FY2014
Surveillance of Health in School Children and Adolescents
Project Report
Chapters 1-3(Abstract Draft)

Committee for Surveillance of Health in School Children and Adolescents
Chaired by Takehiko Ohzeki (Emeritus Professor of Hamamatsu University School ofMedicine)

August 30, 2016

Prepared for the Globalization Committee

A. Introduction
The Public Interest Incorporated Association Japan Society of School Health (JSSH)[Nihon Gakko Hokenkai] aims to provide evidence that contributes to the education andgovernment administration in health at national and municipal levels by surveying andanalyzing the health status of school children and junior and senior high school students in thisproject.
This is primarily a questionnaire survey; different factors such as “risk factors forlifestyle-related disease,” “lifestyle (exercise, diet, and others),” “mental health,” and “allergysymptoms” are investigated, and statistical analysis and tabulation are conducted.
In FY2014, 123 elementary, junior high, and senior high schools in total from 21
prefectures were surveyed as the surveillance collaborators. A total of 19219 school children
and students were surveyed, as shown in the table below.

GenderTotalBoysGirlsGradeOverall
Elementary Elementary Elementary Junior high Senior highschool
schoolschoolschoolschoolGrades 1-2 Grades 3-4 Grades 5-6 Grades 1-3 Grades 1-3
1,121
1,377
1,319
3,844
1,988
9,659
1,080
1,330
1,282
3,647
2,221
9,560
2,201
2,707
2,601
7,491
4,219 19,219

The survey period was from December 2014 through February 2015.
Specifically, the JSSH distributes the questionnaire sheets to the collaborators throughlocal Societies of School Health and Boards of Education, and children/students or theirguardians fill out the answers based on the health status on schooldays excluding Saturdays andSundays. The items for the lifestyle-related disease risk factors are completed by class teachers
or school nurses.
The questionnaire sheets are sent back from the schools to the JJSH via Boards ofEducation, after the respondents’ names are painted over or cut apart.
B. Overview of the Survey Results1) Introduction
This project started in 1992, and the survey is conducted every other year and the datatabulation is carried out in the following year. This time, the survey was conducted in FY2014,
and its report is released in FY2015.
Based on the data accumulated so far, the JSSH has published school life manuals forschool children and students, namely Desirable Lifestyle (FY2005) and Lifestyle for Children
Nurtured at Home and Schools (FY2010).
This is an abstract to present the survey summary. Please refer to Health Surveillance of
School Children and Students: Project Report for more details. The overview of the survey
results are as follows.
2) Survey Results by Category(1) Risk factors for lifestyle-related disease
The prevalence of obesity was determined by the percentage of overweight; the highest
score for boys and girls was observed at Age 12 (13.4%) and Age 15 (10.3%), respectively.
It is likely that “the trend of high prevalence of obesity continues to date,” consideringthat the obesity prevalence was about 3% in 1970. This survey also revealed the increase ofobesity among the senior high school boys and girls.
The prevalence of thinness was highest at Age 15 (2.4%) for boys and at Age 12 forgirls (4.3%).
When the standard for high waist circumference is assumed to be 75cm or more forelementary school children and 80cm or more for junior high school students by applying themetabolic syndrome diagnosis standards for small children in Japan, 16.1%/10.6% (boys/girls)
of 5th and 6th graders and 13.0%/8.6% of junior high school students were determined to havehigh waist circumference. Those whose waist circumference was half or more of his/her bodyheight were 19.5%/10.6% for 5th and 6th graders and 12.9%/12.2% for junior high school
students.
The prevalence of hypertension was 0.1-1%, which was similar to previous surveys.
Hypertension was also observed in 1.3-7.2% of the senior high school boys.
Dyslipidemia was evaluated based on the abnormal level of total cholesterol(≥220mg/dl), increased level of LDL cholesterol (≥140mg/dl), and decreased level of HDLcholesterol (≤40mg/dl); 4.7, 3.4, 1.4/3.2, 1.5, 1.4% of elementary school children, 1.7, 1.0,2.0/4.1, 2.3, 1.1% of junior high school students, and 1.3, 2.9, 2.5/6.5, 5.4, 1.5% of senior highschool students.
The scores of the obese group were statistically significant in seven indexes, namely,
systolic and diastolic blood pressures, average blood pressure, total cholesterol, LDL cholesterol,
HDL cholesterol, and arteriosclerosis index (note: HDL cholesterol was significantly lower,
others were higher).
(2) Lifestyle
Overall, 69.4% and 51.6% of boys and girls answered that they “have a bowel
movement daily,” respectively. One every five to eight junior high and senior high school girls
answered that they “sometimes do not have a bowel movement for a few days.”
As for the status of having a breakfast, 95.0/95.7% (boys/girls) answered that they “eatbreakfast most days.” The incidence of missing breakfast was high among the senior highschool students at 11.0/7.6%, followed by the junior high school students at 6.3/5.7%.
Within the obese groups of the junior high school girls and senior high school boys,
more students answered that they “do not eat breakfast” (with statistical significance). Within
the thin group of senior high school girls, 15.7% of them answered that they “do not eat
breakfast” (with statistical significance).
Within the thin group, about 10% of the junior high school boys, 3rd and 4th grade girls,
and junior high school girls answered that they “want to be thinner;” however, this figure
increased to about 20% among the senior high school girls (with statistical significance). Within
the obese group, the boys and girls of the 1st and 2nd grades, junior high school boys, andsenior high school boys answered that they “feel they are okay as is” (with statisticalsignificance).
Overall, 73.9/56.2% has a daily habit of being physically active. The figure for thesenior high school girls in particular was notably low in terms of age distribution.
In terms of gender, the average time of exercise for boys and girls was 3 hours and 58
minutes and 3 hours and 24 minutes for strenuous exercise, 2 hours and 46 minutes and 2 hours
and 19 minutes for moderate exercise, and 1 hour and 42 minutes and 1 hour and 29 minutes forlight exercise, respectively. The survey showed a bipolar trend; the exercise time decreases as
the grade advances, while students involved in extracurricular activities in junior or senior highschool exercise longer.
When the time of playing electric games, surfing on the Internet, and watching atelevision are totaled as the “screen time,” the overall average for boys and girls was 5 hours
and 55 minutes and 5 hours and 40 minutes, respectively. In terms of the grades, it rapidly
increased as the grade advances; the screen time for boys and girls was 3 hours and 38 minutes

and 3 hours and 21 minutes for the 1st and 2nd grades and increased to 6 hours and 49 minutes
and 6 hours and 36 minutes for junior high school students and 7 hours and 11 minutes and 7hours and 1 minute for senior high school boys and girls, respectively.
The proportion of going to after-school cramming schools was lowest in the 1st and 2ndgrades at 16.1/17.1% and was followed by a gradual increase; the peak was 45.0/45.3% for thejunior high school students.
In terms of the correlation between the lifestyle results and the blood test results, thosewith shorter exercise time often had abnormal levels of LDL-cholesterol.
The average time of going to sleep was 21:20/21:20 for the 1st and 2nd graders, but itchanged to 23:12/23:21 for junior high school students and 23:50/23:53 for senior high school
students. These values are roughly 10 to 30 minutes later than those observed in a similar study
conducted in FY1981 (see FY1981 School Children and Students Health Status Survey byJSSH).
The average time of waking up was 06:35 for both boys and girls of the 1st and 2ndgrades, 06:37/06/32 for junior high school students, and 06:38/06:32 for senior high school
students.
The time to leave home for school was 07:30/07:29, and the duration to leave home
after waking up was 55/57 minutes, overall.
(3) Mental healthIn the Question 34.1 that examines the depressive emotion, “Sometimes I feel like I
don’t want to do anything because I feel depressed,” 23.1% of boys and 28.2% of girls
answered positively.
In the Q34.7 “Sometimes I think I want to die,” 14.3/22.8% (boys/girls) answered that
“Sometimes I feel like I want to die.” In light of the nature of such answers, it was advised thatthe relevant respondents should receive prompt attention and response for these particularquestions.
In the Q34.3 on “hyperactivity,” “I cannot stay still because I cannot calm down,”
23.9/18.4% answered positively, suggesting higher incidence in boys than in girls.
In the Q35.2 on “behavior,” “Sometimes I lose my temper over trivial things,”
26.5/25.8% answered positively, overall.
In the Q35.4 about “having friends,” 14.0/9.1% answered that “I have been bullied orteased by others.”
To examine the “trend of temper dysregulation,” the answers of “often,” “sometimesand “occasionally” to Q34 as well as “highly applicable” and “applicable” to Q35 werecollectively totaled and assessed following a flow chart; 6.4/9.1% of junior high students and7.1/9.5% of senior high school students were shown to be positive.
The trend of temper dysregulation in the populations of disaster-affected regions wasmore evident among junior and senior high school girls with over 10% in both cases; 7.7/10.1%
of junior high school students and 6.4/13.0% of senior high school students were experiencing
temper dysregulation in the disaster areas.
Many items were shown to be statistically significant (α>0.05) when compared to theBody Style Group 3, especially in the obese groups of girls.
(4) Allergy
The prevalence of bronchial asthma was 17.1% overall; 4.5% (5.5% and 3.4% for boys andgirls, respectively) are those who are currently diagnosed and 12.6% are those who had beenpreviously diagnosed. In terms of grades, the 1st and 2nd graders were the highest at 6.7%, and highschool students were the lowest at 2.1%. There was no significant difference among grades interms of past diagnosis. When the question asked if a respondent has experienced any wheezing or
whistling in the chest, 6.6% answered “Yes.” Those who answered “Yes” were also asked if his/her
sleep was ever disrupted by the wheezing, and 49.9% answered “No;” it suggests that the other half

of them may be suffering from the nighttime sleep disorder. Those who experience such
episodes 1 to 3 times a year (presumably the intermittent type) accounted for 70.2%, and those
who experience 4 to 12 times a year who are likely somewhere between the intermittent typeand mild persistent type or worse accounted for 16.4%.
The prevalence of atopic dermatitis was 12.6% overall; 5.5% (boys/girls 5.8/5.2%) arethose who are currently diagnosed, and 7.1% are those who had been previously diagnosed. The
prevalence rate among the 1st and 2nd graders was the highest at 7.1%, and the junior highschool students were the lowest at 4.3%. The ratio of past diagnosis was highest at senior highschools and the lowest at the 1st and 2nd grades. The total of the current and past diagnosis
showed little difference across the school grades, indicating that the incidence of atopic
dermatitis is not increasing recently unlike bronchial asthma.
The prevalence of food allergy was 7.9% overall; 2.5% (2.9/2.1%) are those who are
currently diagnosed, and 5.4% are those who had been previously diagnosed. The total of thecurrent and past diagnosis ratio was highest at the 1st and 2nd grades, suggesting that theprevalence of food allergy was increasing in the last 12 years. The peanut was the most common
cause (17.0%) among the possible food items included in the survey, followed by chicken eggs
(16.4%); the lowest was the soy (2.3%).
The prevalence of cedar pollen allergy was 13.3% overall; 9.3% (10.0/8.6%) are those
who are currently diagnosed, and 4.0% are those who had been previously diagnosed. There wasno notable difference across age. The prevalence of sick building syndrome was 0.8%, and the bee
venom allergy was 0.1%.
Among the past history, anaphylaxis was 3.9% and shock was 0.6%. The ratio of those
who carry epinephrine, which accounted for 0.1% in the previous survey, increased to 0.3% in thissurvey.
In terms of mental health issues, the odds ratio between those “applicable” and “notapplicable” for bronchial asthma and the answer “Sometimes I lose my temper over trivialthings” was 0.638 (95% Confidence Interval: 0.420-0.971). The odds ratio for positive ornegative answers to the question “I have been bullied or teased by others” was 1.900 (95% CI:1.117-3.233).
In terms of food allergy and mental health, the odds ratio for positive or negative
answers for the question “I cannot stay still because I cannot calm down” was 1.953 (95% CI:1.265-3.016), and the odds ratio for “I sometimes get angry, start crying or feel happy all thesudden” was 1.762 (95% CI: 1.013-3.04).
C. Committee Structure and Other Notes* Committee for Health Status Surveillance of School Children and Students
Fumio Inoue: Kyoto University of Education (Lifestyle)Takanori Imai: Showa University School of Medicine (Allergy symptoms)
Takehiko Ohzeki: Emeritus Professor of Hamamatsu University School of Medicine (Chair)Seiko Kashihara: Setagaya City Nakazato Elementary School (Lifestyle)
Reiko Sugiura: Wayo Women’s University Department of Health and Nutrition (Lifestyle)
Takahiro Tsuchiya: The Institute of Statistical Mathematics (Statistical analysis)
Keiichi Hanaki: Tottori University Faculty of Medicine School of Health Sciences(Lifestyle-related disease)
Koichi Hirano: Hamamatsu City Welfare Medical Center for the Developmental Medicine(Mental health)
Mitsunori Murata: Tokyo Women’s Medical University and Wayo Women’s University(Observer)

* We thank the following members of the Ministry of Education, Culture, Sports, Science andTechnology (MEXT) for their great assistance and advice.
MEXT Elementary and Secondary Education Bureau: Natsuki Matsunaga, Nobuko Iwasaki,Akihiro Koide, and Ryoichi Mori
* The following members of the Globalization Committee will consider the preparation of an
English translation of the abstract.
Takashi Eto
Takehiko Ohzeki
Hiroko Kodama
Mari Michinaga
Mitsunori Murata
Kanako Kitahara
Sei Yumikura (Chair)