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Objective　Obesity associated with an increased consumption of ultra-processed foods (UPF) has been reported by studies abroad using the NOVA food classification system, an international framework for classifying food according to the degree of processing. However, no such study has been conducted in Japan. In this study, we evaluated the association between UPF consumption, nutrient intake, and obesity using the NOVA system.Method　In September 2017, we conducted a survey using a questionnaire of patients who had attended routine health checkups in Manazuru Town, Kanagawa Prefecture and collected their three-day dietary records as well as medical examination results. The final analysis included 169 patients (66 men, 103 women). Food consumed by the respondents were classified into four groups of NOVA systems. The dietary share of UPF (UPF energy ratio) was compared to total energy intake (except alcoholic beverages and eating out). Nutrient intake and obesity risk were compared across the UPF energy ratio tertile (low, middle, and high intake). Covariance and logistic regression analysis were conducted and adjusted based on age, sex, household structure, education, income, and total energy intake (except energy-providing nutrients, macronutrients, and protein intake per body weight) to analyze the association between UPF consumption and nutrient intake. Finally, for obesity, we adjusted for physical activity and smoking status using a similar analysis of the relationship between UPF consumption and energy providing nutrients and macronutrients.Result　Approximately 75% of patients investigated were older than 65 years. The average (standard deviation) UPF energy ratio was 29.7% (15.0). There were no significant differences in socioeconomic status among groups according to the UPF energy ratio. The high-UPF group had a significantly greater total energy intake. However, the protein energy ratio, protein intake per body weight, dietary fiber, and vitamins A, E, K, B 1 , B 6 , C, niacin, folic acid, potassium, magnesium, and iron intake were significantly lower in the high-UPF group. Moreover, the high-UPF group had a significantly higher BMI. The odds ratio for obesity was higher (4.51[1.50-13.57]) in the high-UPF group than in the low-UPF group (1.00).Conclusion　Those who consumed more UPF had lower protein intake and suffered from multiple vitamin and mineral deficiencies. Furthermore, their energy intake was greater, and the odds ratio for obesity was significantly higher. It has been suggested that excessive UPF consumption warrants further attention.

Objectives Aiming at improvement of the Japan Health Insurance Association's Specific Health Guidance initiatives and human resource development, we conducted a qualitative study to clarify the features necessary for and the challenges hindering the achievement of good performance of the initiatives.Methods From November 2014 to January 2015, we conducted 10 focus group interviews, each 90 minutes long, with 64 public health nurses from 10 Japan Health Insurance Association branches. In addition, self-administered questionnaires were administered to obtain the participants' basic characteristics. After we excluded one group for failing to meet our performance targets, we divided the remaining nine focus groups according to two patterns: Maintenance and Progress. The four focus groups fitting the Maintenance pattern had a well-established track record, and the five focus groups fitting the Progress pattern had a track record of good growth. Using open coding of the interview transcripts, we extracted efforts or needs in two domains, individual and branch, Then, we placed codes in eight main categories: [quality], [general practice], [dietary guidance practice], [success factor], [branch system], [training and skill development], [approach to the member office], and [past efforts]. We further extracted important subcategories based on their rates of appearance within branches.Results Data from 56 female public health nurses working at nine branches were included in the analysis. With respect to the individual domain, subcategories such as "building rapport," "creating the physical environment," and "taking the initiative in evaluating one's own lifestyle" in the 〈high emphasis〉 segment of the [general practice] category were common to both patterns. In addition, "increasing opportunities for training" and "enhancement of training program content" were found for both patterns in relation to the 〈demand〉 segment of the [training and skill development] category. However, most participants chose "yes" in response to whether there was ample training opportunity.Conclusion This study showed some common efforts and practices among public health nurses in both patterns, which indicates good performance of the Specific Health Guidance initiatives. However, there is a need to further enhance the training program to strengthen the entire organization. Future studies should focus on understanding the characteristics of and factors involved in low-performing branches.

Objectives: The effects of a comprehensive intervention program for community-dwelling elderly on frailty and dietary habits were examined., Methods: We conducted randomized control trials to examine the efficacy of the intervention. To examine lasting changes, we made paired comparisons between pre- and post- intervention and at a three-month follow-up. The subjects were recruited in Hatoyama town, Saitama prefecture. The program was composed of exercise, nutritional education, and social participation and was held from October to December 2011. The exercise program aimed at fall prevention and took place twice per week for 60 min. The nutritional education aimed at prevention of malnutrition, and the social participation program aimed at prevention of "homeboundness"; both were held once per week for 30 min. Questionnaires inquired about frailty and dietary variety. A blood test was conducted to ascertain nutritional state, and a brief self-administered diet history questionnaire was used to estimate food and nutrient intake. To examine the efficacy of the intervention, 22 control subjects (CR) and 21 subjects in the intervention group (IV) were analyzed with intention to treat. To examine lasting changes, 16 subjects in IV who correctly completed surveys at each of the three time points were analyzed, using repeated ANOVA and a multiple comparison procedure., Results: 1. Men comprised 70-80% of subjects, and the average age was 75.7±5.4 and 74.7±5.4 years in IV and CR, respectively. 2. There was no significant difference in pre- and post-intervention changes between IV and CR in frailty, which was the main outcome of the study. 3. A significant difference in pre- and post-intervention values was noted in ① "homeboundness", one of the components of frailty (median [25-75%tile]): IV 0 [0-0] and CR 0 [0-1] (P=0.023); ② nutrient intake (mean±standard deviation [SD], energy ratio [%E]): protein, IV 2.3±0.7 and CR -0.3±2.0 (P=0.002); animal protein, IV 2.4±1.5 and CR -0.5±1.5 (P=0.002); and ③ food intake (mean±SD, g/1000 kcal): fish, IV 18.1±25.1 and CR -4.1±21.9 (P=0.004); egg, IV 5.0±11.2 and CR -2.1±11.3 (P=0.046). All variables improved in IV. 4. Lasting improvement was observed in "homeboundness" and protein intake [%E]., Conclusion: Although the intervention did not improve frailty, it may improve frailty and dietary habits by improving homeboundness and increasing protein intake.

Objective: We performed the follow-up tests for three years for junior high school students by the quasi-experimental design to investigate the medium-term effect of smoking prevention education in the elementary school., Methods: The intervention group consisted of 106 school students of three elementary schools and received a smoking prevention program in the elementary school. Moreover, the follow-up tests were conducted at each grade of junior high school, and the booster program was mailed. The comparison group consisted of 193 school students of another three elementary schools without the program., Results: The intervention effects were recognized on knowledge up to the second grade of junior high school for boys and up to the third grade for girls, on awareness of the importance of not smoking at the second grade, and on the intention of smoking at the age of 20 for girls up to the first grade. On the other hand, the intervention effects were not recognized on smoking experience for boys and girls. However, increase of the rate of smoking experience was not significant in the intervention group, while it was significant in the comparison group., Conclusion: The effect of the program for three years was judged to be moderate.

Object: The purpose of this study was to clarify factors related to eating breakfast among elementary school children., Method: The subjects were 196 fifth-grade pupils from two elementary schools in Osaka Prefecture. The main survey items were as follows: Number of eating breakfast days in the last week, appetite for breakfast, sleeping habits, knowledge on food, attitude related to eating breakfast, self-esteem, social skills, and eating behavior of family members. The Rosenberg Scale was used to measure global self-esteem and the Pope Scale for estimation of family-related self-esteem. Social skills were assessed using the scale developed by Shimada et al., which consists of subscales for pro-social skills, withdrawal behavior, and aggressive behavior., Results: The main results were as follows: (1) The percentages of children who ate breakfast everyday in the last week were 78.3% for boys and 70.2% for girls, who no significant difference between the sexes. (2) The children who ate breakfast everyday in the last week (everyday-eating group) had more appetite for breakfast and went to bed earlier than the children who one or more days without eating (lack-of-eating group). (3) Compared with the lack-of-eating group, the everyday-eating group showed higher scores in family-related self-esteem and pro-social skills, and lower scores for aggressive behavior. (4) Regarding knowledge on food except influence of sugar for health, there were no differences between the everyday-eating and lack-of-eating groups. However, the former included more children who thought that eating every breakfast was very important, compared with the latter. (5) Children who expressed the following answers were more abundant in the everyday-eating group than in the lack-of-eating group: (1) Family members prepare breakfast every day; (2) They ate breakfast with family members everyday in the last week; (3) They often talk with family members during meals and snacks., Conclusions: From the above results, the following are suggested in relation to the development of eating breakfast for elementary school children: (1) Only providing knowledge on nutrition is insufficient; (2) Development of a positive attitude toward the significance of breakfast is necessary; (3) Development of a daily living rhythm, including sleeping behavior, is important; (4) Encouraging the development of family-related self-esteem and the social skills is important. Therefore, especially in the elementary school stage, not only conducting eating behavior education at school, but also intervention to affect family members' behavior and attitudes has an important role.

The aim of the present study was to investigate current problems of snacking behavior and their relationship to stress coping among 1,486 fourth through ninth grade students from 10 elementary schools and six junior high schools. An anonymous self-completed questionnaire was utilized which included items about 1) selection of snack foods, which were classified into healthy, popular, complementary and western-style snacks, 2) problems of snacking behavior, which included external and emotional eating scores, and 3) stress coping scale. The stress coping scale contained two sub-scales; problem-focused and emotion-focused coping. The results were as follows: 1) Students who frequently went without breakfast did not select healthy foods, i.e., fruits and dairy products, but popular snacks, i.e., potato chips, pop corn and sweet beverage. 2) Both external and emotional eating scores increased by age in girls but was not apparent in boys. 3) Students who preferred either western-style or popular snacks showed higher score of external and emotional eating. 4) The score of problem-focused coping was positively correlated with preference for health snacks, but emotion-focused coping was positively correlated with external and emotional eating scores. The close relationship between snack food selection and problematic aspects of eating behavior suggests that modification of eating behavior is necessary to develop healthy snack habits in early adolescents. Also, it is interesting that snacking behavior is closely related to stress coping, which suggested the behavioral intervention for healthy eating habit should be included in development of stress-coping skills against various kinds of demands in life.

Object: This study examined the relationship between smoking behavior and self-esteem among Japanese early adolescents., Method: The study sample comprised 1,486 fourth through ninth grade students from 10 elementary schools and six junior high schools throughout nine prefectures. Data were collected using an anonymous self-administered questionnaire which included items measuring smoking behavior, self-esteem, intention to smoke in the future, self-efficacy to refuse peer pressure to smoke, the smoking behaviors of their parents, siblings and friends. Self-esteem was measured using the Harter Perceived Competence Scale which includes four areas: cognitive, social, physical, and general., Results: The main results were as follows: 1) Ever smokers had lower cognitive and general competence scores, but a higher physical competence score than never smokers, especially among males. 2) Ever smokers had more smoking parents, siblings and friends than never smokers. 3) Ever smokers had stronger intention to smoke in the future than never smokers. 4) Ever smokers had lower self-efficacy to refuse peer pressure to smoke than never smokers., Conclusion: The results of this study about the relationship between smoking behavior and self-esteem were consistent with those of some previous studies in the U.S. Therefore, it is suggested that effective smoking prevention programs for Japanese early adolescents should include strategies to enhance self-esteem.

The purpose of this study was to evaluate the short-term effect of a smoking prevention program for Japanese elementary school-children in the fifth and sixth grades. The program was developed with concepts found in the Know Your Body Program and the conclusions of a National Cancer Institute-convened Expert Advisory Panel, and focused on teaching about the short-term effects of smoking and on resistance to social pressures to smoke. The study was conducted with a quasi-experimental design. An intervention group (52 boys and 54 girls) received three sessions for both the fifth grade in 1992 and the sixth grade in 1993. Moreover, the intervention group received a pre-test before the first session and a post-test after the third session in each grade. A comparison group (102 boys and 91 girls) received the same tests at the same time as the intervention group, but did not receive any program on smoking prevention. The short-term effect of the program were evaluated using the results of the pre-test in the fifth grade and of the post-test in the sixth grade in both groups. The results were as follows: 1) Remarkable short-term effects of the intervention were seen in respect to awareness of the importance of not smoking in girls, and also in the knowledge of the short-term effects of smoking in both sexes. 2) The intervention was not effective with respect to intention to smoke at the age of 20 and self-efficacy of refusing to smoke in both sexes. 3) The short-term effects were not clear in the smoking behavior in both sexes because the rates of ever smokers and of monthly smokers were almost the same for two years between the intervention group and the comparison group. 4) The smoking behaviors of children, their parents and their best friends had little influence on the results of the post-test in the sixth grade.

Predictive factors for adolescent smoking behavior were examined prospectively in a cohort of 199 adolescents who participated in a survey in March 1983 and were followed up about 7 years later. In 1983, as junior high school students (grades 1-3), subjects completed a questionnaire which consisted of variables on smoking behaviors of subjects' family and friends, attitudes toward smoking, knowledge about the effects of smoking on health, and self-prediction of future smoking behavior. In 1990, a similar survey including variables on subjects' smoking behavior was again carried out. At that time, all were 20 years or older. It was found that the number of friends in 1983 who smoke was strongly associated with smoking behavior in 1983, and for both sexes smoking behavior in 1983 and self-prediction of future smoking behavior in 1983 were the factors which were associated with smoking behavior in 1990. Furthermore, a model for predicting smoking behavior was deduced from the foregoing results and the findings of prior studies. The covariance structure analysis supported the validity of the model and revealed that smoking behavior in 1983, number of friends who smoke, and self-prediction of future smoking behavior were important in predicting smoking behavior 7 years later.

As part of a longitudinal study dealing with the effects of the noise from the Tohoku Shinkansen on the living environment of school children, social surveys were conducted on children in an elementary school near the Tohoku Shinkansen line in Saitama prefecture, by means of a questionnaire from July 1984 through February 1986. Between October and November in 1986, noise levels were also measured adjacent to the houses of subjects who lived within one hundred meters of the railroad track. The present paper is devoted to the examination by multiple regression analysis of factors related to the degree of annoyance at home resulting from the Tohoku Shinkansen noise expressed by subjects. The main results were as follows: 1. Multiple correlation coefficients between the degree of annoyance of the Tohoku Shinkansen noise at home and noise levels were less than 0.3. 2. When annoyance at school from the noise and the self-rated quality of sleep were incorporated in multiple correlations, the values of multiple correlation coefficients exceeded 0.5. These results suggest that so far as individual responses are considered, non-physical factors such as sensitivity to noise and quality of sleep account for a considerable part of the total variance of individual responses.

As part of developing the Know Your Body (KYB) program for Japan, a questionnaire survey was administered assessing knowledge, attitudes, and behavior regarding cigarette smoking, alcohol drinking, dietary lifestyle and exercise. The subjects, about 13,000 in total, were students in elementary, junior and senior high schools in 9 prefectures. The main results concerning knowledge of foods that cause or prevent adult diseases are as follows: 1) Correct responses on the relationship of excessive salt intake and hypertension were made by 39% of males and 41% of female in the fifth grade of elementary school. In the third grade of junior high school, the percentage of correct answer for the same question increased to 80% of males and females, and in the third grade of senior high school, it rose to 90% of males and 91% of females. No clear sex difference was seen in all the grades of school. 2) Less than 23% of the students from the first to fourth grade of elementary school knew the word "cholesterol" and could distinguish high cholesterol foods. In the sixth grade of elementary school, more than 50% of students knew the word "cholesterol". In the third grade of junior high school, more than 50% of students could distinguish high cholesterol foods correctly and recognized the relationship of excessive cholesterol intake to heart disease. These results provide a basis for determination of the age for introducing nutrition education. 3) The percentage of correct answers for distinguishing green-yellow vegetables, showed a clear sex differential. The percentage of correct answers concerning dietary fiber was 75% for males and 81% for females in senior high school.

The "Japan Know Your Body Study" (JKYB) is an example of collaborative activities of technology transfer carried out in Japan in several phases. The first phase is a needs assessment and data collection survey and it was administered during 1989. A survey was conducted throughout 9 prefectures in Japan with participation by 49 schools. Subjects were students in elementary, junior and senior high schools who ranged in age from 6 to 18 years. Participants, 12,892 in total, completed a survey on knowledge, attitude and behavior regarding cigarette smoking, alcohol drinking, diet, exercise and so on. The main results concerning cigarette smoking and alcohol drinking behavior were as follows: 1) The percentage of monthly male smokers rose remarkably from 8% in the third grade of junior high school to 37% in the third grade of senior high school, while that of female smokers showed a slow rise from 3% to 15%. The sex difference for smoking behavior was clear among senior high school students. 2) Smoking rates increased in proportion to the numbers of parents, siblings and friends who smoked. Above all, smoking behavior of friends was strongly related. Among senior high school students, for example, 50% of males and 46% of females who had two or more smoking friends were smokers, as compared to 5% of males and 2% of females with no smoking friends. 3) The percentage of monthly drinkers rose at a steady pace from 13% of males and 7% of females in the fifth grade of elementary schools to 59% of males and 50% of females in the third grade of senior high schools. The sex difference for alcohol drinking behavior among senior high school students, while statistically significant, was not as pronounced as that for smoking behavior. These results suggest that tobacco- and alcohol-use prevention programs should be introduced in elementary schools and those programs should include components relating to the social influences of parents, siblings and friends.

The aim of the Japan Adolescent Smoking Survey (JASS) is to standardize the definitions of smoking behavior among Japanese adolescents together with measurement methods and questionnaires concerned. A study of 9921 school children aged 9 to 18 years in 17 elementary schools, 16 junior high schools and 18 senior high schools in 9 prefectures, was conducted between June and July of 1989, to determine the relationship between actual smoking behavior during the past month or year and the "self-referent label" concerning their smoking status. The main results were as follows: 1) The percentage of those who smoked at least one cigarette during the past month showed a high degree of similarity to the percentage of those who referred to themselves as "regular smokers" or "occasional smokers". 2) Less than 10% of students who identified themselves as "never smokers" or "ex-smokers" smoked at least one cigarette during the past month, while more than 80% of students who referred to themselves as "regular smokers" or "occasional smokers" smoked during the past month. 3) On the whole, those who smoked 20 or more cigarettes during the past month referred to themselves as "regular smokers"; those who smoked between 2 and 19 cigarettes as "occasional smokers"; those who smoked 1 cigarette as "ex-smokers"; those who did not smoke during the past month as "never smokers". 4) The definition where students who smoked one cigarette during the past month are classified as a category of smoker, displayed a high level of sensitivity and specificity for all school-level groups and for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

The maximum train speed of the Tohoku Shinkansen was increased from 210 to 240 km/h in March 1985. In order to determine the effects of the expected increase in noise level on the living environment of school children, a longitudinal study was carried out in an elementary school near the Tohoku Shinkansen line in Saitama prefecture comprising noise measurements and social surveys of the school children and their mothers using a questionnaire. The results were as follows: 1. When measured 25 meters away from the railroad track, the noise level increased from 73 to 76 dB (A)along the inbound track, while it increased from 77 to 78 dB (A)along the outbound track. 2. The maximum noise level in a classroom when an outbound train passed at a speed of 216 km/h was 67 dB(A). 3. In the school environment the most pronounced effects of the Shinkansen noise were annoyance and listening disturbance, with the percentages reporting such significantly increasing after the speed-up. 4. In the home environment the most pronounced effects of the Shinkansen were annoyance, structural vibration, television interference, and listening disturbance. However, the percentages of these complaints did not show any significant change after the speed-up. 5. Among those living near the railroad track there were significant differences between children and their mothers in the percentages reporting annoyance, television and radio listening interference, and structural vibration, with the percentages for the mothers being higher than their children. These results indicate that disturbances in listening has especially increased in the school environment after the speed-up and that the increase in both noise levels and number of train passages have contributed to increasing disturbance.

One hundred and seventy-four second year senior high school students (106 males and 68 females) participated in a questionnaire survey to analyze factors associated with smoking. The questionnaire consisted of variables on family smoking, beliefs regarding smoking, knowledge about the dangers of smoking, etc. Smoking behavior about three and a half year later, when the subjects had become adults (twenty years old), was then investigated. The relationships between their behavior and the variables obtained in the earlier research were analyzed in detail. The results were as follows: 1) Family smoking was related to smoking behavior at the stage of second year of senior high school for males and to smoking onset after second year of senior high school for females. 2) Self-prediction regarding future smoking was related to both smoking behavior during senior high school and smoking onset in the future. Almost all beliefs regarding smoking was related to smoking behavior at the second year of senior high school, however, these beliefs were not effective in predicting future behavioral change. 3) Knowledge about the dangers of smoking was related to neither the smoking behavior at the stage of senior high school nor behavioral change in the future.