会員の研究

Background Intergenerational transmission of physical abuse is well-known; however, the potential for contextual effect modification remains unknown. Objective We investigated whether the norms of tolerance for child physical abuse modify the intergenerational transmission of physical abuse. Participants and setting Data from the Child Living Standard Survey (grades five and eight) conducted between 2016 and 2018 in three prefectures in Japan was analyzed. Methods The norms of tolerance for child physical abuse were calculated based on the proportion of caregivers who physically abuse their offspring in each of the 33 districts (n = 43,534). The caregivers' childhood physical abuse victimization and perpetration of child physical abuse were assessed via questionnaire. A multilevel analysis was performed to evaluate the cross-level interaction of the norms of tolerance for child physical abuse at the neighborhood level on the association between the caregiver's childhood physical abuse victimization and perpetration of child physical abuse, stratified by fathers (n = 4334) and mothers (n = 38,290). Results By district, the average percentage of caregivers who physically abuse their offspring was 14.4 %. Intergenerational transmission was confirmed for both fathers and mothers. Fathers who are living with highly tolerant norms for child physical abuse showed higher odds of intergenerational transmission of physical abuse, while mothers showed no effect modification. Conclusion The norms of tolerance for child physical abuse showed a more prominent intergenerational transmission of physical abuse for fathers but not for mothers. To modify the cycle of physical abuse, interventions to reduce norms of tolerance for child physical abuse may be useful.

Background While Japan provides universal healthcare, immigrants may experience hampered access to healthcare. A comprehensive review of immigrant healthcare access is also lacking. This systematic review aims to examine barriers and facilitators of healthcare access among immigrants in Japan. Methods We searched for literature published in English and Japanese until January 9, 2024. Studies were included if they assessed factors influencing any stage of immigrants’ healthcare access, such as perceiving needs, seeking, reaching, utilizing healthcare and the consequences of healthcare, as defined by the Levesque framework. We performed a thematic analysis to further identify categories (PROSPERO: CRD42023418554). Findings After screening 2791 articles, we identified 67 studies (40 quantitative, 23 qualitative, 4 mixed methods) meeting eligibility criteria. Limited healthcare information led immigrants to seek alternative information sources and affected immigrants' perceived healthcare needs. Longer duration of stay improved access to healthcare information. Cultural and healthcare system differences affected healthcare seeking. Reaching and utilizing healthcare were hindered by heavy workloads, undocumented status, financial hardship, and limited insurance but were facilitated by support from family and friends. The healthcare system was often insufficient to support immigrants’ language and cultural needs leading to dissatisfaction and poor compliance. Interpretation Findings highlight the critical importance of a multidimensional approach to support immigrants in Japan, ranging from improving healthcare information access to creating immigrant-friendly health systems. More research is needed on the healthcare access among vulnerable immigrants, such as undocumented and low-skilled labor immigrants and children. Funding No specific funding source supported this study.