{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:04:32Z","timestamp":1791648272520,"version":"4.3.4"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T00:00:00Z","timestamp":1694131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Older adults who live alone in poverty are highly susceptible to non-communicable diseases and other adverse conditions owing to health disparities resulting from social structures. However, the factors associated with health behavior to prevent non-communicable diseases in this population are rarely explored. The purpose of this study was to identify factors associated with health behavior to prevent non-communicable diseases among older adults living alone in poverty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a self-administered mail survey covering 2,818 older adults living alone who were receiving public assistance, randomly selected from lists of individuals receiving national public assistance in all 1,250 local social welfare offices across Japan. A total of 1,608 individuals completed the questionnaire, a valid response rate of 57.1%. Respondents\u2019 mean age was 74.5\u2009years (standard deviation\u2009=\u20096.7), and 52.9% were women. The study variables included demographic characteristics, scores on a health behavior scale for older adults living alone and receiving public assistance (HBSO), and individual and community-related factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Logistic regression analysis revealed that the individual factor of having a health check-up in the past 12\u2009months [odds ratio (OR): 1.45, 95% confidence interval (CI): 1.10\u20131.91] and the community-related factors Lubben social network scale score (OR 1.15, 95% CI: 1.12\u20131.18) and Community Commitment Scale score (OR: 1.04, 95% CI: 1.00\u20131.08) were significantly associated with HBSO scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>To improve health behavior among older adults living alone in poverty in Japan, social structures, such as lowering mental barriers to the detection, treatment, and management of non-communicable diseases and developing human resources, should be changed to provide social support, such that these individuals are not only dependent on family and friends.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1207334","type":"journal-article","created":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T05:56:37Z","timestamp":1694152597000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Factors associated with health behaviors in preventing non-communicable diseases among older adults living alone in poverty in Japan"],"prefix":"10.3389","volume":"11","author":[{"given":"Yuki","family":"Imamatsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etsuko","family":"Tadaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,8]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780198565895.001.0001","volume-title":"R. Social determinants of health","author":"Marmot","year":"2005"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1111\/hsc.12932","article-title":"Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes-a review of the literature","volume":"28","author":"Frier","year":"2020","journal-title":"Health Soc Care Community"},{"key":"ref3","first-page":"e12268","article-title":"Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health-An integrative review","volume-title":"Nurs Inq","author":"Baah","year":"2019"},{"key":"ref4","year":"2010"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2458-14-198","article-title":"Social and health policies or interventions to tackle health inequalities in European cities: a scoping review","volume":"14","author":"Pons-Vigu\u00e9s","year":"2014","journal-title":"BMC Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1161\/CIRCRESAHA.121.319811","article-title":"Social determinants of cardiovascular disease","volume":"130","author":"Powell-Wiley","year":"2022","journal-title":"Circ Res"},{"key":"ref7","year":"2018"},{"key":"ref8","first-page":"271","article-title":"Stuck AE. Health risk appraisal in older people 1: are older people living alone an \u201cat-risk\u201d group?","volume":"57","author":"Kharicha","year":"2007","journal-title":"Br J Gen Pract"},{"key":"ref9","first-page":"785","article-title":"Factors associated with participants in health examination among elderly population comparison comparison three regional characteristic","volume":"27","author":"Hirai","year":"2009","journal-title":"journal of rural planning"},{"key":"ref10","year":"2014"},{"key":"ref11","first-page":"785","article-title":"Prevalence and characteristics of social isolation in the elderly in a dormitory suburb according to household composition","volume":"57","author":"Saito","year":"2010","journal-title":"Jpn J Public Health"},{"key":"ref12","year":"2021"},{"key":"ref13","year":"2017"},{"key":"ref14","year":"2019"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1016\/S0140-6736(17)31544-1","article-title":"Population health and regional variations of disease burden in Japan, 1990\u20132015: a systematic subnational analysis for the global burden of disease study","volume":"390","author":"Nomura","year":"2017","journal-title":"Lancet"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1093\/fampra\/cmz022","article-title":"Income and education are associated with transitions in health status among community-dwelling older people in Japan: the JAGES cohort study","volume":"36","author":"Ikeda","year":"2019","journal-title":"Fam Pract"},{"key":"ref17","year":"2020"},{"key":"ref18","year":"2019"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e1001160","DOI":"10.1371\/journal.pmed.1001160","article-title":"Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment. Byass P, editor","volume":"9","author":"Ikeda","year":"2012","journal-title":"PLoS Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1177\/109019818200900213","article-title":"Labels, systems and motives: some perspectives for future research and programs","volume":"9","author":"Gochman","year":"1982","journal-title":"Health Educ Q"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1016\/j.jchf.2015.02.009","article-title":"Contribution of major lifestyle risk factors for incident heart failure in older adults","volume":"3","author":"del Gobbo","year":"2015","journal-title":"Heart failure"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1093\/gerona\/gly101","article-title":"Sedentary behavior and prevalent diabetes in 6,166 older women: the objective physical activity and cardiovascular health study","volume":"74","author":"Bellettiere","year":"2019","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"881","DOI":"10.3945\/jn.113.189407","article-title":"Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults","volume":"144","author":"Reedy","year":"2014","journal-title":"J Nutr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/BMJOPEN-2014-006046","article-title":"Are interventions for low-income groups effective in changing healthy eating, physical activity and smoking behaviors? A systematic review and meta-analysis","volume":"4","author":"Bull","year":"2014","journal-title":"BMJ Open"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.ypmed.2013.02.023","article-title":"Community-based dietary and physical activity interventions in low socioeconomic groups in the UK: a mixed methods systematic review","volume":"56","author":"Everson-Hock","year":"2013","journal-title":"Prev Med Acad Press"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1186\/s12889-021-11347-x","article-title":"Development of a health behavior scale for older adults living alone receiving public assistance","volume":"21","author":"Isozaki","year":"2021","journal-title":"BMC Public Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"P96","DOI":"10.1093\/geronb\/53b.2.p96","article-title":"The role of self-perceived usefulness and competence in the self-esteem of elderly adults: confirmatory factor analyses of the bachman revision of Rosenberg\u2019s selfesteem scale","volume":"53","author":"Ranzijn","year":"1998","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1207\/S15327957PSPR0601_3","article-title":"Self-esteem and socioeconomic status: a meta-analytic review","volume":"6","author":"Twenge","year":"2002","journal-title":"Rev Soc Psychol Rev"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12877-016-0406-z","article-title":"Self-perceived uselessness and associated factors among older adults in China","volume":"17","author":"Zhao","year":"2017","journal-title":"BMC Geriatr"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1177\/0956797613510949","article-title":"Self-affirmation among the poor: cognitive and behavioral implications","volume":"25","author":"Hall","year":"2014","journal-title":"Psychol Sci"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1111\/j.1749-6632.1999.tb08111.x","article-title":"Socioeconomic status and chronic stress. Does stress account for SES effects on health? Annals of the new York Academy of Sciences","volume":"896","author":"Baum","year":"1999","journal-title":"New York Acad Sci"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1007\/s00038-012-0429-y","article-title":"Income-related health inequalities: does perceived discrimination matter?","volume":"58","author":"Simons","year":"2013","journal-title":"Int J Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1037\/hea0000116","article-title":"The impact of self-affirmation on health-behavior change: a meta-analysis","volume":"34","author":"Epton","year":"2015","journal-title":"Health Psychol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/S0029-6554(99)90073-8","article-title":"Self-esteem and health behavior: theoretic and empirical links","volume":"47","author":"Seigley","year":"1999","journal-title":"Nurs Outlook"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.abrep.2019.100229","article-title":"Associations between selfesteem and smoking and excessive alcohol consumption in the UK: a crosssectional study using the BBC UK lab database","volume":"10","author":"Szinay","year":"2019","journal-title":"Addict Behav Reports"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.jneb.2017.04.008","article-title":"Cooking matters for adults improves food resource management skills and self-confidence among low-income participants","volume":"49","author":"Pooler","year":"2017","journal-title":"J Nutr Educ Behav"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/heapro\/day062","article-title":"Does health literacy mediate the relationship between socioeconomic status and health disparities?","volume":"34","author":"Stormacq","year":"2019","journal-title":"Health Promot Int"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1146\/annurev.soc.012809.102529","article-title":"Socioeconomic disparities in health behaviors","volume":"36","author":"Pampel","year":"2010","journal-title":"Annu Rev Sociol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"149","DOI":"10.3143\/geriatrics.48.149","article-title":"Reliability and validity of the Japanese version of the abbreviated Lubben social network scale","volume":"48","author":"Kurimoto","year":"2011","journal-title":"Nippon Ronen Igakkai Zasshi"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1186\/1471-2458-12-903","article-title":"Development of a community commitment scale with cross-sectional survey validation for preventing social isolation in older Japanese people","volume":"12","author":"Kono","year":"2012","journal-title":"BMC Public Health"},{"key":"ref41","first-page":"119","article-title":"Tyuunennki niokeru tokuteikennkousinnsa mizyusinnsya no tokusei","volume":"60","author":"Funahashi","year":"2013","journal-title":"Jpn J Public Heal"},{"key":"ref42","first-page":"39","article-title":"Comprehensive health examination(\u201cOtasha-kenshin\u201d) for the prevention of geriatric syndromes and a bed-ridden state in the community elderly \u2013 differences in characteristic between participants and non-participants","volume":"50","author":"Suzuki","year":"2002","journal-title":"Jpn J Public Heal"},{"key":"ref43","first-page":"79","article-title":"Social isolation and related factors in elderly caregivers at home","volume":"20","author":"Nagai","year":"2017","journal-title":"J. Japan Acad Commun. Heal Nurs"},{"key":"ref44","author":"Akatsuka","year":""},{"key":"ref45","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1186\/s12877-022-03361-4","article-title":"Factors associated with community commitment among older adults: a stratified analysis of community group leaders and members","volume":"22","author":"Taguchi","year":"2022","journal-title":"BMC Geriatr"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1207334\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T05:56:42Z","timestamp":1694152602000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1207334\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,8]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2023.1207334"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1207334","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,8]]},"article-number":"1207334"}}