Behavioral factors associated with SARS-CoV-2 infection in Japan

Takeshi Arashiro, Yuzo Arima, Hirokazu Muraoka, Akihiro Sato, Kunihiro Oba, Yuki Uehara, Hiroko Arioka, Hideki Yanai, Naoki Yanagisawa, Yoshito Nagura, Yasuyuki Kato, Hideaki Kato, Akihiro Ueda, Koji Ishii, Takao Ooki, Hideaki Oka, Yusuke Nishida, Ashley Stucky, Reiko Miyahara, Chris SmithMartin Hibberd, Koya Ariyoshi, Motoi Suzuki

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: The relative burden of COVID-19 has been less severe in Japan. One reason for this may be the uniquely strict restrictions imposed upon bars/restaurants. To assess if this approach was appropriately targeting high-risk individuals, we examined behavioral factors associated with SARS-CoV-2 infection in the community. Methods: This multicenter case–control study involved individuals receiving SARS-CoV-2 testing in June–August 2021. Behavioral exposures in the past 2 weeks were collected via questionnaire. SARS-CoV-2 PCR-positive individuals were cases, while PCR-negative individuals were controls. Results: The analysis included 778 individuals (266 [34.2%] positives; median age [interquartile range] 33 [27–43] years). Attending three or more social gatherings was associated with SARS-CoV-2 infection (adjusted odds ratio [aOR] 2.00 [95% CI 1.31–3.05]). Attending gatherings with alcohol (aOR 2.29 [1.53–3.42]), at bars/restaurants (aOR 1.55 [1.04–2.30]), outdoors/at parks (aOR 2.87 [1.01–8.13]), at night (aOR 2.07 [1.40–3.04]), five or more people (aOR 1.81 [1.00–3.30]), 2 hours or longer (aOR 1.76 [1.14–2.71]), not wearing a mask during gatherings (aOR 4.18 [2.29–7.64]), and cloth mask use (aOR 1.77 [1.11–2.83]) were associated with infection. Going to karaoke (aOR 2.53 [1.25–5.09]) and to a gym (aOR 1.87 [1.11–3.16]) were also associated with infection. Factors not associated with infection included visiting a cafe with others, ordering takeout, using food delivery services, eating out by oneself, and work/school/travel-related exposures including teleworking. Conclusions: We identified multiple behavioral factors associated with SARS-CoV-2 infection, many of which were in line with the policy/risk communication implemented in Japan. Rapid assessment of risk factors can inform decision making.

Original languageEnglish
Pages (from-to)952-961
Number of pages10
JournalInfluenza and other Respiratory Viruses
Issue number5
Publication statusPublished - 09-2022
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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