Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, Tokyo, Japan.
J Epidemiol Community Health. 2018 May;72(5):e1. doi: 10.1136/jech-2017-209943. Epub 2018 Jan 12.
The study reported in this article examines a health intervention that uses gendered stereotypes of the nursing profession and suggestive uniforms that play on women's sexuality to encourage people to engage in health checkups. The intervention was not under the control of the authors and the study was approved by an institutional research ethics board. The condemns the use of sexism, gender and professional stereotypes and other forms of discriminatory or exploitative behaviour for any purpose, including health promotion programs. In light of concerns raised about this paper (see eLetters with this paper), we are conducting an audit of our review process and will put in place measures to ensure that the material we publish condemns sexism, racism and other forms of discrimination and embodies principles of inclusion and non-discrimination.
Socioeconomically vulnerable people are likely to have more health risks because of inadequate behaviour choices related to chronic social stresses. Brain science suggests that stress causes cognitively biased automatic decision making, preferring instant stress relief and pleasure (eg, smoking, alcohol use and drug abuse) as opposed to reflectively seeking health-maintenance services (eg, health check-ups). As such, hedonic stimuli that nudge people towards preventive actions could reduce health behaviour disparities. The purpose of this intervention study was to test this hypothesis.
An instant health check-up service company had 320 health check-up sessions at (Japanese gambling) parlours; 1721 persons in intervention sessions and 6507 persons in control sessions received the service. The stimuli the company used in the intervention sessions were young women wearing mildly erotic nurse costumes, who solicited the pachinko players for health check-up services. We compared the prevalence of socioeconomically vulnerable individuals between the intervention and control sessions, adjusting for individual-level and parlour-level potential confounders.
Even adjusting for health risks and within-parlour clustering, the intervention sessions gathered more socioeconomically vulnerable customers than the regular sessions. Compared with control sessions, in intervention sessions the adjusted prevalence ratios were 1.15 (95% CI 0.99 to 1.35) for not having a job (vs having a job) and 1.36 (95% CI 1.00 to 1.86) for holders of National Health Insurance (which includes more socially vulnerable people than other insurance programmes).
The results supported our hypothesis. Offering health check-up opportunities equipped with 'tricks' that nudge people to act might be effective for anyone but is potentially more valuable for socially vulnerable people. Ethical discussions are needed to further consider the use of erotic stimuli and other essential drivers of human behaviour.
本文报道的研究考察了一种利用护理职业的性别刻板印象和暗示性制服来激发女性性吸引力以鼓励人们进行健康检查的健康干预措施。该干预措施不受作者控制，研究得到了机构研究伦理委员会的批准。该组织谴责任何目的包括健康促进计划在内的使用性别歧视、性别和职业刻板印象以及其他形式的歧视或剥削行为。鉴于对本文提出的关切（见本文的电子信件），我们正在对我们的审查过程进行审计，并将采取措施确保我们发表的材料谴责性别歧视、种族主义和其他形式的歧视，并体现包容和非歧视的原则。
由于与慢性社会压力相关的行为选择不足，社会经济弱势群体可能面临更多的健康风险。大脑科学表明，压力会导致认知偏见的自动决策，更倾向于即时缓解压力和获得快感（例如，吸烟、饮酒和吸毒），而不是反思性地寻求维持健康的服务（例如，健康检查）。因此，促使人们采取预防措施的享乐刺激因素可能会减少健康行为的差异。这项干预研究的目的是检验这一假设。
一家即时健康检查服务公司在弹珠机厅举办了 320 次健康检查服务；1721 名干预组和 6507 名对照组接受了该服务。公司在干预组中使用的刺激因素是年轻女性穿着略带色情的护士制服，向弹珠机玩家招揽健康检查服务。我们比较了干预组和对照组中社会经济弱势群体的比例，同时调整了个体水平和厅水平的潜在混杂因素。
即使考虑到健康风险和厅内聚类因素，干预组也比常规组招募了更多的社会经济弱势群体客户。与对照组相比，干预组中未就业者的调整后患病率比（95%可信区间）为 1.15（0.99 至 1.35），而国民健康保险（涵盖比其他保险计划更多的社会弱势群体）持有者的调整后患病率比为 1.36（95%可信区间 1.00 至 1.86）。
结果支持我们的假设。提供配备“技巧”的健康检查机会，促使人们采取行动，可能对任何人都有效，但对社会弱势群体更有价值。需要进行伦理讨论，以进一步考虑使用色情刺激因素和其他人类行为的关键驱动因素。
