Objective: To clarify the conditions relating to health literacy (HL) among high school students in Aomori and Nagano prefectures, including differences between the two prefectures, and to clarify factors determining the level of HL.

Methods: We conducted a cross-sectional study using self-administered questionnaires between July 3 and 24, 2018, for 806 second-year students from six high schools in City “B” in Aomori and 978 students from four high schools in City “C” and City “D” in Nagano. The questionnaire items included gender, communicative and critical health literacy (CCHL), Internet use, possession of dreams and targets for the future, identifying oneself as having a “can-do” attitude, motivation for learning, such as preference for studying, preference for learning about health, and prediction about their lifestyles in the future. After a comparison between regions for each item, factors relating to high CCHL were investigated using multi-regression analysis.

Results: High-school students in Aomori Prefecture used the Internet more frequently and had higher CCHL than students in Nagano Prefecture. High CCHL showed positive correlation with Internet use, having future dreams and targets, identifying oneself as having a “can-do” attitude, preference for learning about health, and prediction of regular exercise and weight regulation in the future.

Conclusion: When pursuing the HL education of high school students, it is important that such education promotes the utilization of online health information, possession of future dreams and targets, and circumstances that facilitate a “can-do” attitude.

Objective: In order to improve self-care of hemodialysis (HD) or hemofiltration dialysis patients, this study aims to identify the types of diet and fluid management behavior, and examine the demographic characteristics and adherence status of each type.

Methods: A cross-sectional study with self-administered questionnaire survey was conducted on 577 HD patients. Cluster analysis was used to identify the diet and fluid management behavior types. Demographic characteristics and adherence status were compared between the types using the chi-squared test or Kruskal-Wallis test.

Results: The analysis included 370 patients (64.1%). Five types were identified and each was categorized based on characteristic behavior; “well-management/irregular eating habits” (n=91), “adjustment by cooking and food choice/regular eating habits” (n=64), “adjustment by food choice/monitoring/regular eating habits” (n=76), “adjustment by eating amount/irregular eating habits” (n=62), and “non-management/regular eating habits” (n=77). The proportion of males and preparation of meals by patient’s family or others was significantly high in the “non-management/regular eating habits” type (P=0.005, P=0.001). Diet and fluid adherence status was significantly low in the “adjustment by eating amount/irregular eating habits” and the “non-management/regular eating habits” types (P<0.001, P<0.001).

Conclusion: Five types of diet and fluid management behavior were identified and adherence was low in the “adjustment by eating amount/irregular eating habits” and “non-management/regular eating habits” types. The demographic characteristics of each type should be considered while supporting HD patients.

Objective: The purpose of this field report was to clarify the problems in promoting cancer education faced by the personnel in charge of the prefectural board of education, utilizing visiting lecturers in collaboration with the department of cancer control.

Methods: In 2019, a workshop on the prefectural boards of education was held for administrators in charge of cancer education. Post-workshop, participants were required to write on sticky notes to identify challenges in collaborating with the cancer control department. Using the KJ-method, the participants categorized the recorded insights to generate themes. Subsequently, the researchers coded the themes and extracted the issues. Besides, participants completed a self-administered questionnaire survey, which included questions about attributes and local government characteristics.

Results: All participants in the workshop (N=23) agreed to participate in this study; about 70% were women, with a mean age (SD) of 45.6 (4.8) years. Additionally, about 90% were representatives in the comprehensive cancer education support project by the Ministry of Education, Culture, Sports, Science and Technology. The challenges identified from the content of the sticky notes were classified into two categories: (1) The positioning of cancer education as a cancer control measure is unclear; and (2) Content development utilizing visiting lecturers to promote cancer education is challenging.

Conclusion: Of the two problems we identified in collaborating with the cancer control department, the unclear position of cancer education as a cancer control measure may cause challenges in content development utilizing visiting lecturers.

Objective: To evaluate and describe the process of self-weighing intervention programs at a worksite developed according to the nudge EAST framework.

Project contents: We developed three intervention programs to promote self-weighing for preventing obesity in working generations; the “Quiz Group” (attractive nudge), the “Declaration Group” (social nudge), and the “Success Retrospective Group” (timely nudge), and an easy nudge was used among all the groups. We held one-hour group training sessions with these three programs for Aomori prefecture employees whose self-weighing frequency was less than once a week. We assessed the implementers’ motivation and sense of burden, participants’ satisfaction, and implementation costs including labor costs, by interviews and questionnaire surveys.

Project assessments: Four staff members (three for analysis) implemented the three programs, and eighty-three employees (seventy-eight for analysis) were assigned to each group participated in the programs. The motivation of the participants before the training sessions was higher in the “Quiz Group,” the “Declaration Group,” and the “Successful Retrospective Group,” in this order. The cost of implementation was higher in the “Successful Retrospective Group” (263–291 thousand yen), in the “Quiz Group” (207–235 thousand yen), and the “Declaration Group” (179–207 thousand yen), and the burden of implementation was also in this order. Participants’ satisfaction was 92.6% in the “Quiz Group,” 88.5% in the “Successful Retrospective Group,” and 64.0% in the “Declaration Group” (P=0.016).

Challenges: The “Quiz Group” was estimated to have the greatest potential for dissemination, because both the implementers and the participants obtained high satisfaction from the group. The implementation cost including labor costs was more than twice as high as that estimated in advance. It was also observed that the nudge dissemination phase of the implementers changed from “the acquisition stage” to “the practice stage.”

Objective: To examine the relationship between mothers’ healthy eating literacy (HEL) and problems regarding children’s eating habits.

Methods: Data from an online survey conducted in December 2018 were used. We divided participants into groups Q1 through Q5 based on the HEL quintile score and examined differences in demographics and children’s problematic eating habits (skipping breakfast, irregular meal times, picky eating) using the chi-squared test. Finally, the relationship between HEL and problems regarding children’s eating habits was investigated using logistic regression adjusted for demographics.

Results: A total of 1,899 mothers completed the survey (analysis target rate, 62.1%). In the Q5 group, which had the highest HEL, there were participants with a high level of education (P=0.007) and high annual household income (P=0.001). In the Q1 group, there were more tending participants whose children had irregular meal times (P=0.066) and exhibited picky eating (P=0.075), but there was no significant difference in skipping breakfast (P=0.781). Considering the demographics of mothers and children, there were more participants whose children had irregular meal times in the Q1 group than in the Q5 group (odds ratio [95% confidence interval]=1.44 [1.05–1.98]). This was not associated with skipping breakfast or picky eating.

Conclusions: This study found that the meal times of children of mothers with low HEL were irregular.

Objective: The purpose of this study was to clarify the actual conditions of colds, influenza, and hay fever as well as coping behaviors for these three phenomena in collegiate athletes.

Methods: The participants were athletes belonging to the athletic clubs of a four-year university. The participants were asked about their colds, influenza, and hay fever symptoms and coping behaviors.

Results: Altogether, 149 athletes participated in the study. About two-thirds of them had had a cold or influenza in the past year. Regarding masks, about 16% of the participants never wore a mask, and only about half of the participants always wore a mask. Almost 70% of the participants reported that there were years when they were not vaccinated against influenza. Furthermore, about half of the participants had experienced hay fever symptoms in the past year. Thirteen categories were obtained for coping with hay fever including “using oral medication.”

Conclusion: The results of this study suggest that collegiate athletes commonly suffer from colds, influenza, and hay fever. With regard to wearing a mask and influenza vaccination behaviors in the event of a cold or influenza, it was confirmed that although many of the participants intended to implement the behaviors, some of them did not actually do so.

Purpose: To report and share the insights learned from a workshop, which was held to discuss the role of the Japanese Society of Health Education and Promotion, and the society’s members for practices, research and education under the uncertain outlook to control the COVID-19.

Activities: We held an online workshop for the society’s members on January 24, 2021. A total of 67 members participated in the workshop, which included review reports (6 topics) about the influences on health conditions and/or lifestyles under the conditions of expanding infections of the novel coronavirus, practice reports (6 cases) about health education and health promotion activities during the COVID-19 pandemic, and subsequent group discussions and sharing for all participants. The reviews revealed that the number of published reports from Japan was insufficient compared with those from China and Western countries. Moreover, we surmise that promoting further relevant surveys and researches in Japan was necessary. In discussions regarding the activities, further considerations on disparities, support for individuals including mental problems due to overflowing information, coalitions and networking across the stakeholders, systems for monitoring and assessment, and reports and publications were highlighted as the necessary issues.

Future perspective: The socioeconomic conditions and sense of values, in addition to people’s lifestyles, have dramatically changed, and the widening disparities have become one of the most critical issues. We will, therefore, tackle these problems as health promoters (practitioners), researchers and educators by utilizing the knowledge and insights gained from this workshop, and will contribute to the health education and promotion with the novel coronavirus through our activities as a society as well as individual members.

Objective: To examine the psychological factors related to female university students’ exercise behavior during the period of voluntary restraint from outdoor activities due to the spread of COVID-19.

Methods: We applied the convergent design of the mixed research method for this study. Valid responses were obtained from 205 of the 255 first-year female university students enrolled in the common subject ‘Sports’ at University ‘S’ from April 2020. Responses to a psychological scale on exercise and questions on exercise behavior were used as quantitative data. The respondents’ reasons for and details of their exercise during the period of voluntary restraint was used as qualitative data.

Results: Discriminant analysis of the psychological scale items showed that ‘intentional approach to obstacles’ and ‘Instrumental attitude,’ with standard discriminant coefficients of 0.773 and 0.723, respectively, contributed more to performing exercise whereas ‘positive feelings’ and ‘intention to continue’ were negative and contributed less. The respondents’ reasons for exercising were classified into eight groups: ‘body,’ ‘physical fitness,’ ‘club activities,’ ‘home,’ ‘self-restraint,’ ‘weight,’ ‘health’ and ‘mood.’

Conclusion: ‘Intentional approach to obstacles’ and ‘instrumental attitude’ contributed to the implementation of exercise, while ‘positive feelings’ was negatively related. The reasons for and contents of exercising showed that the language of resumption of extracurricular activities and the awareness of loss of physical strength and muscle power complemented the ‘intentional approach to obstacles.’

Purpose: “Project of Disease Prevention” was taught to school children in elementary school, in Sapporo, Japan. Children learned about infectious disease prevention and transferred health information from “children” to “citizens.”

Main activity: Researchers and teachers of elementary school cooperated in the lesson for thinking by oneself. The project was started in 2019, and was over 20 hours. In 2020, outbreak of covid-19 was declared a global pandemic by the WHO. Seventy-five pupils in 2019 and 82 pupils in 2020 participated in the project.

Evaluation and challenges: Researchers and teachers tried to play to their strengths in the lesson. The practice needs scientific evidence in future studies. We will also verify the practice at home.

“Pa-League Walk” is the official app of the Pacific Baseball League. The app was developed based on behavioral science and gamification, using baseball fandom as a key insight, and is designed to help baseball fans stay active while having fun. One of its unique features includes team-based competition which was to encourage competition between opposing teams’ fans based on the total daily steps taken on “game days.” As an incentive, users receive a digital photo of a randomly selected player (from their favorite team) when they achieve 10,000 steps. The project has continued over the long-term and on a large-scale, with over 60,000 free downloads from all 47 prefectures since March 2016. The analyses using de-identified data show that daily steps among users increased meaningfully after the app’s installation, and that the increase was maintained over the long term. Additionally, the app was effective even for men, middle-aged adults, and people of lower socioeconomic statuses – who were under-represented in traditional health programs. Additionally, about a quarter of users were in the pre-contemplation stage of exercise behavior change upon starting to use the app. This model bridges spectator sports and daily physical activity, suggesting new avenues for health promotion and sports policies. The fandom-based approach can also be applied to other sports and entertainment. Non-monetary incentives, a team-based competition that leverages existing solidarity among the target population, and other gamification elements may also be utilized in behavioral change projects throughout the public and private sectors.