Objective: The purpose of this study was to examine whether 1) health literacy is associated with the awareness of the Japanese physical activity guidelines (Active Guide) and 2) health literacy moderates the association between awareness of Active Guide and physical activity.

Methods: A nationwide, cross-sectional Internet survey of 7,000 Japanese adults was conducted. The survey items included those related to the awareness of Active Guide, two physical activity variables (amounts of moderate-to-vigorous physical activity and sufficient level of physical activity), health literacy, and demographic factors.

Results: Logistic regression analysis revealed significant correlation between health literacy and the awareness of Active Guide. Furthermore, logistic and multiple regression analyses showed that the interaction term of health literacy with awareness of Active Guide was negatively and significantly correlated with physical activity variables. Further stratified analysis indicated that while awareness of Active Guide was significantly and positively correlated with physical activity among groups with low and high health literacy, regression coefficients for the low health literacy group were greater than those for the high health literacy group.

Conclusion: The results implied that individuals with higher health literacy were more likely to be aware of Active Guide and that the positive association between the awareness of Active Guide and physical activity was stronger among those with lower health literacy than those with higher health literacy.

Objective: To identify the relationship between health literacy (HL) and participation in physical exercise/sports and physical activity among women in their 20s to 40s, adjusting for social factors that inhibit exercise/sports activities.

Methods: A cross-sectional study was conducted using an online survey targeting 819 individuals, who were registered with a research company as prospective participants. We measured participants’ HL using the Japanese version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47), and calculated the standard scores for the general HL and its three health domains. The relationship between HL, participation in physical exercise/sports and physical activity was studied using logistic regression analysis. Social factors were included as adjustment variables.

Results: The group with high HL scores had a higher ratio of individuals who participated in physical exercise/sports one or more days a week, and those who had achieved physical activity that exceeded 23 METs-hour/week. The results of multivariate analysis showed a positive relationship between participation in physical exercise/sports, general HL (odds ratio [95% confidence interval]=1.88 [1.32, 2.67]) and health promotion HL (2.07 [1.32, 3.25]). A positive relationship was observed between physical activity, general HL (1.76 [1.23, 2.50]), healthcare HL (1.67 [1.10, 2.55]), and health promotion HL (1.74 [1.11, 2.72]).

Conclusion: The results show HL is associated with participation in physical exercise/sports and physical activity, independent of social factors that are suggested to hinder women’s participation in physical exercise/sports.

Objectives: This study aimed to examine the handwashing skills of children at different grades of kindergarten and to provide suggestions for more effective handwashing instructions.

Methods: This study was conducted in December 2020 and applied an analytical observational method with a cross-sectional design. Kindergartners’ handwashing method, handwashing time, rinsing time, and areas left unwashed were examined, and these differences between grades were analyzed.

Results: Data were obtained from 77 kindergarteners, with parental consent. First graders scored significantly lower than older children in their handwashing method. Less than 60% of the first and second grade children used soap. The first graders spent significantly less time handwashing than the older children. Fewer than 30% of the kindergarteners in all grades met the appropriate rinsing time, and there were no significant differences between grades. The first graders usually only washed their palms properly while leaving other parts unwashed. Second and third graders often failed to wash their fingertips, thumbs, and wrists.

Conclusion: To improve handwashing instruction, first graders need to be taught proper handwashing methods, such as using soap and washing their entire hands. For second and third graders, it is important to emphasize washing all unwashed parts identified in this study. In general, children in all grades need to be taught how to rinse and wipe hands. Furthermore, the handwashing environment needs to be improved, such as changing the placement of soap to make it more accessible for younger children and installing stepstools at handwashing stations.

Objective: This study investigate the effects of using smaller spoons on food intake in healthy young men.

Methods: Twenty-one non-smoking, healthy university male students were included in the study. In a non-randomized crossover trial design, the amount of food consumed, mealtime, and satiety were compared between eating curry with standard-sized and smaller spoons. The suppressive effect of using smaller spoons on food intake may be greater for those who consume more than the estimated energy requirement per meal with a regular spoon. The difference between energy intake and estimated energy requirement with standard-sized spoons for each subject was determined, and the participants were divided into two groups, high energy intake group and low energy intake group, by the median value. The amount of food consumed with both spoons and the duration of meals were compared between the two groups.

Results: There was no difference in the amount of food intake by the participants as a whole due to the two types of spoons. The median (25th and 75th percentile values) of the high energy intake group was lower with the smaller spoons, 592 g (581 g, 679 g), than with regular spoons, 680 (674 g, 893 g). The energy intake was also lower when smaller spoons were used (P=0.026). There was no difference in water consumption amounts and feeling of satiety after the meal between the two conditions.

Conclusion: In young healthy men, smaller spoons could suppress the food intake among those who have a high energy intake with a regular spoon.

Objective: The purpose of this study was to report on the practice of promoting healthy menu choices, via the nudge design, by analyzing cafeteria users in a company.

Activities: A contract was concluded with a non-profit organization to promote healthy menu choices in a company cafeteria, arranged in accordance with the EAST (Easy, Attractive, Social, Timely) framework of the nudge theory.

Activity evaluations: A questionnaire was administered to 100 participants (users of the company cafeteria), and an online survey was conducted with 70 non-participants (workers who had not used the cafeteria). Compared with the non-participant group (70 were analyzed), the participant group (47 were analyzed) had more persons who were interested in both the social-contribution activities and the healthy menu. Moreover, the participant group had a higher rate of experience participating in social-contribution activities (P<0.001 in both cases). The average span of usage in the participation group was 29.3 months, and 71.0% wanted to continue using the cafeteria. These results suggested that the nudges of this study could overcome the drawbacks of prior nudges, “short-term effects.”

Future projects: Due to the limitations of this study, including that the survey method differed for each group, it will be necessary to verify the results under more stringent conditions using employees of the same company.

During the COVID-19 pandemic, information on various infectious diseases was spread simultaneously with the spread of infection. The information spread could be both accurate, and mis- or false information. This situation has been described as an “infodemic” and has various adverse effects on COVID-19 control and public health. The infodemic is greatly affected by the widespread interactive nature of the Internet and the ease of sharing information on social media. Therefore, responses have been via the Internet and social media platforms to ensure that science-based health messages appear first. The content analysis of social media was used to understand trends in information and public perceptions, attitudes, and behavior towards the COVID-19 pandemic. It is important that people can judge misinformation and false information and decide whether to share it. There is also a need to improve digital health literacy in the population. In Japan, the Internet and social media were primary information sources during the COVID-19 pandemic, and many people were exposed to misinformation and false information. Many people could not judge between correct information and misinformation or false information, and there were many cases of spreading and sharing incorrect information. In the future, it is necessary to assess the information on the Internet, social media, and digital health literacy by health experts. Such assessment can be linked to COVID-19 pandemic control, promotion of vaccination, and solutions for coming public health issues.

This special report presents the issues that I have encountered in the two years since COVID-19 began, along with a theoretical framework and related studies. The center of my awareness of the issues is the limitations of the traditional communication that overemphasizes the provision of knowledge to lay people. To break the “curse of knowledge” of health professionals and avoid “message fatigue” that may induce psychological reactance in the target audiences, we need to break away from “communication to teach” and shift to “communication to make feel.” I propose communication strategies such as appealing to affective determinants of health behavior and fundamental human motives. I hope that this report will contribute to apply the lessons learned from COVID-19 to future research and practice of communication for behavior change.

During the COVID-19 pandemic, an infodemic brought the issue of health literacy into focus. Studies were conducted around the world on how health literacy helped citizens respond to COVID-19; the general finding was that health literacy affects knowledge and behaviors related to COVID-19. It is difficult to take the time to improve health literacy in the midst of a pandemic because in that situation governments and citizens are required to act immediately. Hence, it is important to foster health literacy over time so that individuals and societies are prepared for situations that require immediate response and containment. Furthermore, it is important to note that health literacy alone does not enable citizens to respond appropriately to situations like the COVID-19 pandemic; rather, the skills to make decisions based on an appropriate assessment of the reliability of new, uncertain, and frequently changing information, including political and socio-economic news, is important. In addition, it is necessary to examine the benefits and risks of digitalization with the spread of social media as a new area of health literacy from a global and political perspective. In addition, it is important to cultivate the solidarity and social responsibility necessary to respond to a pandemic along with the ability to call on governments and others to improve the capacity of communities to change social and economic structures and processes that negatively affect health (also known as social vaccines). In other words, critical health literacy that can enable citizens to bring about social and political changes is required.

Objectives: The goal of oral health and dental care is to maintain and improve vital social functions such as eating and communication. The purpose of this study was to examine the impact of COVID-19 on the health behavior of dental care providers and patients and the resulting impact on oral health and dental care.

Contents: The oral cavity contains many SARS-CoV-2 (ACE2) receptors. Due to the frequency of contact with saliva and oral mucosa as well as aerosols generated during dental treatment, there is a high risk of SARS-CoV-2 infection at dental clinics. However, it has been proven that the risk of infection can be decreased by thoroughly implementing infection prevention measures. In fact, no cases of SARS-CoV-2 infection due to dental treatment have been confirmed in Japan. The number of people visiting dental clinics decreased when the pandemic began in 2020, but in 2021 dental visitation recovered to 2019 levels. Research has established a clear relationship between oral health and NCDs such as diabetes, obesity, COPD, and cardiovascular disease, which are risk factors for severe COVID-19. It is therefore likely that periodontal disease prevention reduces the risk of developing severe COVID-19.

Conclusion: Dental institutions are highly accessible and can quickly implement infection prevention measures, so they can and should play an important public health role. Lifelong oral health promotion not only contributes to NCD and frailty prevention, but can also contribute to reducing the spread of infectious diseases such as COVID-19.