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EXPLORING HEALTH
PROMOTING LIFESTYLE
BEHAVIORS OF
JAPANESE COLLEGE
WOMEN: PERCEPTIONS,
PRACTICES, AND ISSUES
Junko Tashiro
Published online: 10 Nov 2010.

To cite this article: Junko Tashiro (2002) EXPLORING HEALTH PROMOTING

LIFESTYLE BEHAVIORS OF JAPANESE COLLEGE WOMEN: PERCEPTIONS,
PRACTICES, AND ISSUES, Health Care for Women International, 23:1, 59-70,
DOI: 10.1080/073993302753428438

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EXPLORING HEALTH PROMOTING LIFESTYLE

BEHAVIORS OF JAPANESE COLLEGE WOMEN:
PERCEPTIONS, PRACTICES, AND ISSUES

Junko Tashiro, RN, PhD

St. Luke’s College of Nursing, Tokyo, Japan
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The purpose of this study was to explore health promoting lifestyle be-
haviors (HPLBs) of college women in Japan. In addition, perceived health
status and concerns were evaluated. The methods used were both qualitative
and quantitative. The qualitative data from focus groups with 38 Japanese
college women were used to develop a questionnaire. Subsequently, 546
randomly selected college women responded to the mailed survey (response
rate 54%). Forty percent of the college women respondents perceived them-
selves as “rather unhealthy” or “unhealthy.” The investigator conclude that
(1) perceived HPLBs, health status, and health concerns were mutually as-
sociated, thus, to increase perceived health status and/or decrease perceived
health concerns, promoting healthy lifestyle behaviors must be considered;
(2) the number of perceived motives or cues and the number of perceived
health concerns of importance to college women must be considered to
promote healthy lifestyle behaviors.

Promoting a healthy lifestyle is a major issue for Japanese women. Like

women in developed countries, Japanese women live longer than men, yet
their perceived health status is not necessarily satisfactory (Verbugge &
Wingard, 1987). This global tendency toward a lower perceived health status
for women starts in childhood. Cohen, Brownell, and Felix (1990) and Ra-
dius, Dillman, Becker, Rosenstock, and Horvath (1980) reported that girls
perceived their health to be not as good as that of boys. Duchen-Smith,
Turner, and Jacobsen (1987) noted that most boys (61%) reported their over-

Received 26 May 1999; accepted 10 May 2001.

This article is a portion of my doctoral dissertation. I would like to express my appreciation
to my thesis committee, especially to Dr. Beverly McElmurry. I also recognize the Yamaji
Fumiko Nursing Research and Special Education Fund (Japan), which partially supported my
research project.
Address correspondence to Dr. Junko Tashiro, St. Luke’s College of Nursing, 1-10 Akashi-
cho, Chuo-ku, Tokyo, 104-0044 Japan.

59
 60 J. Tashiro

all health as “very good,” while the majority of girls (68%) reported their
health as “average.” Perry, GrifŽ n, and Murray (1985) stated that healthy
lifestyle behaviors are “learned early in life, are seen to consolidate in ado-
lescence, and then persist in adulthood” (p. 379). Little is known, however,
about the mechanisms and the transition of HPLBs from adolescence to
adulthood in Japanese young women. In this study, perceived HPLBs, health
status, and health concerns of Japanese college women (aged 18 to 22 years)
are explored, and the relationships among those variables are assessed.

HEALTH ISSUES OF JAPANESE YOUNG WOMEN

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The health status of Japanese young women (aged 15–24) is relatively

good in terms of their mortality rates and physical growth (increasing height
and weight). According to the Japanese Health and Welfare Statistics Asso-
ciation (1999), the mortality rate for young women was one of the lowest
(23.3 per 100,000) in the world in 1997, and the average height had in-
creased over the last nine decades. Morbidity and other health indicators
illustrate, however, the need for health promotion in Japan. More young
women aged 15 to 24 (21.4%) complained of illness symptoms than young
men (15.2%), with 12.1% of these young women going to clinics and hos-
pitals for treatment (compared with 9.2% of men). The Health and Wel-
fare Statistics Association (1999) reported young women had several other
health problems, including (1) accidents (the number one cause of death)
and suicide (the number two cause of death); (2) decreasing physical exer-
cise abilities (running, jumping, throwing a ball, and other sports) compared
with the 1980s; (3) an increasing number of minor health complaints such
as fatigue, shoulder stiffness, lower-back pain, migraine, and dysmenorrhea;
and (4) an increasing rate of teen abortions (Inoue & Ebara, 1999). These
health problems are related to lifestyle behaviors, which in turn are related
to perceived health status. Promoting healthy lifestyles is one of the major
health issues for women in Japan.
The quality of school or college health care in Japan is questionable. All
students study health from the Ž fth year of elementary school to the second
year of senior high school; however, researchers (Kadota, 1991; Nishida,
1992; Ueno, Ishiyama, Sugimoto, & Aoyama, 1991; and Watanabe, 1991)
indicate that there is a gap between health knowledge, skills, and behaviors
of Japanese young people. Watanabe (1991) found that 73.3% of the female
freshman college students she studied had some concern about their health;
however, only 5.7% of them exercised. Currently, the state health promotion
programs are devised to improve the health status of persons of all ages
in Japan. Sports education is offered to enhance the physical potential of
adolescents. Further study is needed to assess the effectiveness of school
health programs, however.
In addition, women’s health perspectives are neglected in school and col-
lege health settings in Japan, although more young women attend universities
 Health Promoting Lifestyle Behaviors 61

than ever before (Ministry of Education, Science, Sports, and Culture, 1999).
In college health services, public health nurses are the major providers of
health care targeted toward young women. Although physical screening and
care is provided, health care and education for young women is lacking
(Inoue & Ebara, 1999). Female university students are still a minority (Min-
istry of Education, Science, Sports, and Culture, 1999), and little is known
and discussed about issues of college women’s health and health behaviors.

PURPOSE
The purposes of studying Japanese college women (from freshmen to se-
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niors) were to (1) determine and explore perceived HPLBs, including infor-
mation sources and motives and barriers to HPLBs; (2) determine perceived
health status and health concerns; and (3) examine the relationships among
perceived HPLBs, perceived health status, and perceived health concerns to
explore the determinants of HPLBs.

CONCEPTUAL FRAMEWORK
A model for HPLBs developed by the investigator provided the conceptual
framework for this study (Figure 1). This model combines elements of the
Health Promotion Model developed by Pender (1987), concepts of health and
health promotion deŽ ned in the Ottawa Charter for health promotion (1986),
as well as other relevant studies of health-related behaviors, especially for

Figure 1. Conceptual model

 62 J. Tashiro

young women. HPLBs are referred to as “activities which are voluntarily,

intentionally, and regularly carried out by any person who seeks to enhance
his or her well-being [genki]” (Tashiro, 1996, 1997).

METHOD
The participants in this study were female university students, aged 18
to 24, who lived alone or with a female roommate and were enrolled in the
four-year program of the general specialties of a university located in central
Japan. Female students enrolled in medicine (six-year program) and nursing
(three-year program) were excluded because of their atypical educational
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backgrounds compared with most university students.

This study included both qualitative and quantitative approaches. First,
qualitative data were collected using four focus groups (Krueger, 1994).
The content validity of the discussion topics of the interview guide was
assessed by nursing research experts both in the United States and Japan.
The interview guide was assessed for relevancy and clarity of the discussion
topics by four key informants. The qualitative data were used to develop a
questionnaire. Quantitative data were collected using the questionnaire with
several components to measure demographics, perceived HPLBs, perceived
health status, and perceived health concerns.
The Ž rst and second components of the questionnaire, HPLBs and health
concerns, included questions developed from the information provided by
focus group discussions conducted by the investigator. The components of
perceived health status and demographic data were selected from a pilot
unpublished work of Japanese public health nurses. All components were
integrated into one questionnaire. Following these procedures, the partici-
pants in the second series of focus groups were asked to evaluate the clarity
of the questions. Finally, the questionnaire was used in a pilot test con-
ducted with female nursing students at the university. The content valid-
ity of the questionnaire was assessed by a number of research experts in
Japan. The interitem reliability of the HPLBs index consisting of 50 activi-
ties was .821 (p 5 .000; N 5 93). Following item analysis, we found that
the interitem reliability of the HPLBs index consisting of 38 items was .881
(p 5 .000; N 5 546). Test–retest reliability of the HPLBs index was .664
(p 5 .000; N 5 82).
A computer data Ž le was created and analyzed using the SPSS-PC pro-
gram (1995). The quantitative data were analyzed using descriptive, cross
tabulation, correlational, multiple regression, and analysis of variance and
factor analysis. An alpha level of .05 was used for all statistical tests.

RESULTS
Five hundred forty-six college women returned the mailed questionnaire
(response rate 54%).
 Health Promoting Lifestyle Behaviors 63

Perceived Health Status

Approximately 40% of the female students reported being “rather un-
healthy” and “unhealthy.” The Japanese college women assessed using phys-
ical feelings (taicho; 64% of participants), disease (53%), and mental con-
dition (49%). Forty-Ž ve percent reported being “rather healthy.” Only 15%
reported being “healthy.”

Perceived Health Concerns

Fourteen health concern items were generated from the discussions of the
focus group. The frequency of each of these health concerns was measured.
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On average, each participant reported approximately four health concerns,

including future plans, interpersonal relationships, nutrition/diet, and lack of
physical exercises. Following the item analysis, we retained 10 health con-
cerns (reliability alpha 5 .5218). The total score for the 10 health concerns
was negatively associated with the self-rated health status (perceived health
status; r 5 2 .2283; p 5 .000) and academic classiŽ cation (number of years
in college; r 5 2 .1375; p 5 .000). (See Table 2.)

Perceived Health Promoting Lifestyle Behaviors of Japanese

College Women
Originally 50 activities and 11 themes were derived from the focus group
discussions of the college women. Commonly practiced activities were cate-
gorized, including commitment to group, and mental health self-care. How-
ever, physical exercises was the least common activity practiced. Following
an item analysis, we retained 38 activities and 10 categories (Table 1). Factors
of the 38 items were examined using the factor analysis procedure (compo-
nent analysis). Ten factors were extracted. The 10 factors corresponded to
the 10 categories from the focus groups discussions.
The total score of HPLBs (38 activities) was positively and signiŽ cantly
related to perceived health status (r 5 .2069; p 5 .000; see Table 2).
Perceived health status was correlated with the following four domains
of the HPLBs: mental health self-care (r 5 .2501; p 5 .000), physical
exercises (r 5 .2543; p 5 .000); resting (r 5 .1837; p 5 .000), and

Table 1. Ten categories of health promoting

lifestyle behaviors

Commit to college groups Resting

Positive mental health self-care Health seeking
Recreation Environmental health
Health assessment Eating/nutrition and diet
Health maintenance self-care Physical exercises
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Table 2. Correlation matrix of variables studied (N = 546)

HPLB38 AC HS HC10 CTOT10 SITOT7 RNDESI4 HRTOT2

HPLB38 1.0000
AC 2 .0620 1.0000
HS .2069* * .0193 1.0000
HC10 2 .0997* 2 .1375* * 2 .2283* * 1.0000

64
CTOT10 .1578* * .0861* 2 .0237 .2125* * 1.0000
SITOT7 .1214* * 2 .0315 .0598 .1590* * .4064* * 1.0000
RNDESI4 .0608 2 .0567 2 .0120 .1908* * .1541* * .1235* * 1.0000
HRTOT2 2 .0775 .1551* * .0059 .0218 .0552 2 .0024 .0596 1.0000

Note. P * < .05, P * * < .005. Variable names are as follows: HPLB38 is 38 items of health promoting lifestyle behaviors. AC is academic classiŽ cation,
HS is health status, HC10 is health concerns (10 items), CTOT10 is motives or cues (10 items), SITOT7 is information source (10 items), RNDESI4 is reasons
for not practicing (4 items), and HRTOT2 is risky health behaviors (2 items).
 Health Promoting Lifestyle Behaviors 65

commitment to groups (r 5 .1716; p 5 .000). However, the total score of

HPLBs was negatively and signiŽ cantly related to perceived health concerns
(r 5 2 .0997; p 5 .020).

Perceived Motives or Cues to Engage in Health Promoting

Lifestyle Behaviors
The 13 motives or cues for the HPLBs were derived from the focus group
discussions. The most common motives or cues were the following: “started
living alone,” “books and magazines,” and “from childhood.” The college
women in the high health behaviors practicing group found encouragement
for this behavior from “books and magazines,” “advice of family,” “informa-
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tion learned in peer groups,” and “lecture at the university.” The group prac-
ticing fewer HPLBs responded to cues from childhood and no special cues.
Following the item analysis, we retained 10 items. The relationships between
the motives or cues, health status, health concerns, and the HPLBs were ex-
amined. The total score for motives or cues was positively and signiŽ cantly
correlated with the total score for health concerns (r 5 .2125; p 5 .000)
and the total score for the HPLBs (r 5 .1763; p 5 .000; see Table 2).

Perceived Barriers to Engage in Health Promoting

Lifestyle Behaviors
Nine reasons for not engaging in the HPLBs (perceived barriers) were
derived from the focus group discussions. Following item analysis, we re-
tained only three items as reliable reasons. The most common reasons for
not practicing were “time,” “kiryoku (mental energy),” and “personality.” The
differences between the high and low health promotion practicing groups
were examined. The low practicing group more often chose kiryoku (mental
energy) (v 2 5 12.61; p 5 .0004) and personality (v 2 5 8.296; p 5 .004)
as reasons for not practicing the HPLBs. The total score for reasons for
not practicing had positive signiŽ cant relationships with health concerns
(r 5 .1908; p 5 .000), motives or cues (r 5 .1541; p 5 .000), and infor-
mation sources (r 5 .1235; p 5 .000; see Table 2).

Perceived Information Sources for Health Promoting

Lifestyle Behaviors
The 10 sources of information were derived from analysis of the focus
groups. The college women reported that their experience, parents, books or
magazines, and conversation with friends were common information sources.
Following the item analysis of information sources of the HPLBs, we re-
tained seven items. The total score of information sources was positively
and signiŽ cantly correlated with the total scores of perceived motives or
cues for engaging in HPLBs (r 5 .4074; p 5 .000), having health concerns
(r 5 .1590; p 5 .000), and participating in HPLBs (r 5 .1214; p 5 .000).
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Table 3. Summary of multiple regressions for health status, health concerns, health promoting
lifestyle behaviors (N = 546)

Dependent variable Independent variable B SE B Beta T p

Health status Mental health self-care .0359 .0064 .0064 5.643 .0000
Exercising .0457 .0092 .2004 4.972 .0000
Health concerns 2 .0752 .0158 2 .1908 2 4.744 .0000
Environmental health 2 .0368 .0123 2 .1280 2 2.984 .0030
Health maintenance self-care 2 .0322 .0133 2 .1062 2 2.428 .0155
Resting .0351 .0141 .1071 2.493 .0130
Information sources .0327 .0175 .0746 1.868 .0623

Multiple R 5 .4300, R square 5 .1848, F 5 17.3985, df 5 7, signiŽ cance F 5 .0000.

Health concerns Health concerns 2 .4625 .1039 2 .1830 2 4.449 .0000

66
Reasons for not practicing .3583 .0924 .1564 3.874 .0001
Motives or cues .2259 .0453 .2024 4.984 .0000
Academic 2 .2610 .0690 2 .1519 2 3.781 .0002
Exercising 2 .0597 .0241 2 .1030 2 2.476 .0136
Eating/nutrition 2 .0345 .0117 2 .1192 2 2.957 .0032

Multiple R 5 .40183, R square 5 .1615, F 5 17.074, df 5 6, signiŽ cance F 5 .0000.

HPLBI (38 activities) Health status 4.6117 1.0724 .1827 4.300 .0000
Motives or cues 2.0176 .4775 .1809 4.225 .0000
Health concerns 2 1.3904 .4439 2 .1391 2 3.132 .0018
Academic classiŽ cation 2 1.6255 .7219 2 .0946 2 2.252 .0247
Reasons for not practicing 1.2483 .9713 .0545 1.285 .1993

Multiple R 5 .3004, R square 5 .0903, F 5 10.5761, df 5 5, signiŽ cance F 5 .0000.

 Health Promoting Lifestyle Behaviors 67

Determinants of Perceived Health Promoting Lifestyle Behaviors

Multiple regression analysis (Enter Method) was conducted to examine
the determinants of perceived HPLBs. The variance of perceived health status
was explained by the subscale of the HPLBs (mental health self-care, exer-
cising, environmental health, resting, and health maintenance; R 5 .4300 or
R 2 5 .1848; see Table 3). The variance of perceived health concerns was
explained by perceived health status, reasons for not practicing, motives or
cues, academic classiŽ cation, exercising, and eating/nutrition (R 5 .4018
or R 2 5 .1615; see Table 3). The variance of HPLBs was explained by
perceived health status, motives or cues, perceived health concerns, and aca-
demic classiŽ cation (R 5 .3004 or R 2 5 .0903). (See Table 3.)
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DISCUSSION
Perceived Health Status of Japanese College Women
This result is consistent with the Ž ndings of the Student Life Survey
conducted earlier by the same university, which indicated that 42% of the
female students stayed in bed because of sickness last year (versus 35.5% of
the male students; The University of Tsukuba, 1994). However, this Ž nding
was not consistent with a health survey that indicated that 24% of Japanese
women (aged 15 to 24) annually experienced some kind of illness (Health
and Welfare Statistics Association, 1999). In addition, the study of the gen-
eral Japanese female population (aged twenties), conducted by Ota, Tenkou,
and Iswikawa (1995) reported only 10% of Japanese women (aged twenties)
described their status as “rather unhealthy” or “unhealthy.” These Ž ndings
suggest that more of the Japanese college women studied perceive them-
selves as rather unhealthy or unhealthy than the young Japanese women in
the general population. This Ž nding is consistent with Duffy’s study (1989)
of female university employees (aged 21–65).

Perceived Health Concerns of Japanese College Women

The health concerns of Japanese college women included the follow-
ing: mental (future plans, education, interpersonal relationships, sexual re-
lationships), basic lifestyle (eating/nutrition and exercising), and physical
concerns (disease or injury). This Ž nding was partially consistent with the
study of American college female freshmen conducted by Vinal and col-
leagues (1986). Perceived health concerns was conversely related to per-
ceived health status and number of years in college. These Ž ndings suggested
that (1) health concerns decreased perceived health status, and (2) younger
college women had more health concerns than older college women. Future
attempts to improve perceived health status should focus on these health
concerns of college women.
 68 J. Tashiro

Perceived Health Promoting Lifestyle Behaviors of Japanese

College Women
The category of commit to the group or college community was unique
for the Japanese college women, but was partially consistent with the in-
terpersonal domains of the Health Promoting Lifestyle ProŽ le developed by
Walker, Sechrist, and Pender (1987) to measure health promoting lifestyle in
the United States. The college women reported that the times in the “com-
mit to the group” were important to the achievement of self-actualization.
Cortazzi (1993) states that the Japanese express family values in the notion
of the Ie (house) which is the basis of feudalism. This notion of Ie has been
applied to extended families and is used to develop closely knit groups such
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as companies or workplaces, as well as schools. A focus group participant

reported that when she did not participate in her group because of her in-
jury, she was lonely and depressed. As Japanese college women reported,
the content of the commit to college groups was of primary importance.
The Ž ndings supported the conclusion that HPLBs, especially in the ar-
eas of mental health, physical exercises, environmental health, and health
maintenance, were reciprocally associated with the perceived health status
of Japanese college women. In addition, although the correlation coefŽ cient
was not large, HPLBs were also negatively and signiŽ cantly correlated with
perceived health concerns. Perceived health status was also important in pro-
moting the HPLBs. In examining HPLBs, the number of motives or cues
and the number of health concerns must be considered because of their in-
 uence on the HPLBs. The number of motives or cues was explained by
the number of information sources, especially from books and magazines,
on advice of family, information learned in peer group, and lecture at the
university. The Ž ndings of this study suggested that the provision of more
information enables people to practice HPLBs.

IMPLICATIONS AND RECOMMENDATIONS

To decrease the number of college women who assessed themselves as
rather unhealthy or unhealthy, we must promote of healthy lifestyle be-
haviors in the area of mental health care, exercising, environmental health,
health maintenance self-care, and resting, as well as reduction in health con-
cerns in the areas of disease or injury and decline of physical ability. More
college-based services for the promotion of healthy lifestyle behaviors need
to be provided by college health nurses to in uence health status and reduce
health concerns. More college community mental health services should be
provided. College health nurses along with counselors from the center should
provide information to promote mental health.
To encourage college women to adopt a healthy lifestyle, we should con-
sider using the information from books and magazines, family, peer groups,
and lectures at the university regarding healthy lifestyle behaviors. College
 Health Promoting Lifestyle Behaviors 69

health nurses could provide information regarding healthy lifestyle behav-

iors using news letters or the university newspaper for college women. Also,
greater opportunities for peer group interactions should be provided. Finally,
women’s health courses should become part of the regular college or uni-
versity curriculum in Japan.

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