Health inequalities in school children inOkinawa and the school’s role toimprove their health and well-being:
before and after the COVID-19 pandemic
Minoru Takakura
Faculty of Medicine
University of the Ryukyus
JICA Workshop “Building Stronger Partnerships
in the New Normal: Post-COVID-19 in Asia andthe Pacific Islands” 2021.3.18
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School closure due to the COVID-19
pandemic
School closure in Okinawa

March (short period), April, May, August (staggeredattendance)

The effects of school closure on health in childrenand adolescents2

Mental health↓ (Nearchou et al, 2020; Loades et al, 2020)



Physical activity↓ (Cachón-Zagalaz et al, 2020)

Sedentary behaviors (screen time)↑ (Stockwell et al, 2021)

Sleep quality↓ (Bates et al, 2020)

Some groups, such as low SES groups, seem to be more
vulnerable to the burden of the COVID-19 pandemic.

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School closure due to the COVID-19
pandemic
The effectiveness of school closure during
coronavirus outbreaks

Data from the SARS outbreak suggest that school
closures did not contribute to the control of theepidemic (Viner et al, 2020)．

Voluntary behavioral changes, such as telework, had anassociation with COVID-19 incidence and mortality thatwas 3 times stronger than that of school closures(Zimmerman & Anderson, 2021)．

We should re-realize that schools are very important
place in where the students can go about healthy
daily living.

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Socioeconomic inequalities in youth
health and the school’s role

The aim of the study was to examine the association
between caries, SES, and tooth-brushing program
after school lunch in elementary schools.
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Methods
Study design and setting

Cross-sectional study in 43 public elementary schools
under the jurisdiction of two regional education
boards in Okinawa in 2018

Data collection

A self-administered questionnaireData of dental caries and SES provided by school
records

Participants



5



1,248 fifth graders (aged 11 years) enrolled in thestudy schools with informed consents from parents

The study protocol was approved by the IRB of theUniversity of the Ryukyus
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Measures Dental caries
 DMF (decayed, missing, filled teeth)≧1
 DMF＝0

 Socioeconomic status (SES) Received school expense subsidies(low SES) Not received school expense subsidies(High SES)
 Tooth-brushing time after school lunch Yes/No

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The prevalence of caries in children
by sociodemographic variables(%)
70

The overall prevalence was 39%
60
50.9
50

47.0
42.0

40

46.7

40.9
36.9

35.9

35.2

38.2

36.4

30

20

100Boys GirlsSex
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2>=

<2

Number ofsibling<2/d 2/d>=

1/d>= <1/d

Toothbrushing

SweeteneddrinkYes

No

School expensesubsidies

The result of multilevel logistic
regression analysis
School-level
Tooth-brushingprogram

OR=1.8 (95%CI:1.03-3.0)

Individual-level
SES(school expensesubsidies)

Caries
OR=1.7 (95%CI:1.2-2.4)

Adjusted for individual- and school-level covariates
and school clustering effects
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Conclusion


The tooth-brushing program after school lunch has
an independent association with dental caries among
school children.

School-level activities might have contextual effects
on individual health over and above individual-level
characteristics, such as SES and health-related
behaviors.

Although it is difficult to change SES by individual
efforts, school-level activities can play the importantrole in promoting health and well-being amongchildren and adolescents.

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