Objectives: Small-size schools on remote islands or in remote areas often have combined classes for several grade levels, and different grade students are taught together in one class. The majority of relationships among students remain unchanged for nine years until junior high school graduation. It was then hypothesized that because of these conditions, stress is more likely to occur at such schools. The aim of this study was to confirm this hypothesis. Methods: To investigate the stress states and lifestyle conditions, we conducted questionnaire surveys with 143 pupils and 86 students at small-size elementary and junior high schools on a remote island for comparison with students at such schools in remote and suburban areas on the main island of Japan. Results Elementary school students at the school on the remote island showed fewer stress symptoms. There were fewer stress factors, and well-developed support structures were provided in them. There were only few students enrolling in cram schools and private lessons. Many students had regular hours for sleep and ate a proper breakfast. Junior high school students at the school on the remote island showed studyrelated stress in spite of well-developed support structures. Conclusion: These results on the elementary school students did not support our hypothesis that students at small-size schools on the remote island have high stress. However, studying condition became a cause of stress for junior high school students
