Specific Health Guidance Research Articles

Factors associated with acquiring exercise habits through health guidance for metabolic syndrome among middle-aged Japanese workers: A machine learning approach

ObjectivePhysical inactivity increases the risk of mortality and chronic morbidity. Therefore, it is crucial to establish strategies to encourage individuals to increase their physical activity and develop exercise habits. The objective of this study was to explore factors associated with acquiring exercise habits using machine learning algorithms. MethodsThe analyzed dataset was obtained from the Specific Health Guidance for metabolic syndrome systematically implemented by the Japanese Ministry of Health, Labor, and Welfare. We selected target individuals for health guidance without exercise habits in 2017 and assessed whether the participants acquired exercise habits through health guidance in 2018. We applied ten machine learning algorithms to build prediction models for acquiring exercise habits. ResultsThis study included 16,471 middle-aged Japanese workers (age, 49.5 ± 6.2 years). Among the machine learning algorithms, the Boosted Generalized Linear Model was the best for predicting the acquisition of exercise habits based on the receiver operating characteristic curve on the test set (ROC-AUCtest, 0.68). According to the analyses, the following factors were associated with the acquisition of exercise habits: being in the maintenance or action stage of changing exercise and eating behaviors based on the transtheoretical model; regular physical activity or walking; normal high-density lipoprotein cholesterol; and high alcohol consumption. ConclusionsOur findings can be used to establish an efficient strategy for encouraging individuals to acquire exercise habits through Specific Health Guidance or other health guidance. However, the lower ROC-AUCtest suggests that additional variables are necessary to enhance the prediction model.

Ethical Issues in Research on the Japanese Health Checkups and Specific Health Guidance

Ethical Issues in Research on the Japanese Health Checkups and Specific Health Guidance

Legal Protection of Pilgrims on Health Istithaah Standards in Indonesia

Hajj pilgrims are obliged to carry out their worship in accordance with the provisions of Islamic law, for this reason it is necessary to carry out health checks and health guidance for Hajj pilgrims in the concept of regulating Hajj health istithaah, namely Minister of Health Regulation Number 15 of 2016. Learn from the implementation of the Hajj in 2023 where the death rate for Hajj pilgrims is high , the government is drafting new regulations strengthening standards for determining Hajj health istithaah. This research is normative legal research and is descriptive analytical in nature. The results of the research show that this new regulation does not fulfill the aspect of legal protection for Hajj pilgrims because some of the Hajj pilgrims who are determined to not meet the Hajj health istithaah requirements while not having enough time to improve their health conditions in order to achieve istithaah. Specific and intensive health guidance is needed to prepare the Hajj pilgrims' health istithaah.

Comparison of BMI changes in Japanese adults receiving face-to-face versus online counseling for specific health guidance: a noninferiority prospective observational study.

This study aimed to evaluate the noninferiority of online counseling over face-to-face counseling for specific health guidance (SHG). This prospective observational study was conducted using specific health checkup (SHC) and SHG data of individuals with health insurance in Japan. We analyzed data from 1431 participants who met the inclusion criteria, including those who underwent online or face-to-face counseling between April 1, 2020 and March 31, 2021, and received an SHC in the following year but no earlier than 90days after their first counseling session. Assessed variables comprised demographics, counseling methods, and SHC results, including baseline questionnaire findings and body mass index (BMI) at follow-up. We performed inverse probability of treatment weighting (IPTW) using propensity scores, with changes in BMI as the objective variable and the counseling method as the explanatory variable. We set the noninferiority margin to 0.175, based on a previous study. The online and face-to-face counseling groups comprised 455 (31.8%) and 976 (68.2%) participants, respectively. The number of men and mean age were 214 (47.0%) and 49.9years (SD: 6.9years), respectively, in the online counseling group, and 491 (50.3%) and 51.1years (SD: 7.6years), respectively, in the face-to-face counseling group. IPTW using propensity scores revealed a regression coefficient of -0.014 (95% CI: -0.157 to 0.129) for the online group compared with the face-to-face group (P = .847). The CI was within the noninferiority margin. The effects of online counseling on BMI are likely noninferior to those of face-to-face counseling.

Utilization of the standard questionnaire in specific health checkups

Objectives Interviewing people about their health behaviour in specific health checkups (SHCs) is thought to promote awareness of and help improve such behaviour. The standard questionnaire (SQ) for SHCs consists of 22 items presented in the guidelines of the Ministry of Health, Labour, and Welfare. However, using items other than those necessary for stratification for specific health guidance (SHG) is optional. We believe that clarifying the actual utilization of SQ items could contribute to improving the procedure used for the fourth SHCs and SHG, which will be initiated in 2024. This study seeks to clarify the actual utilization of the SQ for (1) conducting SHCs, (2) planning, implementing, and evaluating SHG and health programs aimed at preventing lifestyle-related diseases, and (3) planning, implementing, and evaluating the data health plan.Methods We enrolled 3,179 people from 1,741 departments in charge of national health insurance, 47 Japan Health Insurance Association branches, and 1,391 health insurance societies across all municipalities in Japan. One participant among the study participants was the main person in charge of SHCs and SHG at each facility. We conducted a self-reported survey on the implementation of SHCs and SHG in February 2022. This study was approved by the ethics review board of the institution to which the first author belongs.Results A total of 1,221 (38.4%) were received. The proportions of valid responses from national health insurance departments, Japan Health Insurance Association branches, and health insurance societies were 816 (46.9%), 47 (100%), and 358 (25.7%), respectively. Over 96% of responders used the group SHCs method, and over 93% of those adopting the individual SHCs method used each of the 22 SQ items. However, 187 (18.2%) responders found it difficult to use the item "If you had the opportunity to receive health guidance for lifestyle improvement, would you take it?" The reason was that the on-request SHG system was misunderstood. Additionally, only approximately 50% of respondents used the SQ to develop, implement, and evaluate their health program.Conclusion We believe there will be no problem in implementing the SQ even if using all its component items is required. However, the aforementioned item needs to be revised. Methods to encourage health insurers and their supporters to use the SQ for health-related data collection and health program planning should be devised.

Health guidance intervention mitigates the escalation of predicted comprehensive cardiovascular disease risk: Interrupted time series design

IntroductionMetabolic syndrome increases the risk of cardiovascular events. Despite the Japanese healthcare system's efforts in early detection and intervention, particularly through Specific Health Checkup and Guidance programs, research on their effectiveness is limited. This study evaluated the impact of Specific Health Guidance on the predicted risk of atherosclerotic cardiovascular disease (ASCVD) in working-age Japanese individuals. MethodsEmploying an Interrupted Time Series (ITS) design, this study compared the trends in predicted ASCVD risk and each individual risk factor used for the prediction of ASCVD risk before and after intervention in individuals participating in the guidance. ResultsAnalyses based on the ITS design indicated that participation in Specific Health Guidance programs, specifically the intensive level program, mitigates the increase trend of the predicted ASCVD risk. On the other hand, the impact on the trends of individual cardiovascular risk factors was minimal. ConclusionsThe intensive level Specific Health Guidance appeared to reduce the increasing trend in ASCVD risk, emphasizing the importance of comprehensive risk assessment in evaluating health interventions. However, the results are limited owing to the specific demographics and short evaluation period. Further research is necessary to understand the long-term impacts and broader applicability.

Cigarette smoking and progression of kidney dysfunction: a longitudinal cohort study.

Cigarette smoking is one of the most important life-modifiable risk factors for CVD events. The effect on CKD progression caused by smoking remained uncertain, while the effect on CVD had been established. The study population included participants from the specific health check and specific health guidance, an annual health check-up for all inhabitants of Japan who were aged between 40 and 74 years. 149,260 subjects (male, 37.1%; female, 62.9%) were included in this analysis. The relationship between smoking status along with new-onset proteinuria and eGFR deterioration more than 15 mL/min/1.73 m2 was examined. Median observation periods were 1427 days [738, 1813] in males and 1437 days [729, 1816] in females. In male participants, the strongest factor upon kidney dysfunction was new-onset proteinuria (1.41 [1.31 1.51], P < 0.001). The second strongest factor on kidney deterioration was smoking (1.24 [1.16 1.31], P < 0.001). In female participants, strongest factor upon kidney dysfunction was smoking (1.27 [1.16-1.39], P < 0.001). The second strongest factor on kidney deterioration was new-onset proteinuria (1.26 [1.17 1.36], P < 0.001). To reveal the relationship of effects from new-onset proteinuria and smoking on the kidney function, the participants were divided into four groups with and without new-onset proteinuria and smoking. The group with both proteinuria and smoking had significantly worst renal prognosis (P for trend < 0.001). Large longitudinal observation study revealed smoking has an evil effect on the progression of CKD. This evil effect could be observed in CKD patients with proteinuria as well as in general population without new-onset proteinuria.

Cost-effectiveness of behavioural counselling intervention compared with non-intervention for adult patients with metabolic syndrome to prevent cardiovascular diseases and type 2 diabetes in Japan: a microsimulation modelling study

ObjectivesNationwide lifestyle intervention—specific health guidance (SHG) in Japan—employs counselling and education to change unhealthy behaviours that contribute to metabolic syndrome, especially obesity or abdominal obesity. We aimed to perform a...

Exact-matching algorithms using administrative health claims database equivalence factors for real-world data analysis based on the target trial emulation framework

AbstractReal-world data have become increasingly important in medical science and healthcare. A new, effective, and practically feasible statistical design is needed to unlock the potential of real-world data that decision-makers and practitioners can use to meet people’s healthcare needs. In the first half of the study, we validated our proposed new method by simulation, and in the second half, we conducted a clinical study on actual real-world data. We proposed the “Exact Matching Algorithm Using Administrative Health Claims Database Equivalence Factors (AHCDEFs)” using a target trial emulation framework. The simulation trials were conducted 500 times independently, considering the misclassification and chance errors of all variables and competing events of outcome. Two conventional methods, multivariate and propensity score analyses, were compared. Next, we estimated the effect of specific health guidance provided in Japan on the prevention of diabetes onset and medical expenditures. Our proposed novel method for real-world data returns improved estimates and fewer type I errors (the probability of erroneously determining that there is a difference when, in fact, there is no difference) than conventional methods. We quantitatively demonstrated the effectiveness of specific health guidance in Japan in preventing the onset of diabetes and reducing medical expenditures during five years. We proposed a new method for analyzing real-world data and an exact-matching algorithm using AHCDEFs. The larger the number of patients available for analysis, the more the AHCDEFs that can be matched, thereby removing the influence of confounding factors. This method will generate significant evidence when applied to real-world data.

Database profile of the Fukuoka-City Information Platform for Community-based Integrated Care.

The Fukuoka-City Information Platform for Community-based Integrated Care is an advanced big data platform that aggregates information on the health and medical services of Fukuoka citizens. Fukuoka City is engaged in a joint project with Kyushu University to promote policy making through a large-scale real-world data analysis. This paper describes the framework for this cooperative effort and the features of the analytical platform. Fukuoka City is the fifth most populous ordinance-designated city in Japan, with an estimated population of approximately 1.6 million. Under an agreement with Fukuoka City, Kyushu University was granted access to a portion of the city's anonymized healthcare database as secondary-use information. The database contains information on resident registration, health insurance claims, specific health checkups and health checkups for the older adults, specific health guidance, long-term care insurance data, and cancer screenings collected after fiscal year 2012. Each of these constituent datasets can be interlinked using anonymized hashed key variables, allowing individuals to be followed across databases and over time. The platform allows longitudinal investigation of the complex association between various aspects of healthcare, such as medical procedures, examinations, interviews, medical costs, long-term care certifications, and care costs. The platform can provide valuable public-health information because it is relatively large for a single database, and because it allows analysis of data across multiple domains and tracing of individuals over time.

Perception of Public Health Nurses on Health Foods and Utilization of Health Food Informationduring Specific Health Guidance

This study aimed to investigate the awareness of public health nurses (PHNs) regarding health foods and the actual utilization of health food-related information in specific health guidance. A questionnaire survey among PHNs working in municipalities in Kagoshima Prefecture (n=170, response rate; 41.5%) was conducted in September 2022. As a result, 39.4% of the PHNs had experience using health foods, and 43.5% consulted about health food from local residents. Major topics of consultation included effectiveness (78.4%) and drug interactions (35.1%). Approximately 10.2% of the PHNs always confirm the use of health food during specific health guidance, while 41.6% did not ever check. Additionally, 36.3% of the PHN were aware of the obligation to report adverse events caused by health foods to the prefectural governments and Ministry of Health, Labor, and Welfare. The present study showed that recognition and intelligibility on health foods varied among PHNs. Therefore, knowledge acquisition on safety and efficacy is needed for proper use of health foods.

A Body Shape Index and Aortic Disease-Related Mortality in Japanese General Population.

Aortic diseases (ADs), including aortic dissection, aortic aneurysm, and aortic rupture, are fatal, with extremely high mortality rates. A body shape index (ABSI), an anthropometric measure calculated as waist circumference adjusted by height and weight, improves the predictive capacity for mortality. However, whether ABSI is a risk factor for AD-related mortality in the general population remains unclear. We used a nationwide database of 630,842 individuals (aged 40-75 years) who participated in the annual "Specific Health Check and Guidance in Japan" between 2008 and 2010. During the follow-up period of 3.8 years, 159 AD-related deaths occurred, including 105 aortic dissections and 54 aortic aneurysm ruptures. The subjects were divided into three groups based on ABSI tertiles. Kaplan-Meier analysis demonstrated that the 3rd tertile (with the highest ABSI) had the greatest risk among the three groups. Multivariate Cox proportional hazard regression analysis demonstrated that ABSI was significantly associated with AD-related death after adjusting for confounding risk factors. Neither waist circumference nor body mass index consistently predicted AD-related death in the multivariate model. The prediction capacity was significantly improved by the addition of ABSI to the confounding risk factors. We demonstrated for the first time that ABSI, a surrogate marker for abdominal visceral fat tissue, was associated with AD-related deaths in the general population, suggesting the importance of central adiposity in the development of AD.

The effect of lifestyle on the mortality associated with respiratory diseases in the general population

Lifestyle factors, including smoking habit, diet, and physical activity, affect the prognosis of various diseases. We elucidated the effect of lifestyle factors and health status on deaths from respiratory diseases in the general Japanese population using data from a community health examination database. Data of the nationwide screening program of the Specific Health Check-up and Guidance System (Tokutei-Kenshin), targeting the general population in Japan, from 2008 to 2010 were analyzed. The underlying causes of death were coded according to the International Classification of Diseases (ICD)-10. The hazard ratios of the incidence of mortality associated with respiratory disease were estimated using the Cox regression model. This study included 664,926 participants aged 40–74 years, who were followed up for 7 years. There were 8051 deaths, including 1263 (15.69%) deaths from respiratory diseases. The independent risk factors of mortality associated with respiratory diseases were male sex, older age, low body mass index, no exercise habit, slow walking speed, no drinking habit, smoking history, history of cerebrovascular diseases, high hemoglobin A1c and uric acid levels, low low-density lipoprotein cholesterol level, and proteinuria. Aging and decline of physical activity are significant risk factors for mortality associated with respiratory diseases, regardless of the smoking status.

Effects of being eligible for specific health guidance on health outcomes: A regression discontinuity analysis using Japan's data on specific health checkups

The significance of general health checkups and guidance is controversial. To examine the effectiveness of Japan's specific health checkup (SHC) and specific health guidance (SHG) programs, this study applied a regression discontinuity design (RDD) using the SHC results database collected by a private company. We applied a sharp RDD with a cutoff body mass index (BMI) of 25 kg/m2 for those with a waist circumference (WCF) of <85 cm in men and < 90 cm in women, with risks of hypertension, dyslipidemia or diabetes, and aged between 40 and 64 years. Study outcomes were differences in BMI, WCF, and major cardiovascular risk factors between the baseline year and the following year. We analyzed the data of baseline years of 2015, 2016, and 2017 separately and their pooled data. We judged the results to be robust significant when significant results in the same direction were found in all four analyses. A total of 1,041,607 observations out of 614,253 people were analyzed. We found robust significant results that those eligible for SHG in the baseline year had a lower BMI (both men and women) and lower WCF (men only) in the following year than those not eligible for SHG: BMI for men (−0.12 kg/m2, 95% CI [confidence interval]: −0.15 to −0.09); BMI for women (−0.09 kg/m2, 95% CI: −0.13 to −0.06); and WCF for men (−0.36 cm, 95% CI: −0.47 to −0.28) in the pooled data. Robust significant results were not found in WCF for women or in major cardiovascular risk factors.

Effectiveness of a targeted primary preventive intervention in a high-risk group identified using an efficiency score from data envelopment analysis: a randomised controlled trial of local residents in Japan

ObjectiveTo determine whether a minimal intervention based on the data envelopment analysis (DEA)-identified efficiency score effectively prevents hypertension.DesignRandomised controlled trial.SettingTakahata town (Yamagata, Japan).ParticipantsResidents aged 40–74 years belonged to the information...

The Effect of a mHealth App (KENPO-app) for Specific Health Guidance on Weight Changes in Adults With Obesity and Hypertension: Pilot Randomized Controlled Trial

Commercial smartphone apps that promote self-monitoring of weight loss are widely available. The development of disease-specific apps has begun, but there is no app for specific health guidance (SHG) to prevent metabolic syndrome, type 2 diabetes, and cardiovascular diseases in middle-aged adults in Japan. This study aimed to determine the efficacy of an SHG mobile health app in facilitating weight loss in Japanese adults with obesity and hypertension. In a 12-week, statistician-blinded, randomized parallel controlled trial, 78 overweight and obese men aged 40-69 years were assigned in a 1:1 ratio to either the usual support plus KENPO-app group (intervention group) or the active control group. KENPO-app (release April 10, 2019; OMRON Healthcare Co., Ltd.) was developed by the study team and focus groups and uses behavior change techniques (ie, self-monitoring and goal-setting theory). This app was developed for SHG based on the four specific health checkups and guidance system in Japan: (1) focusing primarily on achieving the target (weight loss of ≥2 kg); (2) assessing healthy eating, exercise habits, smoking habits, relaxation, and self-weighing; (3) providing information on the results of specific health checkups; and (4) starting an intervention period of 6 months with the interim assessment at 3 months. The initial assessment explored the following: personality traits (4 types), health checkup data concerns (10 items), symptom concerns (10 items), and the aim of the intervention (weight loss, improving fitness, symptoms, laboratory data). Chatbot-supported health information on health and health behavior was selected from 392 quizzes based on app data and was provided to participants. The KENPO-app had chatbot-supported feedback and information provision combined with a self-monitoring tool (weight, steps, and blood pressure). Data on active exercise, healthy eating, and healthy lifestyle habits were obtained using a web-based self-administered questionnaire at baseline and 12 weeks. The trial's retention rate was 95% (74/78). The adherence to daily self-weighing, wearing the pedometer, and blood pressure monitoring in the KENPO-app group was significantly higher than those in the active control group. Compared with the active control group, the median body weight and BMI of the intervention group significantly decreased at 3 months (-0.4, IQR -2.0 to 0.6 kg vs -1.1, IQR -2.7 to -0.5 kg; P=.03; -0.1, IQR -0.6 to 0.3 kg vs -0.4, IQR -0.8 to -0.2 kg; P=.02, respectively). The intervention increased the percentage of participants who self-reported taking ≥8000 steps, eating vegetables before rice, eating slowly, and relaxing. Personality traits were associated with the degree of weight loss in the intervention group. The SHG-specific KENPO-app was feasible and induced modest but significant weight loss in adults with obesity. University Hospital Medical Information Network Center UMIN000046263; https://tinyurl.com/bderys3b.

Effectiveness of letter and telephone reminders for specific health guidance use: A randomized controlled trial for those intending to use health guidance in a large city

Objectives Medical insurers have applied a reminder (i.e., recall) system to improve the implementation rate of specific health guidance. However, the effectiveness of the system has not been verified. This study aims to examine the effectiveness of two methods of specific health guidance reminders (i.e., letter and telephone) using a randomized controlled trial.Methods Subscribers of National Health Insurance in Yokohama City, Kanagawa Prefecture, who were eligible for specific health guidance in 2020, were recruited. A specific health examination questionnaire was used to identify participants intending to use health guidance. The intervention period was from September to November 2020, with 252 people being randomly assigned to one of the three groups: a "no-reminder group," "a letter-reminder group," or "a telephone-reminder group" (84 people each). Those in the letter-reminder group received a reminder by mail and those in the telephone-reminder group received a reminder by phone from a public health nurse two weeks after the specific health guidance coupon was sent to the participants by mail. The outcome showed the utilization rate of specific health guidance. Chi-square tests were performed to compare the three groups and conduct multiple comparisons (post-hoc test).Results The participants had a mean age of 61.4±11.0 years and 70.6% were male. There was no difference among the three groups in terms of demographic characteristics and the results of specific health examinations. The utilization rates of specific health guidance were 20.2% in the no-reminder group, 22.6% in the letter-reminder group, and 20.2% in the telephone-reminder group; thus, the three groups did not significantly differ (χ2=0.191, P=0.909). Multiple comparisons also showed no difference between any two groups. However, in the telephonereminder group, 56.0% of the participants themselves or their family members could be reached by a public health nurse, and their utilization rate was higher than those participants whom a public health nurse could not reach.Conclusion Neither letter nor telephone reminders changed the participants' utilization rates of specific health guidance compared to those with no reminder. Although the effectiveness of a telephone reminder might be underestimated, this study suggests setting a lower priority in reminding those who intend to use health guidance.

S-30-1: THE IMPORTANCE OF MULTIDISCIPLINARY INTERVENTION FOR THE PREVENTION OF CVD IN JAPAN

Preventing illness and promoting health is important for prolonging healthy life expectancy, and it also leads to the reduction of medical and long-term care costs. As Japan has entered a super-aged society, prevention of CVD, which causes stroke and dementia, the main causative diseases of the need for long-term care, is becoming more important. In addition, it is necessary to widely implement these CVD prevention strategy from an early stage. In other words, not only the tertiary preventive measures after the onset, but also the secondary preventive measures that extract high-risk populations and the primary preventive measures that approach the entire community are required. Under these circumstances, the specific health checkup and specific health guidance system was started in 2008 in Japan. This system has a new concept in which medical insurers take the lead in implementing it, and aims to prevent the onset of illness by providing lifestyle modification support to people at high risk of metabolic syndrome. This system has been established nationwide and has been successful. On the other hand, there are not a few people who leave medical treatment of lifestyle-related diseases, discontinued treatment, or even have not received medical checkup, which is an urgent issue. It is expected that various medical professionals will provide health guidance for those undergoing treatment, encourage continuous treatment, support for improving adherence, along with the nationwide health promotion such as increasing the rate of people taking health checkup or improvement of healthy environment in the community and workplace. The extension of healthy life expectancy for the entire nation will be realized by strengthening of cooperation between preventive intervention and medical care by various medical professionals. In the session, we will outline the current status of multidisciplinary collaboration efforts of health professionals in community, and introduce the examples of RCT results of nurse-led alcohol guidance effects in hypertensive outpatient clinics that we have conducted.

Effect and factors associated with weight and waist circumference reductions in information and communication technology-based specific health guidance

Effect and factors associated with weight and waist circumference reductions in information and communication technology-based specific health guidance

Current status of awareness, knowledge, beliefs, and behavioral intentions regarding the Japanese physical activity guidelines and their relationship with physical activity and sedentary behavior

Objective This study clarified the current status of awareness, knowledge, beliefs, and behavioral intentions regarding the Japanese physical activity guidelines (Active Guide) and their relationship with physical activity, sedentary behavior, and the participants' characteristics.Methods A cross-sectional study was conducted with 7,000 participants aged 20-69 years registered with an online survey company. Awareness, knowledge, beliefs, and behavioral intentions regarding the Active Guide were examined. Awareness was assessed by unprompted and prompted recall. Knowledge was assessed by numerical responses to "the recommended daily activity time (18-64 years/65 years and older)" and "physical activity time to be increased (plus-ten)," respectively. To survey the beliefs and behavioral intentions, we created a 5-point scale for the Active Guide. For physical activity, the amount of moderate-to-vigorous intensity physical activity was calculated from the Japan Public Health Center-based prospective Study (JPHC study) questionnaire. Physical activity level was calculated from the standard specific medical checkup and health guidance questionnaire. For sedentary behavior, the Japanese version of the International Physical Activity Questionnaire (IPAQ) was used. The dependent variables were awareness, knowledge, beliefs, and behavioral intentions. The independent variables were physical activity, sedentary behavior, and the participants' characteristics (gender, age, body mass index, marital status, educational background, work status, and household income). After descriptive statistics were measured, a logistic regression analysis was performed to examine the associations.Results Unprompted and prompted recall of the Active Guide were 1.7% and 5.3-13.4%, respectively. Those with knowledge of it scored 37.2%, 7.0%, 24.8%, and 2.6% for recommended daily activity time (18-64 years), daily physical activity time (65 years and older), plus-ten, and all three items answered correctly, respectively. The median (interquartile range) score of the beliefs was 21 (16-25) points (32-point scale). Those with behavioral intentions scored 51.4% for "recommended daily activity" and 66.9% for "plus-ten." Logistic regression analysis showed that awareness, knowledge, beliefs, and behavioral intentions were positively associated with moderate-to-vigorous intensity physical activity and level. The results were inconsistent for sedentary behavior. Although personal characteristics differed based on assessment item, they were mainly associated with age, education level, employment, and household income.Conclusions This study revealed that the number of people who had awareness and knowledge of the Active Guide remained low. Those with awareness, knowledge, beliefs, and behavioral intentions were more physically active. However, the results for sedentary behavior were not consistent. Hence, further research is required to understand this tendency. A future longitudinal study is also required.