Kyan Akira, Takakura Minoru
Faculty of Medicine, University of the Ryukyus.
Center for Social Common Capital beyond 2050, Institutional Advancement and Communications, Kyoto University.
Environ Health Prev Med. 2025;30:70. doi: 10.1265/ehpm.25-00052.
Changes in socioeconomic inequalities in health behaviours following the COVID-19 pandemic remain unknown, particularly among Japanese school-aged adolescents. Therefore, in this study, we examined changes in socioeconomic inequalities in school-aged adolescents' health behaviours, including physical activity (PA), screen time (ST), sleep duration, breakfast consumption, and bowel movement frequency, before and after the pandemic.
This three-wave repeated cross-sectional study utilised data from the 2019, 2021, and 2023 National Sports-Life Survey of Children and Young People in Japan, analysing data from 766, 725, and 604 participants aged 12-18 years, respectively. Favourable health behaviours were defined as moderate-to-vigorous PA of ≥60 min/day, ST <2 h/day, sleep duration of 8-10 h, daily breakfast consumption, and bowel movements at least every 3 days. Absolute and relative socioeconomic inequalities were quantified using the slope index of inequality (SII) and the relative index of inequality (RII). Temporal changes were analysed using quadratic trend analyses, employing interaction terms between socioeconomic status and survey year.
Significant quadratic trends indicated that socioeconomic inequalities in breakfast consumption decreased substantially from 2019 (SII: 20.7%, RII: 5.09) to 2021 (SII: -0.1%, RII: 0.95) but resurged in 2023 (SII: 16.2%, RII: 3.70). This resurgence may have been primarily driven by changes among those in the moderately low-income (poverty level II) and higher-income groups, which had a breakfast consumption rate of 81.0, 87.0, and 76.4% in 2019, 2021, and 2023, and 88.7, 82.1, and 87.5%, respectively. Among low-income households, adherence to PA recommendations significantly declined from 18.6% to 5.3%, and ST adherence worsened over the study period. No significant inequalities or trends were observed for sleep duration or bowel movement frequency across survey years.
Socioeconomic disparities in breakfast consumption among Japanese school-aged adolescents resurfaced after initially narrowing during the pandemic, likely driven by changes in moderately low-income and higher-income groups. Among low-income households, adherence to PA and ST guidelines declined over time. However, at the population level, socioeconomic inequalities in PA did not exhibit a consistent trend of widening or narrowing. This study highlights the need for sustained public health initiatives to address these socioeconomic disparities.
新冠疫情后健康行为方面社会经济不平等的变化仍不明确，尤其是在日本学龄青少年中。因此，在本研究中，我们调查了疫情前后学龄青少年健康行为方面的社会经济不平等变化，这些健康行为包括身体活动（PA）、屏幕使用时间（ST）、睡眠时间、早餐摄入情况和排便频率。
这项三波次重复横断面研究利用了2019年、2021年和2023年日本儿童和青少年全国体育-生活调查的数据，分别分析了766名、725名和604名12至18岁参与者的数据。良好的健康行为被定义为每天进行≥60分钟的中等至剧烈身体活动、每天屏幕使用时间<2小时、睡眠时间为8至10小时、每天食用早餐以及至少每3天排便一次。使用不平等斜率指数（SII）和不平等相对指数（RII）对绝对和相对社会经济不平等进行量化。使用二次趋势分析来分析时间变化，采用社会经济地位和调查年份之间的交互项。
显著的二次趋势表明，早餐摄入方面的社会经济不平等在2019年（SII：20.7%，RII：5.09）至2021年（SII：-0.1%，RII：0.95）大幅下降，但在2023年又有所回升（SII：16.2%，RII：3.70）。这种回升可能主要是由中等低收入（贫困水平II）和高收入群体中的变化驱动的，这两个群体在2019年、2021年和2023年的早餐摄入率分别为81.0%、87.0%和76.4%，以及88.7%、82.1%和87.5%。在低收入家庭中，遵循身体活动建议的比例从18.6%显著下降到5.3%，并且在研究期间屏幕使用时间的遵循情况变差。在各调查年份中，睡眠时间或排便频率未观察到显著的不平等或趋势。
日本学龄青少年早餐摄入方面的社会经济差距在疫情期间最初缩小后又重新出现，可能是由中等低收入和高收入群体的变化驱动的。在低收入家庭中，对身体活动和屏幕使用时间指南的遵循情况随时间下降。然而，在总体人群层面，身体活动方面的社会经济不平等并未呈现出持续扩大或缩小的趋势。本研究强调了持续开展公共卫生举措以解决这些社会经济差距的必要性。
