"What Did You Do in the War, Daddy?": Paternal Military Conscription During WWII, Economic Hardship and Family Violence in Childhood, and Health in Late Life in Japan.

Childhood adversity is a risk factor for poor health in late life and includes economic hardship and family violence, whose prevalence is high among offspring of military conscripted father. We assessed the association between paternal military conscription (PMC) and paternal war death (PWD) during Second World War and self-rated health (SRH) among older adults in Japan. Data were obtained from a population-based cohort of functionally independent people aged 65 years or older from 39 municipalities across Japan in 2016. Information on PMC and SRH was obtained through a self-report questionnaire. A total of 20,286 participants were analyzed with multivariate logistic regression to investigate the association between PMC, PWD, and poor health. Causal mediation analysis was performed to see whether childhood economic hardship and family violence mediated the association. Among participants, 19.7% reported PMC (including 3.3% PWD). In the age- and sex-adjusted model, older people with PMC showed higher risk of poor health (odds ratio [OR]: 1.16, 95% confidence interval [CI] [1.06, 1.28]), while those with PWD were not associated (OR: 0.96, 95% CI [0.77, 1.20]). Causal mediation showed a mediation effect of childhood family violence exposure on the association between PMC and poor health (proportion mediated: 6.9%). Economic hardship did not mediate the association. PMC, but not PWD, increased the risk of poor health in older age, which was partially explained by the exposure to family violence in childhood. There appears to be a transgenerational health impact of war which continues to affect the health of offspring as they age.

On the Direct and Indirect Effects of the Great East Japan Earthquake on Self Rated Health through Social Connections: Mediation Analysis.

The Great East Japan Earthquake created health hazards for many people. Using Panel Data gathered in Iwanuma city, Japan, at two points in time (in 2010 before the quake, and in 2013 after the quake), we found that the high degree of housing damage negatively affected victims' self rated health (SRH) (direct effect), and decreased the levels of their social connections, which in turn also had a harmful effect on their SRH (indirect effect). We also found that although the direct impacts of earthquakes disappear relatively quickly, the harmful indirect effects associated with a decrease in social connections are slower to dissipate. We conducted a first-difference two-step GMM estimation to consider the possible problem of endogeneity. The results support the above conclusion, and show that in the short-term, the indirect impacts of the earthquake accounted for 55% of all the impacts experienced.

Which part of community social capital is related to life satisfaction and self-rated health? A multilevel analysis based on a nationwide mail survey in Japan.

This paper aims to clarify the association between various social capital components at the municipal level (community social capital) and two quality-of-life factors at the individual level [individual self-rated life satisfaction and self-rated health (SRH)] based on data from a nationwide social capital survey that the authors carried out in 2013 in Japan (N = 3406 in 99 municipalities). The survey covers residents in Japan between the ages of 20 and 79 years. We focus on both contextual social capital and household income inequality in terms of the Gini coefficient at the municipality level since, to the best of our knowledge, no paper has explicitly dealt with municipalities in Japan as the units of contextual social capital and the Gini. Our analyses show that the subjective life satisfaction of individuals, after controlling for socioeconomic status and health at the individual level, is associate with both an income gap and social capital at the municipal level. Every component of community social capital in this study except for generalized reciprocity, both cognitive (generalized trust, particularized trust, and particularized reciprocity), and structural (three types of group participation and daily contacts with neighbors, friends/acquaintances, and colleagues), and the Gini coefficient on earned income were associated with self-rated life satisfaction at the individual level with statistical significance. However, SRH is associated only with cognitive social capital at the community level. SRH has no significant association with structural components of community social capital or with a community income gap in terms of the Gini coefficient on personal income. Judging from the results of estimates in the study, most of the components of community social capital at the municipal level seem to play an important role in enhancing self-rated life satisfaction. Life satisfaction may be associated with the broad atmosphere of the municipal level where one resides, while SRH is associated with cognitive social capital rather than structural social capital. However, the difference in the impact of contextual social capital between the two QOL indices may indicate the importance of considering a proper contextual level that is suitable for the outcome.

Does social participation improve self-rated health in the older population? A quasi-experimental intervention study.

Social participation has been linked to healthy aging and the maintenance of functional independence in older individuals. However, causality remains tenuous because of the strong possibility of reverse causation (healthy individuals selectively participate in social activities). We describe a quasi-experimental intervention in one municipality of Japan designed to boost social participation as a way of preventing long-term disability in senior citizens through the creation of 'salons' (or community centers). In this quasi-experimental intervention study, we compared 158 participants with 1391 non-participants in salon programs, and examined the effect of participation in the salon programs on self-rated health. We conducted surveys of community residents both before (in 2006) and after (in 2008) the opening of the salons. Even with a pre/post survey design, our study could be subject to reverse causation and confounding bias. We therefore utilized an instrumental variable estimation strategy, using the inverse of the distance between each resident's dwelling and the nearest salon as the instrument. After controlling for self-rated health, age, sex, equivalized income in 2006, and reverse causation, we observed significant correlations between participation in the salon programs and self-rated health in 2008. Our analyses suggest that participation in the newly-opened community salon was associated with a significant improvement in self-rated health over time. The odds ratio of participation in the salon programs for reporting excellent or good self-rated health in 2008 was 2.52 (95% CI 2.27-2.79). Our study provides novel empirical support for the notion that investing in community infrastructure to boost the social participation of communities may help promote healthy aging.

Does social capital affect the incidence of functional disability in older Japanese? A prospective population-based cohort study.

BACKGROUND: Recent increases in numbers of older people have been accompanied by increases in those with functional disability. No study has examined the association between community social capital and the onset of functional disability. METHODS: The association between community social capital and the onset of functional disability was examined using data from the Aichi Gerontological Evaluation Study, a prospective cohort established in 2003 in Japan. Perceptions of community social capital (indicators of social cohesion such as trust of others and extent of social participation) in 6953 men and 7636 women aged 65 years or older were surveyed. Multilevel survival analysis using the discrete-time hazard model was applied. RESULTS: During 4-year follow-up, onset of functional disability occurred in 759 men and 1146 women. Women living in communities with higher mistrust had 1.68 (95% CI 1.14 to 2.49) times higher OR of onset of disability, even after adjusting for covariates. Mediators did not substantially change this association. Lack of social participation seemed to affect the health of women, though the effect was marginal (OR for covariates adjusted model =1.12 (95% CI 0.96 to 1.31)). There were no significant ORs among men. CONCLUSIONS: Lower community social capital was associated with higher incidence of onset of functional disability among older women but not among men. Community-based interventions to promote social capital may be useful for preventing functional disability of older Japanese women.

Participation in sports organizations and the prevention of functional disability in older Japanese: the AGES Cohort Study.

BACKGROUND: We sought to examine prospectively the difference in the association between incident functional disability and exercise with or without sports organization participation. METHODS: The study was based on the Aichi Gerontological Evaluation Study (AGES) Cohort Study data. In October 2003, self-reported questionnaires were mailed to 29,374 non-disabled Japanese individuals aged 65 years or older. Of these, 13,310 individuals were introduced to the Study, and they were followed for 4 years. Analysis was carried out on 11,581 subjects who provided all necessary information for the analysis. RESULTS: Analysis was carried out on incident functional disability by 4 groups of different combinations of performance of exercise and participation in a sports organization Active Participant (AP), Exercise Alone (EA), Passive Participant (PP) and Sedentary (S). Compared to the AP group, the EA group had a hazard ratio (HR) of 1.29 (1.02-1.64) for incident functional disability. No significant difference was seen with the PP group, with an HR of 1.16 (0.76-1.77). When a measure of social networks was added to the covariates, the HR of the EA group dropped to 1.27 (1.00-1.61), and significant differences disappeared. In contrast, it showed hardly any change when social support was added. CONCLUSION: The results suggested that, even with a regular exercise habit, incident functional disability may be better prevented when a person participates in a sports organization than when he/she does not. In addition, participation in a sports organization correlates positively with social networks, which may lead to a small decrease in incident functional disability.

Place-specific constructs of social capital and their possible associations to health: a Japanese case study.

The story of Roseto, Pennsylvania, USA, is one of the most widely cited studies of the putative influence of community social cohesion on population health. However, few contemporary studies of community-based "social capital" on health have addressed "communities" as unique places with unique histories outside of a Western context. In the present study, we focus on a specific region of Japan (which we call the M-region to preserve anonymity). Using survey data and qualitative interviews, we discuss the historical and contextual origins of the high social capital in the M-region that could account for its relatively good health profile. The analysis of survey data suggested that the residents of M-region have higher norms of reciprocity and participate more in horizontal organizations (including volunteer group, citizen or consumer group, sports group or club, and hobby group), and it also indicated better health status and behaviors in some outcomes among the residents of M-region. Based on qualitative interviews, the origins of social capital in the M-region appeared to be rooted in the strong sense of solidarity fostered by the fact that many of the residents were recruited into the region by the same local employer (a steel manufacturing company). Our study points to the need to ground studies of community-based "social capital" and health on detailed knowledge of the historical context of specific places.

Trends in cause specific mortality across occupations in Japanese men of working age during period of economic stagnation, 1980-2005: retrospective cohort study.

OBJECTIVE: To assess the temporal trends in occupation specific all causes and cause specific mortality in Japan between 1980 and 2005. DESIGN: Longitudinal analysis of individual death certificates by last occupation before death. Data on population by age and occupation were derived from the population census. SETTING: Government records, Japan. PARTICIPANTS: Men aged 30-59. MAIN OUTCOME MEASURES: Age standardised mortality rate for all causes, all cancers, cerebrovascular disease, ischaemic heart disease, unintentional injuries, and suicide. RESULTS: Age standardised mortality rates for all causes and for the four leading causes of death (cancers, ischaemic heart disease, cerebrovascular disease, and unintentional injuries) steadily decreased from 1980 to 2005 among all occupations except for management and professional workers, for whom rates began to rise in the late 1990s (P<0.001). During the study period, the mortality rate was lowest in other occupations such as production/labour, clerical, and sales workers, although overall variability of the age standardised mortality rate across occupations widened. The rate for suicide rapidly increased since the late 1990s, with the greatest increase being among management and professional workers. CONCLUSIONS: Occupational patterns in cause specific mortality changed dramatically in Japan during the period of its economic stagnation and resulted in the reversal of occupational patterns in mortality that have been well established in western countries. A significant negative effect on the health of management and professional workers rather than clerks and blue collar workers could be because of increased job demands and more stressful work environments and could have eliminated or even reversed the health inequality across occupations that had existed previously.

Assessing the association between all-cause mortality and multiple aspects of individual social capital among the older Japanese.

BACKGROUND: Few prospective cohort studies have assessed the association between social capital and mortality. The studies were conducted only in Western countries and did not use the same social capital indicators. The present prospective cohort study aimed to examine the relationships between various forms of individual social capital and all-cause mortality in Japan. METHODS: Self-administered questionnaires were mailed to subjects in the Aichi Gerontological Evaluation Study (AGES) Project in 2003. Mortality data from 2003 to 2008 were analyzed for 14,668 respondents. Both cognitive and structural components of individual social capital were collected: 8 for cognitive social capital (trust, 3; social support, 3; reciprocity, 2) and 9 for structural social capital (social network). Cox proportional hazard models stratified by sex with multiple imputation were used. Age, body mass index, self-rated health, current illness, smoking history, alcohol consumption, exercise, equivalent income and education were used as covariates. RESULTS: During 27,571 person-years of follow-up for men and 29,561 person-years of follow-up for women, 790 deaths in men and 424 in women were observed. In the univariate analyses for men, lower social capital was significantly related to higher mortality in one general trust variable, all generalised reciprocity variables and four social network variables. For women, lower social capital was significantly related to higher mortality in all generalised reciprocity and four social network variables. After adjusting for covariates, lower friendship network was significantly associated with higher all-cause mortality among men (meet friends rarely; HR = 1.30, 95%CI = 1.10-1.53) and women (having no friends; HR = 1.81, 95%CI = 1.02-3.23). Among women, lower general trust was significantly related to lower mortality (most people cannot be trusted; HR = 0.65, 95%CI = 0.45-0.96). CONCLUSIONS: Friendship network was a good predictor for all-cause mortality among older Japanese. In contrast, mistrust was associated with lower mortality among women. Studies with social capital indices considering different culture backgrounds are needed.

Social capital, income inequality and self-rated health in Chita peninsula, Japan: a multilevel analysis of older people in 25 communities.

The effect of social capital on one's health has drawn researchers' attention. In East-Asian countries, however, such an effect has been less studied than in Western countries. Mindful of this background, this study aimed to investigate the linkage between social capital and health at the level of a small area in Japan, and also to examine whether social capital mediates the relation between income inequality and health. The main survey targeted 34,374 people aged 65 years and older from 25 communities who were without the need of nursing care. We collected 17,269 questionnaires (response rate 50.2%), from which we used 15,225 (response rate 44.3%) which had complete information on self-rated health, age, and sex. The main outcome measure was self-rated health status (1=fair/poor; 0=very good/good). The individual-level variables of age, sex, equivalised income, marital status, educational attainment, and type of housing were included to control for compositional effects. Average income, social capital and the Gini coefficient were used as community-level variables. The variable of social capital was calculated as the percentage of individuals in the community samples who reported "yes" or "it depends" to the question "Generally speaking, would you say that most people can be trusted?" When the individual-level variables and the average equivalised income at the community level were controlled for, we found that high social capital and a decreased Gini coefficient were significantly associated with good self-rated health using a multilevel model. The association between social capital and self-rated health was insignificant after adjustment for the Gini coefficient. However, in other series of models, we also detected a statistically significant linkage between the increased Gini coefficient and negative responses to the question of individual-level trust using multilevel models. This suggests that people who live in conditions of high-income inequality tend to exhibit low trust levels, and that social capital mediates the relation between income inequality and health. This study is, to our knowledge, the first investigation of the linkage between social capital and health in Japan using multilevel analysis, and reports the first supported result of the relative income hypothesis in Japan. Additionally, the statistically significant linkage between the increased Gini coefficient and low trust observed in this study provides additional evidence to support the social cohesion and collective social pathway between income inequality and health.

[An evaluation of an area's social capital by public health nurses].

PURPOSE: To clarify how public health nurses evaluate the social capital (SC) of an area and clarify associations with the area's health level. METHOD: Using a five-point scale, we conducted a questionnaire survey of public health nurses (n = 70) in area B of prefecture A with questions about: (1) health behaviour; (2) the residential environment; (3) social relationships; (4) activity and responsiveness; and (5) total health level in different elementary school districts. In the same area, we also conducted a questionnaire survey of the elderly living in the community (n = 17,269) and compared the results with those of the public health nurse survey. Correlation analysis and multiple regression analysis were applied to identify associations between variables in a comparison of the two surveys. RESULTS: Correlations between the two surveys for an SC index were found, for example between (3) social relationships and "locality attachment" (r = .425, P<0.01), (3) social relationships and "meeting friends" (r = .404, P<0.01), and (4) activity and responsiveness and "receiving support" (r = .233, P< 0.05), indicating that public health nurses can determine the kind of SC that an area has. The results of multiple regression analysis, using total health level as a dependent variable and the other four variables as independent variables, showed that an area's SC (indicated by social relationships and activeness and responsiveness) can be evaluated using associations with the area's health level. Experienced public health nurses (n = 24, 11 and above service years) well captured social relationships and evaluated them in relation to health level, whereas young public health nurses (n = 46, 10 and below service years) well captured activity and responsiveness and evaluated them in relation to health level. CONCLUSION: On the basis of the results showing that public health nurses can determine an area's SC in relation to its health level, we could show using social capital theory the importance of having a public health nurse evaluate and diagnose a community's SC.

Association between depression and socio-economic status among community-dwelling elderly in Japan: the Aichi Gerontological Evaluation Study (AGES).

This study investigated the prevalence of depression by area and socio-economic status (SES). Study participants were 32,891 Japanese elderly aged 65 and over who responded to a postal survey conducted in 15 municipalities in 2003. Depression was assessed using a short version of the Geriatric Depression Scale (GDS-15). SES was measured using years of education and income adjusted for family size. After adjustment for age, illness, higher level of activities of daily living, sex, marital status, and self-rated health, depression was still significantly associated with lower SES and residential area. Further research should also examine the area effect on health.