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Background: This longitudinal study aimed to examine the changes in psychological distress of the general public from the early to community-transmission phases of the COVID-19 pandemic and to investigate the factors related to these changes. Methods: An internet-based survey of 2,400 Japanese people was conducted in two phases: early phase (baseline survey: February 25–27, 2020) and community-transmission phase (follow-up survey: April 1–6, 2020). The presence of severe psychological distress (SPD) was measured using the Kessler’s Six-scale Psychological Distress Scale. The difference of SPD percentages between the two phases was examined. Mixed-effects ordinal logistic regression analysis was performed to assess the factors associated with the change of SPD status between the two phases. Results: Surveys for both phases had 2,078 valid respondents (49.3% men; average age, 50.3 years). In the two surveys, individuals with SPD were 9.3% and 11.3%, respectively, demonstrating a significant increase between the two phases (P = 0.005). Significantly higher likelihood to develop SPD were observed among those in lower (ie, 18,600–37,200 United States dollars [USD], odds ratio [OR] 1.95; 95% confidence interval [CI], 1.10–3.46) and the lowest income category (ie, <18,600 USD, OR 2.12; 95% CI, 1.16–3.86). Furthermore, those with respiratory diseases were more likely to develop SPD (OR 2.56; 95% CI, 1.51–4.34). Conclusions: From the early to community-transmission phases of COVID-19, psychological distress increased among the Japanese. Recommendations include implementing mental health measures together with protective measures against COVID-19 infection, prioritizing low-income people and those with underlying diseases.

On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.

•This study assessed patterns of HPV vaccine hesitancy among women in Japan.•Cluster analysis revealed 3 hesitancy patterns: acceptance, neutral, and refusal.•Acceptance was more common among students and high-income women.•Refusal was more common among workers and unemployed women.•Vaccine awareness promotion must consider sociodemographic characteristics. Cervical cancer is a preventable disease caused by human papillomavirus (HPV). The HPV vaccine uptake in Japan has been slow since the Ministry of Health, Labour and Welfare suspended the recommendation for proactive HPV vaccination in 2013. In April 2022, Japan initiated catch-up vaccinations for women who missed the opportunity to receive the HPV vaccine. However, as of September 2022, very few women had received catch-up vaccination, raising concerns about vaccine hesitancy in the target population. It is necessary to understand the thinking and motivation of the target population to develop effective strategies to improve vaccination rates. Therefore, using cluster analysis, this study aimed to clarify the pattern of HPV vaccine hesitancy among the catch-up generations in Japan. This descriptive study was based on an Internet survey completed by 3,790 women in Japan aged over 18 years who were eligible for catch-up vaccination and had not yet received an HPV vaccine. Participants were asked about their intention and thinking about the HPV vaccine and descriptive norms on vaccination intention. Cluster analysis using k-means clustering was performed to clarify these patterns. Cluster analysis revealed three hesitancy patterns: acceptance, neutral and refusal. The acceptance group, with high intention, comprised 28.2% of the participants, and students and a high-income level mainly dominated this group. The refusal group, with negative thinking and low intention, accounted for 20.1% and was more prevalent among workers and the unemployed. The neutral group, with neutral thinking and intention, accounted for 51.6%. The perceived effect of descriptive norms on vaccination intention was large in the acceptance group but small in the refusal group. HPV vaccine awareness promotion strategies must be based on the characteristics of each group and the different distributions of sociodemographic factors.

Objectives To compare physical activity (PA) and sedentary behavior (SB) levels during work time between those who work from home (WFH) and at workplaces (no WFH), and by WFH subgroups. Methods This cross‐sectional internet‐based survey included 1239 workers (mean age [standard deviation], 44.7 [13.7] years; 59.2% men) living in the Tokyo Metropolitan Area. Time spent sitting (SB), standing (light‐intensity PA; LPA), walking, and engaging in heavy labor (moderate‐to‐vigorous PA; MVPA) during work time was measured using the Work‐related Physical Activity Questionnaire. Workers reported weekly WFH percentages (eg, 0% implies no WFH and 100% implies full WFH), and WFH percentages were categorized into no WFH (0% WFH) and WFH (1%‐100% WFH) groups. The WFH group was further subcategorized into 1%‐25%, 26%‐50%, 51%‐75%, and 76%‐100% subgroups. Results Overall, 494 workers (39.9%) worked from home. During working hours, SB time was longer in the WFH group than in the no WFH group (mean minutes [% working‐time SB]: 335.7 vs 224.7 min [74% vs 50%]). Significantly shorter LPA and MVPA times (%) were reported in the WFH group than in the no WFH group (LPA, 59.6 vs 122.9 min [14% vs 29%]; MVPA, 55.3 vs 91.9 min [13% vs 22%], all P < .001). Among the WFH subgroups, longer SB time and shorter LPA and MVPA times were observed in the highest WFH group (WFH 76%‐100%) than in the WFH 1%‐25% and 26%‐50% subgroups. Conclusions Workers who telecommuted were less physically active and had longer sedentary during work time than those who worked at the workplaces.

Background An increasing number of studies have demonstrated that light-intensity physical activity (LPA) confers health benefits after adjustment for moderate-to-vigorous physical activity (MVPA). The purpose of this systematic review was to summarize existing epidemiological evidence on associations of objectively measured LPA with health outcomes in adults. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched on PubMed, Web of Science, CINAL, and Cochrane Library for articles analyzing the association between objectively determined LPA and health outcomes that were published up to January 2017. Data were extracted regarding authors, publication year, country of survey, study setting, number of participants, study design, physical activity (PA) assessment (type of accelerometer and intensity), health outcomes, confounders, and results (summary measures and association). A coding system was used to summarize the results. Results Of the 3254 studies identified, 24 cross-sectional and 6 longitudinal studies were included in this review. Most of the studies targeted the Western population. LPA was inversely associated with all-cause mortality risk and associated favorably with some cardiometabolic risk factors including waist circumference, triglyceride levels, insulin, and presence of metabolic syndrome. Only a small amount of data were available on mental health and cognitive function. Conclusions LPA appears to be beneficially associated with important health outcomes after adjustment for MVPA in the adult population. Although current global PA guidelines recommend only MVPA, promoting LPA may confer additional health benefits.

Background: Prolonged periods of sitting time can be adversely associated with older adults’ well-being and functional capacities. Understanding patterns and contexts of sedentary behaviors (SB) can inform approaches to prevention. This study examined Japanese older adults’ objectively-assessed patterns and reported domains of SB and their interrelationships. Methods: Participants (n = 297; aged 65–84 years) of this cross-sectional study wore an accelerometer for 7 days and completed a survey. Five measures related to SB patterns were identified from the accelerometer data. SB from six domains, socio-demographics, and chronic conditions were identified from the survey data. Relative contributions of six domains to objectively-measured prolonged sedentary time (≥30 minutes) and the number of breaks were examined in a series of multivariate linear regressions. Covariates were socio-demographics, chronic conditions, and accelerometer wear time. Results: On average, participants spent 8.8 hours a day sedentary (58% of accelerometer wear time), with 7.6 breaks per sedentary hour, and 3.7 hours a day through prolonged sedentary bouts (4.4 time/day). The proportions of time in the SB domains were 9.4% for car, 4.0% for public transport, 6.1% for work, 45.5% for television (TV) viewing, 9.8% for computer use, and 25.1% for other leisure. Domains of SB that contributed significantly to longer sedentary time through prolonged bouts were TV viewing and computer use. TV viewing was also associated with a lesser number of breaks. Conclusions: For Japanese older adults, initiatives to address SB could focus on breaking-up prolonged periods of SB by encouraging more frequent breaks, especially during TV viewing.

Background: Studies have shown that rural residents face disadvantages concerning medical access and socio-economic conditions. However, the social determinants of health among older people in rural areas are still unclear. The Neuron to Environmental Impact across Generations (NEIGE) study investigated the social determinants of health among older rural adults. Methods: A survey was conducted among the older residents of Tokamachi City, Japan. We randomly selected study participants (N = 1,346) from four stratified groups by age (65–74 and 75–84 years) and residential area (Tokamachi center [downtown] and Matsunoyama [mountain]). The survey collected data on socio-economic status, lifestyle, health, and neighborhood environment. Blood and urine sampling were also conducted, and physical activity was assessed. Magnetic resonance brain imaging (MRI) and Apo-E gene were also examined in the analysis. Results: In total, 527 people participated in the NEIGE study (participation rate: 39.2%). The average age of the participants was 73.5 (standard deviation, 5.6) years, and 47.3% were male. No differences in demographics were found between downtown and mountain residents, except for educational attainment, which was lower among mountain residents. Lifestyles were similar, except for the higher percentage of everyday drinkers (33.3–35.3%) in the mountain area. Concerning physical health, muscle mass, grip strength, and measured physical activity were significantly higher among mountain residents. However, gait speed and balance were better among downtown residents. Conclusion: The findings of the NEIGE study will help elucidate the social determinants of health in older rural adults in Japan, and emphasize the different outcomes between downtown and mountain areas.

Background Although it is globally known that Japan has high prevalence of active school travel among children, there are few international studies on Japanese children’s school travel. Moreover, only few studies have focused on the differences in their mode of travel between to-school and from-school. This study examined the associations of neighborhood built, safety, and social environments with walking to/from school among elementary school-aged children in Chiba, Japan. Methods We conducted an online survey with 1545 parents of children aged 6–12 years residing in Chiba between 25 and 27 November 2020 during the COVID-19 pandemic. A neighborhood was defined as the area of a postcode provided by the participants. Each neighborhood environment was assessed based on the built environment (new town designation, walkability, distance to school, population density), social environment (neighborhood cohesion and connection), and safety (CCTVs, a road section for walking alone, safety volunteers). Neighborhood walkability was measured using subscales of the Neighborhood Environment Walkability Scale (youth and abbreviated versions) including crime safety and traffic safety. Parents’ perceived influence of COVID-19 on school commuting and after-school activities were also included in the model as covariates. Walking to and from school were separately analyzed using multinomial logistic regressions, where new towns and walkability were computed separately as explanatory variables. Results Four fifths of children walked to and from school daily. Walking to school was positively associated with crime safety, neighborhood connections, and schools sited in new towns. Walking from school had positive associations with traffic safety, neighborhood cohesion, and CCTVs, but negative associations with safety volunteers and after-school activities. The presence of a section for walking alone and perceived influence of COVID-19 had negative associations with walking to and from school. Conclusions Recent social changes such as declining birthrate, decline in public elementary schools, and increasing after-school activities may change parental attitudes toward children’s walking to/from school, and subsequently, their mode of school travel over time. To maintain the high prevalence of walking to/from school in Japan, multidisciplinary approaches involving different stakeholders from education, public health, and urban planning are required to overcome sectionalism and support this behavior in the long term.

Background: Daily step count is the simplest measure of physical activity. However, little is known about how daily step count related to time spent in different intensities of physical activity (PA) and sedentary behavior (SB). Methods: These cross-sectional data were derived from 450 older Japanese adults (56.7% men; mean age, 74.3 years) who were randomly selected from three communities and responded a survey. Daily step count and time spent in moderate-to-vigorous PA (MVPA), light-intensity PA (LPA), and SB were measured using a validated wearable technology (HJA-350IT). Associations of daily step count with time spent in measured behaviors were examined using linear regression models with isometric log-ratio transformations of time-use composition, adjusting for gender, age, and residential area. Results: Participants averaged 5,412 (standard deviation, 2,878) steps/d and accumulated MVPA, LPA, and SB corresponding to 4.0%, 34.8%, and 61.2% of daily waking time, respectively. Daily step count significantly increased with increase in time spent in MVPA relative to other behaviors (ie, LPA and SB) and in the ratio of LPA to SB after allowing for MVPA. After stratification, daily step count was significantly related to the ratio of LPA to SB in those taking <5,000 steps/d, but not in those taking 5,000–7,499 and ≥7,500 steps/d. Conclusions: Higher daily step count can be an indicator of not only larger relative contribution of time spent in MVPA, but also higher ratio between LPA and SB, particularly among those who are the least physically active.

Vaccination could be a key protective measure against coronavirus disease 2019 (COVID-19), and it is important to understand the acceptability of the COVID-19 vaccine among the general public. However, there is no study on the acceptance of a COVID-19 vaccine in Japan. Therefore, this study aimed to describe the COVID-19 vaccine acceptance and hesitancy situation in Japan and assess the factors associated with such issues. This was a cross-sectional study based on an internet survey completed by 2956 people. Participants were asked to indicate how likely they were to get vaccinated for COVID-19. In addition, the participants responded to questions regarding sociodemographic factors, attitudes, and beliefs regarding COVID-19 infection and vaccination. The proportion of participants with a high likelihood of getting a COVID-19 vaccine was 62.1%. Multiple logistic regression analysis showed that vaccine acceptance was lower among several sociodemographic groups, such as women, adults aged 20–49 years, and those with a low-income level. Several psychological factors, especially the perceived effectiveness of the COVID-19 vaccine, and willingness to protect others by getting oneself vaccinated, were associated with vaccine acceptance. Our results indicate that the perceived effectiveness of the vaccine and willingness to protect others may play an important role in the acceptance of the COVID-19 vaccine.