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The Internet is known to be used for health purposes by the general public all over the world. However, little is known about the use of, attitudes toward, and activities regarding eHealth among the Japanese population.
This study aimed to measure the prevalence of Internet use for health-related information compared with other sources, and to examine the effects on user knowledge, attitudes, and activities with regard to Internet use for health-related information in Japan. We examined the extent of use via personal computers and cell phones.
We conducted a cross-sectional survey of a quasi-representative sample (N = 1200) of the Japanese general population aged 15–79 years in September 2007. The main outcome measures were (1) self-reported rates of Internet use in the past year to acquire health-related information and to contact health professionals, family, friends, and peers specifically for health-related purposes, and (2) perceived effects of Internet use on health care.
The prevalence of Internet use via personal computer for acquiring health-related information was 23.8% (286/1200) among those surveyed, whereas the prevalence via cell phone was 6% (77). Internet use via both personal computer and cell phone for communicating with health professionals, family, friends, or peers was not common. The Internet was used via personal computer for acquiring health-related information primarily by younger people, people with higher education levels, and people with higher household incomes. The majority of those who used the Internet for health care purposes responded that the Internet improved their knowledge or affected their lifestyle attitude, and that they felt confident in the health-related information they obtained from the Internet. However, less than one-quarter thought it improved their ability to manage their health or affected their health-related activities.
Japanese moderately used the Internet via personal computers for health purposes, and rarely used the Internet via cell phones. Older people, people with lower education levels, and people with lower household incomes were less likely to access the Internet via cell phone. The Internet moderately improved users’ health-related knowledge and attitudes but seldom changed their health-related abilities and activities. To encourage communication between health providers and consumers, it is important to improve eHealth literacy, especially in middle-aged people. It is also important to make adequate amendments to the reimbursement payment system and nationwide eHealth privacy and security framework, and to develop a collaborative relationship among industry, government, and academia.
The number of Internet users has increased considerably worldwide [
A 2007 Japanese national survey showed that 69% used the Internet in the past year, 61% through personal computers and 57% through cell phones [
This study aimed to measure the prevalence of Internet use for health-related information compared with other sources, to examine user characteristics, and to examine the association of Internet use with user knowledge, attitudes, and activities regarding health-related information in Japan. Additionally, we examined the extent of Internet use via personal computers and cell phones.
We designed a cross-sectional survey of the Japanese general population aged 15–79 years. We used a scheduled omnibus survey conducted by Nippon Research Center Ltd [
The survey contained a set of questions about participant characteristics, use of the Internet for health-related information, and the perceived effects of Internet use on knowledge, attitudes, and activities for health purposes. Almost all items were derived from the original questionnaire used in Baker and colleague’s study [
We collected basic demographic data from participants, including age, sex, household income, level of education, and place of residence. Health-related characteristics were self-reported health status (excellent, very good, good, fair, or poor) and chronic diseases: hypertension, diabetes or hyperglycemia, cancer, heart problems (heart attack, angina due to coronary heart disease, heart failure, or other heart problems), depression, obesity, and hyperlipidemia. The main outcome of this study was frequency of Internet use for any purpose and ownership of cell phones.
We classified Internet use into four types: (1) use of a Web browser via personal computer, (2) use of a Web browser via cell phone, (3) use of email via personal computer, and (4) use of email via cell phone. We prepared four questions: “How often do you use a Web browser (or email) to acquire information or advice for health care via your personal computer (or through your cell phone)?” We defined “Internet use” as more than once a year. In addition, to compare the extent of Internet use, we also measured the extent other sources were used for health-related information (television, newspapers, radio, magazines, direct mail, and public relations magazines). To investigate the extent of interactive Internet use for health-related communication, we asked participants about their use of the Internet for three purposes: “to contact doctors or other health care providers,” “to contact a family member or friend about health or health care,” and “to contact other people who have similar health conditions or concerns.” We examined the extent of use for these three purposes via personal computer and cell phone.
We examined the perceived effects of Internet use on knowledge and attitudes using participant responses (strongly agree, agree, disagree, or strongly disagree) to the following statements: “improved my understanding of symptoms, conditions, or treatments in which I was interested,” “improved my ability to manage my health care needs without visiting a doctor or other health care provider,” “led me to seek care from different doctors or health providers than I otherwise would have,” and “affected the way I eat or exercise.” We also examined Internet user confidence or anxiety (“I felt confident,” “I wasn’t influenced,” “I felt anxious,” or “I’ve never obtained [this information]” after obtaining the following health-related information: “information on diseases you have,” “information on diseases you want to prevent,” “information on treatment of diseases,” “information on doctors and health care facilities,” “information on peers,” and “information on a healthy lifestyle, fitness, or nutrition.”
We examined the perceived effects of Internet use on activities by collecting data on the number of times participants visited a health professional and the number of times they telephoned them. Additionally, we asked “Have you ever told health professionals about information from the Internet?”
We tabulated the responses and computed the prevalences. Then, we used logistic regression analysis to investigate the relationships between Internet use for health-related information and respondent characteristics (age, sex, annual household income, level of education, place of residence, and self-reported health status). We evaluated eight logistic regression models. The outcomes for models 1–4 were use of the Internet via personal computer for (1) acquiring health-related information, (2) contacting health professionals, (3) contacting family/friends about health-related information, and (4) contacting peers. The outcomes for models 5–8 were use of the Internet via cell phone for (5) acquiring health-related information, (6) contacting health professionals, (7) contacting family/friends, and (8) contacting peers. For each variable, we report odds ratios and 95% confidence intervals. The Hosmer-Lemeshow goodness-of-fit test was performed for each model. All analyses were performed using SPSS version 18.0 (IBM Corporation, Somers, NY, USA). All
The purpose of the study was explained on the first page of the questionnaire, and we declared that responses to questionnaires were regarded as informed consent. This survey was conducted as an unlinked anonymous survey. The study protocol was approved by the Ethics Committee of Kyoto University Faculty of Medicine.
Characteristics of the 1200 survey participants included in our analysis are shown in
Participant characteristics (N = 1200)
n | % | ||
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15–19 | 75 | 6 | |
20–34 | 285 | 23.8 | |
35–49 | 295 | 24.6 | |
50–64 | 324 | 27.0 | |
65–74 | 169 | 14.1 | |
75–79 | 52 | 4 | |
Mean (SD) | 46.4 (17.4) | ||
|
595 | 49.6 | |
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0–2999 | 194 | 16.2 | |
3000–5999 | 418 | 34.8 | |
6000–9999 | 314 | 26.2 | |
10,000– | 112 | 9.3 | |
Unknown | 162 | 13.5 | |
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0–12 | 728 | 60.7 | |
13–15 | 241 | 20.1 | |
16– | 224 | 18.7 | |
Unknown | 7 | 1 | |
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Excellent/very good | 248 | 20.7 | |
Good | 350 | 29.2 | |
Fair | 520 | 43.3 | |
Poor | 82 | 7 | |
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Urbanb | 690 | 57.5 | |
Nonurban | 510 | 42.5 | |
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≥3 | 33 | 3 | |
2 | 86 | 7 | |
1 | 258 | 21.5 | |
0 | 823 | 68.6 |
a ¥1000 = about US $10.
b Cities with a population of at least 150,000 people.
Prevalence and frequency of Internet use for health purposes (N = 1200)
Frequency of use, % (n) | ||||||||
In the past year, about how often did you | Total ever in the past year | More than once per week | About once per week | About once per month | Every 2–3 months | Less than every 2–3 months | ||
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Television | 60.1 (721) | 21.7 (260) | 14.8 (178) | 10.8 (129) | 5 (54) | 8.3 (100) | ||
Newspapers | 50.3 (604) | 17.3 (207) | 13.3 (159) | 9.1 (109) | 4 (48) | 7 (81) | ||
Public relations magazines | 40.3 (484) | 1 (17) | 2 (27) | 20.6 (247) | 6 (77) | 9.7 (116) | ||
Magazines | 34.2 (410) | 3 (38) | 4 (50) | 12.3 (147) | 7 (83) | 8 (92) | ||
Radio | 19.1 (229) | 5 (56) | 4 (52) | 4 (50) | 2 (26) | 4 (45) | ||
Direct mail | 16.5 (198) | 1 (15) | 2 (25) | 6 (68) | 4 (45) | 4 (45) | ||
Web browser via... | ||||||||
Personal computer | 23.7 (284) | 4 (45) | 4 (47) | 6 (69) | 6 (67) | 5 (56) | ||
Cell phone | 5 (63) | 1 (14) | 1 (8) | 1 (15) | 1 (8) | 2 (18) | ||
Email via... | ||||||||
Personal computer | 5 (61) | 1 (15) | 1 (8) | 1 (15) | 1 (8) | 1 (15) | ||
Cell phone | 4 (48) | 1 (14) | 0 (6) | 1 (12) | 0 (2) | 1 (14) | ||
The Internet (Web browser or email) via... | ||||||||
Personal computer | 23.8 (286) | 4 (48) | 4 (47) | 6 (70) | 5 (65) | 5 (56) | ||
Cell phone | 6 (77) | 2 (21) | 1 (7) | 2 (19) | 1 (7) | 2 (23) | ||
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The Internet via... | ||||||||
Personal computer | 7 (79) | 1 (8) | 1 (6) | 2 (18) | 1 (17) | 3 (30) | ||
Cell phone | 3 (36) | 2 (7) | 0 (2) | 1 (6) | 1 (6) | 1 (15) | ||
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The Internet via... | ||||||||
Personal computer | 8.6 (103) | 2 (20) | 1 (16) | 2 (20) | 2 (19) | 2 (28) | ||
Cell phone | 12.3 (148) | 2 (29) | 2 (25) | 3 (34) | 1 (15) | 4 (45) | ||
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The Internet via... | ||||||||
Personal computer | 4 (52) | 1 (14) | 0 (4) | 1 (8) | 1 (8) | 2 (19) | ||
Cell phone | 6 (67) | 1 (8) | 1 (10) | 1 (17) | 1 (10) | 2 (22) |
We also considered interactive use of the Internet for health-related communication (see
Results of logistic regression models for Internet use via personal computer for each health purpose by demographic characteristics (N = 1200)
For acquiring information | For contacting professionals |
For contacting |
For contacting peers | ||
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286 (23.8%) | 79 (7%) | 103 (8.6%) | 52 (4%) | |
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15–19 | 0.5 (0.2–1.0) | 0.2 (0.0–1.3) | 0.6 (0.2–1.7) | 0.3 (0.0–2.5) | |
20–34 | Reference | Reference | Reference | Reference | |
35–49 | 1.2 (0.8–1.7) | 1.0 (0.6–1.7) | 0.9 (0.5–1.4) | 0.8 (0.4–1.6) | |
50–64 | 0.6 (0.4–0.9)b | 0.7 (0.4–1.4) | 0.7 (0.4–1.2) | 0.7 (0.3–1.5) | |
65–79 | 0.2 (0.1–0.4)b | 0.4 (0.2–1.1) | 0.3 (0.1–0.8)b | 0.3 (0.1–1.1) | |
|
1.0 (0.8–1.4) | 1.8 (1.1–2.9)b | 1.5 (0.9–2.3) | 1.7 (0.9–3.2) | |
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0–2999 | Reference | Reference | Reference | Reference | |
3000–5999 | 1.6 (0.9–2.7) | 1.2 (0.5–3.0) | 1.1 (0.5–2.5) | 1.2 (0.4–3.4) | |
6000–9999 | 1.7 (1.0–2.9) | 1.6 (0.7–4.0) | 1.5 (0.7–3.3) | 1.2 (0.4–3.6) | |
10,000– | 2.5 (1.3–4.8)b | 1.1 (0.4–3.4) | 1.6 (0.7–4.0) | 2.3 (0.7–7.3) | |
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0–12 | Reference | Reference | Reference | Reference | |
13–15 | 1.8 (1.2–2.6)b | 1.9 (1.0–3.3)b | 1.7 (0.9–2.9) | 1.7 (0.8–3.6) | |
16– | 4.8 (3.3–6.8)b | 2.6 (1.4–4.7)b | 3.8 (2.3–6.4)b | 2.8 (1.4–5.8)b | |
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1.4 (0.9–2.1) | 0.6 (0.2–1.4) | 1.1 (0.6–2.0) | 0.7 (0.3–1.8) | |
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Excellent/very good | Reference | Reference | Reference | Reference | |
Good | 1.4 (0.9–2.1) | 1.0 (0.5–1.8) | 1.3 (0.8–2.3) | 3.0 (1.2–7.7)b | |
Fair | 1.1 (0.7–1.6) | 0.9 (0.5–1.6) | 0.7 (0.4–1.2) | 1.9 (0.7–4.9) | |
Poor | 1.8 (0.9–3.6) | 0.6 (0.2–2.3) | 1.1 (0.4–3.1) | 1.4 (0.3–7.6) | |
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a Odds ratio (95% confidence interval).
b Confidence interval does not include 1.0.
c ¥1000 = about US $10.
d Population of at least 150,000 people.
e Hosmer-Lemeshow goodness-of-fit test.
Results of logistic regression models for Internet use via cell phone for each health purpose by demographic characteristics (N = 1200)
For acquiring information | For contacting professionals |
For contacting |
For contacting peers | ||
|
63 (5%) | 36 (3%) | 148 (12.3%) | 67 (6%) | |
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15–19 | 0.6 (0.2–1.6) | 0.9 (0.3–3.1) | 0.6 (0.3–1.2) | 0.6 (0.2–1.9) | |
20–34 | Reference | Reference | Reference | Reference | |
35–49 | 0.5 (0.3–1.0)b | 0.3 (0.1–0.8)b | 0.5 (0.3–0.8)b | 0.6 (0.4–1.2) | |
50–64 | 0.2 (0.1–0.4)b | 0.2 (0.1–0.6)b | 0.2 (0.1–0.3)b | 0.2 (0.1–0.5)b | |
65–79 | n/ac | n/ac | 0.0 (0.0–0.1)b | 0.0 (0.0–0.3)b | |
|
1.2 (0.7–2.0) | 1.3 (0.6–2.7) | 2.0 (1.4–3.0)b | 2.2 (1.3–3.9)b | |
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0–2999 | Reference | Reference | Reference | Reference | |
3000–5999 | 1.2 (0.5–3.1) | 0.6 (0.2–1.9) | 0.7 (0.4–1.4) | 1.0 (0.4–2.4) | |
6000–9999 | 1.2 (0.4–3.2) | 1.2 (0.4–3.5) | 1.1 (0.6–2.0) | 0.9 (0.4–2.4) | |
10,000– | 1.7 (0.6–5.4) | 0.7 (0.2–3.3) | 1.0 (0.5–2.2) | 1.0 (0.3–3.2) | |
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0–12 | Reference | Reference | Reference | Reference | |
13–15 | 1.1 (0.6–2.2) | 1.3 (0.5–3.0) | 1.2 (0.8–2.0) | 1.2 (0.6–2.3) | |
16– | 1.4 (0.7–2.8) | 1.3 (0.5–3.1) | 2.0 (1.3–3.2)b | 1.9 (1.0–3.6) | |
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1.9 (1.0–3.8) | 0.9 (0.3–2.7) | 0.8 (0.4–1.5) | 0.5 (0.2–1.4) | |
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Excellent/very good | Reference | Reference | Reference | Reference | |
Good | 1.0 (0.5–2.1) | 2.2 (0.8–6.0) | 1.9 (1.2–3.2)b | 3.8 (1.7–8.7)b | |
Fair | 0.9 (0.4–1.8) | 1.5 (0.5–4.2) | 1.3 (0.8–2.2) | 2.0 (0.8–4.6) | |
Poor | 3.3 (1.1–9.6) | 2.5 (0.5–13.5) | 1.8 (0.7–4.5) | 1.6 (0.3–8.2) | |
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a Odds ratio (95% confidence interval).
b Confidence interval does not include 1.0.
c Not applicable.
d ¥1000 = about US $10.
e Population of at least 150,000 people.
f Hosmer-Lemeshow goodness-of-fit test.
Perceived effects of Internet use on health care understanding and decisions among Internet users
n | Agree or strongly agree | |
Improved my understanding of symptoms, conditions, or treatments in which I was interested | 210 | 143 (68.1%) |
Affected the way I eat or exercise | 197 | 134 (68.0%) |
Led me to seek care from different doctors or health providers than I otherwise would have | 190 | 41 (22%) |
Improved my ability to manage my health care needs without visiting a doctor or other health care provider | 188 | 43 (23%) |
Perceived effects of Internet use on feelings of confidence and anxiety among Internet users
Feeling after obtaining information on... | n | Feeling confident | No effect | Feeling anxious |
Diseases you have | 158 | 98 (62%) | 52 (33%) | 8 (5%) |
Diseases you want to prevent | 125 | 77 (62%) | 46 (37%) | 2 (2%) |
Treatment of diseases | 167 | 108 (64.7%) | 53 (32%) | 6 (4%) |
On doctors and health care facilities | 99 | 93 (63%) | 50 (34%) | 4 (3%) |
On peers | 147 | 61 (62%) | 34 (34%) | 4 (4%) |
On a healthy lifestyle, fitness, or nutrition | 129 | 82 (64%) | 45 (35%) | 2 (2%) |
Perceived effects of Internet use on health-related activities (number of times visited or telephoned a physician or other health provider) among Internet users
Number of times... | n | Increased | No effect | Decreased |
Visited a physician or other health provider | 234 | 15 (6%) | 208 (88.9%) | 11 (5%) |
Telephoned a physician or other health provider | 232 | 1 (0%) | 216 (93.1%) | 15 (7%) |
Perceived effects of Internet use on health-related activities (experiences of telling health professionals about health-related information from the Internet) among Internet users
n | Have done | Tried, but never done | Never tried | |
Have told health professionals about health-related information from the Internet | 236 | 39 (17%) | 12 (5%) | 185 (78.4%) |
This study revealed four principal findings. First, the prevalence of Internet use via personal computer for acquiring health-related information was about one-quarter among those surveyed (23.8%), whereas the prevalence of Internet use via cell phone for this purpose was low (6%). The prevalence of Internet use via personal computer was higher than radio (19.1%), but lower than television (60.1%), newspapers (50.3%), and magazines (34.2%). Second, younger people, people with higher education levels, and people with higher household incomes were more likely to acquire health-related information by accessing the Internet via personal computer. Third, the prevalence of Internet use for health-related communication with health professionals, family, friends, or peers was small. Although cell phones were rarely used for this type of communication in general, 12.3% of respondents used cell phones for contacting family or friends specifically for health-related purposes. Finally, the majority of those using the Internet for health care purposes thought the Internet improved their health-related knowledge and affected their lifestyle attitudes, and felt confident after obtaining health-related information through the Internet. In contrast, less than one-quarter of respondents thought Internet use improved their ability to manage their health or changed their health-related activities. We further discuss these four findings below.
First, we found that the prevalence of Internet use via personal computer for health-related information was lower in Japan (24% in 2007) than in the United States (40% in 2001) [
Second, our results regarding characteristics of Internet users were consistent with many preceding studies pointing out that older people, people with lower education levels, and people with lower household incomes reported less frequent access to the Internet [
Third, our results suggest that online communication generally remains uncommon in Japan. For communication with family, friends, or peers, cell phones were more used than personal computers. Cell phones were not used as a tool to acquire information, but as a tool for communication by people of all income levels. This could be because even average people in Japan can have advanced cell phones, which are frequently used for email communication with family or friends. For communication with health professionals, the Internet was less used in Japan than in the Unites States [
One reason why online communication generally remains uncommon in Japan might be the lack of systems related to eHealth in Japan. In the reimbursement payment system in Japan, the cost of health professional communications with patients is not reimbursed. In the Japanese context of universal health insurance coverage, treatments covered by insurance are not performed together with treatments not covered by insurance. Most health professionals and medical organizations do not promote this communication. Moreover, the legal system pertaining to personal medical information protection in Japan is not fully developed with regard to eHealth. The Japan Internet Medical Association (JIMA) was founded in 1998 to establish a framework for Internet medical usage [
The other reason why online communication generally remains uncommon in Japan could be the absence of a well-developed collaborative relationship among industry, government, and academia in Japan. In the United States, the vast majority of active eHealth services, such as WebMD, have been created by ventures put forth by cooperation and innovation among practitioners, researchers, and private industry [
Fourth, our study showed that people tended to use the Internet for obtaining health-related information and felt confident in the information they obtained, which is compatible with many studies [
Our findings have public health implications. Our results showed that Internet use of health-related information remains less common in Japan than in other developed countries [
This study had some limitations. We acknowledge that the study’s sample size was too small to examine the details of individuals who access the Internet via cell phone. The prevalence of Internet use via cell phone was lower than we had expected. Since this study aimed to measure the prevalence of Internet use for health-related information among the general Japanese population, a further study targeting the subset of Internet users who access the Internet via cell phone is required. We also acknowledge that there are no data about the response rate of respondents. In order to examine the extent of selection bias, we compared some indicative items of this survey with a national representative survey [
In 2007, Japanese moderately used the Internet via personal computers for health purposes, and rarely used the Internet via cell phones. Older people, people with lower education levels, and people with lower household incomes were less likely to access the Internet via cell phone. The Internet moderately improved user health-related knowledge and attitudes, and encouraged user confidence in health-related information. However, it seldom changed their health-related abilities and activities, and was not often used for communicating with physicians. The paucity of Internet use for communication with physicians might be due to the payment system in Japan. Moreover, Internet users did not generally share the information they obtained from the Internet with health professionals. The health-related information from the Internet was inadequately used. Although cell phones were used as a communication tool for health purposes, the reimbursement payment system in Japan might be an obstacle to communication between health providers and health consumers. To encourage this communication, it is important to improve eHealth literacy, especially in middle-aged people. It is also important to make adequate amendments to the reimbursement payment system and nationwide eHealth privacy and security framework, and to develop a collaborative relationship among industry, government, and academia.
We are grateful to Professor Laurence C Baker, who provided the original questionnaire that was used in his work [2,29,36]. We also thank Mio Nakamura at Nippon Research Center Ltd for coordinating the survey. This survey was supported by a Grant-in-Aid for Scientific Research (A) from the Ministry of Education, Culture, Sports, Science and Technology, Japan to T Nakayama. The sponsor played no role in study design, data collection, analysis, or interpretation; in the writing of the paper; or in the decision to submit the paper for publication.
None declared
YT designed the protocol, was responsible for the data analysis, and drafted the manuscript. TO, SO, and TN gave valuable advice for developing the questionnaire. TO, TI, and TN supported drafting the manuscript and analyzing the data. All authors gave valuable advice for designing the protocol and preparing the manuscript. TN conceived the study and acted as supervisor.
Characteristics of survey participants and the Japanese population.
Health status of survey participants and the Japanese population.
Japan Internet Medical Association
Ministry of Health, Labour and Welfare