Proposed Cut-Off Score for the Japanese Version of the Fear of Coronavirus Disease 2019 Scale (FCV-19S): Evidence from a Large-Scale National Survey in Japan.

The Fear of coronavirus disease 2019 (COVID-19) Scale (FCV-19S) is a seven-item self-administered psychological scale for measuring the fear of this disease. The scale has been widely adapted and validated worldwide. This study aimed to propose a cut-off score for the validated Japanese version of the FCV-19S. We conducted a nationwide online survey and included 26,286 respondents in the analysis. Respondents answered questions on their sociodemographic characteristics, and using the FCV-19S and six-item Kessler Psychological Distress Scale, we measured psychological distress and assessed whether the fear of COVID-19 interfered with their daily lives. A total score of ≥21 points was considered adequate to identify those with psychological distress or difficulties in daily living because of the fear of COVID-19. This cut-off score will contribute to mental health assessment during the COVID-19 pandemic.

Fear of COVID-19 Among Japanese Workers and Exacerbation of Chronic Pain: A Nationwide Cross-Sectional Study.

OBJECTIVE: To evaluate the association between fear of the coronavirus disease 2019 (COVID-19) and exacerbated chronic pain among workers during the pandemic, as well as productivity loss. METHODS: We collected data using Internet-based self-reported questionnaires, on fear of COVID-19, work productivity status, exacerbation of chronic pain during the pandemic, and several confounding factors. RESULTS: The multivariate logistic regression analysis showed that a high level of fear of COVID-19 was associated with an increased exacerbation of chronic pain (adjusted odds ratio, 2.31; 95% confidence interval, 1.21-4.44). Meanwhile, the presence of fear of COVID-19 and exacerbated chronic pain were associated with productivity impairment (adjusted odds ratio, 2.03; 95% confidence interval, 1.44-2.85). CONCLUSIONS: Our study shows that workers' fear of COVID-19 is correlated with exacerbated chronic pain and risk of presenteeism.

Association between Poverty and Refraining from Seeking Medical Care during the COVID-19 Pandemic in Japan: A Prospective Cohort Study.

This limited study examined how low household income affected avoidant behaviors to seek medical care during the pandemic. We investigated an association between household income below the relative poverty line and refraining from seeking medical care (RSMC) in a longitudinal study during the COVID-19 pandemic. We conducted an analysis of a population-based internet cohort in Japan. Individuals aged 20 to 79 years old living in Japan participated in the internet surveys between 2020 and 2021. The primary outcome was the RSMC of regular visits and new symptoms in 2021. A total of 19,672 individuals were included in the analysis. Household income below the relative poverty line in 2020 was significantly associated with refraining from seeking regular medical visits for men and women (for men, odds ratio: 1.28; confidence interval: 1.19, 1.83; for women, odds ratio: 1.42; confidence interval: 1.14, 1.82) in 2021, after accounting for RSMC in 2020. Relative poverty in 2020 was also associated with the RSMC of new symptoms among men (for males, odds ratio: 1.32; confidence interval: 1.05, 1.66) in 2021 after adjusting for covariates. The study suggested the need to alleviate the financial burden of vulnerable people seeking medical care and advocate for making necessary medical visits, even in a pandemic.

The influence of information sources on intention changes to receive COVID-19 vaccination: A prospective cohort study in Japan.

BACKGROUND: Before the COVID-19 vaccine became available, many Japanese people were undecided about whether or not to receive them. Their decisions were keys to achieving herd immunity. The impact of the type of information source on the COVID-19 vaccine uptake decision-making process remains unclear. We aimed to investigate the association between information source usage on COVID-19 and subsequent vaccine uptake status among those who have yet to decide whether to receive vaccines from non-prioritized people for vaccination. METHODS: Prospective cohort online self-administered surveys were conducted in February 2021 (T1), before the start of the mass vaccination program, and September-October 2021 (T2), when the vaccines were available to all citizens. The survey's target population was registered monitors of an Internet research company. Participants who answered "I want to get vaccinated after waiting to see how it goes." at T1 were eligible for analysis. The outcome variable was the COVID-19 vaccine uptake status in T2, and the predictors were 20 types of information sources, categorized based on people (family members, etc.), institutions (governments, etc.), or media (TV news, etc.). Adjusted odds ratio and 95% confidence intervals were estimated using logistic regression adjusted for possible confounders. RESULTS: The 5,139 respondents, mean age and standard deviation was 42.8 ± 12.5, 55.7% female, were eligible for analysis. 85.7% completed vaccination (including reserved/intended people) in T2. In the multivariate logistic analysis, odds ratios (95% confidence interval) for vaccine uptake were 1.49 (1.18-1.89) for workplaces/schools, 1.81 (1.33-2.47) for LINE, 0.69 (0.55-0.86) for Internet news and 0.62 (0.48-0.82) for video sharing sites. CONCLUSIONS: The type of information source usage played an important role in the decision to vaccinate against COVID-19. Although caution is needed in interpreting the results, obtaining information from workplaces/schools and LINE was influential in promoting immunization.

Association of combustible cigarettes and heated tobacco products use with SARS-CoV-2 infection and severe COVID-19 in Japan: a JASTIS 2022 cross-sectional study.

Insufficient evidence has been accumulated regarding associations of heated tobacco products (HTPs) use with coronavirus infection and severity of coronavirus disease 2019 (COVID-19), an ongoing pandemic. We conducted a cross-sectional study using data from an internet questionnaire administered in February 2022 to 30,130 individuals from the general Japanese population (age range, 16-81 years). Single users of HTPs and dual users of combustible cigarettes and HTPs comprised 5.2% and 7.3% of respondents, and 6.7% and 38.0% of those infected (n = 1117). Approximately 70% of infected dual users experienced severe disease. Single users of HTPs and dual users were more likely to be infected with coronavirus than never-users (adjusted odds ratio [aOR] = 1.65/4.66; 95% confidence interval [CI] 1.26-2.15/3.89-5.58). Regarding severity, former and current tobacco users (former/combustible cigarettes/HTPs: aOR = 1.88/3.17/1.90; 95%CI 1.11-3.19/1.77-5.67/1.01-3.59) were more likely to be administered oxygen than never-users, and dual users required oxygen administration the most (aOR = 4.15, 95%CI 2.70-6.36). Use of HTPs may increase risks of coronavirus infection and severe COVID-19. Our results provide an opportunity to consider the safety of tobacco products use, including HTPs, during the COVID-19 pandemic.

Faster surgery initiation in oral cancer patients during the COVID-19 pandemic in Osaka, Japan.

BACKGROUND: We investigated the impact of the COVID-19 pandemic on oral cancer (OC), comparing diagnosis and number of pre-operative days in the diagnosis of OC in 2019 (pre-COVID-19) and that in 2020 (during the COVID-19 pandemic). METHODS: Using data from a cancer registry-based study on the impact of COVID-19 on cancer care in Osaka (CanReCO), we collected details of sex, age, residential area, cancer site, date of diagnosis, clinical stage at first treatment and number of pre-operative days in OC patients. RESULTS: A total of 1470 OC cases were registered. Incidence of OC before and during COVID-19 was 814 and 656 cases, respectively. During the first wave of the pandemic (March to May 2020), incidence was about half that in the same period in 2019 (2019; n = 271, 2020; n = 145). Number of pre-operative days (median number of days between the first hospital visit and surgery date) was significantly shorter during the COVID-19 year (24.5 days) than in the pre-COVID-19 year (28 days, p = 0.0015). CONCLUSIONS: Incidence of OC during the COVID-19 pandemic was lower than in pre-COVID-19. Despite disruption in the healthcare system, the number of pre-operative days for OC cases was shorter during the pandemic.

Machine-learning approaches to identify determining factors of happiness during the COVID-19 pandemic: retrospective cohort study.

OBJECTIVE: To investigate determining factors of happiness during the COVID-19 pandemic. DESIGN: Observational study. SETTING: Large online surveys in Japan before and during the COVID-19 pandemic. PARTICIPANTS: A random sample of 25 482 individuals who are representatives of the Japanese population. MAIN OUTCOME MEASURE: Self-reported happiness measured using a 10-point Likert scale, where higher scores indicated higher levels of happiness. We defined participants with ≥8 on the scale as having high levels of happiness. RESULTS: Among the 25 482 respondents, the median score of self-reported happiness was 7 (IQR 6-8), with 11 418 (45%) reporting high levels of happiness during the pandemic. The multivariable logistic regression model showed that meaning in life, having a spouse, trust in neighbours and female gender were positively associated with happiness (eg, adjusted OR (aOR) for meaning in life 4.17; 95% CI 3.92 to 4.43; p<0.001). Conversely, self-reported poor health, anxiety about future household income, psychiatric diseases except depression and feeling isolated were negatively associated with happiness (eg, aOR for self-reported poor health 0.44; 95% CI 0.39 to 0.48; p<0.001). Using machine-learning methods, we found that meaning in life and social capital (eg, having a spouse and trust in communities) were the strongest positive determinants of happiness, whereas poor health, anxiety about future household income and feeling isolated were important negative determinants of happiness. Among 6965 subjects who responded to questionnaires both before and during the COVID-19 pandemic, there was no systemic difference in the patterns as to determinants of declined happiness during the pandemic. CONCLUSION: Using machine-learning methods on data from large online surveys in Japan, we found that interventions that have a positive impact on social capital as well as successful pandemic control and economic stimuli may effectively improve the population-level psychological well-being during the COVID-19 pandemic.

Impact of the COVID-19 pandemic on pregnancy postponement - evidence from Japan.

Japan has faced a decline in fertility since the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to investigate the rate of pregnancy postponement and its contributing factors, with a particular focus on economic- and COVID-19 infection-related indicators. This study used data from 768 observations of married women aged 18 to 50 years with pregnancy intentions. The data were obtained from two rounds of a large web-based survey conducted by the Japan COVID-19 and Society Internet Survey (JACSIS) in 2020 and 2021. A generalised estimating equation (GEE) model was employed, as well as Poisson regression models for sub-sample analysis divided by year to estimate the year differential magnitude of the contributing factors' impacts. Approximately 20% of married women with childbearing intentions postponed their childbearing. The analyses revealed that declining income and anxiety about future household finances were significantly related to delayed childbearing, while fear of COVID-19 and infection rate were not. Additionally, the adverse effects of unfavourable economic conditions were stronger in 2021. Notably, age did not influence the decision of pregnancy postponement. Older women postponed pregnancy just as much as younger women. In conclusion, this study confirmed that the COVID-19 pandemic, particularly its related adverse economic conditions, contributed to Japan's current baby bust. Considering that advanced maternal age is already common in Japan, this decreased fertility may result in the long-term negative consequence of further population decline.

Associations of parent-child exercise with family relations and parental mental health during the COVID-19 pandemic.

BACKGROUND: Due to COVID-19 pandemic and behavior restrictions, deterioration of family relations and mental health in child-rearing households has been reported. This study examined whether frequent parent-child exercise (PCE) is associated with improved family relations and parental mental health under COVID-19. METHODS: Using data from the Japan COVID-19 and Society Internet Survey (JACSIS), a nationwide survey conducted in August-September 2020, we extracted respondents with children aged 6 to 18 years (n = 2960). Logistic regression was performed to investigate the association between PCE frequency and changes in family relations and parental mental health. RESULTS: Compared with participants with 6-12-years old children, those with 13-18-years old children reported less PCE. Among participants with 6-12-years old children, compared to those without PCE, those conducted PCE more than once per week reported more improved relation with children and greater happiness (ORs ≥ 1.69), controlling covariates. Those conducted PCE 3 or more times a week also reported decreased loneliness (OR = 0.68). Whereas PCE conducted 1-2 times a month was not associated with any changes in participants with children of 6-12-years old, it was associated with more improved relations with children and spouses in participants with children of 13-18-years old (ORs ≥ 1.98). DISCUSSION: This study is the first to investigate the association of PCE with family relations and parental mental health under COVID-19. Our results suggest that PCE may enhance family relations and parental mental health and the effect may differ according to child's age.

Possible contribution of COVID-19 vaccination to the subsequent mental well-being in Japan.

The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on mental well-being. Vaccination may have played a pivotal role in enduring this mental health crisis. The present study aimed to longitudinally investigate the association between COVID-19 vaccination and mental health status among Japanese population in 2021. Longitudinal data of 17,089 individuals aged 15-79 years who participated in a nationwide online study were analyzed. Baseline and follow-up mental health statuses were assessed using the Kessler Psychological Distress Scale (K6). General linear and multivariable logistic regression models adjusted for baseline levels of mental distress were used to examine the association between vaccine receipt and follow-up levels of mental health. Mean K6 scores were lower in the vaccinated than in the non-vaccinated participants. Those who had received one or two doses of COVID-19 vaccines were associated with improved mental health at follow-up in subjects with psychological distress at baseline (odds ratio [OR] 1.31 and 1.35, respectively) and were inversely associated with deteriorated mental health status at follow-up in subjects without psychological distress at baseline (OR 0.66 and 0.70, respectively) compared with no vaccination groups, respectively. The present study would indicate that one or two doses of COVID-19 vaccinations contributed to mental well-being in Japan. This finding might provide evidence for promoting vaccination against COVID-19 and emerging infectious diseases in the future.

Socioeconomic and sociodemographic factors associated with food expense insufficiency during the COVID-19 pandemic in Japan.

OBJECTIVE: To examine the status of food expense insufficiency in Japan during the coronavirus disease 2019 (COVID-19) pandemic and the socioeconomic and sociodemographic factors associated with food expense insufficiency. DESIGN: Food expense insufficiency before and after the pandemic was assessed. The multivariable-adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated for the association between food expense insufficiency and socioeconomic and sociodemographic factors. SETTING: A large-scale, cross-sectional online questionnaire survey. PARTICIPANTS: From August to September 2020, 25,482 participants aged 15-79 years completed the questionnaire (JACSIS 2020 study; Group 1). In October 2020, 917 single parents were surveyed for oversampling purposes. There were 179 single parents in Group 1 and a total of 1096 single parents in Group 2. RESULTS: Group 1 and Group 2 had 747 (2.9%) and 55 (5.0%) participants, respectively, who experienced food expense insufficiency for the first time after April 2020. Young age, part-time employment, being a single parent (in Group 1), and the number of people in the household (five or more in Group 1 and child/children alone in Group 2) were significantly associated with food expense insufficiency. As being a single parent was significantly associated with food expense insufficiency in Group 1 (AOR [95% CI] = 7.23 [5.40-9.68]), we further examined it in Group 2. Single parents who exhibited multiple factors (young age, part-time employment, living only with child/children) were likely to experience food expense insufficiency (15.3-15.8%). CONCLUSIONS: Triggered by the pandemic, a small percentage of individuals experienced food expense insufficiency. We identified that factors such as young age, part-time employment, and being a single parent were significantly associated with food expense insufficiency, and discovered that a multiplicity of these factors further increased the risk. Our findings suggest an urgent need to support individuals with a potentially high risk of food expense insufficiency.

Psychological Distress During the Coronavirus Disease 2019 Pandemic and Associated Factors Among Undergraduate Students in Japan.

OBJECTIVE: This cross-sectional study aimed to examine factors potentially associated with psychological distress among undergraduate students during the coronavirus disease 2019 pandemic in Japan. METHODS: We analyzed data of 958 undergraduates (median age 20 y; 56.8% women) from a Web-based, self-administered questionnaire survey conducted from August to September 2020. Prevalence ratios (PRs) for psychological distress defined as 5 points or over of the Kessler Psychological Distress Scale (K6) were calculated by Poisson regression models. RESULTS: The proportion of psychological distress was 40.0%. In the mutually-adjusted model, the following were significantly associated with psychological distress: decreases in household income to 50-99% of the prepandemic amount compared with no change (PR = 1.48), newly experiencing unpaid wages compared with no experience (PR = 1.44), insufficient money to buy necessities compared with no shortage (PR = 1.45), receiving a student loan or scholarship compared with none (PR = 1.27), and communication 1 to 3 times a month compared with at least once a week (PR = 1.22). In contrast, school closure during the pandemic compared with no closure was inversely associated with psychological distress (PR = 0.78). CONCLUSIONS: Among undergraduate students in Japan, economic difficulties significantly predicted psychological distress.

[Prevalence of COVID-19 vaccination and approval rating of the social implementation of its certification: the Japan COVID-19 and Society Internet Survey (JACSIS) in September and October 2021].

Objective　We aimed to investigate the prevalence of COVID-19 vaccination and approval rating of the social implementation of its certification to stimulate economic activities such as travel and restaurant use ("vaccine passport").Methods　Using data from the Japan COVID-19 and Society Internet Survey (JACSIS) conducted in September-October 2021, we calculated the prevalence of the COVID-19 vaccination and prevalence ratios by educational level and occupation. We also analyzed the reasons for (not) being vaccinated. In addition, we examined the association between the percentage of respondents who thought that the "vaccine passport" should be used for economic recovery and socioeconomic status/trust in government vaccine information.Results　Of 27,423 survey participants (aged 20-79 years; 13,884 women and 13,539 men), the prevalence of COVID-19 vaccination was 74.8%, whereas 1,695 (6.2%) "wanted to be vaccinated after seeing how it went," and 1,742 (6.3%) indicated an "unwillingness to vaccinate." The prevalence of COVID-19 vaccination did not differ between women and men. In addition, the prevalence among people who graduated from university/graduate school was significantly higher than that of high school graduates (adjusted prevalence ratio, 1.09; 95% confidence interval (95% CI): 1.07-1.12). Regarding occupation, the adjusted prevalence ratio of "professional/technical" to "office workers" was 1.05 (95% CI: 1.01-1.07). Among the "vaccinated (twice)" group, the most common reason for vaccination was "do not want to infect family members or others" (53.0%). Among the "unwillingness to vaccinate" group, the largest percentage indicated "because I am worried about adverse reactions" (44.5%). Among the "unwillingness to vaccinate" group, only 12.2% of respondents answered that the "vaccine passport" should be utilized for economic recovery, while 41.8% of the "vaccinated (twice)" group agreed with having the "vaccine passport" (adjusted prevalence ratio, 0.30; 95% CI: 0.25-0.37). By occupation, the highest percentage was the "sales and marketing" workers (40.4%). This proportion was significantly higher in the "strongly or fairly agree" group (49.5%) for the reliability of vaccine information from the government than in the "neither agree nor disagree" group (27.5%, P<0.01).Conclusion　Differences in the prevalence of COVID-19 vaccination were found by socioeconomic status. In addition, trust in government information was associated with an approval rating of the social implementation of the "vaccine passport" in Japan. However, the results suggest that citizens' expectations and interests are not high regarding the use of the "vaccine passport" to stimulate economic activity.

Burnout and its associated factors among healthcare workers and the general working population in Japan during the COVID-19 pandemic: a nationwide cross-sectional internet-based study.

OBJECTIVES: To examine the prevalence and the associated factors of burnout among both healthcare workers (HCWs) and the general working population, which has not yet been unknown, using large-scale, nationwide data. DESIGN: Cross-sectional internet-based study. SETTING: Nationwide internet survey conducted between 8 and 26 February 2021 in Japan. PARTICIPANTS: Workers aged 20-64 years. We classified the workers as HCWs and the general working population. EXPOSURES: Demographic characteristics (age, sex and marital status), socioeconomic status (education, employment and income), health-related, work-related and industry-related factors (smoking, alcohol use, physical and psychiatric comorbidities, working hours, types of healthcare professionals, experience on the COVID-19 frontline and working industries). MAIN OUTCOME MEASURES: Burnout defined as a score of ≥3 points on the Mini-Z Single-Item Burnout Scale. RESULTS: Of the included 12 650 workers, 1087 were HCWs. After inverse probability weighting on data from the 2016 Comprehensive Survey of Living Conditions, burnout in HCWs and the general working population was 33.5% (95% CI 29.2% to 38.0%) and 31.0% (95% CI 29.7% to 32.4%), respectively. In the weighted multivariable modified Poisson regression models, working 60 hours or more was associated with burnout in all workers (HCWs: prevalence ratio (PR) 2.52, 95% CI 1.68 to 3.76; general population: PR 1.26, 95% CI 1.07 to 1.48). Widowed/separated compared with married was associated with burnout only among HCWs (PR 1.69, 95% CI 1.16 to 2.47), whereas presence of physical or psychiatric comorbidities was associated with burnout among the general working population (PR 1.14, 95% CI 1.03 to 1.28; and PR 1.65, 95% CI 1.45 to 1.87, respectively). CONCLUSIONS: Burnout was prevalent in both HCWs and the general working population in Japan. Both common and specific risk factors were observed. Our findings highlight the need for the general workplace policy and targeted interventions for burnout prevention.

Gender Difference in Fear and Anxiety about and Perceived Susceptibility to COVID-19 in the Third Wave of Pandemic among the Japanese General Population: A Nationwide Web-Based Cross-Sectional Survey.

Existing research suggested gender differences in fear and anxiety about and perceived susceptibility to COVID-19 and previous infectious disease pandemics. We analyzed whether women felt fear and anxiety about and perceived susceptibility to COVID-19 more frequently than men in Japan. We conducted a cross-sectional analysis using internet survey data collected during the third wave of the pandemic in Japan. The subjects were enrolled from the Japanese general population: 11,957 men and 11,559 women. Fear and anxiety specifically related to COVID-19 were evaluated with the Japanese version of the Fear of COVID-19 Scale (FoCS). The question "How likely do you think you will be infected with COVID-19?" was used to assess the perceived susceptibility to COVID-19. Women had higher mean (standard deviation) FoCS scores [18.6 (5.6) vs. 17.5 (5.9), d = 0.190] and reported the median or higher FoCS score (57.4% vs. 51.4%, φ = 0.060) and perceived susceptibility (13.6% vs. 11.5%, φ = 0.032) more frequently than men. The odds ratios (95% confidence intervals) adjusted for age, having a spouse, comorbidities, watching commercial TV stations' news programs, employment status, and household income were 1.24 (1.17-1.32) and 1.27 (1.16-1.38), respectively. We observed that women were more anxious and fearful about and perceived the susceptibility to infectious diseases more frequently than men even one year after the pandemic occurred in Japan, although the effect size was small.

Risk factors for workplace bullying, severe psychological distress and suicidal ideation during the COVID-19 pandemic among the general working population in Japan: a large-scale cross-sectional study.

OBJECTIVES: To investigate the risk factors for workplace bullying and mental health outcomes among workers during the COVID-19 pandemic. DESIGN: A cross-sectional study. SETTING: A nationwide online survey was conducted from August to September 2020 in Japan. PARTICIPANTS: 16 384 workers (men: n=9565; women: n=6789). MAIN OUTCOME VARIABLES: Workplace bullying was measured by one item from the Brief Job Stress Questionnaire; severe psychological distress according to the Kessler Psychological Distress Scale (≥13) and suicidal ideation by one item. Prevalence ratios were calculated by modified Poisson regression analyses adjusting for potential confounders such as gender, age, occupational characteristics and a prior history of depression. RESULTS: Overall, 15% of workers experienced workplace bullying, 9% had severe psychological distress and 12% had suicidal ideation during the second and third wave of the COVID-19 pandemic in Japan. The results of this study showed men, executives, managers and permanent employees had a higher risk of bullying than women or part-time workers. Increased physical and psychological demands were common risk factors for bullying, severe psychological distress and suicidal ideation. Starting to work from home was a significant predictor for adverse mental health outcomes but a preventive factor against workplace bullying. CONCLUSIONS: The results of this study showed different high-risk groups for bullying or mental health during the pandemic. Any intervention to decrease workplace bullying or mental health problems should focus not only on previously reported vulnerable workers but also workers who have experienced a change in work style or job demands.

COVID-19 vaccine literacy and vaccine hesitancy among pregnant women and mothers of young children in Japan.

BACKGROUND: Delays in the spread of vaccination have been recognized as an urgent public health issue in the context of the COVID-19 pandemic. Vaccine literacy (VL) is a critical determinant of vaccine uptake; however, little is known about VL among pregnant women and mothers of young children. METHODS: We analyzed data from a nationwide, cross-sectional internet survey in Japan on VL and vaccine hesitancy, conducted with 1,639 pregnant women and 5,688 mothers of young children who had given birth after July 2019, between July 24 and August 30, 2021. RESULTS: Vaccine hesitancy was observed in 51.1 % of pregnant women and 31.9 % of mothers of young children. The risk of vaccine hesitancy was significantly higher among pregnant women with lower interactive/critical skills (risk ratio [RR] 2.10, 95 % confidence interval [CI] 1.59, 2.78, p < 0.001), although functional skills did not significantly correlate with vaccine hesitancy. For mothers of young children, we found a significantly higher risk of vaccine hesitancy among those with low VL functional skills (RR 1.38, 95 % CI 1.19, 1.61), p < 0.001) and low interactive/critical skills (RR 1.29, 95 % CI 1.10, 1.50, p = 0.001). CONCLUSIONS: Our findings suggest that aiding individuals to correctly evaluate vaccine-related information is critical for improving vaccine acceptance rates among both pregnant women and mothers of young children. Meanwhile, improving the comprehensibility of communication toolkits may be important for women with children but have a limited effect among pregnant women.

Loneliness and Increased Hazardous Alcohol Use: Data from a Nationwide Internet Survey with 1-Year Follow-Up.

We aimed to examine the association between loneliness and developing alcohol dependence or hazardous alcohol use. A cohort study was conducted utilizing data from a nationwide internet survey in 2021 and 2022 in Japan. A total of 15,854 follow-up participants (55% men, with a mean age of 52.8 years) were divided based on AUDIT scores: nondrinkers (AUDIT: 0), low-risk drinkers (AUDIT: 1-7), medium-risk drinkers (AUD: 8-14), high-risk drinkers (AUDIT: 15-19), and probable alcohol dependence (AUDIT: 20-40). The University of California, Los Angeles Loneliness Scale (Version 3), a short-form three-item scale, was used to assess loneliness (high loneliness score of ≥6). The prevalence of high loneliness was higher in nondrinkers than that in low- and medium-risk drinkers, i.e., 22%, 18%, and 17%, respectively, as well as in high-risk drinkers (32%) and those with probable alcohol dependence (43%) compared to non-high-risk drinkers (19%). After adjusting for various factors (sociodemographic, social isolation, psychological distress, and smoking), non-high-risk drinkers (AUDIT: 0-14) with high loneliness were more likely to become high-or-over-risk drinkers (AUDIT: 15-40) than those without high loneliness, with adjusted risk ratios of 1.45 (95% confidence interval: 1.08-1.96) through multivariable binary logistic regression. Among non-high-risk drinkers, people with high loneliness scores at baseline were associated with increased high-risk drinking patterns with probable alcohol dependence.