely recognized, implementation and evaluation are still in the beginning stages.
Contents: Oral health evaluation consists of (1) health education and health policy, (2) oral health behavior, (3) oral diseases and oral function, and (4) general health impact. Patients are generally seen by dental professionals only, so medical and general healthcare professionals have limited understanding of the methods used in oral healthcare settings. In order to improve oral health at the personal, institutional, or community level, coordination between dental and general healthcare professionals is needed. Health risk reduction, health promotion, and health education are becoming more and more critical.
Conclusion: This article proposes a new conceptual framework for the evaluation of overall oral health. The primary benefit of this framework is that it will contribute to increased effectiveness and efficiency in the practice of healthcare. The establishment of a system is urgently needed, which integrates the various fields related to oral health and which provides a framework for research and implementation.

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Background: The Dental and Oral Health Promotion Law has been promulgated and enforced in Japan since August 2011. The measure stemmed from a rising awareness among dental professionals that the existing system of laws promoting lifelong oral health was insufficient, especially for adults and workers. Moreover, the relationship between oral health and systemic health is widely recognized, as in studies demonstrating the role of oral care in preventing aspiration pneumonia.
Contents: The Dental and Oral Health Promotion Law in Japan is interpreted as a basic concept law to comprehensively promote oral health. Within the text of this law, oral health is presented as a basic and important component to achieving optimal health and high quality of life. Toward its enforcement, the law prescribes integrated promotion of dental and oral health policies based on mutual coordination with other related activities and persons, among other means. Meanwhile, local ordinances for oral health promotion have so far been established in 29 prefectures and 23 cities and towns. Such expansion of the dental and oral health promotion movement is expected to continue.
Recommendations: Recently, the status of oral health in Japan has significantly improved, but many problems remain. In particular, regional and interindividual gaps in dental caries status must be closed and greater coordination with lifestyle-related disease interventions established. Moving forward, serious discussions will be held with key community members on oral health policies for achieving healthy and high-quality lives for all. On this platform, comprehensive community-based oral health policies will then be promoted nationwide.

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Background: In 2005, Japan Dental Association (JDA) published a report proposing a reform of the current system of adult oral health screening. The newly proposed system would aim to identify risk factors of dental disease and provide individualized oral health instruction. The following year, JDA began preliminary trials of the new system in a number of communities. In 2009, JDA officially announced the establishment of the new system nationwide.
Program Description: Under the new program, the procedure consists of two phases. The first phase makes use of a structured questionnaire to assess oral health and set self-determined short-term goals for individual oral health behavior improvement. The questionnaire consists of 20 items which are classified into four categories: subjective oral health status, oral health related QOL, oral health behavior, and environmental factors. The second phase is a follow-up involving health instruction and evaluation of oral health improvement.
Conclusion: This new adult oral health program of JDA can be implemented not only by dental professionals but also by other health professionals. Due to its cost-effectiveness and wide-ranging applicability, it is likely to contribute greatly to the improvement of adult oral health.

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Objective: This paper reports on the effectiveness and challenges of a new dental check-up program for adults. The program employs the standard oral health assessment and instruction program for adults proposed by the Japan Dental Association.
Methods: The program comprised a self-reported questionnaire and multiple sessions of individual oral health instruction. It was administered by dental hygienists to 1,464 employees in 29 workplaces in Hokkaido Prefecture. Data from 577 employees aged 20 to 64 years who completed both the baseline questionnaire and the follow-up questionnaire were analyzed.
Results: The self-reported frequency of tooth brushing as well as use of inter-dental brush or dental floss had increased significantly after the instruction. For example, the rates of tooth brushing three times a day and using inter-dental brush or dental floss everyday had improved from 29.7% to 38.0% and from 10.4% to 20.6%, respetively. Additionally, a subjective examination revealed significant improvement of several symptoms of dental disease. Additionally, a subjective examination revealed significant improvement of several symptoms of dental disease.
Conclusion: These results suggest that the program is an effective resource for promoting the oral health of employees in workplace settings.

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Background: Tooth loss is directly associated with decreased chewing function. At present, many older people experience compromised chewing ability and performance due to missing teeth. However, tooth loss is not an inevitable phenomenon of ageing; it can and should be prevented.
Contents: Recent studies have shown that decreased chewing ability due to tooth loss affects dietary quality and nutrient intake, especially in adulthood. Large-scale epidemiological studies among community-dwelling people both within Japan and abroad suggest that tooth loss inhibits adequate consumption of beneficial dietary elements. Findings of such studies indicate that those having poor oral health related to tooth loss tend to avoid firm foods in favor of carbohydrate-rich soft foods, resulting in unbalanced nutrient intake. Particularly in the case of more fragile elderly populations, poor oral condition is a clear risk factor for undernutrition. Moreover, several studies have suggested that such risk could be effectively reduced by comprehensive oral health interventions.
Conclusion: Greater partnership and coordination is necessary between oral health and nutrition professionals. Evidence-based policy should reflect and respond to the fact that unbalanced nutrition intake stemming from poor oral health conditions increases risk of several diseases in the adult life stages. Particularly for populations in the old-age life stage, role-sharing among health care sectors offering support for “eating” is important. Further, common indices for oral health and nutrition professionals to engage in sustainable partnership and coordination along such lines must be established.

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Background: The second basic program for shokuiku (food and nutrition education) promotion was enacted by the Cabinet Office in 2011 and is in effect for the five-year period from 2011 to 2015. The basic program contains the eleven target items related to shokuiku promotion. One of which involves increasing the proportion of citizens who chew food well and taste carefully when eating. The nutrition and dietary habits get strongly linked with oral health more and more in the practice of shokuiku and health promotion.
Contents: Influences of eating behavior, dietary habits, and food intake on the development of oral function and oral health were reviewed for children, adult, and elderly. Findings demonstrated the necessity of collaboration between the scientific field of oral health and nutrition sciences for health promotion and education.
Conclusion: In conclusion, we present three suggestions for strengthening the relationship between nutrition and oral health. First, collaborative research should be promoted more vigorously. Second, collaborative efforts in the field of shokuiku, health guidance, and nursing care should be more actively implemented, and results from these collaborations should be presented to the public. Third, professionals in both oral health and nutritional fields, such as dentists, dental hygienists, and registered dietitians, should strive to develop a better understanding each other.

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