Objective: Local legislators affect local educational administration. The purpose of this study is to clarify the association between their attitudes towards sexuality education and their gender sensitivity through their views about gender roles.
Methods: A cross-sectional survey was conducted to collect information about attitudes towards sexuality education at school and traditional gender roles among all eligible 2,731 legislators in Hokkaido (a prefecture in Japan) using structured questionnaires. To ascertain gender sensitivity, their views about traditional gender roles were scored using such statements as “the husband should go out to work and the wife should look after the home”, “men as well as women should do housework” and “there can be a negative effect if a mother works before her child has entered elementary school”.
Results: The response rate was 55.9%. Of valid responders, 82.3% (men 81.0%, women 92.7%) showed their interest in sexuality education and HIV/AIDS prevention activities in Hokkaido. Male legislators who had high gender sensitivity (as compared with those who had low gender sensitivity) tended to ask about youth health issues in assemblies and also showed support for more practical sexuality education activities such as condom distribution and promotion.
Conclusion: Legislators' gender sensitivity affected their interest in sexuality education and was related to their raising of issues about youth health in assemblies.

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Objective: Medication adherence among patients with chronic diseases should be considered in the context of their relationship with healthcare providers and lifestyles. To support medication adherence among patients with chronic diseases under long-term medication, we developed a new medication adherence scale and evaluated its reliability and validity.
Methods: The scale items were constructed based on a literature review and interviews with patients with chronic diseases and prescribing physicians. A self-administered questionnaire including these scale items was administered to 888 patients recruited from hospital outpatients and groups of patients with chronic diseases. The study analyzed 509 responses (response rate = 57.3%).
Results: In exploratory factor analysis, 14 items were categorized under 4 factors (“collaboration with healthcare providers,” “motivation of access and utilization of information regarding medication,” “agreement with taking medication and its fit with their lifestyle,” and “medication compliance”). A confirmatory factor analysis showed that χ²/df = 4.4, CFI = 0.93, and RMSEA = 0.047. The Chronbach's α of the subscales were 0.92, 0.80, 0.55 and 0.74, respectively. The correlation coefficients between these subscales and other related measures were between 0.43 and 0.60, indicating adequate concurrent validity. The relationships between patient demographic characteristics and medication adherence were comparable with previous studies, suggesting good constructive validity.
Conclusions: This study demonstrated the reliability, validity and practicality of the newly developed scale for assessing medication adherence among patients with chronic diseases. Further refinements may be needed to improve the relatively low reliability for one of the subscales.

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Objectives: Incentives are a method to motivate people to exercise. To provide effective incentives, it is desirable to know how incentive types are affected by an individual's phase within the Stages of Change model for exercise behavior. This study aimed to examine this relationship.
Methods: In this cross-sectional survey, 1,295 Japanese adults (40-69 years) were registered with a Japanese social research company. Measured variables included the strength of motivation according to each type of incentive, a desirable monetary incentive to motivate exercise, and the Stages of Change for exercise behavior.
Results: Strength of motivation differed significantly with type of incentives (p < 0.01) and the Stages of Change for exercise behavior (p < 0.01). Although a significant interaction (p < 0.01) was also observed, there were small differences in the strength of motivation across the Stages of Change for exercise behavior for the top three incentives: money, a gift certificate, and a travel coupon. The amount of money necessary to reach a 50% cumulative frequency distribution for the motivation for exercise was 2,000 yen in the pre-contemplation phase, 1,000 yen in the contemplation phase, 1,500 yen in the preparation and action phase, and 500 yen in the maintenance phase.
Conclusion: The effects of incentives on strength of motivation for exercise vary significantly depending on the type of incentive and the individuals' the Stages of Change for exercise behavior. Further studies are needed to practically examine the effect of incentives on physical activity.

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Objectives: We examined the differences in experience, confidence and willingness to learn between public health nurses and registered dietitians who provide Specific Health Guidance. We aimed to assess and suggest improvements for their service.
Methods: A cross-sectional survey was distributed to 1,758 public health nurses and registered dietitians who implement public health policy nationwide and provide Specific Health Guidance autonomously or with an agency. The anonymous self-report questionnaire was posted to participants. The participants were asked to respond to 49 questions about their experience, confidence, willingness to learn, and participation in training for health guidance. The responses from the 718 public health nurses and registered dietitians, who responded to the questionnaire (response rate: 40.8%), were compared using the Mann-Whitney U test, χ² test and t-test.
Results: Experience was examined by 20 of the 49 questions. Registered dietitians had a higher percentage of responses that indicated “little experience”. For “planning and evaluation,” both groups reported that they had “little experience” with technology. The public health nurses reported that they had “no confidence” with respect to the 16 questions that examined “understanding the nutritional science of dietary therapy” and “providing and using guidelines”. Moreover, for the 19 questions about technology, public health nurses reported that they had “significant experience but no confidence” (p < 0.05).
Conclusions: Reports from public health nurses and managerial dietitians differed in terms of their experience, confidence and willingness to learn with respect to Specific Health Guidance techniques. Public health nurses reported having experience but lacked confidence with respect to more techniques.

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Purpose: To closely examine the questions community pharmacists receive from type-2 diabetes patients, and research the issues regarding drug administration guidance that meets patient needs.
Method: We conducted a descriptive study using community pharmacists who participated in the Community Pharmacists for Diabetes Intervention Study in Japan (COMPASS Project) in May and November 2011. Main survey items were respondent attributes (age, sex, and job classification) and the questions type-2 diabetes patients frequently asked at the pharmacy (hereinafter “the questions”). We asked the participants to respond with free-style descriptions of a maximum of the three most frequently asked questions. We then conducted text analysis of the questions collected using SPSS Text Analysis For Survey 3.0J. For visualization we adopted Web graphs.
Results: We received responses from 139 pharmacists (48 males, 83 females, and 8 non-specified) (collection rate 100%). As for the age of the respondents, those in their twenties accounted for the majority (44.7%), followed by those in their thirties (37.1%), and in their forties (12.9%). A total of 366 items of response were received. Our text analysis extracted 16 categories, including “how,” “diet,” “test values,” “drugs,” and “will it continue?” These categories covered 75.1% of the descriptions collected from the respondents. Additionally, the Web graphs confirmed correlations between these categories, including “diet-how-good,” “drugs-dosage-how,” and “drugs-for the rest of my life-will it continue?”
Conclusion: The questions type-2 diabetes patients asked community pharmacists were roughly divided into three: “treatment,” “lifestyle,” and “anxiety.” This indicates that pharmacists need to provide type-2 diabetes patients with comprehensive support that includes psychological support and lifestyle guidance.

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This article introduces the trend of International Union for Health Promotion and Education (IUHPE)/Northern Part of the Western Pacific (NPWP) with a particular focus on the period after 2011. The Executive Board organization system has changed in IUHPE and aims at being more active and lively. There are many participants and presenters from NPWP including Japan to the IUHPE general meeting and APHPE which are held once every three years. How to increase the number of members remains a challenge.

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Purpose: The purpose of this article was to overview the first health promotion foundation in the Asia-Pacific region, ThaiHealth, especially focusing on its history and mechanism, principles and activities, and evaluation method.
Methods: The information was collected from the presentations and interviews during the 21^st IUHPE world conference, related books and website, addition to the lecture given at the field trip to ThaiHealth.
Results: ThaiHealth was established when the Thai Health Promotion Foundation Act (B.E.2544) was enacted in 2001. The unique characteristic of its form is that it is under the supervision of the Prime Minister (currently Deputy Prime Minister and Minister of Finance), but it is not a part of the bureaucratic system. It utilizes a sustainable financing system through a two-percent surcharge levied on excise tax from tobacco and alcohol. The surcharge requires tobacco and alcohol producers to pay as an additional tax on top of the excise tax, and the surcharge is used for health promotion activities by ThaiHealth. ThaiHealth has an independent evaluation board to ensure its accountability, transparency, and efficiency. The board measures its effectiveness on not only health aspects, but also economic aspect using Social Return on Investment (SROI) of health promotion. ThaiHealth emphasizes health promoting public policies, issue-based programs, and holistic approaches. The characteristic of its activities is to improve people's health status by changing their value, lifestyle, and social environment.
Conclusions: We can learn from ThaiHealth, especially its mechanism and evaluation method, in order to improve health promotion in Japan.

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Objective: Salutogenesis and sense of coherence (SOC) have been two of the most important topics at the IUHPE World Conference on Health Promotion in recent years. The aim of this paper was to explore the trends and issues in these areas by sorting out and examining the studies of these topics at the 21st IUHPE World Conference on Health Promotion.
Methods: Topics relating to salutogenesis and SOC at the 21st IUHPE World Conference on Health Promotion were sorted as follows: relevant symposiums and sub-plenary sessions, oral and poster sessions, and sessions in other areas.
Results: Salutogenesis-related presentations were organized into one day, August 26th. There were two sessions with titles in which “salutogenesis” or “salutogenic” were included, namely, “Salutogenesis and intergroup relations: Can the sense of coherence predict openness towards the ‘other’?” and “Focusing on people's resources and compentecies: to reduce NCDs through a salutogenic approach.” In addition, there were some relevant presentations in the sessions related to health literacy, capacity building, health promotion research, and so on.
Conclusion: On the whole, presentations about salutogenesis and/or SOC were not grouped together under a specific session bearing the term “salutogenesis” but were found in the various working-group sessions. This may mean that salutogenesis comprises one of the basic theories at the IUHPE. As European Union nations, it is necessary to take a position on salutogenesis and SOC in Japanese health promotion and academic fields.

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Objective: This report introduced presentations and discussions of sessions on health literacy at the 21st IUHPE World Conference on Health Promotion 2013.
Results: Measures assessing health literacy are needed as tools for supporting individuals who face difficulties in making appropriate health decisions with health information. More comprehensive new scales were introduced at the conference, which had been developed with not only the individual in mind but also the broader society in their definitions of health literacy as a construct. This change reflects the growing realization that health literacy is fundamental in bridging the gap between quality healthcare and an increasingly diverse modern society. Presentations on the European Health Literacy Survey, in particular, highlighted the presence of a social gradient in health literacy along with the vital role of health literacy measures and interventions in reducing health disparities and ensuring equity. Health literacy was regarded as the empowerment; with the recent introduction of many actions worldwide, the communication of much needed health information across various levels of health literacy was observed.
Conclusion: Beyond being a core concept of health promotion, health literacy was shown to be an “umbrella term” under which many salient concepts abound, including equity. It is also one of measurable and modifiable social determinants of health.

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