Clarifying the factors affecting the implementation of the “early to bed, early to rise, and don’t forget your breakfast” campaign aimed at adolescents in Japan

Purpose: This study aimed to assess the success of the Japanese government’s “Early to bed, early to rise, and don’t forget your breakfast” (EB, ER, and DFB) health promotion program for adolescents, which has been ongoing since 2006. Methods: We randomly selected 264 junior and senior high schools and conducted a survey of their habits related to EB, ER, and DFB. We defined EB, ER, and DFB as follows: bedtime before 10 p.m. (junior high school) or 11 p.m. (senior high school) and waking-up before 7 a.m., at which point the student should eat breakfast every day. Multivariate analysis was performed on the students’ lifestyles, and school-related factors were set as independent variables. Results: Data from 84,988 participants (31,474 from junior and 53,514 from senior high school) were analyzed. The effective response rates were 47.9% for junior high schools and 53.7% for senior high schools (overall rate: 51.4%). The data showed that 70–80% of students complied with ER and DFB, while less than 10% complied with EB. For almost all adolescents, “using the Internet ≥ 2 h/day” was the most negative factor influencing EB, ER, and DFB, and “family rules for using the Internet” was the most positive factor. Conclusions: For Japanese adolescents, it is especially important to promote the achievement of EB, and limits on the amount of time and rules for using the Internet were significantly related factors. Further study is required to clarify these causal relationships for an improved implementation of EB, ER, and DFB.