Non-Consensual Sex among Japanese Women in the COVID-19 Pandemic: A Large-Scale Nationwide Survey-Based Study (preprint)

Background: Non-consensual sex including rape and sexual assault has been a global concern and may have been influenced by the COVID-19 pandemic, however the information on this topic is limited. Therefore, our objective was to survey the incidence rate of non-consensual sex among Japanese women aged 15-79 years between April to September 2020, following the COVID-19 pandemic in Japan.   Materials and Methods: We utilized the data obtained from a nationwide, cross-sectional internet survey conducted in Japan between August and September 2020. Sampling weights were applied to calculate national estimates, and multivariable logistic regression was performed to identify factors associated with non-consensual sex. Data was extracted from a cross-sectional, web-based, self-administered survey of approximately 2.2 million individuals from the general public, including in men and women.   Results: Excluding men and responses with inconsistencies, the final analysis included 12,809 women participants, with 138 (1.1%) reporting experiencing non-consensual sex within a five-month period. Being aged 15–29 years and having a worsened mental or economic status were associated with experiencing non-consensual sex.   Conclusions: Early intervention to prevent individuals from becoming victims of sexual harm should be extended to economically vulnerable and young women, especially during times of societal upheaval such as the COVID-19 pandemic. Additionally, Japan should prioritize the implementation of comprehensive education on the concept of sexual consent.

Association of COVID-19 vaccine intake with diagnosis, hospitalization, and oxygenation/ventilation: A longitudinal analysis, 2021-2022, Japan (preprint)

Limited national-level data exist on COVID-19 vaccine effectiveness against infection outcomes based on individual characteristics. We analyzed 19,482 individuals aged 16-81 who responded to baseline (2021) and follow-up (2022) Internet-based surveys. COVID-19 vaccine intake (0/1/2+ doses) during the follow-up period was examined, and outcomes included COVID-19 diagnosis, hospitalization, and oxygenation/ventilation. Adjusted prevalence ratios (APRs) were computed using Poisson regression models, controlling for baseline characteristics including precautionary measures practiced. 81.6% of respondents received ≥1 dose of COVID-19 vaccine during the follow-up period. Among those without COVID-19 history at baseline (N=19,182), 10.9% and 6.6% reported COVID-19 diagnosis within the past year and past 2 months at follow-up, respectively. Respondents who received 1 or 2+ doses were less likely to be diagnosed in the past year (APR=0.76 and 0.43) and past 2 months (APR=0.87 [not statistically significant] and 0.51) compared to those who did not. Among 1,999 respondents diagnosed with COVID-19 during the follow-up, those with 1 or 2+ vaccine doses showed lower likelihoods of hospitalization (APR=0.78 and 0.86) and receipt of oxygenation/ventilation (APR=0.87 and 0.61), although not statistically significant. Considering the interaction of socioeconomic and behavioral characteristics, the results supported the protective effect of the COVID-19 vaccine against infection.

Relationship Between Heated Tobacco Products and Placental Abruption: A Prospective Cohort Study Using Online Questionnaire (preprint)

Background Placental abruption (PA) is a critical obstetric complication, with maternal smoking recognized as a key risk factor. Despite the increased use of heated tobacco products (HTPs), the impact of HTPs remains unclear. This study investigated whether pregnant women using HTPs are at a higher risk of PA than non-users.Methods We analyzed data from "the Japan COVID-19 and Society Internet Survey," a prospective, self-reported online survey cohort. Questionnaires were randomly distributed between July 28, 2021, and August 30, 2021. Pregnant respondents in 2021 were invited to complete an additional survey from February 14, 2022, to February 28, 2022. We set the outcome as the absolute risk difference (aRD) and relative risk ratio (rRR) of PA incidence due to smoking HTPs in the first trimester of pregnancy. The sample size included 12 836 participants. We calculated outcomes using a generalized linear model (GLM) and inverse probability of treatment weighting (IPTW). We also performed a Bayesian approach and multiple-bias analysis for sensitivity analysis.Results We found the robust aRD of 0.07 (95% confidence interval (CI): 0.06, 0.09) and the rRR of 11.3 (95% CI: 7.5, 17.0). Multiple bias analyses showed that unmeasurable confounders would need to have at least an rRR = 14 relationship with both exposure and outcome to disprove the observed association. There has not been post hoc analysis or secondary use of data.Conclusion Early pregnancy use of HTPs is associated with an increased risk of PA.

Relationship between regular cervical cancer screening and social background in Japan during the COVID-19 pandemic (preprint)

Background: Among Organization for Economic Co-operation and Development countries, Japan has one of the lowest cervical cancer screening rates. The cancer screening rate has reportedly worsened with the coronavirus disease of 2019 (COVID-19) pandemic. This study investigated the COVID-19 history and socioeconomic background of people who did not undergo on-time cervical cancer screening (CCS) during the two years of COVID-19-related restrictions in Japan. Methods: We used data from the Japan COVID-19 and Society Internet Survey, a nationwide, internet-based, self-report, cohort observational study conducted in 2022. The outcome variable was identified by asking whether the respondent had undergone on-time CCS within the last two years. This study used multivariate log-binomial regression models to evaluate inequalities during regular checkups for CCS. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were estimated to incorporate socioeconomic background variables. Results: Of 12,066 respondents, 6469 (53.6%) had yet to undergo CCS within two years. The prevalence ratio (PR) of on-time CCS was 0.70 (95% CI: 0.63–0.79) for those in their 20s and 0.78 (95%CI:0.70-0.87) for those in their 60s, compared to their 40s. Moreover, socioeconomic inequities were found in the following groups: unemployed/student, unmarried, high school graduate or lower, and household income below 4 million yen. PR of on-time CCS with a history of COVID-19, unvaccinated status, or fear of COVID-19 was not significantly different from that of respondents who underwent CCS. However, the PR of those who had not undergone on-time CCS was significantly lower than that of respondents who had undergone breast cancer screening (PR: 0.29, 95% CI: 0.28–0.31). Conclusion: the relationship between socioeconomic inequalities and CCS hesitancy was prevalent among the younger respondents. Our findings will help policymakers identify problems and strategies to improve CCS screening rates in Japan.

Adverse Childhood Experiences and living in the socially deprived areas in adulthood: A cross-sectional study of the nationwide data in Japan (preprint)

Objectives: This study aimed to examine whether having adverse childhood experiences (ACEs) was associated with living in a deprived area in adulthood.  Methods: The cross-sectional study was conducted by using nationwide data in 2022 of the Japan COVID-19 and Society Internet Survey (JACSIS). Participants were community dwelling people 18 years or older. ACEs were assessed by Japanese version of 15-items ACE measurement tool (ACE-J). Living condition was measured by Area Deprived Index (ADI) and Densely Inhabited District (DID) based on zip code. Multivariable logistic regression to analyze the associations between ADI and ACE 4+ was conducted, controlling for individual-level factors, such as age, sex, marital status, and education, as an additional analysis.  Results: The total of 27,967 participants were included in the analysis. The prevalence of emotional neglect, childhood poverty, and school bullying were 34.5%, 21.9%, 20.0%, respectively. More than 70.1% of the population had one or more ACE(s). The number of ACEs was associated with significantly higher risk of living in deprived area in the adulthood (p<0.001). ACEs were not associated with living in density area. The association between ADI and ACEs 4+ was non-significant after controlling the individual-level factors.  Conclusion: People with higher number of ACEs tend to live in deprived areas in adulthood. Policy makers in highly deprived areas can apply the trauma-informed approach for the community care and support, which is critical to mitigating deficit perspectives and facilitating comprehensive support for those who experience ACEs.

COVID-19 testing avoidance among patients with cardiovascular disease (preprint)

Background: Rapid coronavirus 2019 (COVID-19) testing in symptomatic cases is extremely important for preventing the spread of COVID-19 infection and early therapeutic intervention. In contrast, whether symptomatic patients are tested depends largely on their health literacy, interpretation, and knowledge of COVID-19. We aimed to investigate the rate of COVID-19 testing avoidance despite having common cold symptoms in patients with cardiovascular disease and examine factors related to testing avoidance. Methods: A large-scale epidemiological questionnaire survey, the Japan COVID-19 and Society Internet Survey 2022 (JACSIS), was conducted online from April to May 2022. The rate of COVID-19 testing avoidance was investigated in patients aged 20 to 80 years with cardiovascular risk factors (hypertension, dyslipidemia, or diabetes) or a history of cardiovascular disease (angina, myocardial infarction, or stroke), only those exhibiting common cold symptoms during the 2 months in the survey. Results: Of the 1,565 eligible patients, 58% (909 patients) did not undergo COVID-19 testing. Multivariate analysis revealed that older age, obesity, non-walking regularly, long sedentary time, eating alone, frequent snacking, and having received 4 COVID-19 vaccinations were independently associated with testing avoidance. Conclusions: In the chronic phase of the COVID-19 pandemic, prompt COVID-19 testing at the time of symptomatic disease is important, and strategies to reduce testing hesitancy should be considered.

Partner Relationships, Hopelessness, and Health Status Strongly Predict Maternal Well-Being During the COVID-19 Pandemic: A Machine Learning Approach (preprint)

No recent studies have explicitly focused on predicting the well-being of pregnant women during the novel coronavirus disease (COVID-19) pandemic. This study used data from an extensive online survey in Japan to examine predictors of the subjective well-being of pregnant women during the COVID-19 pandemic. We developed and validated a machine learning model using data from 400 pregnant women obtained in 2020 to identify three factors that predict subjective well-being. The results confirmed that the model could predict pregnant women's subjective well-being with 84% accuracy. The variables that contributed significantly to this prediction were "partner help," "hopelessness," and "health status." The machine learning model was built again using these three factors, trained and validated using data from 400 pregnant women in 2020, and predicted using data from 1,791 pregnant women in 2021, with an accuracy of 88%. These were also significant risk factors for subjective well-being in regression analysis adjusted for maternal age, region, parity, education level, and presence of mental illness. This model would help identify pregnant women with low subjective well-being during the COVID-19 pandemic, and appropriate interventions can then be initiated.

Factors associated with father-infant bonding in the COVID-19 pandemic: An internet-based cross-sectional study in Japan (preprint)

The Covid-19 pandemic has forced changes in our lifestyles and affected the relationships between father and infant. The aim of this study was to explore factors associated with father-infant bonding during the Covid-19 pandemic in Japan. This study was a cross-sectional study using a nationwide online survey data. The Japanese version of the Mother-to-Infant Bonding Scale (MIBS) was used for father-infant bonding. The study participants were divided into two groups depending on their partners’ parity. A linear regression model (Gauss-Markov-type) was used for the two groups. A total of 1,055 men were included in the analysis. Of these men, 521 (49.4%) had a partner who was primipara, and 534 (50.6%) had a partner who was multipara. No significant differences were found between the two groups for MIBS-J scores. The fathers’ mental health, relationship with the partner and family members, abusive behavior towards children, wanted pregnancy, and admission history to NICU for the youngest child were associated with father-infant bonding. As for factors related to Covid-19, caring for the child while the partner is at home has a negative impact on bonding, while fear related to infection with Covid-19 has no negative impact on the bonding.

The association between social isolation and loneliness with COVID-19 vaccine uptake (preprint)

As coronavirus disease 2019 (COVID-19) vaccine uptake has plateaued at an unsatisfactory level, we must detect groups who are potential vaccine recipients. We examined social isolation and loneliness, increasingly recognised but neglected social determinants of health, as associated with being unvaccinated. Using a representative sample of the Japanese general population from Internet surveys (JACSIS 2021 and JASTIS 2022), social isolation was assessed using the Lubbern Social Network Scale and loneliness was assessed using the UCLA Loneliness Scale version 3. We used a multivariable logistic regression model to calculate the odds ratio (OR) of being unvaccinated in 2022 in socially isolated or lonely people after adjusting for demographics. In addition, we asked unvaccinated participants why they were not vaccinated. Our results show that people who were socially isolated were significantly less likely to receive information from people who had been vaccinated (11% vs. 15%), and less likely to have a negative impression of vaccination (27% vs. 19%) compared with people who were not socially isolated. Socially isolated people tended not to have had a COVID-19 vaccination even though they had no negative impression regarding the vaccine. Socially isolated people are important targets to reach to increase the number of vaccinated people.

Married women’s decision to delay childbearing, and loneliness, severe psychological distress, and suicidal ideation under crisis: Online survey data analysis from 2020 and 2021 (preprint)

Background The COVID-19 pandemic has affected every aspect of our lives, including the decision to become pregnant. Existing literature suggests that infertility and the decision to delay childbearing at a younger age are associated with a lower level of well-being and regrets when women start to desire a baby. Thus, the decision to delay childbearing due to the pandemic could negatively affect the well-being of women. This study focuses on how pregnancy decisions affect the well-being of women during the COVID-19 pandemic.Methods From the Japan COVID-19 and Society Internet Survey, a nationally representative web-based survey, 768 observations of married women aged 18 to 50 years who had the intention of getting pregnant during the pre-pandemic period (conducted in 2020 and 2021) were used. Loneliness, severe psychological distress, and suicidal ideation were used as well-being indicators. For pooled data, a generalised estimated equation (GEE) model was used to estimate how pregnancy decision related to well-being indicators. For a sub-analysis, the sample was divided by the survey year and a Poisson regression model was used.Results Approximately 20% of married women reported that their decision to postpone childbearing was due to the pandemic. The GEE analysis showed an association between delaying childbearing and severe psychological distress, with the prevalence ratio (PR) being 2.06 [95% CI (1.40–3.03)]. Furthermore, loneliness and suicidal ideation that occurred after the beginning of the pandemic were significantly related to the decision to delay childbearing—1.55 [95% CI (1.03,2.34)] and 2.55 [95% CI (1.45–4.51)], respectively. Moreover, these PRs were larger for 2021 compared to 2020.Conclusion During the COVID-19 pandemic, approximately one-fifth of married women who had childbearing intentions before the pandemic decided to postpone pregnancy. They exhibited a deteriorated mental health state. Furthermore, the negative associations were larger in 2021 compared to 2020. Loneliness has negative consequences for both mental and physical health, as well as elevated severe psychological distress and suicidal ideation among those who decided to postpone pregnancy. Therefore, the current results should not be overlooked by society.

Structural equation modeling of the effects of psychological distress and a fear of coronavirus disease 2019 on diabetes care in Japan (preprint)

This study aimed to examine the effects of psychological distress and a fear of coronavirus disease 2019 (COVID-19) on diabetes care in Japan. We used data from a 2020 nationwide internet survey in Japan involving 28,000 respondents aged 15–79 years. The question items included psychological factors (Kessler psychological distress scale and fear of COVID-19), employment, trust in neighbors, informal caregiving, and history of diabetes care. After excluding respondents with comorbidities and those who had not visited the hospital, 625 patients with diabetes were analyzed. Statistical mediation was then examined through a path analysis using structural equation modeling. Discontinued diabetes care was independently associated with psychological distress (risk ratio = 1.44, 95% confidence interval [1.01–2.06]) and a fear of COVID-19 (1.41 [1.01–1.95]). The results of the structural equation modeling indicated that a fear of COVID-19, employment, trust in neighbors, and informal caregiving were indirectly associated with continued diabetes care via psychological distress. These findings suggest that a fear of COVID-19 is associated with continued diabetes care via psychological distress. COVID-19 pandemic may affect psychological distress and lead to refrained diabetes care among Japanese patients with diabetes. Moreover, employment, trust in neighbors, and family caregiving were also found to buffer refrained diabetes care. As psychological factors and socioeconomic status can affect diabetes care, a fear of COVID-19 should be considered in patients with diabetes to help ensure the continuation of diabetes treatment.

Heated tobacco products and a telemedicine smoking cessation programme: A retrospective study (preprint)

ABSTRACT Objectives Japan is one of the largest markets for heated tobacco products (HTP), and the number of HTP users, including dual users, is burgeoning. However, it is not yet clear whether a telemedicine smoking cessation programme is helpful for nicotine-dependent people who use HTPs. Methods We retrospectively evaluated the effectiveness of a telemedicine smoking cessation programme for nicotine-dependent tobacco product users, comparing short- and long-term continuous abstinence rates (CAR) from 9 to 24 weeks (CAR9-24) and 9 to 52 weeks (CAR9-52). We divided programme participants into 1) exclusively cigarette users, 2) exclusively HTP users, and 3) dual users. Using logistic regression with inverse probability weighting, an adjusted odds ratio (aOR) with a 95% confidence interval (CI) for CAR was calculated to compare the differences among the three groups. Results We analysed 733 telemedicine smoking cessation programme participants (exclusively cigarette users, 52%; exclusively HTP users, 31%; and dual-users, 16%) dating August 2018 to October 2020. HTP users had higher CARs than the exclusively cigarettes group in CAR9-24 (aOR, 1.12; CI, 1.02–1.23; p=0.02) and CAR9-52 (aOR 1.09; CI, 0.99–1.19; p=0.08). Conversely, dual users had lower CARs than the exclusively cigarettes group in the CAR9-24 (aOR, 0.85; CI, 0.76–0.95; p=0.004) and CAR9-52 (aOR, 0.88; CI, 0.79–0.97; p=0.01). Conclusions Exclusively HTP users achieved higher CARs, whereas dual users had lower CARs than exclusively cigarette users over short- and long-term periods. A telemedicine smoking cessation programme may be a reasonable option for exclusively HTP users. Key messages What is already known on this topic Telemedicine smoking cessation programmes can be helpful for some nicotine-dependent people. What this study adds Exclusively HTP users had higher continuous abstinence rates (CARs) than the exclusively cigarettes group. Conversely, dual users had lower CARs than the exclusively cigarettes group. A telemedicine smoking cessation programme may be a reasonable option for exclusive HTP users. How this study might affect research, practice, or policy In addition to conventional combustible cigarettes, the number of HTP users, including dual users, is burgeoning in Japan. This study could add an effective and alternative option for HTP users to remotely quit smoking in the era of COVID-19 and beyond.

SARS-CoV-2 Suppression and Early Closure of Bars and Restaurants: A Longitudinal Natural Experiment (preprint)

Despite severe economic damage, full-service restaurants and bars have been closed in hopes of suppressing the spread of SARS-CoV-2 worldwide. This paper explores whether the early closure of restaurants and bars in February 2021 reduced symptoms of SARS-CoV-2 in Japan. Using a large-scale nationally representative longitudinal survey, we found that the early closure of restaurants and bars decreased the utilization rate among young persons (OR 0.688; CI95 0.515-0.918) and those who visited these places before the pandemic (OR 0.754; CI95 0.594-0.957). However, symptoms of SARS-CoV-2 did not decrease in these active and high-risk subpopulations. Among the more inactive and low-risk subpopulations, such as elderly persons, no discernible impacts are observed in both the utilization of restaurants and bars and the symptoms of SARS-CoV-2. These results suggest that the early closure of restaurants and bars without any other concurrent measures does not contribute to the suppression of SARS-CoV-2.

Risk factors for workplace bullying, severe psychological distress, and suicidal ideation during the COVID-19 pandemic: a nationwide internet survey for the general working population in Japan (preprint)

ObjectivesThe pandemic of the new coronavirus disease (COVID-19) has created a challenging environment for workers. This study aimed to investigate the risk factors for workplace bullying and mental health outcomes during the pandemic among workers. MethodsWe conducted a nationwide online cross-sectional survey from August to September 2020 in Japan (N = 16,384). Workplace bullying was measured by one item from the Brief Job Stress Questionnaire; severe psychological distress (SPD) by K6 ([≥]13); and suicidal ideation by one item. Prevalence ratios were calculated by Poisson regression analyses adjusting for potential confounders such as gender, age, occupational characteristics, and a prior history of depression. ResultsOverall, 15% of workers experienced workplace bullying, 9% had SPD, 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 compared to women or part-time workers. Increased physical and psychological demands were common risk factors for bullying, SPD, and suicidal ideation. Newly starting working from home was a significant predictor for adverse mental health outcomes, however, it was found to be a preventive factor against workplace bullying. ConclusionsThe results of this study found different high-risk groups for bullying or mental health during the pandemic. When intervening to decrease workplace bullying or mental health problems, we should focus on not only previously reported vulnerable workers but also workers who experienced a change of their working styles or job demands. Key messagesO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIWorkplace bullying is one of the severe job stressors in the workplace that cause mental health problems. C_LIO_LIHealth care workers, less-educated workers, and non-regular female workers have been reported to have greater psychological distress during the COVID-19 pandemic. C_LI What are the new findings?O_LIAbout 15% of workers experienced workplace bullying, 9% had SPD, and 12% had suicidal ideation during the pandemic in Japan. C_LIO_LIMen, executives, managers, and permanent workers had a higher risk of bullying compared to women or part-time workers. C_LIO_LIIncreased physical or psychological demands were common risk factors for bullying, SPD, and suicidal ideation. C_LIO_LIWhile newly starting working from home was a preventive factor against workplace bullying, it was found to be a significant risk factor for adverse mental health outcomes. C_LI How might this impact on policy or clinical practice in the foreseeable future?O_LIThe results of this study indicate a different pattern of high-risk groups for bullying or mental health during the pandemic. C_LIO_LIWhen intervening to decrease workplace bullying or mental health problems, we should focus on not only previously reported vulnerable workers but also workers who experienced a change of their working styles or job demands. C_LI

The effect of social restrictions, loss of social support, and loss of maternal autonomy on postpartum depression in 1 to 12-months postpartum women during the COVID-19 pandemic (preprint)

Background This study focuses on postpartum women, who are one of the most vulnerable populations during the COVID-19 pandemic, aiming to reveal mental health consequences of social restrictions, loss of social support, or loss of autonomy. Methods A cross-sectional study for postpartum women was conducted in October 2020 (N = 600). The Edinburgh Postpartum Depression Scale (EPDS) was used to measure postpartum depression. The prevalence ratios were estimated by log-binomial regression models, adjusting for age, education, household income, residence area, parity, the timing of delivery, and a prior history of depression. Results The prevalence of postpartum depression was 28.7% (EPDS ≥ 9), 18.6% (≥ 11), and 13.1% (≥ 13). Social restrictions including cancellation of home visits by health care professionals, or cancellation of infant checkups or vaccinations, loss of support during pregnancy or after delivery including loss of opportunities to consult with health care professionals or friends, or cancellation of parents or other family members’ visits to support, and loss of autonomy about delivery or breastfeeding, were associated with postnatal depression. Conclusion About 30% of women who delivered and raised a baby during the COVID-19 pandemic had postpartum depression, which is much higher than a pre-pandemic meta-analysis. COVID-19 related social restrictions or loss of social support from healthcare professionals, family, and friends were significantly associated with postpartum depression. Also, loss of maternal autonomy in delivery and breastfeeding is associated with postpartum depression. The results indicate that both formal and informal support should not be limited to prevent postpartum depression during the pandemic.

SARS-CoV-2 Suppression and Early Closure of Bars and Restaurants : A Longitudinal Natural Experiment (preprint)

Despite severe economic damage, full-service restaurants and bars have been closed in hopes of suppressing the spread of SARS-CoV-2 worldwide. This paper explores whether the early closure of restaurants and bars in February 2021 reduced symptoms of SARS-CoV-2 in Japan. Using a large-scale nationally representative longitudinal survey, we found that the early closure of restaurants and bars decreased the utilization rate among young persons (OR 0.688; CI95 0.515-0.918) and those who visited these places before the pandemic (OR 0.754; CI95 0.594-0.957). However, symptoms of SARS-CoV-2 did not decrease in these active and high-risk subpopulations. Among the more inactive and low-risk subpopulations, such as elderly persons, no discernible impacts are observed in both the utilization of restaurants and bars and the symptoms of SARS-CoV-2. These results suggest that the early closure of restaurants and bars without any other concurrent measures does not contribute to the suppression of SARS-CoV-2.

Use of heated tobacco products may be associated with hypertensive disorders of pregnancy and low birth weight in Japan: An analysis of the JACSIS study (preprint)

ABSTRACT Background Little is known about heated tobacco product (HTP) use in pregnant women and associated maternal and neonatal risks for hypertensive disorders of pregnancy (HDP) and low birth weight (LBW). Thus, this study aimed to assess the status of HTP use among pregnant women in Japan and explore the risk of HDP and LBW associated with HTP use. Methods Using data from the Japan “COVID-19 and Society” Internet Survey (JACSIS) study, a web-based nationwide survey, we investigated 558 post-delivery and 365 currently pregnant women in October 2020. We assessed the prevalence of ever HTP smokers (defined as ever experiencing HTP use) in post-delivery and currently pregnant women. Among post-delivery women, we collected the information regarding HDP and LBW based on their Maternal and Child Health Handbooks (maternal and newborn records). In the multivariable regression analysis, we estimated the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of ever HTP smokers for HDP and LBW compared with those of never HTP smokers using logistic regression. A stratified analysis with respect to combustible cigarette smoking (never/ever) was also performed. Results The prevalence of ever HTP use were 11.7% and 12.6% in post-delivery and currently pregnant women, respectively. Among post-delivery women, ever HTP smokers had higher HDP incidence (13.8% vs. 6.5%, P =0.03), with an OR of 2.78 (95% CI 0.84–9.15) and higher LBW incidence (18.5% versus 8.9%, P =0.02), with an elevated OR of 2.08 (95% CI 0.80–5.39). A similar tendency was observed among never and ever combustible cigarette smokers. Conclusion In Japan, the incidence of HTP use has exceeded 10% among pregnant women, and HTP smoking may be associated with increased maternal and neonatal risks. School-based tobacco prevention and cessation programs should be conducted regardless of product types to prevent life-threatening perinatal complications and deaths. What this paper adds Little is known about heated tobacco product (HTP) use and associated perinatal risks among pregnant women. In Japan, the prevalence of ever HTP use exceeded 10% among pregnant women. HTP use approximately doubled perinatal risk of hypertensive disorders of pregnancy and low birth weight. When stratified by cigarette smoking status, a similar tendency was observed among never and ever cigarette smokers.

Loneliness, social isolation, and pain following the COVID-19 outbreak: data from a nationwide internet survey in Japan (preprint)

The aim of cross-sectional study was to investigate the association between pain and loneliness and increased social isolation during the COVID-19 pandemic. 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 chronic pain history/prevalence. 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 chronic pain history/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 pain prevalence/incidence, intensity, and the history/prevalence of chronic pain.

Factors Associated with Serious Psychological Distress during the COVID-19 Pandemic in Japan (preprint)

Importance: The coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on mental health, leading to higher suicide rates in many countries. However, little is known about the factors associated with worsened mental health during the COVID-19 pandemic. Objective: To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan. Design, Setting, and Participants: A cross-sectional study using a large-scale internet survey conducted between August 25 and September 30, 2020, in Japan. Exposures: Demographics (age, gender, marital status, family composition, and caregiving burden), socio-economic status (income level, employment type, educational attainment); the experience of domestic violence (DV), the state of emergency, fear of COVID-19, and stigma related to COVID-19. Main Outcomes and Measures: Prevalence of SPD, defined as Kessler 6 scale score [≥]13. Results: Among 25,482 individuals included in this study, 2,556 (10%) met the criteria of SPD. Overall, women (adjusted odds ratio [aOR] 1.59; 95%CI, 1.17-2.16; P=0.003), ages 15-29 (aOR compared with ages 45-59, 2.35; 95%CI, 1.64-3.38; P<0.001), low income (aOR compared with intermediate income, 1.70; 95%CI, 1.16-2.49; P=0.007), those who provide caregiving to family members (aOR, 5.48; 95%CI, 3.51-8.56; P<0.001), experiencing DV (aOR, 5.72; 95%CI, 3.81-8.59; P<0.001), and fear of COVID-19 (aOR, 1.96; 95%CI, 1.55-2.48; P<0.001) were associated with a higher prevalence of SPD. Among women aged 15-29 years who experienced the highest rate of SPD, caregiving, DV, fear of COVID-19, and COVID-19-related stigma were associated with a higher likelihood of SPD; whereas economic situation (income level and employment type) and social isolation (marital status) were not associated with the prevalence of SPD. Conclusions and Relevance: Economic situation, caregiving burden, DV, and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women--who have a higher risk of suicide during the COVID-19 pandemic in Japan--similar factors, except economic situation, were associated with a higher rate of SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population's mental health.