Objective　This study aimed to examine the existence of healthy vaccinee bias, a source of distortion in the evaluation of vaccine efficacy, through analysis without random assignment using real data on post-vaccination symptoms from the Nagoya Study, a large epidemiological study of human papillomavirus (HPV) vaccine post-vaccination symptoms.

Methods　For three school years of individuals born in 1997, 1998, and 1999, as the HPV vaccine had a 2-year target period, 3,246 were first vaccinated at age 14 years and 3,961 were unvaccinated. The proportion of symptom onset in these 7,207 individuals during the unvaccinated period at age 13 years was compared by birth year to examine the presence of a healthy vaccinee bias.

Results　Only four symptoms were significantly higher among unvaccinated participants, such as the proportion of “severe headache,” which occurred in 2010 among those born in 1997, “hyperventilation,” which occurred in 2011 among those born in 1998, “fatigue” and “sudden vision loss,” which occurred in 2012 among those born in 1999. Healthy vaccinee biases are rarely observed.

Conclusion　Underestimation of the odds ratio of HPV vaccination due to healthy vaccinee bias is limited, and the claim that the supposedly high odds ratio in the Nagoya Study was masked by a healthy vaccinee bias is invalid.

Objective　Poverty is a factor that affects children’s health through its role in parental depression and stress. While the association between financial status and depression or quality of life scores of mothers has been previously reported in Japan, no study has focused on mothers’ subjective health and physical fatigue perceptions. This study aimed to examine the relationship between mothers’ financial anxiety and subjective health and physical fatigue perceptions.

Methods　We conducted a survey in parents attending routine health checkups for their 18-month-old infant in a single area of City A between November 2017 and October 2019. After excluding those for whom the required analysis data were missing, we analyzed data from 779 parents who responded to the survey and consented to the use of their children’s health checkup data. The response variables were maternal subjective health and physical fatigue perceptions, and the explanatory variables were the presence of financial anxiety in mothers at their child’s 3- or 18-month health checkups and financial anxiety situation in both periods. Financial anxiety was classified into four groups according to status at the 3- and 18-month time points. The independence of the qualitative variables among these four groups was verified using Fisher’s exact test, and the relationship between financial anxiety and maternal subjective health and physical fatigue perceptions was evaluated using logistic regression analysis.

Results　Financial anxiety was present in 54 mothers (6.9%) and 46 mothers (5.9%) at the 3- and 18-month checkup, respectively. Analysis of financial anxiety in both periods showed that 695 mothers (89.2%) had no financial anxiety at either time point, 30 (3.9%) had financial anxiety only at the 18-month checkup, 38 (4.9%) had financial anxiety only at the 3-month checkup, and 16 (2.1%) had financial anxiety at both time points. At the 18-month checkup, the odds ratios of poor subjective health and severe physical fatigue perceptions were 3.85 (95% confidence interval [CI]; 1.34–11.05) and 6.58 (95% CI; 2.18–19.85), respectively, among the mothers who had financial anxiety at both time points compared to those who had no financial anxiety at either time point.

Conclusion　Financial anxiety may affect mothers’ health. Therefore, mothers should be provided with solution-oriented support geared toward mitigating financial anxiety, in coordination with affiliated organizations, if financial anxiety is detected.

Objectives　This study aimed to analyze and clarify the role of public health nurses (PHNs) in assisting mothers who need assistance during antenatal checkups.

Methods　This study was conducted in core city, A. The study participants were PHNs who experienced supporting at least three mothers who required support during maternity health checkups. We interviewed the respondents about their observations, decision points, difficulties in coordination, and other aspects of support. Data were extracted from verbatim transcripts and analyzed inductively.

Results　Sixteen PHNs participants had an average of 9.3 years of experience. The analysis included 10 categories, 43 subcategories, and four themes.

PHNs connected with mothers early depending on the mothers’ wants, based on information gathered during the gestational period (theme 1). PHNs make early telephone visits to mothers based on information obtained during the gestational period. If the mother did not respond to the initial visit, the PHNs attempted to establish contact through other means.

PHNs carefully observed and assessed mothers’ childcare routines and mental and physical conditions (theme 2). To assess the mothers’ mental health status, they were interviewed in detail using the Edinburgh postnatal depression scale. Determining the mother’s condition was challenging; therefore, several PHNs conducted multiple visits and repeated the observations to achieve accurate assessments.

The PHNs stayed close to their mothers and carefully supported them toward independence while assessing their progress (theme 3). PHNs established trusting relationships with mothers.

PHNs served as coordinators in resolving problems and provided ongoing support in cooperation with medical institutions and related organizations (theme 4). The PHNs carefully coordinated consultations and encouraged mothers to consult psychiatrists if appropriate.

Conclusion　Although PHNs provided attentive care to mothers requiring assistance, difficulties arise in accurately diagnosing postpartum depression and connecting mothers to psychiatric services. Guidelines that standardize the assessment of and responses to mental health issues are required. It is necessary to organize the problems faced by mothers and develop a system of cooperation among various organizations.

Objectives　Community residents experience changes over time, including those in the care prevention system, governmental expectations, and their motivations. To support community-based prevention activities, it is necessary to clarify these changes. This study used a qualitative research method to examine changes in roles and feelings among “Kaigoyobou leaders” who had been involved in community-based care prevention activities for 10 years.

Methods　The study participants were nine leaders (six men and three women) who had been active in community-based care prevention for approximately 10 years. Through one-hour semi-structured interviews, we explored their current activities, reasons for taking the leader training course, changes in the content of their activities since completing the course, changes in their roles in activities and feelings about the activities, and what they recognized as important in their activities. Interviews were transcribed verbatim and analyzed using a modified grounded theory approach. From the transcripts, we extracted “concepts” related to changes among the leaders and generated “categories” to summarize the concepts.

Results　The analysis identified 28 concepts summarized into 12 categories. The categories included: “belief in the activities” (e.g., “focusing on preventive effects”), “learning through trial and error” (e.g., “learning continuously”), “developing the activities” (e.g., “expanding the activities”), “commitment to the community” (e.g., “valuing connections with people involved in the activities”), “increasing required roles” (e.g., “taking consultations from juniors”), “relationship with the government” (e.g., “responding to requests from the government”), “benefits from the activities” (e.g., “receiving a sense of accomplishment and satisfaction from the activities”), “burden due to the activities” (e.g., “a shortage of group members”), “aging of stakeholders” (e.g., “increasing age of the participants”), “preparing for continuity” (e.g., “new people wishing to participate”), “considering ending activities” (e.g., “reducing activities due to increasing age of the leaders themselves”), and “impact of the coronavirus.”

Conclusion　Leaders’ strong belief in their activities and their ability to adapt based on successful experiences were crucial. They responded effectively to environmental changes, including evolving government relationships. Fostering leadership belief, highlighting the benefits of activities, and supporting collaborative responses to environmental changes are essential for ongoing success.

Objectives　This study aimed to longitudinally determine the eating behavior and food group intake of female students to examine the relationship between eating behaviors and intention to improve eating habits (change in eating habits stages) and help health education use the behavior change theory.

Methods　This one-year longitudinal study included 130 female students from Japanese colleges. The stage at which eating habits and behaviors (skipping breakfast, eating out, instant food intake, and snacking) and intake of food groups rich in protein, calcium, vitamins, minerals, carbohydrates, and fats and oils were assessed. The stages were as follows; pre-contemplation or contemplation (lower group), preparation (middle group), and action or maintenance (upper group). A self-assessment questionnaire was administered to evaluate eating behaviors and food group intake frequencies using a 5-point Likert scale. P-values of <.05 were considered statistically significant.

Results　A cross-sectional comparison of eating behaviors and food group intake scores demonstrated significant differences between the stages only in snacking behavior. The upper group consumed snacks significantly less frequently than the middle and lower groups. After one year, a longitudinal comparison of eating behaviors and food group intake scores revealed significant differences in the intake of food groups rich in vitamins and minerals (green and yellow vegetables), fats and oils in the pre-contemplation stage, intake of food groups rich in vitamins/minerals (green and yellow vegetables) and frequency of skipping breakfast in the preparation stage, and frequency of eating out and snacking in the action stage. Each stage demonstrated a decreasing trend in food intake and an increasing trend in the frequency of skipping breakfast, eating out, and snacking. The percentages of students whose eating habits stage dropped during the second year were 49.0%, 100%, and 77.8% in the preparation, action, and maintenance stages, respectively. This indicates that there are cases in which readiness reverses in stages with improved eating habits.

Conclusion　In health education on eating habits, it is vital to understand the changes in eating habit stages for each eating behavior and details of actual eating behaviors and habits. Thus, health education should align to the needs of each individual to support them in transforming and maintaining a higher stage of change in their eating habits.

Objective　Poverty is a significant health determinant. As public assistance recipients experience difficulties in health management, a healthcare management support program to provide health checks has been implemented by welfare offices in Japan since 2021. However, effective approaches to maximize health check rates are limited. This study aimed to identify the impact of telephone navigation on recipients’ health check-receiving behaviors, using data from welfare offices in Toyonaka City.

Methods　This study included recipients aged 40–60 years who received telephone navigation for health check programs in 2021 and 2022. In 2021, telephone navigation was provided to eligible recipients. In 2022, the recipients were divided into two groups based on their household identification numbers (even/odd). We examined the difference in the health check rate in 2021 depending on whether the navigation system was connected. Additionally, we examined the differences across groups and navigation periods in 2022.

Results　In 2021, 32 (7.9%) recipients received health checks. Twenty-six (10.2%) of the 255 recipients and six (4.1%) of the 148 recipients in the navigated and non-navigated groups, respectively, underwent health checks. In the navigated group, health check rates were higher among recipients in their 50s (13.3% vs. 3.1%; P = 0.006), unemployed recipients (13.9% vs. 3.6%; P = 0.014), those who did not receive previous health checks (9.1% vs. 1.5%; P = 0.003), and those who did not receive regular medical consultations (8.3% vs. 0%; P = 0.012). In 2022, 247 and 225 patients were assigned to the odd- and even-numbered groups, respectively, with no differences in their characteristics. During the intervention period, four (1.6%) of the 247 recipients and 10 (4.6%) of the 219 recipients in the odd- and even-numbered groups, respectively, underwent health checks. During the non-intervention period, five (2.1%) and six (2.7%) recipients of the odd- and even-numbered groups, respectively, underwent health checks. Health check rates were higher toward the deadlines. The estimated conditional odds ratio for receiving the health checks by the navigation was 1.35 (95% confidence interval; 0.59–2.93, P = 0.503).

Conclusion　Telephone navigation may be effective in some recipients. Meanwhile, targeting recipients with attributes, such as “in their 50s,” “unemployed,” “received no previous health checks,” and “received no regular medical consultations” may increase the response rate. Therefore, policymakers should consider using reliable telephone navigation methods and navigating near deadlines.