Associations between Drug Use and Sexual Risk Behaviours among Men Who Have Sex with Men in Japan: Results from the Cross-Sectional LASH Study.

This study assessed drug use patterns among men who have sex with men (MSM) in Japan, and evaluated their potential associations with sexual risk behaviours. Between September and October 2016, study subjects were recruited through a cross-sectional survey (LASH: Love Life and Sexual Health) using a geosocial networking application for MSM. Of the participants, 25.4% (1756/6921) reported ever having used drugs, and 11.3% (780/6921) reported having done so in the past six months. Those who used drugs were more likely to have greater knowledge of HIV/sexually transmitted infections (STIs). Drug use in the past six months was independently associated with each of the following sexual risk behaviours in the same period: (i) six or more sexual partners (adjusted odds ratio [aOR] = 2.70, 95% confidence interval [CI]: 2.30-3.17); (ii) condomless anal intercourse (aOR = 2.88, 95% CI: 2.43-3.42); (iii) group sex (aOR = 2.60, 95% CI: 2.22-3.05); and (iv) sex work (aOR = 2.30, 95% CI: 1.67-3.16). These results suggest that MSM in Japan who use drugs are more likely to report sexual risk behaviours, while also having greater knowledge of HIV/STIs. Supporting MSM to minimise the harm from drug use may be helpful in reducing HIV transmission among this priority population.

Characterizing changes in drug use behaviour following supply shortages of 5-MeO-DIPT, alkyl nitrites and new psychoactive substances among men living with HIV in Japan.

BACKGROUND: Since 2005, Japan has incrementally banned a range of new psychoactive substances (NPS), including 5-MeO-DIPT (5MO; foxy) and alkyl nitrites (AN; rush, poppers) that have commonly been used among men who have sex with men (MSM). After the largest ban in 2014, these drugs were reported to have disappeared from the domestic market. Given that 5MO/AN/NPS use has been prevalent among men living with HIV in Japan, a population largely comprised of MSM, we sought to characterize changes in their drug use behavior following the supply shortages. METHODS: Using data from two waves of a nationwide survey of people living with HIV in Japan in 2013 and 2019-20 (n = 1042), we employed multivariable modified Poisson regression to identify correlates of self-reported reactions to the 5MO/AN/NPS shortages and changes in drug use behavior in 2019-20 vs. 2013. RESULTS: Among 391 men (96.7% MSM) surveyed in 2019-20, following the supply shortages, 234 (59.8%) stopped using 5MO/AN/NPS, 52 (13.3%) retained access to the supply, and 117 (29.9%) used substitute drugs: most commonly, methamphetamine (60.7%). Individuals who used substitutes were more likely to report unprotected sex (adjusted relative risk [ARR]=1.67; 95% confidence interval [CI]: 1.13-2.47) as well as low (ARR=2.35; 95% CI: 1.46-3.79) and lower middle (vs. upper middle to high) socioeconomic status (ARR=1.55; 95% CI: 1.00-2.41). The prevalence of past-year methamphetamine use (ARR=1.93; 95% CI: 1.11-3.35) and self-reported uncontrollable drug use (ARR=1.62; 95% CI: 1.07-2.53) were significantly higher in 2019-20 compared to 2013. CONCLUSION: Following the supply shortages, approximately one-fifth of our participants used methamphetamine as a substitute for 5MO/AN/NPS. Methamphetamine use and perceived uncontrollable drug use also appeared to have increased at the population level after the supply shortages. These findings suggest a potentially harmful substance displacement effect of the aggressive ban. Harm reduction interventions are needed in this population.

The prevalence and risk factor control associated with noncommunicable diseases in China, Japan, and Korea.

BACKGROUND: Noncommunicable disease (NCD) has become the leading cause of mortality and disease burden worldwide. METHODS: A cross-sectional survey was carried out to investigate the prevalence of NCDs and risk factor control on dietary behaviors and dietary intake in China, Japan, and Korea. RESULTS: There were significant differences among the three countries on the prevalence of hypertension (24.5% in China, 17.6% in Korea, and 15.2% in Japan), diabetes (8.9% in China, 5.7% in Korea, and 4.8% in Japan), hyperlipidemia (13.1% in China, 9.2% in Korea, and 6.9% in Japan), and angina pectoris (3.6% in China, 1.7% in Korea, and 1.5% in Japan). The prevalence rate of hypertension, diabetes, hyperlipidemia, and angina pectoris was highest in China and lowest in Japan. However, 82.2%, 48.4%, and 64.4% of Chinese, Koreans, and Japanese presented good dietary behavior, respectively. Multivariable logistic regression analysis found that sex, age, and marital status were predictors of good dietary behavior. In addition, in comparison with subjects without hypertension, diabetes, or hyperlipidemia, subjects with hypertension, diabetes, or hyperlipidemia significantly improved their dietary behaviors and controlled their intake of salt, sugar, and oil. CONCLUSIONS: The prevalence of NCDs and trends in major modifiable risk factor control in China, Korea, and Japan remain troubling. Public efforts to introduce healthy lifestyle changes and systematic NCDs prevention programs are necessary to reduce the epidemic of NCDs in these three Asian countries.

High prevalence of quasi-legal psychoactive substance use among male patients in HIV care in Japan: a cross-sectional study.

BACKGROUND: Syndemics of illicit drug use and HIV remain as significant public health issues around the world. There has been increasing concern regarding the rapidly growing market of new psychoactive substances, particularly in Asia. In response, the Japanese government has increasingly banned such substances in recent years. We sought to identify the prevalence and correlates of use of quasi-legal psychoactive substances among people living with HIV/AIDS (PLHIV) in Japan. METHODS: Data were derived from a nationwide survey of PLHIV conducted at nine leading HIV/AIDS care hospitals between July and December 2013. The prevalence and correlates of the use of quasi-legal psychoactive substances (e.g., synthetic cannabinoids, cathinone derivatives, etc. that had not been prohibited from using at the time of survey) among male participants were examined using multivariate survey logistic regression. RESULTS: Among 963 study participants, the majority (95.3%) were male. The most commonly used drug among men was quasi-legal psychoactive substances (55.3% ever and 12.8% in the previous year). In multivariate analysis, the lifetime use of tryptamine-type derivatives (i.e., 5-MeO-DIPT or N,N-diisopropyl-5-methoxytryptamine) (adjusted odds ratio [AOR]: 2.42; 95% confidence interval [CI]: 1.36-4.28) and methamphetamine/amphetamine (AOR: 3.59; 95% CI: 2.13-6.04) were independently associated with recent quasi-legal psychoactive substance use. CONCLUSIONS: In our sample of male PLHIV in Japan, quasi-legal psychoactive substances were the most commonly used drugs. Individuals who had ever used tryptamine-type derivatives or methamphetamine/amphetamine were more likely to report recent quasi-legal psychoactive substance use, suggesting a potential shift in drug use patterns from regulated to unregulated substances among this population. These findings indicate a need for further research to examine implications for HIV care.

Recreational drug use and related social factors among HIV-positive men in Japan.

This study aims to determine the relationship between recreational drug use in HIV-positive males in the past year and socio-economic factors and/or social support networks in Japan. A national online survey in a cross-sectional study was conducted by HIV Futures Japan project from July 2013 to February 2014. Of the 1095 HIV-positive individuals who responded, 913 responses were determined to be valid; responses from the 875 males were analysed. A total of 282 participants used addictive drugs (32.2%) in past year. New psychoactive substances were used by 121 participants (13.8%), methamphetamine or amphetamine by 47 (5.4%), air dusters/sprays/gas by 31 (3.5%), 5-methoxy-N,N-diisopropyltryptamine (5MeO-DIPT) by 16 (1.8%) and cannabis (1.0%) by 9. Multiple logistic regression analysis was performed with the use of alkyl nitrites, addictive drugs, air dusters and thinners, which are low illegality, as dependent variables. We found that the odds ratio (95% confidence interval) for use among participants with full-time and temp/contracted/part-time employees compared to management/administration professions were 2.59 (0.99-6.77) and 2.61 (0.91-7.51). Also, a correlation was observed between alkyl nitrites and new psychoactive substances and usage rates in people engaged in few HIV-positive networks. It is necessary to develop targeted policies for drug use prevention and user support among HIV-positive men and to support and provide care for drug users who are isolated or have a narrow HIV/AIDS support network.

[A nationwide survey for implementation of Health Japan 21 anti-smoking countermeasures in municipalities throughout Japan].

PURPOSE: Smoking cessation is one of the most important items for improvement of health in Japan. The Japanese government started a new campaign called the "Health Japan 21" to promote better health of Japanese citizens in the 21st century. The purpose of the present study was to observe the situation of the municipalities throughout Japan regarding implementation of anti-smoking countermeasures and setting of the level of target values to be achieved over the next ten years. METHODS: Mail questionnaire forms were sent to 953 municipalities which had formulated specific local plans for the promotion of health. Of this total, 793 (83.2%) responded to the inquiry. RESULTS: The most commonly implemented countermeasure against smoking was restricting smoking only to limited areas in municipality offices (75%), followed by providing support for stopping smoking (35%), and providing a complete smoke free environment in municipality offices (32.4%). Proportions of local governments putting a ban on smoking on public roads (7.5%), giving publicity to restaurants with smoking restrictions (< 5%) and setting no smoking times in the municipality offices (< 5%) were low. Some 70% of municipalities provided anti-smoking education for school children. Very few local governments took measures such as identifying age at purchasing tobacco, removing vending machines and restricting tobacco advertisement. CONCLUSION: Most municipalities have made much of anti-smoking activities. However, measures for school children were not satisfactorily implemented. The execution rates for anti-smoking activities are low in small-scale municipalities and therefore it is necessary to provide particular support in these cases.

[Family influences on future smoking habits among junior high school students in Japan].

OBJECTIVE: To examine the effects of health-related behavior and family smoking habits on the future smoking habits of junior high school students in two Japanese cities with different life expectancies. METHODS: A cross-sectional study was conducted in January 2005 of all second-grade students in a junior high school in city A located in Aomori prefecture (399 students) and city B located in Nagano prefecture (447 students). Life expectancies in city B were 4.2 years longer in men and 2.9 years longer in women than in city A. Data on feelings about future smoking habits, dislike of tobacco smoke, family smoking habits and health-related behavior were collected. RESULTS: The proportion of boys who went on to become smokers was higher in city A (18.7%) than in city B (10.3%). The proportions of smoking mothers and other smoking family members were also higher in city A, while the proportion of students who disliked tobacco smoke was lower. For girls in both cities, there was a significant positive association between future smoking and maternal smoking. CONCLUSION: The findings suggest that maternal smoking habits are especially strongly correlated with future smoking in girls. The family smoking environment and health-related behavior should therefore be considered in measures to prevent smoking by students.

The intent and practice of condom use among HIV-positive men who have sex with men in Japan.

To evaluate the intent and practice of condom use among Japanese HIV-positive men who have sex with men (MSM), a survey using anonymous questionnaires was carried out and 117 respondents were investigated. For anal sex and oral sex, respectively, 58.1% and 15.2% intended to use condoms and 47.2% and 12.4% used condoms all of the time. The intent of condom use decisively affected the practice of condom use and was closely related to the perceived risk level of HIV/sexually transmitted (STI) transmission. In anal sex, willingness to protect sexual partners from HIV infection was strongly related not only to the intent but also to the practice. Enhancement of willingness to protect oneself from STI was suggested to enhance willingness to protect his/her sexual partners from HIV infection with secondary enhancement of the intent or the practice of condom use. Specific support of MSM with HIV for improving the intent and practice of condom use is urgently needed.

Implementation of a smoke-free policy on school premises and tobacco control as a priority among municipal health promotion activities: nationwide survey in Japan.

We conducted a nationwide survey to evaluate the effect of implementing a smoke-free policy in municipalities that forbid teachers to smoke on school premises. Questionnaires were mailed to 3207 municipalities throughout Japan. After we adjusted for population size and the standardized mortality ratio for male lung cancer, we found that assigning a high priority to tobacco control in municipal health promotion activities was significantly associated with implementation of school tobacco-control policies (odds ratio = 1.50, 95% confidence interval=1.24, 1.81).

[A nationwide survey of municipalities' policy for smoking control and its implementation in relation to its priority grading by public health officers].

PURPOSE: The purpose of this study was to investigate the present situation regarding implementation of smoking control programs and to clarify relations with public health officers' attitudes toward smoking control measures. METHODS: A questionnaire form was mailed to the 3,207 local municipalities throughout Japan. The items included in the form were the contents of the smoking control programs, educational activities for passive smoking prevention, interaction with the media to spread education and awareness, and public health officers' attitudes toward smoking control measures. RESULTS: Of 3,207 municipalities, 2,570 (80.1%) responded. Over 95% of local municipalities were undertaking smoking control programs. Among the programs carried out in practice, dividing areas into smoking and non-smoking sections in local government office buildings had the highest proportion of support (80%). On the other hand, complete prohibition of smoking in local government office buildings and non-smoking support programs were conducted by less than 20%. The dissemination of education activities were executed in 60 percent of government office buildings, and 36% of schools, but only 20% of athletic gyms, hospitals, and other facilities. Sixty percent of public health officers recognized the importance of smoking control programs. A non-smoking support program and complete prohibition of smoking in government office buildings were more likely to be executed in for local municipalities with a higher priority for smoking control programs. No significant association was found between attitudes regarding program importance and the division of areas into smoking and non-smoking sections in government office buildings. CONCLUSIONS: Our results suggest that promotion of smoking control measures in local municipalities may be dependent on the public health officers' attitude toward the issues. High priority should be given to assisting public health officials and other key personnel in recognizing the importance of implementing smoking control measures for attaining better health.