Spa could have direct effects for physical and mental health but also non-daily pleasure with a visit to spa itself and surroundings. Therefore, the visit should be strongly related with quality of life (QOL) as well as general health status. First of all, this study was conducted to clarify these relationships. Secondly, the QOL was investigated as a confounding factor to health effects of spa. Subjects of this study are about all 6, 000 citizens older than 40 years of age living in Japanese J-town. Self-administrated questionnaires were distributed to the subjects at once and collected for the analysis (Response rate; 94.5%). With regard to the spa visit, (1) no visit at all recently in two or three years, (2) once a year, (3) twice or three times a year and (4) once a month, (5) twice or three times a month were classified.
With regard to QOL (Quality of Life), a questionnaire of WHO-QOL was used. The present study demonstrated the visitors to spa have significantly higher WHO-QOL for each subcategory; physical health, psychological status, social relationship, and environment status compared with non-visitors. Therefore, the visitors have had higher total scores of WHO-QOL compared with non-visters. With regard to past history of fracture, the visitors have had significantly lower it's prevalence compared with non-visitors. However, the significance of prevalence was cancelled in adjusting the WHO-QOL. WHO-QOL relating to the frequency of spa visit as well as the prevalence of fracture was identified as a confounding factor to health effects of spa.

In the town which commenced health promotion facilities using hot spring in May, 2000, how the utilization frequency influences afterwards health status and active life expectancy, was investigated by the follow-up study.
The research subjects were all inhabitants aged 40 or more years living in J town with about 10, 000 inhabitants in Toyama Prefecture, Japan. The cooperation request of the survey was carried out to women's association, when the survey was performed in December, 2000.
With regard to the entry survey, the answers of 5, 812 (95.0%)of the 6, 117 registered inhabitants were collected. They were served to the follow-up survey on (1) death, (2) bone fracture, (3) cerebral apoplexy, (4) senile dementia, (5) welfare facilities entrance, (6) long term admission beyond 6 months, (7) bed bound, (8) diabetes mellitus from April, 2001 to March, 2004. The sex-age matched control was randomly selected from the inhabitants participated in the entry survey for case-control study.
As the result, the occurrence rates of (1) death and (2) bone fracture were significantly lower in the group with twice or more utilization of the hot spring per year compared with the group utilizing once or less per year, and (3) cerebral apoplexy showed the slightly significant relationship, even after adjusting with exercise habit and WHO-QOL of confounding factors. The other events were not significantly associated with frequency of hot spring utilization.
It has been indicated that health promotion facilities using hot spring could contribute to active life expectancy via health and welfare promotion.