Author: Naoki

We published a new paper from Resources, Conservation and Recycling.

Highlights
・In Japan, the carbon footprint of health care accounted for 4.6% of total national emissions in 2011.

・By 2015, the annual carbon footprint had increased to 72.0 MtCO₂e owing to the growth of medical expenditures.

・The carbon footprint per patient with or without hospitalization was 12 and 2.1 tCO₂e/y, respectively.

・Avoiding generation of unused medicines can potentially reduce emissions by 1.24 MtCO₂e/y.

・To safeguard planetary health, more options for health promotion and carbon emission mitigation need to be provided.

Abstract
The carbon footprint of Japanese health care services, i.e. the domestic greenhouse gas (GHG) emissions caused by health care expenditures, including the associated fixed capital, were calculated using input-output analysis. In 2011 the total carbon footprint of these services was 62.5 × 10⁶ metric tons of CO₂ equivalent (MtCO₂e), which is 4.6% of total domestic GHG emissions. Medical services involving hospitalization accounted for the greatest share, at 15.7 MtCO₂e. The second highest category, Medical services without hospitalization, accounted for only slightly less: 14.2 MtCO₂e. However, the difference in emissions per patient between these two categories was considerable. On average, emissions per patient for Medical services (hospitalization) were 12 tCO₂e/patient, whereas for Medical services (non-hospitalization) they were only 2.1 tCO₂e/patient, or 5.4 times less. In terms of type of medical condition, the greatest annual emissions were associated with cardiovascular disease (6.2 MtCO₂e) and neoplasm (4.0 MtCO₂e). In terms of age, emissions attributed to patients aged 65 and over accounted for more than half of total health care emissions. By 2015, the total carbon footprint had increased to 72.0 MtCO₂e, a rise of over 15% in four years. Although medical care and pharmaceuticals are the main factors responsible for this increase, emissions associated with nursing services have also risen, suggesting that demographic aging may be having a significant impact on GHG emissions. As a countermeasure, the potential annual GHG mitigation achievable through avoidance of unused prescribed medicines resulting in waste was estimated at 1.24 MtCO₂e, comparable with the total carbon footprint of home medicines. To safeguard planetary health, in addition to implementing technological improvements to the supply chains of health care services, it will be necessary to provide citizens further options for achieving health promotion and GHG mitigation simultaneously.

Graphical abstract

 

Keisuke Nansai , Jacob Fry , Arunima Malik , Wataru Takayanagi , Naoki Kondo(2019) Carbon footprint of Japanese health care services from 2011 to 2015.Carbon footprint of Japanese health care services from 2011 to 2015. Resources, Conservation and Recycling 152.
https://doi.org/10.1016/j.resconrec.2019.104525

we published a new book from Springer: The Atlas of Health Inequalities in Japan.

From the book website:

This new health atlas of Japan presents a series of maps about the health of the contemporary Japanese population, i.e. detailed maps of health indicators in small areas using cartograms. This is the first comprehensive small-area based health atlas about contemporary Japan using vital statistics from 1995-2014. Each map is supplemented with concise explanations written by leading epidemiologists and health geographers in Japan. The book employs various cutting-edge methods in spatial epidemiology, Bayesian spatial smoothing for the reliable mapping of mortality indices,  advanced cartographic transformations using the concept of aerial cartograms, and summary statistics of socioeconomic health inequalities. The atlas highlights geographical aspects of social gradients in health by comparing mortality maps with distribution of deprivation index during the recent long-lasting economic stagnation period of Japan known as the lost decades. This health atlas will be a useful resource for international comparisons between Japan and other advanced countries in terms of health and related socioeconomic disparities between regions. It will be of interest to public health practitioners, administrators, researchers and students working on health geography and public health.

 

We published a new paper from International Journal of Behavioral Nutrition and Physical Activity.

Abstract

Background: In light of recent theories in behavioural economics, an intervention program with monetary incentives could be effective for helping patrons order healthy food, even if the incentive is small and less than one’s perceived marginal value.

Methods: In this single-arm cluster crossover trial at 26 local restaurants, a 1-week campaign offered a 50-yen (approximately 0.5 US dollars) cash-back payment to customers ordering vegetable-rich meals, while no pre-order incentives were offered during the control period.

Results: In total, 511 respondents out of 7537 customers (6.8%), and 704 respondents out of 7826 customers (9.0%), ordered vegetable-rich meals during the control and intervention periods, respectively. During the intervention period, the covariate-adjusted proportion of vegetable-rich meal orders was 1.50 times higher (95% confidence interval [CI]: 1.29 to 1.75), which increased daily sales by 1.77 times (95% CI: 1.11 to 2.83), even when subtracting the cost of cash-back payments. Respondents who reported spending the least amount of money on eating out (used as a proxy measure for income) were the least likely to order vegetable-rich meals during the control period. However, these individuals increased their proportion of purchasing such meals during the intervention period (a 3.8 percentage point increase (95% CI: 2.82 to 4.76) among those spending the least vs a 2.1 percentage point increase (95% CI: 1.66 to 2.62) among those spending the most; P for interaction = 0.001). Similarly, irregular employees exhibited a larger increase (+ 5.2 percentage points, 95% CI: 4.54 to 5.76) than did regular workers (− 1.4, 95% CI: − 1.66 to − 1.05, P for interaction = 0.001).

Conclusions: A program with an immediate low-value monetary incentive could be a public health measure for reducing inequalities in making healthy food choices.

Trial registration: UMIN Clinical Trials Registry, UMIN000022396. Registered 21 May 2016.

Keywords: Health inequality, Diet, Health behaviour, Marketing, Nudge, Japan

Wataru Nagatomo , Junko Saito , and Naoki Kondo.(2019). Effectiveness of a low-value financialincentive program for increasing vegetablerich restaurant meal selection and reducing socioeconomic inequality: a cluster crossover trial. International Journal of Behavioral Nutrition and Physical Activity 16:81.
https://doi.org/10.1186/s12966-019-0830-5

We published a new paper from PLOS ONE.

Abstract
The prevalence of electronic cigarette (e-cigarette) use has rapidly increased among young people, while conventional cigarette use has decreased in this age group. However, some evidence suggests that e-cigarette use is likely to induce conventional cigarette smoking. The present study explored the social influence of the prevalence of e-cigarette use in the peer network and in the general population as a potential mechanism by which e-cigarette use affects adolescents’ overall smoking behaviours. For this purpose, we developed an agent-based model in which young agents repeatedly choose to smoke conventional cigarettes and/or e-cigarettes, or to remain non-smokers. The choice is based on the agent’s evaluation of the utility derived from smoking and attitude towards smoking (‘openness’), which is influenced by smoking prevalence in the agent’s peer network and in the broader society. We also assumed a ‘crossover’ effect between the different types of smoking. The model was calibrated with United States National Youth Tobacco Survey data to reflect real-world numbers. We further simulated the prevalence of different types of smoking under counterfactual scenarios with different levels of openness and crossover effects. The models developed successfully reproduced actual prevalence trends in different types of smoking from 2011 to 2014. Openness to smoking is associated with a dramatic increase in e-cigarette smoking and especially in dual smoking, which cancels out the decline in sole conventional smoking. Larger crossover effects are associated with a higher prevalence of conventional smoking. The simulation results indicate that the social influence of the prevalence of e-cigarette use may influence young people to initiate or continue conventional cigarette smoking. Assessing the impact of e-cigarettes in the general population as a ‘healthier’ alternative to conventional smoking may require carefully monitoring trends in young people’s smoking behaviours.

Chao D, Hashimoto H, Kondo N (2019) Social influence of e-cigarette smoking prevalence on smoking behaviours among high-school teenagers: Microsimulation experiments. PLoS ONE 14(8): e0221557. https://doi.org/10.1371/journal.pone.0221557
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221557

We published a new paper from Bulletin of the World Health Organization.

 Problem
The measures for long-term care prevention that the Japanese
government had introduced in 2006 were unsuccessful because of the
failures to identify high-risk individuals and to enrol enough
participants in the community prevention programme.

Approach
The Japanese government shifted its primary strategy from a high-risk
strategy to a community-based population strategy in 2015, by
reforming the Long-term Care Insurance Act. This act is focusing on
community-based care and social determinants of health. The Act and
the government’s plans for long-term care prevention are inspired by a
social participation intervention called ikoino saron, that is
gathering salons for people older than 65 years. These salons, managed
by local volunteers, are held once or twice a month in communal spaces
within walking distance of community members’ homes and have a low
participation fee. At the gatherings, older people can meet and
interact with others through enjoyable, relaxing and sometimes
educational programmes.

Local setting
Japan has the world’s largest ageing population, with 27.7% (35.2
million/126.7 million) of people older than 65 years.

Relevant changes
Studies have shown that participation in the salons was associated
with a halved incidence in long-term care needs and about one-third
reduction in the risk of dementia onset. Evidence also suggests that
financially vulnerable older adults were more likely to participate in
such interventions. In 2017, 86.5% (1506/1741) of the Japanese
municipalities had implemented the salons.

Lessons learnt
Integrated care for long-term care prevention should consider
interventions targeting the whole community in addition to high-risk
individuals.

Saito, Junko, Haseda, Maho, Amemiya, Airi, Takagi, Daisuke, Kondo, Katsunori. et al. (‎2019)‎. Community-based care for healthy ageing: lessons from Japan. Bulletin of the World Health Organization, 97 (‎8)‎, 570 – 574. World Health Organization. http://dx.doi.org/10.2471/BLT.18.223057

We published a new paper from PLoS ONE.

Abstract

Backgrounds

Recent evidence has suggested that in Japan, professionals and
managers have a higher risk of poor health than other workers (e.g.,
clerks and manual laborers), and this effect may be stronger among
women than men. Low organizational justice, which is known to be a
potential risk factor for poor health among employees, may explain the
gender-specific association.

Methods

We examined the associations between perceived organizational justice
and psychological distress and stress-related behaviors (smoking and
heavy drinking) in 2,216 female and 7,557 male employees aged 18 to 69
years from the Japanese Study of Health, Occupation, and Psychosocial
Factors Related Equity. We measured both procedural and interactional
justice, and compared managers and professionals with other employees.

Results

After adjusting for demographic characteristics and occupational
stress, low levels of perceived procedural and interactional justice
were found to be associated with a high prevalence of psychological
distress for both women and men, regardless of occupational status.
Among female managers and professionals, perceived interactional
justice (measured as the levels of supports by supervisors, etc.) was
significantly associated with smoking, whereas no such association was
observed among other workers. When interactional justice was perceived
to be low, the prevalence of smoking was 6.5 percentage points higher
among managers and professionals than among others. Neither procedural
nor interactional justice was associated with risk of heavy drinking.

Conclusions

Female managers and professionals in a workplace with unsupportive
supervisors may be more likely to engage in unhealthy coping behaviors
to manage their stress. Creating supportive workplaces may be
beneficial in increasing workers’ health, especially for female
managers and professionals.

Kobayashi Y, Kondo N (2019) Organizational justice, psychological
distress, and stress-related behaviors by occupational class in female
Japanese employees. PLoS ONE 14(4): e0214393.
https://doi.org/10.1371/journal.pone.0214393

We published a new paper from Suicide and Life-Threatening Behavior, Early View.

Abstract

Objective

In recent years, rural areas have reported higher suicide rates than
urban areas worldwide. Although agricultural activity is a key
characteristic of many rural areas, rurality may also have
heterogeneous qualities based on the type of agriculture pursued.
However, to date, no study has examined potential linkages between
suicide rate and types of agriculture.

Method

In this study, we used 1983–2007 annual time‐series data of the
standardized mortality ratio (SMR) of suicide and product‐specific
agricultural outputs in Japanese municipalities to shed light on this
phenomenon. We conducted a multilevel linear regression analysis,
taking into account a hierarchical structure of the time‐series data,
limiting our analysis to municipalities where agricultural land use
was high.

Results

Our multilevel analysis showed that the animal husbandry output was
positively associated with suicide SMR in both women and men, with a
stronger relationship among women, whereas no association was observed
in agricultural crop output. Temporal analysis showed that the
association could be observed consistently throughout the period
between 1983 and 2007.

Conclusions

This study raises the possibility that the industrial and cultural
characteristics of communities that rely on animal husbandry may be
associated with an increased risk of suicide.

Kanamori, M., Kondo, N. (2019). Suicide and Types of Agriculture: A
Time-Series Analysis in Japan. Suicide and Life-Threatening Behavior,
Early View
https://onlinelibrary.wiley.com/doi/full/10.1111/sltb.12559　(OpenAccess)

We published a new paper from International Journal of Environmental Research and Public Health.

Abstract

Evidence suggests that socioeconomically disadvantaged children may experience a greater increase in overweight risk during macroeconomic downturns. We examined whether inequalities in the risk of overweight between Japanese children from single- and two-parent households increased after the 2008 global financial crisis. We used data from ten waves (2001 to 2011) of a nationwide longitudinal survey following all Japanese children born within 2 weeks in 2001 (boys: n = 15,417, girls: n = 14,245). Child overweight was defined according to age- and sex-specific cut-offs for Body Mass Index (BMI). Interaction between a binary measure of crisis onset (September 2008) and single-parent status was assessed using generalized estimating equation models. Covariates included baseline household income and income loss during the crisis. Girls from single-parent households showed a greater increase in the odds of overweight after crisis onset (adjusted odds ratio (AOR), 1.23; 95% confidence interval (CI), 1.04–1.46) compared to girls from households with two parents, regardless of household financial status. A similar though statistically non-significant trend was observed among boys (AOR, 1.10; 95% CI, 0.92–1.30). Child overweight risk by single-parent status may increase during macroeconomic downturns, at least among girls. Financial aid to single-parent households may not suffice to redress this gap.

Koichiro Shiba and Naoki Kondo. The Global Financial Crisis and Overweight among Children of Single Parents: A Nationwide 10-Year Birth Cohort Study in Japan. Int. J. Environ. Res. Public Health 2019, 16(6), 1001;
doi: 10.3390/ijerph16061001

We published a new paper from International Journal of Environmental Health Research.

ABSTRACT

One possible predictive factor that affects both pro-environmental behavior and health behavior is health consciousness (a psychological state where an individual is aware of and involved in his/her health condition). We examined the relationship between health consciousness and two pro-environmental behaviors (recycling and green purchasing) within health professionals in a Japanese large hospital.Multivariate linear regression analysis revealed a significant association between health consciousness and recycling behavior, while there was no association between health consciousness and green purchasing behavior. We assume that health consciousness can certainly be a factor promoting pro-environmental behavior, but that it may have been insufficient to cause green purchasing, because of the organizational norm of recycling in the Japanese context. Given that there is previous evidence about the relationship between health consciousness and health behavior, health consciousness might be a predictive factor that encourages both health behavior and pro-environmental behavior simultaneously.

Shimoda, A., Hayashi, H., Sussman, D., Nansai, K., Fukuba, I., Kawachi, I., & Kondo, N. (2019). Our health, our planet: a cross-sectional analysis on the association between health consciousness and pro-environmental behavior among health professionals. International journal of environmental health research.
https://doi.org/10.1080/09603123.2019.1572871