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Background: Poverty negatively impacts beneficial aspects of mental development, such as resilience. Toothbrushing, an oral health behavior, has the potential to protect children's resilience through its anti-inflammatory and self-management effects and may be more effective for children, especially children in poverty. This study investigated whether toothbrushing boosts resilience among children, especially children under poverty, and modifies the association between poverty and resilience using a longitudinal population sample of school children. Methods: Data from the Adachi Child Health Impact of Living Difficulty (A-CHILD Study) were analyzed. A baseline study was conducted in 2015 in which the children were in first grade and followed through fourth grade (N = 3459, response rate: 80%, follow-up rate: 82%). Poverty was assessed by material deprivation (life-related deprivation and child-related deprivation) and annual household income at baseline. Children's toothbrushing frequency was assessed at baseline and classified into less than twice a day or twice or more a day. Children's resilience was assessed at baseline and follow-up using the Children's Resilient Coping Scale (range 0-100). Results: Children who brushed their teeth twice or more a day in first grade had 3.50 points greater resilience scores in fourth grade than those who brushed their teeth less than twice a day in first grade. After adjusting for confounders, including resilience in first grade, among underpoverty children, those who brushed their teeth twice or more a day in first grade had higher resilience scores [2.66 (95% CI = 0.53, 4.79)] than those who brushed their teeth less than twice a day. Among nonpoverished children, toothbrushing frequency in first grade did not significantly correlate with resilience in fourth grade. Conclusions: The beneficial effect of toothbrushing twice or more a day on resilience was more significant among children in poverty than among those without poverty in elementary school in Japan. Health policy focused on frequent toothbrushing may contribute to boosting resilience among children living in poverty. [ABSTRACT FROM AUTHOR]

International standardization of medical education requires Japanese medical schools to restructure their curricula to include "behavioral science." Two influential documents for Japanese medical education, the "Model Core Curriculum for Medical Education in Japan" and the "Scope of the Japanese National Examination for Medical Doctors" include some key terms regarding behavioral science. However, they are not systematic and the phrase "behavioral science" itself could not be found in these documents. The new global standards for medical education, the "Basic Medical Education WFME Global Standards," require medical schools to include behavioral science in their curricula. The definition of "behavioral science" in the global standards emphasizes social aspects and determinants of health, which is also a key concept of public health. From the view point of public health, it is hoped that the systematic introduction of behavioral science into Japanese medical education will strengthen the public health mindset of medical doctors, which in turn will support the healthcare system in communities. [ABSTRACT FROM AUTHOR]

This article discusses the core curriculum for behavioral science, from the perspective of psychology, recommended by the Japanese Society of Behavioral Medicine and seeks to explain how the curriculum can be effectively implemented in medical and health-related departments. First, the content of the core curriculum is reviewed from the perspective of psychology. We show that the curriculum features both basic and applied components and that the basic components are closely related to various aspects of psychology. Next, we emphasize two points to aid the effective delivery of the curriculum: 1) It is necessary to explain the purpose and significance of basic components of behavioral science to improve student motivation; and 2) it is important to encourage student self-efficacy to facilitate application of the acquired knowledge and skills in clinical practice. [ABSTRACT FROM AUTHOR]

In Japan, the "Food Education Basic Law" (The Basic Law on Shokuiku, food education) was enacted in 2005. The comprehensive food education programs, namely Shokuiku, aim to improve dietary practices to reduce lifestyle-related diseases. Dental caries is one of the diseases associated with inappropriate dietary habits. Thus, food education may influence the prevalence of dental caries. However, there are no data regarding the association between public based-food education and dental caries. The aim of the present study was to investigate the relationship between knowledge about comprehensive food education (Shokuiku) and dental caries experience in Japanese university students. A total of 2,184 students (1,240 men, 944 women), aged 18-20 years, were examined. They had attended the Shokuiku program while in junior/senior high school. The numbers of teeth present, and decayed, missing and filled teeth (DMFT) (dental caries experience) were recorded. Additional information was collected via a questionnaire regarding knowledge about food education, dietary habits and oral health behavior. Of the students, 315 men (20.7%) and 345 women (52.8%) reported that they know and can explain the meaning and content of the word "Shokuiku". After adjusting for potential confounding factors, subjects who did not have knowledge about Shokuiku had higher adjusted odds ratio (OR) for dental caries experience (DMFT >0) than those who had (adjusted OR, 1.23; 95% CI, 1.02-1.48; p<0.05). These observations revealed that having knowledge about comprehensive food education in university students correlates with low prevalence of dental caries. [ABSTRACT FROM AUTHOR]

Studies to date have shown that individual invitation (call) and re-invitation (recall) are effective in improving cancer screening rate. Also, by dividing subjects into segments and sending unique messages to each segment, the cancer screening rate is further improved. However, this approach is not realistic in the local governments due to limited resources, so we used social marketing and nudge techniques to develop cancer screening recommendation materials that do not need to send separately. This study therefore aimed to verify the effect of these materials in the real world. We compared the cancer screening rates in municipalities within Japan that used the invitation materials we developed (colorectal, breast, lung, cervical and stomach cancer), with those from the previous year. In addition, the usefulness of the materials in the real world was examined multilaterally using RE-AIM framework (Reach, Effectiveness, Adaption, Implementation, Maintenance). From 2015 to 2018, 4.3 million residents (Reach) from 787 municipalities (Adaption) were sent invitation materials for cancer screening. Of 167 municipalities that were compared, 141 (83%) showed an increase in screening rate when our materials were used. Overall, the screening rate improved by 2.6% or 1.44 fold (p < 0.001) (Effectiveness). However, the screening rate varied greatly depending on how screening is provided. Of the four years studied, 75 municipalities used the same materials for two or more years (Implementation). The material developed in this study improved the cancer screening rate in the real world, and it may be possible to further improve the screening rate if the number of opportunities for screening and its capacity is increased at the timing of sending materials. The materials can be found on the website (http://rokproject.jp/kenshin/) and free electronic files are available to municipalities wishing to use them. • Cancer Screening rates can be increased by social marketing approach. • Behavioral economics approach such as nudge is also effective. • Usefulness in a real world should be evaluated multifacetedly. • Materials may be more useful if they are less effective but easier to use. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites., Methods: 1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of "Easy" and "Attractive," while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models., Results: The screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45-2.12) and that of group B was 4.08 (95% CI 3.44-4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder., Conclusions: While fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.

Despite their prevalence and burdens, oral diseases are neglected in universal health coverage. In Japan, a 30% copayment (out of pocket) by the user and a 70% contribution by Japan's universal health insurance (JUHI) are required for dental and medical services. From the age of 70 y, an additional 10% is offered by JUHI (copayment, 20%; JUHI, 80%). This study aimed to investigate the effect of cost on dental service use among older adults under the current JUHI system. A regression discontinuity quasi-experimental method was used to investigate the causal effect of the JUHI discount policy on dental visits based on cross-sectional data. Data were derived from the 2016 Japan Gerontological Evaluation Study. This analysis contained 7,161 participants who used JUHI, were aged 68 to 73 y, and responded to questions regarding past dental visits. Analyses were controlled for age, sex, number of teeth, and equalized household income. Mean ± SD age was 72.1 ± 0.79 y for the discount-eligible group and 68.9 ± 0.78 y for the noneligible group. During the past 12 mo, significantly more discount-eligible participants had visited dental services than noneligible participants (66.0% vs. 62.1% for treatment visits, 57.7% vs. 53.1% for checkups). After controlling for covariates, the effect of discount eligibility was significant on dental treatment visits (odds ratio [OR], 1.36; 95% CI, 1.32 to 1.40) and dental checkups (OR, 1.49; 95% CI, 1.44 to 1.54) in the regression discontinuity analysis. Similar findings were observed in triangular kernel-weighted models (OR, 1.38 [95% CI, 1.34 to 1.44]; OR, 1.52 [95% CI, 1.47 to 1.56], respectively). JUHI copayment discount policy increases oral health service utilization among older Japanese. The price elasticity for dental checkup visits appears to be higher than for dental treatment visits. Hence, reforming the universal health coverage system to improve the affordability of relatively inexpensive preventive care could increase dental service utilization in Japan.

The aim of this study was to examine the association between toothbrushing frequency and school refusal among elementary school children. We used data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) longitudinal study conducted between 2015 and 2016 in Adachi City, Tokyo, Japan. A questionnaire was distributed to all first-grade children aged 6 to 7 years (N = 3697, follow-up rate: 86.2%). Propensity score (PS) matching was applied to collapse the known covariates on toothbrushing frequency in grade 1 on the association with school refusal in grade 2. Among the followed children, 2.4% showed school refusal in grade 2 (89 children) and 23.5% (870 children) brushed their teeth once or less than once daily in grade 1. After propensity score matching, children with toothbrushing once or less than once daily in grade 1 were 2.25 (95% CI: 1.25-4.05) times more likely to show school refusal in grade 2, compared with those with toothbrushing twice or more a day. Our findings suggest that toothbrushing once or less than once daily is an independent risk factor for school refusal among children. Oral health promotion to recommend toothbrushing more than once a day could prevent school refusal. Further intervention studies investigating the mechanism and causality are warranted.

The term behavioral science was coined in 1946 by a research group at the University of Chicago led by Miller. It is defined as "science that systematically reveals the rules of human behavior". To elucidate human behavior, they proposed combining biological science and social science. In Japan, achievements in behavioral science research have accumulated and have been applied in health education and health policy. In this paper, we describe the current status and future approaches in social medicine through an overview of behavioral science research in Japan with regard to the following five points: 1) representative theories and techniques in health behavior, 2) differences in health awareness, 3) a new approach of behavioral science based on the dual process theory, behavioral economics, and zero-order prevention, 4) diversity in behavioral changes and 5) experimental research in behavioral science.