Introduction : This study aimed to clarify any associations between familial smoking, especially parental smoking, and high school students' perceptions of smoking.
Methods : Questionnaires on familial smoking and the Kano Test for Social Nicotine Dependence (KTSND) were distributed to junior high school students. The KTSND is a tool to evaluate positive perceptions of smoking. We analyzed the relationship between the total KTSND score and school grade, gender, familial smoking, paternal smoking, and maternal smoking.
Results : We received 761 valid responses (valid response rate : 90.4%). Five hundred forty-three students had family members who smoked (71.4%), 394 had smoking fathers (51.8%), and 214, smoking mothers (28.1%). The total KTSND score correlated with familial smoking (10.55 vs 9.46, p=0.009) and maternal smoking (11.18 vs 9.87, p=0.002).
Conclusion : Familial smoking, especially maternal smoking, correlated with positive perceptions of high school students towards smoking. Promoting smoking cessation in women with children may be effective in preventing tobacco use among children.

Association between smoking prevention education for elementary and junior high school students and the modification of their parents' smoking behavior — Can child education change parental behavior?
Introduction : This study aimed to investigate an association between a smoking prevention education program for elementary and junior high school students, and the subsequent behavior modifications of their parents.
Methods : Preventative education programs for smoking were provided to four elementary and three junior high schools in Kamisu City, Ibaraki Prefecture, Japan. We encouraged participating students to discuss the knowledge derived from the education sessions with their families. One month after completing the program, questionnaires were distributed to the parents of the students to investigate whether they had modified their smoking behavior as a result of what they had learnt from their children.
Results : Two questionnaires were distributed to each of 1109 families, and 1427 valid responses were received. Analysis showed that 794 parents had been informed about tobacco use from their children (55.6%) and 271 parents had modified their smoking behavior (19.0%) as a consequence. This included smoking cessation, decreasing tobacco consumption, and smoking avoidance in the presence of their children. Behavior modification was significantly correlated with the knowledge they had derived from their children based on the preventative smoking education program (odds ratio = 3.3 ; 95% CI : 2.4-4.6).
Conclusion : Implementation of an education program for smoking prevention focused on elementary and junior high school students can lead to modification of smoking behavior in both students and their parents, respectively.

Early clinical exposure has been implemented worldwide as an effective method of medical education. The duration of early clinical exposure is 1 year in some universities in Western countries. In Japan, however, early clinical exposure occurs most often through health and welfare services, and its duration varies. One-year early clinical exposure and reflection upon it were implemented for first-year students at Mie University School of Medicine in 2006 to motivate them and to teach them about professionalism. The effectiveness of this program was evaluated with a questionnaire, a daily log, and a portfolio.1) The questionnaire survey revealed that students considered the program extremely valuable. They had learned much about communication skills, the relationship between medicine and society, patients' families, and professionalism.2) An analysis of the daily logs clearly showed that students were unsure and hesitant at the start of the program. However, they gradually became accustomed to participating in this program and began to learn earnestly.3) Qualitative analysis of the portfolios revealed that students considered 10 items important in the practice of medicine, including communication skills, responsibility, the value of being a physician, professionalism, and the motivation to study medicine.4) In their final reports, the students described the expected behaviors of physicians they should seek to perform, by learning medical ethics or through professionalism.5) In conclusion, 1-year early clinical exposure is a more effective method than short-term or intermittent exposure for medical students because of its uniqueness and the maintenance of motivation.

1) By participating in the white coat ceremony, 60% percent of students felt that they had been accepted as fledgling medical professionals and become members of the medical community, and 86% began to think that they must take care of patients sincerely in the near future.2) The white coat ceremony made students aware that they would become physicians and gave them an opportunity to renew their enthusiasm for starting clinical clerkships. The distance between students and teachers was reduced.3) We will continue to hold the white coat ceremony, because it is an effective way of teaching professionalism to students.

Since 2009, a five-day, regional health care, clinical clerkship in medically underserved areas has been available to all fifth-year medical students at the University of Tsukuba. In the program, students listen to and observe health problems in non-clinical settings, wherever these problems actually exist. Students can experience health care lectures and health examinations. They can also experience a clinical work environment. The short stay helps students to understand the living environment of the area they observe. It is also effective for students to consider health problems from the perspective of the local inhabitants. This program aims to directly convey the interest and importance of community medicine, and to contribute to the supply of physicians in these areas. A longitudinal study is needed to evaluate the effect of the program.