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Studies have reported that short-term blood pressure (BP) variability (BPV) is associated with type 2 diabetes mellitus (T2DM) incidence, but the association with long-term BPV remains unclear. The present study investigated the associations of long-term BPV as well as the time trend of BP changes over time with the incidence of T2DM. This study followed a cohort of 3017 Japanese individuals (2446 male, 571 female) aged 36-65 years from 2007 through March 31, 2019. The root-mean-square error (RMSE) and the slope of systolic BP (SBP) change regressed on year were calculated individually using SBP values obtained from 2003 to baseline (2007). A multivariable Cox proportional hazard model was applied to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for tertiles of SBP RMSE and continuous SBP slopes adjusted for age, sex, smoking status, regular exercise, sodium intake, family history of diabetes, sleep disorder, body mass index (BMI), SBP, and fasting blood glucose (FBG) at baseline, and BMI slope from 2003 to 2007. The highest RMSE tertile compared to the lowest was associated with a significantly higher incidence of T2DM after adjusting for covariates (HR: 1.79, 95% CI: 1.15, 2.78). The slope was also significantly associated with T2DM incidence until baseline SBP and FBG were adjusted (HR: 1.03, 95% CI: 0.99, 1.07). In conclusion, long-term SBP variability was significantly associated with an increased incidence of T2DM independent of baseline age, sex, BMI, SBP, FBG, lifestyle factors and BMI slope from 2003 until baseline.

Purpose This study compared working cancer survivors’ self-rated health status (SRHS), physical functional capacity, depressive symptoms, and happiness to those of cancer-free workers. Methods A nationwide general population-based cross-sectional study on a sample of Japanese was conducted. Prevalence of deteriorated SRHS, restricted physical functional capacity, depressive symptoms, and perceived happiness were compared between working cancer survivors and cancer-free workers with multivariable logistic regression analysis adjusted for age and sociodemographic and health-related backgrounds. Results Of the 28,311 male and 26,068 female workers, 977 (3.5%) and 1267 (4.9%) were cancer survivors, respectively. Working cancer survivors reported deteriorated SRHS more frequently than cancer-free workers: 21.3% vs. 13.8%, multivariable-adjusted odds ratio (95% confidence interval), 1.64 (1.39–1.95) for men, 23.8% vs. 17.5%, 1.34 (1.16–1.54) for women. Restricted physical functional capacity was reported more frequently in working cancer survivors than cancer-free workers: 6.8% vs. 2.6%, 1.76 (1.34–2.32) for men, 4.9% vs. 2.0%, 2.06 (1.56–2.71) for women. No significant difference was found for depressive symptoms: 21.6% vs. 22.9% in men, 30.0% vs. 28.5% in women. Working cancer survivors felt happiness more frequently than cancer-free survivors in men (77.3% vs. 71.7%, 1.21 (1.01–1.45)) but not in women (76.1% vs. 74.9%). Conclusions Working cancer survivors had worse SRHS and more restricted physical functional capacity than cancer-free workers. In men, working cancer survivors felt happiness more frequently than cancer-free workers. Implications for Cancer Survivors Continuous support to improve cancer survivors’ SRHS and physical functional capacity would be necessary even while they are working.

Aims/Introduction The Japanese government started a nationwide screening program for metabolic syndrome (MetS) to prevent cardiovascular diseases and diabetes in 2008. Although impaired fasting glucose (IFG) is a strong predictor for type 2 diabetes mellitus, the program does not follow up IFG in non‐MetS individuals. This study aimed to examine the risk and the population attributable fraction (PAF) of MetS and IFG for incidence of type 2 diabetes mellitus. Materials and Methods Japanese workers (3,417 men and 714 women) aged 40–64 years without a history of diabetes were prospectively followed. MetS was defined as either abdominal obesity plus two or more metabolic risk factors, or being overweight in the case of normal waist circumference plus three or more metabolic risk factors. IFG was defined as fasting blood glucose 100–125 mg/dL. Results During a mean 6.3 years, 240 type 2 diabetes mellitus cases were identified. Compared with those without MetS and IFG, the multivariable‐adjusted hazard ratios (95% confidence interval) of non‐MetS individuals with IFG, MetS individuals without IFG and MetS individuals with IFG for type 2 diabetes mellitus were 4.9 (3.4–7.1), 2.4 (1.6–3.5) and 8.3 (5.9–11.5), respectively. The corresponding PAFs for type 2 diabetes mellitus incidence were 15.6, 9.1 and 29.7%, respectively. Conclusions IFG represented a higher risk and PAF than MetS for type 2 diabetes mellitus incidence in middle‐aged Japanese individuals. The coexistence of MetS and IFG showed the highest risk and PAF for type 2 diabetes mellitus incidence. The current Japanese MetS screening program should be reconsidered to follow up non‐MetS individuals with IFG., The present study showed that non‐metabolic syndrome individuals with impaired fasting glucose represented a higher risk and population attributable fraction than metabolic syndrome individuals without impaired fasting glucose for type 2 diabetes mellitus incidence in middle‐aged Japanese individuals.

We examined the association between objective and perceived neighborhood characteristics and self-reported leisure-time physical activity (PA) in older Japanese residents living in areas ranging from metropolitan to rural in 2016. Objective measures used were walkability and the numbers of parks/green spaces and sports facilities within 500 or 1000 m of subjects&rsquo, homes, calculated using geographic information systems. Subjective measures were the subjects&rsquo, perceptions of their neighborhoods, assessed using a structured questionnaire. All variables were divided into three groups, and the lowest tertile was used as the reference. We assessed the location and frequency of strolling or brisk walking, moderate-intensity PA, and vigorous-intensity PA (sports) using a self-reported questionnaire and defined as performing a certain type of PA 3&ndash, 4 times/week as a habit. Living in a neighborhood in the highest tertile for walkability and number of parks/green spaces as well as perception of having good access to recreational facilities, observing others exercising and the presence of walkable sidewalks was associated with walking and sports habits (multivariable odds ratios (ORs): 1.33&ndash, 2.46, all p &lt, 0.05). Interestingly, objective measures of PA-friendly environmental features were inversely associated with moderate-intensity PA habits, potentially because moderate-intensity PA consisted predominantly of gardening. In conclusion, living in an environment supportive of PA, whether objectively or subjectively measured, is related to leisure-time PA habits among older Japanese adults.

Aims/Introduction To prospectively investigate whether simultaneous elevation of gamma‐glutamyl transferase (GGT) and alanine aminotransferase (ALT) is associated with the increase of type 2 diabetes mellitus incidence independent of alcohol drinking, body mass index and triglycerides. Methods A total of 2,775 Japanese male workers who had no history of type 2 diabetes mellitus were followed. High GGT and ALT were defined as the top tertiles (GGT cutpoint: 49 IU/L, ALT cutpoint: 28 IU/L). Three groups were created using these dichotomized GGT and ALT cutpoints: both low, either high or both high. Multivariable Cox proportional hazards models were carried out adjusted for potential confounding factors. Results A total of 276 type 2 diabetes mellitus cases were identified during 12 years (27,040 person‐years) of follow up. Participants with simultaneously elevated GGT and ALT had a significantly higher incidence of type 2 diabetes mellitus, even after adjustment for fasting insulin and fasting blood glucose compared with the group without GGT or ALT elevation. Similar associations were observed in non‐ or light‐to‐moderate alcohol drinkers, as well as in participants with normal weight. However, the association was weaker in participants with triglycerides

Objective To examine whether laughter yoga (LY), i.e., simulated laughter, alters cortisol and dehydroepiandrosterone (DHEA) levels and cortisol/DHEA (C/D) ratios. Methods In a randomized controlled trial, 120 healthy university students were allocated to experiencing LY, watching a comedy movie (spontaneous laughter), or reading a book. Salivary cortisol and DHEA levels were measured immediately before, immediately after, and 30 min after the intervention. Results Cortisol levels and C/D ratios significantly decreased by time in the LY and comedy movie groups. Significant group*time interactions were found between these two groups for cortisol levels and C/D ratios. DHEA levels did not change by time in the LY group. Conclusions LY decreased cortisol levels and C/D ratios but did not affect DHEA levels. Simulated and spontaneous laughter differently affected the dynamics of cortisol levels and C/D ratios. Effect of spontaneous laughter on the cortisol dynamics lasted longer than that of simulated laughter. (UMIN000019409).

Background The distributions of socioeconomic status (SES) factors have been changing in Japan. We examined the relationships among SES and self-rated health (SRH) in Japanese adults. Methods We analyzed 1,178 men and 1,555 women. We showed the distribution of SRH by sex and age and examined cross-sectional relationships among educational attainment, marital/living statuses, working status, household income and expenditure, and fine SRH (defined as excellent, very good, or good). We adjusted for age, subjective symptoms, visiting doctors, monthly equivalent household expenditure (EHE), and living in their own house. Results The age-standardized prevalence of fine SRH was 79% and 73% among men and women, respectively. Among men, graduating from high school (adjusted odds ratio [aOR] 1.53; 95% confidence interval [CI], 1.07-2.19, relative to graduating from elementary or junior high school) and university or junior college (aOR 1.74; 95% CI, 1.15-2.62) was associated with fine SRH. Among women, graduating from university or junior college was associated with fine SRH (aOR 1.65; 95% CI, 1.12-2.46). Neither marital/living status nor working status was associated with SRH after adjustments for age in either sex. Among women, high EHE and income were associated with fine SRH (the highest expenditure group: aOR 1.80; 95% CI, 1.22-2.65; the highest income group: aOR 2.15; 95% CI, 1.34-3.46, relative to the corresponding lowest group). These simple relationships were not observed for men. Conclusions High educational attainment was associated with fine SRH. Relationships among household income, EHE, and fine SRH differed by sex.

The Yale Food Addiction Scale 2.0 (YFAS 2.0) is used for assessing food addiction (FA). Our study aimed at validating its Japanese version (J-YFAS 2.0). The subjects included 731 undergraduate students. Confirmatory factor analysis indicated the root-mean-square error of approximation, comparative fit index, Tucker&ndash, Lewis index, and standardized root-mean-square residual were 0.065, 0.904, 0.880, and 0.048, respectively, for a one-factor structure model. Kuder&ndash, Richardson &alpha, was 0.78. Prevalence of the J-YFAS 2.0-diagnosed mild, moderate, and severe FA was 1.1%, 1.2%, and 1.0%, respectively. High uncontrolled eating and emotional eating scores of the 18-item Three-Factor Eating Questionnaire (TFEQ R-18) (p &lt, 0.001), a high Kessler Psychological Distress Scale score (p &lt, 0.001), frequent desire to overeat (p = 0.007), and frequent snacking (p = 0.003) were associated with the J-YFAS 2.0-diagnosed FA presence. The scores demonstrated significant correlations with the J-YFAS 2.0-diagnosed FA symptom count (p &lt, 0.01). The highest attained body mass index was associated with the J-YFAS 2.0-diagnosed FA symptom count (p = 0.026). The TFEQ R-18 cognitive restraint score was associated with the J-YFAS 2.0-diagnosed FA presence (p &lt, 0.05) and symptom count (p &lt, 0.001), but not with the J-YFAS 2.0-diagnosed FA severity. Like the YFAS 2.0 in other languages, the J-YFAS 2.0 has a one-factor structure and adequate convergent validity and reliability.

Objective To investigate differences in the association of parental history of diabetes with the risk of type 2 diabetes mellitus (T2DM) in the offspring according to the sex of the parent and the offspring's body weight. Methods A prospective cohort study of 4446 middle-aged non-diabetic Japanese men and women were followed in Aichi Prefecture, central Japan, from 2002 to 2011. Subjects were categorized by their self-reported parental history of diabetes (“no parental history,” “father only,” “mother only,” and “both”). The association of parental history of diabetes and incidence in the offspring was examined according to overweight status adjusted for age, sex, birth weight, smoking, alcohol consumption, physical activity, total energy intake, body mass index, and number of metabolic syndrome components. Results During follow-up (median 8.9 years), 277 subjects developed T2DM. Parental history of diabetes was positively associated with T2DM incidence. However, stratified analysis by overweight status revealed that only maternal history was associated with increased T2DM incidence in non-overweight subjects (hazard ratio = 2.35, 95% confidence interval: 1.41–3.91). While in overweight subjects, paternal history was significantly associated with higher T2DM incidence (hazard ratio = 1.98, 95% confidence interval: 1.19–3.28). Conclusions Our results suggest that parental history of diabetes mellitus is associated with the incidence of T2DM in offspring differently according to the sex of the affected parent and the offspring's body weight.

Background and aims Coronary heart disease (CHD) and stroke have common risk factors, but some of these differ in the magnitude or direction of associations between CHD and stroke. We assessed whether the impact of each risk factor differed between CHD and stroke mortality in Asians. Methods In total, 104 910 subjects aged 40–79 years without histories of cancer, CHD and stroke at baseline were followed between 1988 and 2009. Competing-risks analysis was used to test for differences in the associations of each risk factor with two endpoints (CHD and stroke). Population attributable fractions (PAFs) were also calculated for these endpoints to estimate the population impact of each risk factor. Results During a median 19.1-year follow-up, 1554 died from CHD and 3163 from stroke. The association of hypertension with CHD was similar to that with stroke in terms of the magnitude and direction (multivariable-adjusted hazard ratio for CHD: 1.63 vs. stroke: 1.73 in men and 1.70 vs. 1.66 in women). Conversely, the magnitude of these associations differed for smoking (CHD: 1.95 vs. stroke: 1.23 in men and 2.45 vs. 1.35 in women) and diabetes (1.49 vs. 1.09 in men and 2.08 vs. 1.39 in women). The highest PAF for CHD was caused by smoking in men and by hypertension in women; that for stroke was caused by hypertension in both sexes. Conclusions Hypertension associations and PAFs were consistent between CHD and stroke, but not for other risk factors. These findings may be useful to optimize public health intervention strategies.

Objective To examine the prospective effects of psychosocial job characteristics evaluated with the Demand-Control-Support (DCS) and Effort–Reward Imbalance (ERI) models on insomnia. Methods A prospective cohort study with a two-year observation was performed. The subjects were 1022 middle-aged (⩾39 years) Japanese workers. The following associations were analyzed: high job strain, low social support, effort–reward imbalance, and overcommitment to work at the baseline with self-reported persistence and future onset of insomnia. Results Among those who were insomniacs at the baseline ( N =292), low social support [adjusted odds ratio (95% CI): 2.00 (1.18, 3.40)] and effort–reward imbalance [2.40 (1.13, 5.10)] at the baseline had a significant relationship to insomnia at the follow-up. Among those who were not insomniacs at the baseline ( N =730), overcommitment to work [1.75 (1.16, 2.66)] and high job strain [1.72 (1.06, 2.79)] at the baseline were associated with insomnia at follow-up. Conclusions Prospective effects of psychosocial job characteristics on insomnia differed between its persistence and future onset. Proportionate reward for work effort and sufficient support at work assist recovery from insomnia, while overcommitment to work and high job strain cause future onset of insomnia.

In this prospective cohort study for Japanese patients with established ischemic heart disease (IHD), the authors investigated the rate of success of smoking cessation 3 months after hospital discharge and its related factors. The subjects included 90 current smokers admitted for IHD. A total of 58 subjects (64%) had quit smoking for 3 months after being discharged. In comparison with subjects with acute myocardial infarction, those with stable angina (SA) showed a significantly lower frequency of smoking cessation (relative risk of resuming smoking (95% confidence interval):2.06 (1.09, 3.92), p=0.036). This relationship remained significant even after controlling for sex, age, and scores of the Fagerstrom Test for Nicotine Dependence (adjusted odds ratio:3.39 (1.01, 11.37), p=0.048). However, it became insignificant when hospital admission followed by emergency medical service (EMS) care was additionally adjusted (adjusted odds ratio:2.48 (0.36, 16.97), p=0.356). The smoking cessation rate in this study was identical to that observed in studies conducted in Japan prior to the recent social changes with regard to tobacco use. SA still appears to be a risk factor for smoking resumption after discharge. Experiencing EMS care would be an intermediate variable in this relationship.

BACKGROUND: Evidence is still insufficient regarding the effects of Power Rehabilitation (PR) on physical performance and higher-level functional capacity of community-dwelling frail elderly people.METHODS: This nonrandomized controlled interventional trial consisted of 46 community-dwelling elderly individuals with light levels of long-term care needs. They were allocated to the intervention (I-group, n = 24) and control (C-group, n = 22) groups. Of them, 32 persons (17 in the I-group; 15 in the C-group) (median age, 77 years; sex, 28% male) completed the study. The I-group subjects underwent PR twice a week for 12 weeks. The outcomes were physical performance (muscle strength, balance, flexibility, and mobility) and higher-level functional capacity as evaluated by the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) and the level of long-term care need as certified by the public long-term care insurance.RESULTS: The I-group demonstrated a significant improvement in the measured value of the timed up-and-go test (median change, a decrease of 4.4 seconds versus a decrease of 0.2 seconds, p = 0.033) and the timed 10-meter walk (a decrease of 3.0 seconds versus an increase of 0.2 seconds, p = 0.007) in comparison with the C-group. No significant change was observed in the TMIG-IC scores or in the level of long-term care need in the I-group.CONCLUSION: PR improved mobility of community-dwelling frail elderly people; however, such improvement did not translate into higher-level functional capacity. Our findings demonstrate the difficulty in transferring the positive effects associated with PR into an improvement in higher-level functional capacity.J Epidemiol 2007; 17: 61- 67.

Evidence is limited concerning the influences of high psychological job strain and low social support at work on daytime secretion of dehydroepiandrosterone (DHEA), which demonstrates anti-cortisol effects. We carried out a cross-sectional study to examine the associations of job strain and social support with daytime secretion amounts of DHEA and cortisol and daytime variation of the cortisol-to-DHEA ratio (C/D ratio) in healthy female workers. Study subjects comprised 115 healthy female nursery school teachers. Area under the curve with respect to ground (AUCG) of salivary DHEA, cortisol and C/D ratio was calculated for estimation of daytime secretion and variation. Social support scores were negatively associated with daytime DHEA secretion (standardized partial regression coefficient = −0.343, P

Excess intake of iodine is a suspected risk factor for thyroid cancer. Previous epidemiological research from Japan reported that daily intake of seaweed was associated with a four-fold higher risk in postmenopausal women, whereas others reported a null association. A major source of iodine intake in Japan is from edible seaweeds, and it is reported to be among the highest in the world. We examined the association between seaweed intake frequency and the risk of thyroid cancer in women in the Japan Collaborative Cohort Study followed from 1988 to 2009. Seaweed intake, together with other lifestyle-related information was collected using a self-administered questionnaire at baseline. Seaweed intake frequency was categorized as follows: 1-2 times/week or less, 3-4 times/week, and almost daily. Hazard ratios and the 95% confidence intervals of thyroid cancer incidence according to seaweed intake frequency were estimated using Cox proportional hazards regression. During 447 876 person-years of follow-up (n=35 687), 94 new cases of thyroid cancer were identified. The crude incidence rate was 20.9 per 100 000 person-years. The hazard ratio of thyroid cancer in women who consumed seaweed daily compared with women who ate it 1-2 times/week or less was 1.15 (95% confidence interval: 0.69-1.90, P for trend=0.59). Further analyses did not indicate any association between seaweed intake and the risk of thyroid cancer on statistically adjusting for potential confounding variables as well as on stratification by menopausal status. The present study did not find an association between seaweed intake and thyroid cancer incidence in premenopausal or in postmenopausal women.

The degree of nicotine dependence is an important predictor of successful cessation of smoking among smokers. Some investigators reported a possible relationship between reducing job stress and successful smoking cessation . This may be attributable to the effect of job stress on nicotine dependence. That is, high levels of job stress could produce and/or maintain high levels of nicotine dependence among smokers, and could result in difficulty in smoking cessation. If this hypothesis were true, workplace smoking cessation programs should take account of the influence of job stress on nicotine dependence, and measures to curb nicotine dependence resulting from coping with job stress should be introduced into the programs. There are, however, few reports that deal with the influence of job stress on the nicotine dependence of smokers in the workplace. Tobacco dependence is a multi-dimensional addiction that includes psychological and behavioral aspects of dependence on smoking or nicotine as well as physiological dependence 7, . It is important to measure various aspects of nicotine dependence separately. Two short and easyto-apply self-reporting questionnaires are frequently used to screen for nicotine dependence. They are the Fagerstrom Test of Nicotine Dependence (FTND) 2) and the Tobacco Dependence Screener (TDS). They evaluate different aspects of nicotine dependence. The FTND assesses the physiological aspects of nicotine dependence and is positively associated with the number of cigarettes smoked per day and the plasma level of nicotine and cotinine 2, . On the other hand, the TDS is closely correlated with the psychological aspects of nicotine dependence; a TDS score of 6 or greater indicates nicotine dependence diagnosed according to the International Classification of Diseases, 10 revision (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders, third edition revised (DSM-III-R), with sensitivity values of 95% and 79%, and specificity values of 81% and 66%, respectively. In addition, previous studies reported a poor concordance between the FTND score and the DSM-III-R diagnosis; Moolchan et al. showed that the highest kappa (at a cutoff of the FTND=7 or greater) was .205. The objective of this cross-sectional study was to examine the relationship between perceived job stress and nicotine dependence assessed with two self-reporting questionnaires (i.e., the FTND and TDS) completed by workers who smoked tobacco. Nurses were chosen as subjects in this study. They are health professionals with a reportedly high prevalence of smoking ; in addition, they are expected to act as role models for patients with a desire to quit smoking. Elkind has reported that certain peculiar characteristics associated with the hospital environment and the nursing process may contribute to the smoking habits of nurses. Nurses deserve special attention in developing a smoking cessation program which considers the influence of job stress on the smoking habit.

Although the global prevalence of both the overweight and obese is on the rise, there are variations among regions or countries, and sexes. Approximately half or more than half of the population are overweight/obese defined as body mass index ≥25 kg/m2in the Americas (61.1%), Europe (54.8%), and Eastern Mediterranean (46.0%) according to the World Health Organization, while a much lower prevalence is observed in Africa (26.9%), South-East Asia (13.7%), and the Western Pacific (25.4%). Females are more likely to be overweight/obese in the Eastern Mediterranean, Africa, South-East Asia and the majority of countries in the Americas and Western Pacific but not in the most of the countries in Europe. These region-sex-ethnicity differences in prevalence may be a clue to the causes of the obesity epidemic. Epidemiological studies done in the USA, Europe, and Asia found that higher BMI was significantly associated with increased incidence of coronary artery disease (CAD) and ischemic stroke, but the association with hemorrhagic stroke incidence was not always consistent. The association of BMI with CAD and ischemic stroke was generally independent of known mediators, which would indicate the importance of controlling or preventing overweight/obesity for the prevention of cardiovascular disease. (Circ J 2014; 78: 2807–2818)

We examined the influence of work-related effort-reward imbalance and overcommitment to work (OC), as derived from Siegrist's Effort-Reward Imbalance (ERI) model, on the hypothalamic-pituitary-adrenocortical (HPA) axis. We hypothesized that, among healthy workers, both cortisol and dehydroepiandrosterone (DHEA) secretion would be increased by effort-reward imbalance and OC and, as a result, cortisol-to-DHEA ratio (C/D ratio) would not differ by effort-reward imbalance or OC. The subjects were 115 healthy female nursery school teachers. Salivary cortisol, DHEA, and C/D ratio were used as indexes of HPA activity. Mixed-model analyses of variance revealed that neither the interaction between the ERI model indicators (i.e., effort, reward, effort-to-reward ratio, and OC) and the series of measurement times (9:00, 12:00, and 15:00) nor the main effect of the ERI model indicators was significant for daytime salivary cortisol, DHEA, or C/D ratio. Multiple linear regression analyses indicated that none of the ERI model indicators was significantly associated with area under the curve of daytime salivary cortisol, DHEA, or C/D ratio. We found that effort, reward, effort-reward imbalance, and OC had little influence on daytime variation patterns, levels, or amounts of salivary HPA-axis-related hormones. Thus, our hypotheses were not supported.

The objective was to clarify factors, including Internet-accessed advice for smoking cessation, associated with smoking cessation among participants of the Quit Smoking Marathon (QSM), a one-month smoking cessation program involving use of e-mails and a mailinglist.The subjects were 88 volunteers who aimed to quit smoking and completed the QSM program. Those who remained abstinent from smoking at 1 year thereafter were defined as successful quitters. Factors associated with successful smoking cessation were examined by multiple logistic regression analysis adjusted for confounders and separately for use of nicotine replacement therapy (NRT).Successful smoking cessation was reported by 49 subjects (55.7%). For the NRT-free group, sending 10 or more e-mails to the mailing-list was significantly associated with successful smoking cessation [odds ratio: 10.7, P=0.015].Frequent e-mailing to the mailing-list followed by obtaining personal advice is an effective way to quit smoking among QSM participants not using NRT.

Background and purpose The details of risky psychosocial job characteristics related to insomnia are unclear, although potential relationships between the two have been suggested. The study objective was to clarify these relationships by using the demand-control-support (DCS) model and the effort-reward imbalance (ERI) model. Patients and methods A cross-sectional questionnaire survey was conducted with 1081 middle-aged (39 years and older) workers in a corporate group of electric products in Osaka, Japan. The study variables included insomnia symptoms (non-refreshing sleep, difficulty falling asleep, frequent sleep disruption, and early morning arousal) and psychosocial job characteristics which were evaluated using the DCS and ERI models, gender, age, disease, sleep-related factors, occupational status, and health practices. Results ERI [odds ratio (95% confidence interval): 2.27 (1.43, 3.60)], overcommitment [1.86 (1.40, 2.47)], and high job strain [1.55 (1.12, 2.15)] were independently associated with insomnia. The odds ratio of insomnia for individuals with high job strain was increased by adding ERI or overcommitment. Conclusions The ERI and DCS models describe the adverse psychosocial job characteristics related to insomnia. Simultaneously employing these two models is more useful than employing a single model to identify workers at risk of insomnia. The conceptual framework derived from the job stress models assists in defining preventive measures for insomnia in workers.