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Background: Little is known about pathological Internet use (PIU) and online risky behaviors among elementary school children. We aimed to investigate the prevalence and factors associated with PIU and online risky behaviors. Methods: A school-based cross-sectional study was conducted in Toyama, Japan in 2018. The study included 13,413 children in the 4th–6th grades (mean, 10.5 years old) from 110 elementary schools (61.1% of elementary schools in Toyama). We assessed PIU using Young’s Diagnostic Questionnaire (YDQ) and risky behaviors. Poisson regression analysis was conducted. Results: Totally, 13,092 children returned questionnaires (response rate 97.6%). The prevalence of PIU was 4.2% and that of each risky behavior was as follows: 21.6% for spending money online, 6.6% for uploading personal movies, 5.2% for interpersonal issues, and 2.4% for having met strangers. PIU was significantly associated with boys (prevalence ratio [PR] 1.26; 95% confidence interval [CI], 1.04–1.52), skipping breakfast (PR 1.43; 95% CI, 1.14–1.79), Internet time (for 2∼3 h, PR 3.49; 95% CI, 2.63–4.65; for 3∼4 h, PR 4.45; 95% CI, 3.27–6.06; and for ≥4 h, PR 8.25; 95% CI, 6.45–10.55), physical inactivity (PR 2.63; 95% CI, 2.00–3.47), late bedtime (PR 1.86; 95% CI, 1.45–2.39 for ≥11 p.m.), no rules at home (PR 1.22; 95% CI, 1.01–1.46), no child-parent interaction (PR 1.37; 95% CI, 1.06–1.77), and no close friends in real life (PR 1.69; 95% CI, 1.30–2.19). Conclusions: PIU and risky behaviors were not rare among the elementary school children. Besides unhealthy lifestyles, social and family environments were associated with PIU. Having child-parent interaction and helping children develop close friendships in real life are effective deterrents to PIU.

Work is a major social determinant of health. We conducted a cross-sectional study to explore the association between coronary heart disease (CHD), its risk factors, and the working environment among Japanese male workers. We collected data from 10,572 workers (mean age 49.9) who underwent annual medical check-ups in Toyama, Japan, in 2016. This study included data from health check-ups and questionnaires on medical history of CHD, hypertension, and diabetes, and the use of medication. The working environment included company size and industry categories. Company size was classified into 4 categories according to the number of full-time workers (1-20, 21-100, 101-300, 301-). The industry category was classified into 10 categories. Logistic regression analysis was performed to explore the association. In total, 1.5% of patients had a history of CHD and 31.5% and 11.0% of participants were suffering from hypertension and diabetes, respectively. Compared to workers in a large company, those in a smaller company were more likely to have CHD. Moreover, there was a significant association between CHD's risk factors and working in the transportation industry. Health providers, including medical doctors, should consider employee working environment as a potential risk factor for CHD.

Background Walkable neighbourhoods promote physical activity and prevent obesity, but there is limited evidence to inform urban planning strategies for public health within the context of rural Japan. This study describes associations between neighbourhood walkability and obesity in Toyama, a regional municipality in Japan. Methods A cross-sectional analysis of the Toyama Prefecture National Health Insurance data (n = 3454) in 2016 using Analysis of Covariance (ANCOVA) and binary logistic regression. Walk Score® was used to estimate neighbourhood walkability. Results Residents from highly walkable neighbourhoods generally had lower mean body mass index (BMI), but significant associations between neighbourhood walkability and BMI and prevalence of obesity were only observed in women (adjusted OR: 0.46, 95% CI: 0.26–0.80). Men below 65 years old had higher obesity prevalence (adjusted OR: 1.76, 95% CI: 1.34–2.30). Daily alcohol consumption was associated with lower odds of being obese among men (adjusted OR: 0.72, 95% CI: 0.55–0.95). Hypertension, diabetes mellitus and dyslipidaemia were associated with higher obesity prevalence among residents, regardless of gender. Conclusions Walkable environment may improve health outcomes for rural communities in Japan. Further studies are required to create equitable and inclusive living spaces for men and women to access healthier lifestyle choices.

Sickness absence is increasingly affecting society at different levels. This study explores how work, family, and personal health-related characteristics will contribute to socioeconomic status (SES) differences in future long sickness absence (7 days or more) with respect to sex differences.A total of 1562 civil servants worked for the Local Japanese government and were considered from 2003 to 2014 for this study. Logistic regression analyses were performed to examine whether there were employment-grade differences in long sickness absence after 11 years and whether such SES differences were associated with work, family, and personal health-related characteristics or sexes.Male low-grade employees had a significantly higher odds ratio (OR) for long sickness absence (age-adjusted OR = 1.75, 95% confidence interval (CI) [1.04-2.95]). However, after adjustment for work characteristics, the association of significance disappeared (OR = 1.65, [0.96-2.84]). Female low-grade employees had a significantly lower OR for long sickness absence after 11 years (OR = 0.26, [0.08-0.86]). Male employees working long hours and male and female employees in high job demand take less sickness absence. Meanwhile, male employees working short hours take longer sickness absence.This study showed that male employees at low grades take longer sickness absence than those at high grades; however, this was alleviated by work characteristics. Female employees at low grades take less sickness absence than those at high grades. Japanese female employees with low grades, male employees with long working hours, and both sexes with high job demands take less sickness absence, although they may be unhealthy because of work stress.

Objective Social activities play an important role in the maintenance of health and well-being of the older adults. The aim of this study was to identify characteristics of the rural older adults who do not participate by type of social activities.Methods This survey examined 1,537 older adults randomly selected at a sampling rate of 0.5% from among those living in Toyama prefecture of Japan, in 2014. Of the total, 947 ambulatory older adults living in their own homes were analyzed using Poisson regression. Results were presented as prevalence ratio (PR). The level of statistical significance was set at P0.05 (two-sided test).Results The participants included 426 men (mean age 73.9 ± 6.5 years) and 521 women (mean age 74.8 ± 7.0 years). In terms of work, both men and women did not work at an older age (men PR 1.15 over 75 years old, women PR 1.11 over 70 years old). Men did not work during outpatient treatment (PR 1.09) and the Revised Hasegawa Dementia Scale (HDS-R) 21-25 points (PR 1.09) and 20 points or below. Women who did not drink alcohol did not work (PR 0.93). Both men and women did not participate in residential activities at older ages (men PR 1.12 over 70 years old, women PR 1.11 over 80 years old). Men with 20 points or below on HDS-R (PR 1.16) and with work history of only physical labor (PR 1.12), and women living with family (PR 0.92) were less likely to participate in residential activities. In the hobby group, both men and women with work history of only physical labor were less likely to participate (men PR 1.05, women PR 1.08). Men with education of 9 years or below (PR 1.05) and women living alone (PR 1.07) were less likely to participate. Hobby groups did not relate with age and cognitive decline. In the senior citizens' club, men and women who did not drink alcohol were less likely to participate (men PR 0.91, women PR 0.89). Men who smoked (PR 1.06), men with psychological symptoms (PR 1.09), and women with 20 points or below on HDS-R (PR 1.13) were less likely to participate.Conclusion Factors related to non-participation of older adults in rural cities depended on the type of social activities. In order to promote social activity among the older adults in rural cities, it is important to consider specific measures taking into account the type of social activities.

Background Although parents seek the best for their children, nutrition education for parents has attracted little attention to improve their children's dietary habits. To address this gap, this study aimed to examine the relationship between parental lifestyle factors and children's dietary habits. Methods We used data from the questionnaire survey of the Super Shokuiku School Project conducted in January 2016. The participants consisted of 1,632 elementary school children who answered questions about their lifestyle, while their parents answered parental lifestyle questions, including Breslow's seven health practice score (BHPS). Logistic regression analysis was performed to evaluate the strength of the relationship between parental lifestyle factors and parental dietary attitudes or children's dietary habits. Results Compared with good maternal BHPS (scores of 6-7), poor maternal BHPS (scores of 0-3) was significantly associated with less parental interest in Shokuiku, less parental consideration of nutrient balance, and an increased rate of children eating breakfast alone (adjusted odds ratio [aOR] 2.95; 95% confidence interval [CI], 1.82-4.78, aOR 3.86; 95% CI, 2.50-5.96, and aOR 2.42; 95% CI, 1.34-4.35, respectively). There was no significant difference between parental BHPS and the following children's dietary habits: frequency of eating breakfast, vegetable intake, and snacking. These habits of children were associated with their personal lifestyle factors. Conclusion Two types of dietary habits among children were associated with lifestyle factors of both parents and children. Nutrition education might be especially important for parents to improve their dietary attitude and children's dietary habits. However, different nutrition education interventions would be needed to appropriately address each dietary habit.

Background Individual lifestyle factors are associated with dental caries in children. The aim of this study was to investigate comprehensively the association between dental caries in elementary school children and lifestyle factors of the children and their parents. Methods Children from five elementary schools in Takaoka city, Toyama Prefecture, Japan (1,699: 848 boys, 851 girls, age range 6-12 years) participated in a survey conducted in March 2016. Questions on socioeconomic status (SES) and lifestyle factors in the children and their parents were included. Children who received treatment for three or more dental caries were defined as having many caries. Logistic regression analysis was performed to evaluate whether these factors were associated with the number of caries. Results The percentage of children with many caries (≥3) was 38.4%. In univariate analysis, being in 5th or 6th grade, frequent snacking, short sleep duration, long hours of media use, paternal smoking, and parental skipping of breakfast were significantly associated with many caries. Lack of affluence was marginally significant. In multivariate analysis, the association of short hours of sleep and long hours of media use remained significant. The adjusted odds ratio (OR) for media use of 1-2 h and more than 2 h were 1.79 (95% confidence interval [CI]: 1.30-2.46) and 2.24 (95% CI: 1.61-3.11) respectively. The adjusted OR for less than 8 h of sleep was 1.49 (95% CI: 1.07-2.06). Conclusions Long duration of media use and short duration of sleep were associated with dental caries. Establishing a healthy lifestyle is necessary for preventing dental caries in children.

High level of work-family conflict (WFC) is an important risk factor for stress-related health outcomes. However, many studies are cross-sectional studies. In this study, we aimed to clarify how changes in WFC levels over a period 5 yr can affect workers’ mental and physical health, and to clarify whether there are gender differences of them. This study examined 1,808 civil servants (1,258 men and 550 women) aged 20–65 yr working in a local government in the west coast of Japan from 2003 to 2008. Logistic regression analyses were used to examine whether the change in WFC contributes to workers’ health problems and whether there are gender differences. This study revealed association sustained high WFC and deterioration of WFC conflict with poor mental health and poor job satisfaction for both men and women. In men high WFC conflict and deterioration was associated with poor mental health (OR=2.74). On the other hand, women had strong relationship between WFC changes and poor physical health (OR=2.64). WFC was an important factor as a social determinant of health of Japanese civil servants, and the change in WFC affects subsequent health problems with different trends in men and women.

Purpose Although pubertal timing is gradually becoming earlier in Japan, support as for physical and mental health among children experiencing earlier puberty than their peers is inadequate. To better understand health and life satisfaction in seventh grade students (age 12–13 years), examination of relationships between health outcomes and pubertal timing, socioeconomic status, and lifestyle factors is necessary. Methods Participants of the Toyama Birth Cohort Study (4,752 males and 4,740 females) answered questions regarding school year of onset of voice break for boys and menarche for girls, sleep quality, mental health difficulties, overall health, quality of life (QOL), and lifestyle. Relationship between health outcomes and pubertal timing was examined using binary logistic regression analysis. Results Earlier pubertal timing was associated with four health-related outcomes. For poor sleep quality, the adjusted odds ratio (OR) of fourth grade males and crude OR of fifth grade females were statistically significant. Regarding mental health difficulties, the crude OR of fifth grade males and adjusted OR of fourth, fifth, and sixth grade females were statistically significant. Associations between poor overall health and fourth grade males and fourth or fifth grade females were observed. For poor QOL, the adjusted OR of fourth grade males and females was statistically significant. Conclusions Relationships between earlier pubertal timing and poor sleep quality, mental health difficulties, poor physical health, and poor QOL were observed. To improve children's quality of life, support from teachers and school doctors and nurses is needed—especially for children with earlier pubertal timing.

This study aims to examine the relationships between sleep onset latency and multiple sleep-related factors of seventh and tenth graders during the transition from childhood to adolescence.Regarding sleep onset latency, we examined the short-term associations in Phase IV (2002) and long-term associations in Phase V (2005) of the Toyama Birth Cohort Study. In total, 4,673 boys and 4,694 girls in Phase IV and 2,969 boys and 3,108 girls in Phase V answered the questionnaire items regarding sleep, physical and mental health, lifestyle, socioeconomic status, and family and school factors. Considering sleep onset latency as the outcome and 13 sleep-related factors as independent variables, we calculated the odds ratio using binary logistic regression. The longitudinal study was conducted with 1,703 boys and 1,919 girls whose sleep onset latency was within 30 min in Phase IV.The following factors were found to be related to longer sleep onset latency in the short term: sleep duration, physical activity, game time, and self-esteem in boys and sleep duration, bedroom environment, game time, abdominal pain, long-standing illness, onset of puberty, mental health difficulties, and school avoidance feelings in girls. Regarding its long-term effects, having a single parent and self-esteem in boys and breakfast, game time, long-standing illness, obesity, onset of puberty, and school avoidance feelings in girls were associated with longer sleep onset latency.Education of adolescent health and sleep hygiene at home and school should include both short-term and long-term associations between sleep and a healthy lifestyle by gender.

Background Pathological gaming (PG) has emerged as one of the major public health concerns worldwide. We aimed to assess PG and its associated factors among elementary school children in Japan. Methods We conducted a school-based observational study in Toyama, Japan in 2018. Totally, 13,413 children in the 4th-6th grades (mean age, 10.5 years) participated in the study. We distributed questionnaires and inquired about their lifestyle, irritability, and school and family environments. Referring to criteria of gaming disorder in the International Statistical Classification of Disease (ICD-11), we asked about three core symptoms: impaired control over gaming, increasing priority given to gaming over other activities, and continuation of gaming despite the negative consequences. Children who had all three criteria in the questionnaire were defined as PG. Results The response rate was 97.6% and 11,826 children were included in our analyses (88.2%). The prevalence of PG was 5.6% (7.8% in boys, 3.2% in girls). Besides sex, PG was significantly associated with lifestyles including skipping breakfast (odds ratio, OR=1.33; 95% confidence interval, CI: 1.05-1.68), physical inactivity (OR=2.23; 95% CI: 1.63-3.05 for rare), late bed time (OR=2.52; 95% CI: 1.96-3.25 for ≥11 p.m), frequent irritability (OR=1.89; 95% CI: 1.47-2.43), frequent feeling of school avoidance (OR=1.92; 95% CI: 1.49-2.46), fewer close friends (OR=1.30; 95% CI: 1.08-1.56 for some), low academic performance (OR=1.53; 95% CI: 1.13-2.08), no child-parental interaction (OR=1.34; 95% CI: 1.02-1.75), and no rules at home (OR=1.21; 95% CI: 1.02-1.43). Conclusion Unhealthy lifestyles, irritability, and low functioning in school and family environments were associated with PG. Besides having a healthy lifestyle, parental involvement appears to be an essential countermeasure for PG in children.

Long sickness absence is more common among low socioeconomic status (SES) groups than high SES groups. This study aimed to evaluate whether work and family characteristics contribute to SES and sex differences in long sickness absence (7 days or more). The participants were 3080 civil servants working for a local Japanese government. In both sexes, low-grade employees were likely to take long sickness absence, with a statistically significant association for men (age-adjusted OR of lowest-grade employees for long sickness absence: 2.30 (95% Confidence Interval (CI): 1.32-4.02)). After adjusting for all variables, SES differences in long sickness absence in men decreased to OR 1.98 (CI 1.10-3.55) but remained significant; in men, being without a spouse was significantly associated with long sickness absence. Employees working long hours had lower OR for long sickness absence after adjusting for all variables in both sexes. Conversely, poor sleep quality and longstanding illness significantly increased OR for long sickness absence. In conclusion, SES differences in sickness absence were explained partly by work and family characteristics, longstanding illness, and poor sleep quality; however, other factors that were not evaluated in this study may also be associated with SES differences.

Objective To explore national and socioeconomic differences in overall job satisfaction, we examined whether those differences can be explained by what job-related factors. Methods Our datasets for this study are from the Whitehall II study and the Japan Civil Servant Study. Of the participants who were 5540 cases, with 3250 people from Great Britain and 2290 from Japan. Results The odds ratio for job dissatisfaction was more than double in Japan compared with Britain. However, after adjusting the related factors-especially the facets of job satisfaction variables-the difference was reversed. Also, regarding the occupational differences, lower occupational grades had lower risks of overall job dissatisfaction, after adjusting for related factors. Conclusions The national and socioeconomic differences in overall job satisfaction were strongly related to facets of job satisfaction rather than job stress factors.

Background Regional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors’ workload, wages, and popularity among medical students by city population sizes. Methods We targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents’ monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital’s information and each hospital’s website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance. Results The average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas. Conclusions Hospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians’ working conditions in Japan, and such disparities need to be corrected.

BACKGROUND This study aims to clarify the association between marital status and dementia in Japan, adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors. METHODS Data from the Japanese Toyama Dementia Survey were used. Individuals aged ≥65 years living in Toyama Prefecture were randomly selected, and 1171 participants were analysed, with a sampling rate of 0.5%. The participants' marital status, socioeconomic status, lifestyle factors, and lifestyle-related diseases were assessed. The odds ratio (OR) of marital status for each lifestyle factor and medical histories were calculated by logistic regression analysis. The OR of marital status for dementia was also calculated by logistic regression analysis. RESULTS The prevalence of dementia was 7.4% for married, and 20.6% for non-married participants. Non-married participants showed a higher prevalence of a history of stroke than married participants. The age- and sex-adjusted OR of marital status for dementia was 1.99 (95% confidence interval (CI) 1.24-3.18) for non-married compared with married participants. Following variable adjustments, the OR for dementia was higher for non-married participants (adjusted OR 1.71; 95% CI 1.03-2.85). CONCLUSIONS Non-marital status was an independent risk factor for dementia in Japan even after adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors. Non-married people were more likely to have dementia because of their history of stroke.

Background Childhood constipation is prevalent and negatively affects quality of life. Although psychological stress and family environment have been identified as risk factors, few epidemiological studies have examined this issue. We aimed to clarify associations of psychological stress and family environment with childhood constipation in a large-scale epidemiological study. Methods In total, 7,998 children aged 9-10 years from the Toyama Birth Cohort Study completed questionnaires. Constipation was defined as bowel movements "less frequently than once every 2 days". Children's lifestyles, including food frequency, psychological stress, family environment, frequency of irritability, unwillingness to attend school, and frequency of interaction with their parents, were analyzed via multivariate logistic regression analysis. Parental employment status and presence at dinner were also examined. Results In total, 312 children (3.9%) experienced constipation. Girls were more likely to experience constipation than boys (5.1% vs 2.8%). In addition, constipation was significantly associated with girl (odds ratio [OR] 1.97; 95% confidence interval [CI], 1.55-2.51), physical inactivity (OR 1.41; 95% CI, 1.01-1.95), overweight (OR 0.58; 95% CI, 0.40-0.85), infrequent fruit (OR 1.94; 95% CI, 1.42-2.66) and vegetable (OR 1.46; 95% CI, 1.03-2.05) consumption, frequent irritability (OR 1.76; 95% CI, 1.24-2.50), unwillingness to attend school (OR 1.66; 95% CI, 1.13-2.43), and infrequent interaction with parents (OR 1.48; 95% CI, 1.06-2.07). Children whose parents were absent at dinner were more likely to experience constipation compared to those whose parents were present at dinner; however, this differences were not statistically significant. Conclusion Psychological stress and infrequent interaction with parents were as strongly associated with childhood constipation as conventional risk factors. Psychological stress and family environment should be more prioritized in caring childhood constipation.

Background Molar incisor hypomineralization (MIH) frequently occurs in children worldwide. However, MIH prevalence throughout Japan has not yet been investigated. The purpose of this study was to clarify MIH prevalence rates and to consider potential regional differences throughout Japan. Methods A total of 4496 children aged 7–9 years throughout Japan were evaluated in this study. MIH prevalence rates among children were evaluated in eight regions throughout Japan. A child’s residence was defined as the mother’s residence during pregnancy. The localization of demarcated opacities and enamel breakdown was recorded on a standard code form using a guided record chart. Logistic regression analysis was used to evaluate whether MIH prevalence rates differed among age groups, sex, and regions. Results The overall prevalence of MIH in Japan was 19.8%. The prevalence of MIH was 14.0% in the Hokkaido region, 11.7% in the Tohoku region, 18.5% in the Kanto Shin-Etsu region, 19.3% in the Tokai Hokuriku region, 22.3% in the Kinki region, 19.8% in the Chugoku region, 28.1% in the Shikoku region, and 25.3% in the Kyushu region. These regional differences were statistically significant. Moreover, MIH prevalence rates decreased with age. No significant sex differences in MIH prevalence rates were demonstrated. Conclusions To our knowledge, this is the first MIH study carried out in several regions throughout Japan. Regional differences existed in MIH prevalence rates; particularly, MIH occurred more frequently in children residing in southwestern areas than those in northeastern areas of Japan.

Background Prolonged screen time (ST), which includes TV viewing and gaming on smartphones and computers, is linked to poor health. Our aim was to explore the associations between school children with prolonged ST and parental internet use (IU) and lifestyles in Japan. Methods Children aged 6 to 13 years from the Super Shokuiku School Project, were surveyed using questionnaires in 2016. The survey assessed the grade, sex, and lifestyle of 1,659 children and parental internet use (IU) and lifestyle using Breslow's seven health behaviors. IU consisted of internet surfing and gaming on personal computers (PC), smartphones, or consoles. Three or more hours of ST was defined as prolonged ST, and its correlates were analyzed using logistic regression. Results Of all, 643 (38.8%) children spent ≥2 hours/day of ST on a week day, whilst 153 (9.2%) children spent ≥3 hours/day. Prolonged ST was significantly associated with children in higher grade (odds ratio [OR] 1.74; 95% confidence interval [CI], 1.20-2.51), boys (OR 2.16; 95% CI, 1.49-3.14), skipping breakfast (OR 1.88; 95% CI, 1.05-3.35), late bedtime (OR 1.80; 95% CI, 1.15-2.82), physical inactivity (OR 1.79; 95% CI, 1.12-2.87), father's IU ≥2 hours/day (OR 2.35; 95% CI, 1.52-3.63), mother's prolonged IU ≥2 hours/day (OR 2.55; 95% CI, 1.43-4.52), mothers with unhealthy behaviors (OR 1.81; 95% CI, 1.05-3.13), no rule setting governing screen time (OR 2.41; 95% CI, 1.63-3.58), and mothers with full-time employment (OR 1.95; 95% CI, 1.06-3.64). Conclusions Prolonged ST among Japanese children was strongly associated with parental IU, no set rules for ST, and mother's unhealthy lifestyles. To reduce children's ST, parental engagement is warranted in the intervention strategy.

Background This study aimed to make future projections of the nationwide prevalence of dementia in Japan using the prevalence of dementia from the Toyama Dementia Survey and population projections. Methods We performed linear regression analysis using the prevalence of dementia by sex and age in 1985, 1990, 1996, 2001, and 2014 from the Toyama Dementia Survey to calculate the estimated future prevalence by sex and age. The estimated prevalence was then multiplied by the estimated future population of people aged 65 years and older by sex and age in each of the 47 prefectures from 2020 to 2045 and added together to calculate the total number of people with dementia. The estimated future prevalence of dementia was calculated by dividing the calculated number of people with dementia by the estimated future population of people aged 65 years and older in each of the 47 prefectures. In addition, the estimated future prevalence of dementia in each of the 47 prefectures from 2020 to 2045 was presented on a map of Japan and grayscale-coded in four levels. Results In 2020, the estimated future prevalence of dementia did not exceed 20% in any prefecture, but in 2025, five prefectures, mainly rural prefectures, had projected rates exceeding 20%. In 2030, the prevalence rate is projected to exceed 20% nationwide, and by 2035, the rate will exceed 25% in 42 prefectures. In 2045, all prefectures excluding Tokyo are projected to have a dementia prevalence rate exceeding 25%, and the rate will exceed 30% in 12 of 47 prefectures. Conclusions Over the next 25 years, the prevalence of dementia in people older than 65 years is projected to exceed 25% nationwide, including metropolitan areas.

This study explored the associations of lifestyle, familial, and social factors with sleep habits in 1882 elementary school children, aged 6–13 years, from the Super Shokuiku School Project in January 2016. A survey assessed sex, grade, sleep habits, lifestyle, social background, and parental lifestyle. Bedtime “≥22:00,” wake-up time “≥07:00,” sleep duration “

Background Mental health problems among workers have become an issue in Japan. The working environment for civil servants is becoming excessively stressful, and there is a need to prevent the onset of depression. In addition to stress at the workplace and at home, social capital has been reported as a factor associated with depression. This study examined whether workplace social capital reduces the association between depression and work-related stress or depression and home-related stress. Methods A total of 3015 Japanese civil servants (1867 men and 1148 women) from Toyama Prefecture were included in this study. Data on depression and workplace social capital, work status, work stress, work–life balance, and physical health were collected. Results The odds ratio for depression was higher for both men and women with low workplace social capital. For those with low workplace social capital, the adjusted odds ratio for depression was 2.93 (95% confidence interval [CI], 2.16–3.98) for men and 2.46 (95% CI, 1.74–3.49) for women. After adjusting for workplace social capital, the associations between depression and low job position, low job support, and moderate family–to–work conflict declined in men and were no longer significant. For women, the strength of the association between depression and unmarried status along with moderate control at work decreased and also lost significance. When the ORs for depression were stratified by high and low workplace social capital and compared with the ORs before stratification, the ORs for depression of long working hours and work–to–family conflict increased for both men and women in the low workplace social capital group. Conclusions Workplace social capital mitigated the effect of workplace and family stress leading to depression in both men and women.

Additional file 1. Questionnaire in Toyama Birth Cohort Study (Phase 3).

BackgroundDespite the fact that there are parents who do not take children with untreated dental caries to a dental clinic, few studies have been conducted to identify the responsible underlying social and family factors. The aim of this study was to investigate whether socioeconomic status and lifestyle factors are associated with dental neglect in elementary school children.MethodsThis study was conducted in 2016 with 1655 children from the Super Shokuiku School Project in Toyama. Using Breslow’s seven health behaviors, the survey assessed: the grade, sex, and lifestyle of the children; parental internet and game use and lifestyle; socioeconomic status. The odds ratios (OR) and 95% confidence intervals (CIs) for having untreated dental caries were calculated using logistic regression analysis.ResultsAmong the children participating, 152 (3.2%) had untreated dental caries. Among them, 53 (34.9%) had not been taken to a dental clinic despite the school dentist’s advice. Dental neglect was significantly associated with children in higher grades (OR, 2.08; 95% CI, 1.14–3.78), father’s Internet and game use ≥ 2 h/day (OR, 1.99; 95% CI, 1.02–3.88), not being affluent (OR, 2.78; 95% CI, 1.14–6.81), and non-engagement in afterschool activities (OR, 1.99; 95% CI, 1.10–3.62).ConclusionsSocioeconomic status was the strongest factor associated with dental neglect despite the fact that the children’s medical expenses are paid in full by the National Health Insurance in Toyama, Japan. Future studies should investigate what factors prevent parents of non-affluent families from taking their children to dental clinics and how they can be socially supported to access adequate medical care.

The Japanese demographic changed rapidly after 1945. There was rapid ageing, a sharp decline in three-generation households, and a rise in solo households. Still, the Japanese family-based collective culture continues to shape individuals’ overall beliefs and attitudes within society. The demographic shift has become a significant constraint on the Japanese social care system, manifesting as ro-ro kaigo (the old caring for the older), kaigo-rishoku (leaving employment to become a carer), and ‘8050’ (parents in their eighties caring for socially withdrawn children in their fifties). The national tendency towards social detachment makes such problems difficult to address. Today, Japan is finding a way to overcome these social challenges and establish an inclusive society by re-connecting people, including the mentally ill, within communities by tapping into the culturally inherited collective mentality of its people.

Background Many studies have already reported on the relationship between exercise habits and health among schoolchildren. However, few have examined social and/or family factors as determinants of exercise habits. Methods This study’s participants included 1721 schoolchildren aged between 6 and 13 who were involved in the Super Shokuiku School Project in January 2016. A survey was conducted to assess gender, grade level, physical activity, lifestyle, overall health, enrichment of school life, social background, and parental lifestyles. Both dislike and lack of physical activity were used to measure poor exercise habits; correlates were analyzed using logistic regression. Results “Lack of close friends” had the strongest links with both dislike (adjusted odds ratio [OR] 5.30; 95% confidence interval [CI], 2.78–10.1) and lack of (adjusted OR 5.40; 95% CI, 2.81–10.4) physical activity. Further, children who engaged in long periods of screen time and lacked parental communication also tended to dislike and lack physical activity. Children with mothers who were unemployed (housewives) and had unhealthy lifestyles, as well as those with poor health, were also more likely to lack physical activity. Conclusion Social and family factors (e.g., having close friends) may be determinants of exercise habits among schoolchildren, independent of their own lifestyle factors. Although a longitudinal study is needed to determine causality, substantial attention may thus be required to these factors when promoting physical activity in children.

Background We aimed to clarify the predisposing factors for adolescent constipation in a longitudinal study, because while factors associated with childhood constipation have been reported, prospective studies on the incidence of constipation are lacking. Methods We enrolled 5540 adolescents aged 12 to 13 years from the Toyama Birth Cohort Study—a community-based prospective study examining children’s health. The incidence of constipation, defined as bowel movement frequency of less than once every 2 days, was surveyed during the three-year period from baseline (grade 4) to follow-up (grade 7). Multivariate logistic regression analyses were performed to explore the association between the incidence of adolescent constipation and their lifestyle variables. Results A total of 261 adolescents (4.7%) developed constipation during the three-year period. Female sex (odds ratio [OR] = 2.62,) overweight (OR = 0.60), and infrequent intake of fruits (OR = 1.50) at baseline were associated with the incidence of constipation. Furthermore, factors related to lifestyle changes and psychological status such as skipping breakfast (OR = 1.73), becoming physically inactive (OR = 1.55), and being persistently irritated (OR = 1.80) were significantly associated with the incidence of constipation. Conclusion Our prospective study demonstrated that female sex, insufficient fruit intake, and deteriorating lifestyles such as skipping breakfast and becoming inactive during the 3-year period were associated with the incidence of adolescent constipation. Beyond anecdotal, maintaining a healthy lifestyle is recommended to reduce the incidence of adolescent constipation.

Background Age-related hearing loss reduces the quality of life in older adults. Low socioeconomic status (SES) has been reported as a risk factor for hearing loss, although this has not been verified in Japan. This study aimed to assess the association between low SES and hearing loss, excluding people with dementia, in Japan. Methods Data from the Toyama Dementia Survey, Japan, were used. Overall, 126 patients with hearing loss and 913 unimpaired controls were identified. Participants’ presentation of dementia, self-reported hearing loss, history of medically diagnosed disease (hypertension, hyperlipidemia, diabetes, stroke, or angina pectoris/cardiovascular disease), lifestyle factors (alcohol consumption and smoking), and SES (educational attainment and occupation) were assessed. Any association between low SES and hearing loss was investigated using logistic regression analysis. Results The odds ratio (OR) for hearing loss was higher for participants with low educational attainment than for those with high educational attainment (age- and sex-adjusted OR 3.08; 95% confidence intervals [CI], 1.51–6.28). After adjusting the models for SES, lifestyle factors, and medical history, the OR increased from 2.90 (95% CI, 1.40–6.01) to 3.43 (95% CI, 1.62–7.27). The OR for hearing loss for participants with blue-collar jobs compared with that of participants with white-collar jobs was not significant (age- and sex-adjusted OR, 1.45; 95% CI, 0.93–2.25). Older age and a history of angina pectoris or cardiovascular disease were found to increase the risk of hearing loss. Conclusions Low educational attainment was independently associated with hearing loss in older adults without dementia in Japan.

Background Many studies have already reported on the relationship between exercise habits and health among schoolchildren. However, few have examined social and/or family factors as determinants of exercise habits. This study investigated factors related to both dislike and lack of physical activity among schoolchildren. Methods This study’s participants included 1,984 school children (1,001 boys and 983 girls) aged between 6 and 13 from the Super Shokuiku School Project in January 2016. A survey was conducted to assess sex, grade level, physical activity, lifestyle, overall health, enrichment of school life, social background, and parental lifestyles. Both the dislike and lack of physical activity were defined as poor exercise habits; correlates were analyzed using a logistic regression. Results “Lack of close friends” had the strongest links with both dislike (adjusted odds ratio [OR] 5.30; 95% confidence interval [CI], 2.78-10.1) and lack of (adjusted OR 5.40; 95%CI, 2.81-10.4) physical activity. Further, children who engaged in long periods of screen time and lacked parental communication also tended to dislike and lack physical activity. Children with mothers who were unemployed (housewife) and had undesirable lifestyles as well as those with poor health were also more likely to lack physical activity. Conclusion Social and family factors (e.g., close friends) may be determinants of exercise habits among schoolchildren independently of their own lifestyle factors. Although a longitudinal study is needed to determine causality, substantial attention should thus be paid to these factors when promoting physical activity.

Objectives A high level of work–family conflict (WFC) is an important risk factor for physical and mental health problems. Although individual work-related factors for WFC have been extensively studied, relatively little is known about whether occupation and gender affect WFC and how such effects might be generated. Study design Cross-sectional study. Methods This study surveyed 3053 civil servants aged 20–65 years working in a local government in the west coast of Japan in 2003. Logistic regression analyses were used to examine whether there are occupational and gender differences in WFC and to clarify the factors underlying these differences. Results WFC was higher in professional and technical workers compared with other occupations for both men and women, with age-adjusted odds ratios (ORs) for these workers of 1.29 in men and 2.58 in women. In men, occupational differences in WFC disappeared after adjusting for work and family characteristics (OR = 1.15). In women, significant occupational differences remained in the final model, but after adjusting for work characteristics the adjusted OR for professional and technical workers was reduced to 1.69. Women were more likely than men to experience high WFC (OR = 2.52). After controlling for work characteristics, the gender difference was considerably reduced (OR = 1.68). Conclusions Work characteristics play a fundamental role in the difference in WFC between not only occupational but also gender differences. Stressful work characteristics among professional and technical workers and among women in all work roles should be addressed to reduce occupational and gender differences in WFC in Japan.