title: Impact of health education and screening over all-cause mortality in Japan: evidence from a cohort study during 1984-2002.
abstract: BACKGROUND
  Health education and screening are two components of preventive health services in Japan since 1983. This study investigated their relationships with all-cause mortality as they are studied insufficiently in Hokkaido, Japan.
  
  
  METHODS
  This study enrolled 1,532 men and 1,653 women aged 40-97 years from 1,702 randomly selected households of 60 areas during 1984-1985 and followed them until 2002. At baseline survey, staffs of 45 health centers collected sociodemographic, medical, behavioral, and dietary information including health education and screening from study subjects with informed consent.
  
  
  RESULTS
  For men, age-adjusted Cox proportional hazard model indicated lower mortality for those who received health education (RR = 0.76, P < 0.01) and screening (RR = 0.83, P < 0.05) than those who did not. Health education showed lower mortality even after adjusting for many variables. Similarly for women, health education (RR = 0.66, P < 0.01) and screening (RR = 0.64, P < 0.001) revealed lower age-adjusted mortality. Almost similar results were found for both services when models were adjusted for many variables and when the deaths including lost to follow-up cases of the first 4 years of baseline survey are excluded.
  
  
  CONCLUSIONS
  This study shows protective effects of health education and screening over all-cause mortality for both sexes. However, further studies are needed to confirm the results.
authors.affiliation: Department of Public Health, Sapporo Medical University, School of Medicine, Sapporo 060-8556, Japan. khan@spamed.ac.jp
authors.forename: Md Mobarak Hossein
authors.initials: MM
authors.lastname: Khan
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Goto
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sonoda
authors.forename: Fumio
authors.initials: F
authors.lastname: Sakauchi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Washio
authors.forename: Kota
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Mori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015438:Health Behavior; D006266:Health Education; D006801:Humans; D038801:International Classification of Diseases; D007564:Japan; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011897:Random Allocation