Objectives The study was performed to find factors in daily routines and living environments of male junior high school students that are linearly or non-linearly related to reduced visual acuity and to assess the strength of their relationships.
Methods Data on daily routines and living environments were collected by questionnaire from 382 male junior high school students and these data are matched with records on visual acuity of each student measured at the annual school medical examinations. In addition to univariate statistical analysis, multivariate analysis was conducted by the spline logistic regression developed in this paper by modifying the similar technique for follow-up studies; the detail of the method is given in the appendix of this paper.
Results A significant association was found between “viewing distance from a TV” and “reduced visual acuity” (P=0.004). There was also a significant interaction observed between “viewing distance from the TV” and “hair-obstructed eyes” (P=0.012). Furthermore, it was found that the adjusted odds ratio between the “reduced visual acuity” and “having 1~2 days of physical activity per week” relative to “having physical activity less than one day per week” was 0.27, which was statistically significant (P=0.022). While the adjusted odds ratio continued to decrease as the physical activity increased per week, this was not significant as compared to “having physical activity 1~2 days per week” (P=0.204).
Conclusions Exercising 1~2 days per week outside of school can prevent reduced visual acuity. In addition, students should be encouraged to prevent hair from obstructing their eyes and they should view TV from a distance of more than 2.5 m, as such behavior can prevent reduction in visual acuity.

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Objective The recommended daily intake of fruits in Japan is 200 g, but average actual intake is much lower. We examined associations between self-reported fruit availability at home and fruit-related eating behavior among sixth-grade schoolchildren in Sakado City, Saitama Prefecture, Japan.
Methods As part of a larger study of school children in Sakado City, 659 sixth-grade from all 13 primary schools in the city completed a survey in their classroom in October 2007 (valid respondent rate 92%). Dietary intake over the previous 1-month period was assessed with a brief, self-administered diet history questionnaires for 10-year-olds. A second questionnaire also assessed health, dietary knowledge, attitudes and behaviors, and perceived food availability at home. Children reported fruit availability at home using the four options of always, often, sometimes, or never. Associations between fruit availability at home and fruit-related eating behaviors were statistically tested, including perception of the importance of and self-efficacy in eating fruits for health as well as the frequency of eating fruit by children and their family, with all analyses conducted separately by gender.
Results Mean fruit intake was the highest among those children who reported that fruits were always available at home (boys 54 g/1,000 kcal, girls 65 g/1,000 kcal), followed by those reporting availability as often (31 g/1,000 kcal, 37 g/1,000 kcal), sometimes (16 g/1,000 kcal, 13 g/1,000 kcal), or never (9 g/1,000 kcal, 12 g/1,000 kcal). Availability was positively associated with intake (P for trend<0.001). Additionally, it was positively associated with childrens' perception of the importance of eating fruit for better health (boys only, P<0.001), self-efficacy in eating more fruit (P<0.001), and the family frequency of eating fruit (P<0.001).
Conclusion These findings suggest that fruit availability at home is a significant factor in fruit-related eating behavior, consistent with results of similar studies in western countries.

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Purposes This study aimed to develop a framework for essential skills and the achievement levels necessary for students graduating from schools that provide education for obtaining a license as a public health nurse (PHN) in Japan.
Methods Two rounds of questionnaire-based investigations using the Delphi methodology were conducted. Subjects were 197 PHNs from municipalities or companies and 146 nurse educators from universities, colleges, junior colleges, or technical nursing schools.
Results (1) The essential skills framework consisted of three (macro, intermediate and micro) levels. Macro-level items were based on the principle of justice, a primary pillar of health care: (A) community assessment to identify health problems; (B) solving and improving particular health problems in collaboration with people to enable them to promote their own health; (C) promoting equitable access and distribution of community resources for health and daily living. Micro-level items had four achievement levels: (I) independent; (II) instructor-guided; (III) laboratory exercise; (IV) theoretical understanding. Micro-level items for A and B had two domains for achievement: individual/family and group/community.
 (2) In the first round over 70% of respondents said “very important,”“important” or “acceptable” for all micro-level items. In the second round, over 90% said all micro-level items fit within macro and intermediate-level items.
 (3) In the second round, micro-level items attained 70% consensus among PHNs and nurse educators were 71 of 93 (76.3%). Micro-level expression was used for adjustment and the final framework of essential skills yielded 3 macro, 8 intermediate and 59 micro-level items and 95 levels of achievement.
 (4) In the final framework, the level of achievement for “individual/family” (Macro-level A and B) was almost level I, and for “group/community” almost II or III. The number of micro-level items at level IV for C was 14 of 21 (66.7%). (5) Compared with PHNs, educators generally assigned a more advanced achievement level for the same skill.
Conclusions This framework offers more clarity to the content and competency of practice and thus should be useful for basic and continuing PHN education. The assumption driving this study was the necessity to improve the nursing educational system, and develop an appropriate curriculum for the PHN national licensure.

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Objective The purposes of this study were 1) to re-examine effects obtained from previous research of a non-face-to-face behavioral intervention in poorer sleepers and 2) to examine the factors impacting on improvement of sleep
Methods The subjects were 178 poor sleepers who participated in an intervention for sleep improvement. The educational procedures comprised a minimal behavioral self-help package for one month that featured self- learning and self- monitoring of practical target habits for change. It was non face-to-face program conducted by only one member of staff. Subjects were asked to answer a questionnaire before and after the intervention. To reexamine the effects of this program found in our previous research, 9 sleep indices, sleep quality, and sleep-related behaviors were compared between before and after intervention. The sleep indices were total sleep time, sleep onset latency, sleep efficiency etc. Subjects were divided into an improvement group (n=63) and a non-improvement group (n=115) using a cutoff value for average change in sleep onset latency and sleep efficiency. After comparison of sleep and behavior between the two groups, logistic regression analysis was conducted to select parameters affecting improvement with this program.
Results Total sleep time was significantly increased from 5.7 h to 6.1 h, sleep onset time decreased 18 minutes, and sleep efficiency improved 5.6 points. With 8 of 9 sleep-related behaviors, the proportion of subjects having an undesirable habit significantly decreased. The mean total number of desirable habit' changes was 2.63 in the improvement group and significantly higher than the 2.06 in the non- improvement group. Logistic regression analysis demonstrated that large sleep onset latency at baseline and beginning of regular exercise significantly affected the improvement of sleep in the subjects, after adjusting for all other parameters.
Conclusion The effects revealed by our previous research were reconfirmed. It is suggested that this program is more useful for persons having severe sleep onset difficulties, and regular exercise is particularly important in improvement of sleep. It is possible that even simple behavioral intervention is feasible with many subjects to improve sleep and related habits in poor sleepers.

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Objective To examine the status of smoking cessation support by nurses in general hospitals, as well as related factors
Methods We conducted a questionnaire survey of 1,206 nurses working in three hospitals (inpatient and outpatient departments), and received 830 valid responses. We collected information in the following areas: sociodemographics, smoking status, work-related stress, experience of learning how to support smoking cessation, knowledge about smoking hazards and methods of assistance with quitting smoking, attitudes towards supporting smoking cessation, subjective norms to support smoking cessation, self-efficacy in smoking cessation support, intention to smoking cessation support, and status of smoking cessation support(Five “A's”). Multiple regression analysis was performed in order to identify factors related to status of smoking cessation support. We explained to subjects, both in verbal and written form, the purpose of the study, maintenance of anonymity, and the data handling and protection of confidentiality.
Results Nurses who asked patients about their smoking status (Ask) accounted for 87.8% of the total, and 88.4% advised them to quit smoking (Advice). A total of 67.5% assessed the intentions of patients to quit (Assess), 66.6% assisted their attempts to quit (Assist), and 53.3% arranged programs to prevent patients from slipping back into the habit (Arrange). The positive influential factors on “Assess” were work-related stress, attitudes, self-efficacy and intention. The positive influential factors for “Assist” were age, experience of learning, self-efficacy, intension. For “Arrange” they were attitudes, self-efficacy and intention. The results suggested that hospital nurses showed positive attitudes towards supporting smoking cessation and were highly motivated. On the other hand, 37.1% had not yet learned methods to support smoking cessation, particularly nicotine replacement therapy, the stages of cessation, and counseling methods and self-efficacy of the support related to them was low.
Conclusions In order to encourage nurses to “Assess”, “Assist”, and “Arrange”, it is necessary to spread training programs which raise self-efficacy.

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