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BackgroundJapan is the leading market for heated tobacco products (HTPs). We assessed the latest prevalence of HTP use including novel products (Ploom S, glo sens, and Pulze).MethodsData were obtained from an internet-based, self-reported survey conducted during February-March 2020 with individuals aged 15–74 years in Japan(n=9044). Prevalence of current (past 30-day) HTP use and cigarette smoking was computed. Poison regression analysis was conducted to examine predictors of HTP use among current cigarette smokers (n=1478). All analyses were weighted to account for selection bias in the internet survey using a nationally representative sample of Japanese population.ResultsIn 2020, prevalence of current HTP use and cigarette smoking was 10.9% and 25.9% in Japan, respectively. The most commonly used HTP brand was IQOS (5.7%) followed by Ploom TECH/Ploom TECH+ (5.4%) and glo (2.6%). Use of Ploom S, glo sens and Pulze was 1.6%, 0.8% and 0.6%, respectively. Among current cigarette smokers, 34.9% of those who were interested in quitting smoking and 30.5% of those who were not interested in quitting reported concurrent use of HTP, respectively (difference not significant). Cigarette smokers who reported having multiple chronic conditions (aPR=2.31), alcohol consumption (aPR=2.07), and e-cigarette use (aPR=1.88) were more likely to use an HTP compared to those who did not report such characteristics.ConclusionsHTP use remained prevalent in Japan. One in three current cigarette smokers used HTPs regardless of whether they were interested inquitting smoking. Continuedsurveillance is important to inform national and global tobaccocontrol strategies.

Background: Japan became the first country where heat-not-burn tobacco products were sold. Therefore, there was no information for actual status on the actual use status or the harms of heat-not-burn tobacco products. The objectives of the study profile are to generate data that can be freely available to external researchers, and to create collaborative research projects in the future. Methods: The Japan “Society and New Tobacco” Internet Survey (JASTIS) is a longitudinal internet cohort study which investigates perception, attitude, and use of heat-not-burn tobacco, electronic cigarettes (e-cigarettes), and conventional tobacco products in Japan. The survey also includes demographic, health-related, and socioeconomic factors. Participants were randomly selected and invited from internet panelists. The baseline survey was closed when the target number of respondents who had answered the questionnaire was met. Results: The study includes three cohorts (1–3) from the 2015 baseline survey and a cohort (4) from the 2017 baseline survey: cohorts 1 and 4 were recruited based on sex and age: men and women aged 15–69 years (n = 8,240 for cohort 1 and n = 5,897 for cohort 4); cohorts 2 and 3 were created using status-based recruiting: e-cigarette and/or heat-not-burn tobacco ever users (n = 2,188; cohort 2) and combustible cigarette smokers without e-cigarette/heat-not-burn tobacco experience (n = 724; cohort 3). The completion rates were 8.5% to 9.9%. All subjects were followed and assessed annually. Response rates for the follow-up survey were 65.5% in 2016, 55.3% in 2017, and 50.9% in 2018. Because Internet-based responders are not a representative sample of the general population of Japan, we conducted adjustment to account for “being an internet survey respondent” and reported tobacco product use in Japan. A recent JASTIS study reported that prevalence of IQOS current-use among Japanese adults had rapidly increased from 0.3% in 2015 to 3.6% in 2017. Conclusion: The JASTIS study provides the first estimates for heat-not-burn tobacco use in the world and e-cigarette use in Japan. For information on collaboration, please contact the corresponding author.

The aim of cross-sectional study was to investigate the association between loneliness, increased social isolation, and pain following the COVID-19 outbreak. A total of 25,482 participants, aged 15–79 years, were assessed using an internet survey; the University of California, Los Angeles Loneliness Scale (Version 3), Short Form 3-item (UCLA-LS3-SF3) was used to assess loneliness, and a modified item of the UCLA-LS3-SF3 was used to measure the perception of increased social isolation during the pandemic. The outcome measures included the prevalence/incidence of pain (i.e., headache, neck or shoulder pain, upper limb pain, low back pain, and leg pain), pain intensity, and the prevalence of past/present chronic pain. Pain intensity was measured by the pain/discomfort item of the 5-level version of the EuroQol 5 Dimension scale. Odds ratios of pain prevalence/incidence and past/present chronic pain prevalence according to the UCLA-LS3-SF3 scoring groups (tertiles) and the frequency of the perceived increase in social isolation (categories 1–5) were calculated using multinomial logistic regression analysis. The mean pain intensity values among different loneliness and social isolation levels were tested using an analysis of covariance. Increased loneliness and the severity of the perceived social isolation were positively associated with the prevalence/incidence of pain, pain intensity, and the prevalence of past/present chronic pain.

At baseline in 2015, 8240 participants aged 15–69 years were randomly selected from a Japanese large internet search agency, Rakuten Research.2 Adjusted estimates using inverse probability weighting (IPW) obtained from a propensity score (calculated by logistic regression models using basic demographic and socioeconomic factors) were calculated to correct for the selectivity of internet-based samples, using a probability sample that is representative of the Japanese population from the Comprehensive Survey of Living Conditions of People on Health and Welfare.3 We further adjusted for non-response using IPW from the 2016 survey or after. According to product type, the most recent 2019 HTP use prevalence (95% CI) in Japan was estimated as follows: 5.8% (4.4%–7.6%) for IQOS, 6.1% (4.7%–7.8%) for Ploom TECH and 3.6% (2.6%–5.0%) for glo (online supplementary table 1). Under the new law, the tobacco industry promotes HTPs on websites, in official stores, consumer electronics retailers and convenience stores.6 7 However, WHO advises policy-makers to ban HTP marketing and provide warning messages about HTPs as well as conventional cigarettes.8 Our study highlights the rapid spread of HTPs in Japan, especially among smokers, men and the younger population. Contributors TT had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.Study concept and design: all authors; acquisition of data: TT; analysis and interpretation of data: AH and TT; drafting of the manuscript: AH and TT; critical revision of the manuscript for important intellectual content: all authors; statistical analysis: AH and TT; and study supervision: NK.

Background: Reluctance of people to receive recommended vaccines is a growing concern, as distribution of vaccines is considered critical to ending the COVID-19 pandemic. There is little information regarding pregnant women’s views toward coronavirus vaccination in Japan. Therefore, we investigated the vaccination rate and reasons for vaccination and vaccine hesitancy among pregnant women in Japan.Methods: We conducted a cross-sectional study involving 1,791 pregnant women using data from the Japan “COVID-19 and Society” Internet Survey, conducted from July to August 2021, and valid response from 1,621 respondents were analyzed. We defined participants with vaccine hesitancy as those who identified with the statement “I do not want to be vaccinated” or “I want to ‘wait and see’ before getting vaccinated.” Multivariate Poisson regression analysis was used to investigate the factors contributing to vaccine hesitancy.Results: The prevalence of vaccination and vaccine hesitancy among pregnant women was 13.4% (n = 217) and 50.9% (n = 825), respectively. The main reasons for hesitancy were concerns about adverse reactions and negative effects on the fetus and breastfeeding. Vaccine hesitancy was significantly associated with the lack of trust in the government (adjusted prevalence ratio, 1.26; 95% confidence interval, 1.03–1.54). Other factors, such as age, educational attainment, and state of emergency declaration, were not associated with vaccine hesitancy.Conclusions: COVID-19 vaccination is not widespread among pregnant women in Japan, although many vaccines have been shown to be safe in pregnancy. Accurate information dissemination and boosting trust in the government may be important to address vaccine hesitancy among pregnant women.

BackgroundResearch suggests that preventive measures are critical to reducing the spread of coronavirus disease 2019 (COVID-19), but evidence regarding the association between trust in government and the practice of preventive measures is limited.ObjectiveTo examine whether the practice of preventive measures against COVID-19 differs by one’s level of trust in government.DesignA cross-sectional analysis using the Japan COVID-19 and Society Internet Survey (JACSIS) conducted in August and September 2020.ParticipantsA nationally representative sample of Japanese individuals aged 15 through 79 years.Main MeasuresThe primary outcome was the composite score for COVID-19 preventive measures, defined as the percentage of preventive measures an individual reported to be practicing (out of nine measures: social distancing, wearing masks, avoiding closed spaces, avoiding crowded spaces, avoiding close contact settings, hand washing, avoiding touching one’s face, respiratory hygiene, and surface disinfection). The secondary outcomes were (1) support for stay-at-home requests, (2) use of a contact-tracing app, and (3) receipt of the influenza vaccine in the previous season.Key ResultsOur analysis included a total of 25,482 individuals. After adjusting for potential confounders, we found that individuals with high trust in government were likely to practice preventive measures more frequently compared to those with low trust (adjusted composite scores, 83.8% for high- vs. 79.5% for low-trust individuals; adjusted difference, +4.3 percentage points [pp]; 95% CI, +2.4 to +6.2pp; P<0.001). We also found that high trust in government was associated with higher likelihoods of support for stay-at-home requests, use of a contact-tracing app, and receipt of the influenza vaccine in the previous season.ConclusionsHigh trust in government was associated with a higher intensity of practicing COVID-19 preventive measures among Japanese individuals at the national level. Our findings may provide useful information to develop and design effective public health interventions.

Heated tobacco products (HTPs) have become popular recently. People with chronic disease, such as diabetes, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD) and cancer, should quit smoking for treatment and recurrence of tobacco-related diseases. However, they have difficulty in quitting smoking, and they may start HTPs use to quit smoking. The purpose of this study is to examine the use of HTPs in people with chronic disease. We used data from an internet study, the Japan Society and New Tobacco Internet Survey (JASTIS). We analyzed 9,008 respondents aged 15–73 years in 2019 using logistic regression. Current use of tobacco products was defined as use within the previous 30 days. Prevalence of current HTP use including dual use and dual use with cigarettes was 9.0% and 6.1% respectively in total. By disease: hypertension 10.2% and 7.4%, diabetes 15.9% and 12.3%, CVD 19.2% and 15.7%, COPD 40.5% and 33.3%, and cancer 17.5% and 11.9%. Diabetes, CVD, COPD, and cancer were positively associated with current use of HTPs (odds ratios (ORs) and 95% confidence intervals (CIs): 1.48 (1.06, 2.07), 2.29 (1.38, 3.80), 3.97(1.73, 9.11), and 3.58(1.99, 6.44), respectively) and dual use of cigarettes and HTPs (ORs and 95% CIs: 2.23 (1.61, 3.09), 3.58 (2.29, 5.60), 7.46 (3.76, 14.80), and 2.57 (1.46, 4.55), respectively) after adjusting for confounders. People with chronic disease were more likely to use HTPs and HTPs together with cigarettes. Further research on the smoking situation of HTPs in patients with chronic diseases is necessary.

Insomnia is a significant public health problem; however, no research has conducted a spatial analysis on insomnia in Japan. Therefore, this study aimed to identify potential spatial clusters of insomnia and its related factors among prefectures and to explore the factors associated with insomnia at the prefecture level in Japan. Data from the Japan COVID-19 and Society Internet Survey (JACSIS 2023) was used to estimate the percentages of smokers, alcohol drinkers, and insomniacs for each prefecture using Bayesian statistics. Getis-Ord Gi* spatial statistics was applied to identify potential clusters for all factors. Additionally, Global Ordinary Least Squares (OLS) regression was conducted to examine factors associated with insomnia at the prefecture level in Japan. The percentage of smokers, alcohol drinkers, and individuals with insomnia in the overall population ranged from 19.2 to 23.4%, 44.6–55.7%, and 8.7–15.8%, respectively. The percentages of smokers and alcohol drinkers were higher among males than females, whereas the percentage of insomnia was greater among females. The hot spots for social welfare expenditure are notably concentrated in the western regions, while the cold spots are concentrated in the central areas of Japan. A similar pattern was observed among the male population for the percentages of smokers, alcohol drinkers, and insomniacs. The factors associated with insomnia differed between males and females. In the male model, percentage of smokers was positively associated with percentage of insomniacs (b = 0.875, p-value < 0.001), whereas in the female model, social welfare expenditure of each prefecture had a significant positive effect on percentage of insomniacs (b = 0.091, p-value = 0.003). In conclusion, smokers, alcohol drinkers, social welfare expenditure and individuals with insomnia exhibit spatial variations and clustering across Japan’s prefectures. Percentage of smokers has a significant positive association with percentage of insomniacs among males, while social welfare expenditure has a positive association with percentage of insomniacs among females.

The vaccine confidence index in Japan is one of the lowest worldwide. This study aimed to examine the proportion of COVID-19 vaccine hesitancy in the Japanese population using a larger sample and more robust statistical methods than previously, and to identify factors associated with vaccine hesitancy. We conducted a nationwide, cross-sectional Internet survey on 8–26 February 2021, and calculated the proportion and odds ratios for vaccine hesitancy. Among 23,142 responses analyzed, the proportion of COVID-19 vaccine hesitancy was 11.3% (10.9–11.7%). The proportion was higher among younger respondents and female respondents, and especially among younger female respondents (15.6%) compared with the lowest proportion among older male respondents (4.8%). The most cited reason for not getting vaccinated was concerns about adverse reactions in more than 70% of the respondents. The proportion of COVID-19 vaccine hesitancy in Japan was comparable to that in previous studies overseas, and the proportion among younger respondents was more than double that among older respondents. Factors associated with the hesitancy were female sex, living alone, low socioeconomic status, and presence of severe psychological distress, especially among older respondents. Thus, adequate measures should be taken to ensure that vaccines are delivered to people with these factors.

Background: Few longitudinal studies have examined the association between skipping breakfast and overweight/obesity in pre-elementary school children. Furthermore, this association may differ between boys and girls. The main objective of this study was to assess whether skipping breakfast in early childhood was associated with later incidence of overweight/obesity, with stratification by gender, using data on children aged 2.5 to 13 years old in The Longitudinal Survey of Newborns in the 21st century. Methods: We examined the associations between skipping breakfast at 2.5 years old and overweight/obesity at 2.5 (n = 34,649), 4.5 (n = 35,472), 7 (n = 31,266), 10 (n = 31,211), and 13 (n = 28,772) years old. To estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of overweight/obesity by each age (2.5, 4.5, 7, 10, and 13 years), a multivariate logistic regression was used adjusting for time-invariant and time-varying covariates. Results: At the age of 2.5 years, 11.0% of boys and 12.2% of girls were skipping breakfast. In fully adjusted models, skipping breakfast at 2.5 years old was not significantly associated with overweight/obesity at 2.5 and 4.5 years old, but was significantly associated with overweight/obesity at 7 and 10 years old, in both sexes. Skipping breakfast at 2.5 years old was significantly associated with overweight/obesity at 13 years old in boys (OR 1.38; 95% CI, 1.17–1.62), but not in girls (OR 1.21; 95% CI, 0.98–1.49). Conclusions: Skipping breakfast in early childhood increased overweight/obesity in later childhood, but there may be gender differences in the association.