Investigating the causal effects of COVID-19 vaccination on the adoption of protective behaviors in Japan: Insights from a fuzzy regression discontinuity design.

BACKGROUND: During the COVID-19 pandemic, concerns emerged that vaccinated individuals might engage less in infection-preventive behaviors, potentially contributing to virus transmission. This study evaluates the causal effects of COVID-19 vaccination on such behaviors within Japan, highlighting the significance of understanding behavioral dynamics in public health strategies. METHODS: Utilizing Japan's age-based vaccination priority for those born before April 1, 1957, this research employs a regression discontinuity design (RDD) to assess the vaccination's impact. Data from the fourth round of a longitudinal online survey, conducted from July 20 to 27, 2021, served as the basis for analyzing 14 infection-protective behaviors, including mask usage, handwashing, and avoiding crowds. RESULTS: A total of 12067 participants completed the survey. The analyzed sample size varied by outcome variable, ranging from 1499 to 5233. The analysis revealed no significant differences in the 14 behaviors examined among fully vaccinated, partially vaccinated, and unvaccinated individuals. This consistency across groups suggests that vaccination status did not significantly alter engagement in protective behaviors during the observation period. CONCLUSIONS: Empirical findings highlight the complexity of behavioral responses following vaccination, indicating that such responses may be influenced by various factors, rather than by vaccination status alone. Additionally, this result underscores the importance of crafting public health policies that account for the intricate interplay between vaccination and behavior. This study contributes to the broader discourse on managing responses to the pandemic and tailoring interventions to sustain or enhance protective health behaviors amid vaccination rollouts.

Correction: Impact of the COVID-19 pandemic on exercise habits and overweight status in Japan: a nation-wide panel survey.

[This corrects the article DOI: 10.1371/journal.pgph.0001732.].

Impact of the COVID-19 pandemic on exercise habits and overweight status in Japan: A nation-wide panel survey.

A catastrophic disaster may cause distant health impacts like immobility and obesity. The aim of this research was to analyse the association of the COVID-19 pandemic and lifestyle factors -exercise habit and overweight status in the Japanese population. Nation-wide online questionnaires were conducted five times from October 2020 to October 2021. The changes in exercise habit, body mass index (BMI) and overweight status (BMI >25kg/m2) were compared between the first questionnaire and a questionnaire conducted a year later. Risk factors for losing exercise habit or becoming overweight were analysed using multiple regression. Data were obtained from 16,642 participants. In the early phase of the pandemic, people with high income and elderly females showed a higher risk for decreased exercise days. The proportion of overweight status increased from 22.2% to 26.6% in males and from 9.3% to 10.8% in females. Middle-aged males, elderly females, and males who experienced SARS-CoV-2 infection were at higher risk of becoming overweight. Our findings suggest that risks for immobility and overweight are homogeneous. Continuous intervention for elderly females and long-term intervention for males infected with SARS-CoV-2 might be especially needed. As most disasters can cause similar social transformation, research and evaluation of immobility and obesity should address future disaster preparation/mitigation plans.

Effects of being eligible for specific health guidance on health outcomes: A regression discontinuity analysis using Japan's data on specific health checkups.

The significance of general health checkups and guidance is controversial. To examine the effectiveness of Japan's specific health checkup (SHC) and specific health guidance (SHG) programs, this study applied a regression discontinuity design (RDD) using the SHC results database collected by a private company. We applied a sharp RDD with a cutoff body mass index (BMI) of 25 kg/m2 for those with a waist circumference (WCF) of <85 cm in men and < 90 cm in women, with risks of hypertension, dyslipidemia or diabetes, and aged between 40 and 64 years. Study outcomes were differences in BMI, WCF, and major cardiovascular risk factors between the baseline year and the following year. We analyzed the data of baseline years of 2015, 2016, and 2017 separately and their pooled data. We judged the results to be robust significant when significant results in the same direction were found in all four analyses. A total of 1,041,607 observations out of 614,253 people were analyzed. We found robust significant results that those eligible for SHG in the baseline year had a lower BMI (both men and women) and lower WCF (men only) in the following year than those not eligible for SHG: BMI for men (-0.12 kg/m2, 95% CI [confidence interval]: -0.15 to -0.09); BMI for women (-0.09 kg/m2, 95% CI: -0.13 to -0.06); and WCF for men (-0.36 cm, 95% CI: -0.47 to -0.28) in the pooled data. Robust significant results were not found in WCF for women or in major cardiovascular risk factors.

Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy and the Three Good Things Exercise for Insomnia: 3-Arm Randomized Controlled Trial.

BACKGROUND: The treatment of insomnia with sleep medication causes problems such as long-term use, dependence, and significant economic losses, including medical expenses. Evidence-based lifestyle guidance is required to improve insomnia symptoms not only in person but also in easy-to-use web-based formats. OBJECTIVE: This study aims to clarify whether unguided internet-based cognitive behavioral therapy (ICBT) or the Three Good Things (TGT) exercise, both administered as self-help internet interventions without email support, could improve insomnia symptoms compared with a waiting list control (WLC) group. METHODS: A 4-week program was implemented, and participants were randomly allocated to 1 of the 3 groups. The primary outcome measure was the Pittsburgh Sleep Questionnaire (PSQI) score at 4 weeks compared with baseline. RESULTS: Of the 21,394 individuals invited to participate, 312 (1.46%) met the eligibility criteria and were randomly assigned to 1 of the 3 groups. Of these 312 individuals, 270 (86.5%; ICBT 79/270, 29.3%; TGT 88/270, 32.6%; and WLC 103/270, 38.1%) completed a postintervention survey at 4 and 8 weeks. The adjusted mean changes of the primary outcome measure (PSQI) in the ICBT (-1.56, 95% CI -2.52 to -0.59; P<.001) and TGT (-1.15, 95% CI -2.08 to -0.23; P=.002) groups at 4 weeks from baseline showed a significant improvement compared with the WLC group. The adjusted mean changes in the secondary outcome measures of sleep onset latency, total sleep time, Athens Insomnia Scale score, and Patient Health Questionnaire-9 score at 4 weeks from baseline, as well as in the PSQI at 8 weeks from baseline, showed significant improvement for ICBT. Moreover, total sleep time, Athens Insomnia Scale, and Patient Health Questionnaire-9 scores at 4 weeks from baseline showed a significant improvement in the TGT group compared with the WLC group. CONCLUSIONS: A total of 4 weeks of unguided ICBT and TGT exercises improved insomnia. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry UMIN000034927; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000039814.

Association between COVID-19 vaccine hesitancy and generalized trust, depression, generalized anxiety, and fear of COVID-19.

BACKGROUND: Although numerous studies have been published on the predictors of COVID-19 vaccine hesitancy, some possible predictors remain underexplored. In this study, we explored the associations of unwillingness and indecisiveness regarding COVID-19 vaccination with generalized trust, mental health conditions such as depression and generalized anxiety, and fear of COVID-19. METHODS: Data of wave 1 (from October 27 till November 6, 2020) and wave 3 (from April 23 till May 6, 2021) of a longitudinal online study conducted in Japan were used for the analyses. Unvaccinated participants were asked at wave 3 about their willingness to be vaccinated, with possible responses of willing, unwilling, or undecided. These three responses were used as the outcome variable, and multinomial logistic regression analyses were conducted with willingness to be vaccinated as the reference group. Explanatory variables included generalized trust, depression, generalized anxiety, and fear of COVID-19 both at wave 1 and 3, and sociodemographic and health-related variables. RESULTS: Of the 11,846 valid respondents, 209 (1.8%) answered that they had already been vaccinated against COVID-19, 7089 (59.8%) responded that they were willing to be vaccinated, 3498 (29.5%) responded that they were undecided, and 1053 (8.9%) responded that they were unwilling to be vaccinated. After adjusting for covariates, we found that: (1) participants with lower levels of generalized trust at wave 1 and 3 were more likely to be undecided or unwilling at wave 3; (2) respondents with moderately severe or severe depression at wave 1 and 3 were more likely to be undecided at wave 3; (3) participants with moderate or severe levels of generalized anxiety at wave 3 but not at wave 1 were more likely to be unwilling at wave 3; and (4) respondents with high levels of fear of COVID-19 at wave 1 and 3 were less likely to be undecided and unwilling at wave 3. CONCLUSIONS: Generalized trust, mental health conditions such as depression and generalized anxiety, and low level of fear of COVID-19 are associated with unwillingness or indecision regarding being vaccinated against COVID-19.

Behavioral Factors Associated with COVID-19 Risk: A Cross-Sectional Survey in Japan.

BACKGROUND: Behaviors to avoid infection are key to minimizing casualties of the COVID-19 pandemic, as well as to avoid excessive interventions that are less effective. This study aims to identify behavioral patterns associated with SARS-CoV-2 infection in the real world. METHODS: A questionnaire-based cross-sectional study was conducted targeting a research panel of NTTCom Online Marketing Solutions Corporation or its affiliates. Data were extracted so that their demographic composition ratios matched the population estimates. Individuals who answered with consistency to have been diagnosed with SARS-CoV-2 at a medical facility were categorized into a SARS-CoV-2 group. Differences in lifestyles were compared using multiple regression and inverse probability weighing. RESULTS: In total 13,277 participants were included, of whom 44 (0.33%) were categorized as the SARS-CoV-2 group. Diagnosis of SARS-CoV-2 was negatively correlated with crowd avoidance, mask wearing, and hand-washing behavior. On the contrary, the diagnosis was positively correlated with some behaviors that appear to be preventive actions against the infection, such as changing clothes frequently, sanitizing belongings, and remote working. CONCLUSIONS: It is important to conduct evidence-based intervention on people's behaviors and to avoid excessive interventions that are less effective, so that people can minimize the indirect harm, such as exhaustion and economic loss.

Are consumer confidence and asset value expectations positively associated with length of daylight?: An exploration of psychological mediators between length of daylight and seasonal asset price transitions.

Many economists claim that asset price transitions, particularly stock price transitions, have a seasonal cycle affected by length of daylight. Although they claim that the seasonal affective disorder (SAD) is a mediator between the length of daylight and asset price transitions, recent studies in psychology have been inconclusive about the existence of SAD, and some economics studies disagree regarding the involvement of SAD in seasonal stock price transitions. The purpose of the present study is to examine if there is any psychological mediator linking length of daylight and seasonal asset price transitions as an alternative or supplement to SAD. As a possible mediator, we examined Japan's consumer confidence index (CCI) and asset value expectations (AVE), which indicate people's optimism for future economy and are generated from a monthly household survey by the Japanese government. We analyzed individual longitudinal data from this survey between 2004 and 2018 and estimated four fixed-effects regression models to control for time-invariant unobserved heterogeneity across individual households. The results revealed that, (i) there was a seasonal cycle of CCI and AVE; the trough occurred in December and the peak in early summer; (ii) the length of daylight time was positively associated with CCI and AVE; and (iii) the higher the latitude, the larger the seasonal cycle of CCI and AVE became. These findings suggest that the length of the daylight may affect asset price transitions through the cycle of optimism/pessimism for future economy exemplified by the CCI and AVE.

Are the effects of blood pressure lowering treatment diminishing?: meta-regression analyses.

BACKGROUND: Previous studies have suggested that the effects of medical interventions tend to diminish over time. We investigated whether the effects of blood pressure lowering treatment on all-cause mortality and stroke have diminished over time. METHODS: We conducted meta-regression analyses. We extracted the target trials from two recently published comprehensive systematic reviews and meta-analyses. Adopted variables were relative risk (RR) of all-cause mortality and stroke, trial start year, mean age, sample size, baseline systolic blood pressure (SBP), difference in attained SBP reduction between intervention groups and control groups (SBP difference), and regional dummies. We implemented single meta-regressions, in which the dependent variable was the log of RR and the explanatory variable was each of other adopted variables. We also conducted multiple meta-regressions, in which the dependent variable was the log of RR and explanatory variables were all of other adopted variables. Our variable of greatest interest was trial start year. RESULTS: The included reviews assessed 85 trials with a total of 343,126 participants. Although trial start year was positively associated with the log of RR in the results of single meta-regressions, it lost significance in multiple meta-regressions for both all-cause mortality and stroke. CONCLUSIONS: The effects of blood pressure lowering treatment on all-cause mortality and stroke have not diminished over time.

Effects of five-minute internet-based cognitive behavioral therapy and simplified emotion-focused mindfulness on depressive symptoms: a randomized controlled trial.

BACKGROUND: Notwithstanding a high expectation for internet-based cognitive behavioral therapy (iCBT) for reducing depressive symptoms, many of iCBT programs have limitations such as temporary effects and high drop-out rates, possibly due to their complexity. We examined the effects of a free, simplified, 5-minute iCBT program by comparing it with a simplified emotion-focused mindfulness (sEFM) exercise and with a waiting list control group. METHODS: A total of 974 participants, who were recruited using the website of a market research company, were randomly assigned to the iCBT group, the sEFM group, and the control group. Those in the intervention arms performed each exercise for 5 weeks. The primary outcome measure was the Center for Epidemiological Studies Depression scale (CES-D) at postintervention. Secondary outcome measures were the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 scale (GAD-7). Intention-to-treat analyses were conducted. RESULTS: During postintervention assessment, there were no significant differences between the intervention arms and the control group in the CES-D, although the difference between the iCBT arm and control group was close to significance (p = 0.05) in favor of iCBT. There was a significant difference in the PHQ-9 in favor of the sEFM group compared with the control group. There were no significant differences in outcome measures between the three groups at the 6-week follow-up. CONCLUSIONS: Although both iCBT and sEFM have the potential to temporarily reduce depressive symptoms, substantial improvements are required to enhance and maintain their effects. TRIAL REGISTRATION: This trial is registered with the UMIN Clinical Trial Registry (UMIN-CTR) (ID: UMIN000015097 ) on 1 October 2014.