Journal of Preventive Medicine and Public Health

Volume 39(4); July 2006

English Abstracts

Opportunities and Challenges for both National and International Public Health Area: The Public Health Sector in Government.: Dae Kyu Oh; J Prev Med Public Health. 2006;39(4):289-292.

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Abstract PDF: To inform choices about the future of people who study public health and preventive medicine, the current status of public health is examined in terms of the public health sector in government. After tracing the major achievements of public health in the modern era, this paper explores the potential of public health and its core functions, which is realized by public health professionals working in the government sector. Finally, this article highlights the international dimension of public health, which is becoming increasingly important and therefore attracting many people who would like to take part.; Summary

Curriculum of Health Promotion and Disease Prevention for the 21st Century -The 5th Revision of Preventive Medicine Learning Objectives.: Byung Chul Chun, Bo Yul Choi, Soo Hun Cho; J Prev Med Public Health. 2006;39(4):293-301.

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Abstract PDF: The preventive medicine learning objectives, first developed in 1977 and subsequently supplemented, underwent necessary revision of the contents for the fourth time to create the fifth revision. However, the required educational contents of health promotion and disease prevention have been changed by the new trends of medical education such as PBL and integrated curriculum, the rapid change of the health and medical environment and the globalization of medicine. The Korean Society of Preventive Medicine formed a task force, led by the Undergraduate Education Committee in 2003, which surveyed all the medical colleges to describe the state of preventive medicine education in Korea, analyzed the changing education demand according to the change of health environment and quantitatively measured the validity and usefulness of each learning objective in the previous curriculum. Based on these data, some temporary objectives were formed and promulgated to all the medical schools. After multiple revisions, an almost completely new series of learning objectives for preventive medicine was created. The objectives comprised 4 classifications and 1 supplement: 1) health and disease, 2) epidemiology and its application, 3) environment and health, 4) patient-doctorsociety, and supplementary clinical occupational health. The total number of learning objectives, contained within 13 sub-classifications, was 221 (including 35 of supplementary clinical occupational health). Future studies of the learning process and ongoing development of teaching materials according to the new learning objectives should be undertaken with persistence in order to ensure the progress of preventive medicine education.; Summary

Does Living nearby a Garbage Dumping Site Degrade the Quality of Life? A Case Study based on Shin-dong Myeon Residents, Chun-cheon Si.: Myung Kyung Lee, Jun Yeol Choi, In Kyoung Kim, Yeong Ah Cho, Young Shin Kim, Hye Jin Jung, Li Na Kim, Young Kyu Lee, Youngtae Cho; J Prev Med Public Health. 2006;39(4):302-308.

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Abstract PDF: OBJECTIVES
This study aims to examine if a garbage dumping site has real and negative influence on the quality of life (QOL) for the nearby residents. The net effects of the residential distance from the garbage dumping site and from the garbage truck route were investigated for five domains of the QOL. METHODS: Two hundred fifty seven Shin-dong Myeon residents, Chun-cheon Si, participated in a selfadministrated survey. The Shin-dong Myeon garbage dumping site began operating in 1996. ANCOVA with generalized linear models and multiple regression analysis were performed. RESULTS: Descriptive analyses show that a residence nearby a garbage dumping site is negatively associated with the physical and environmental domains of the QOL. The residential distance from the garbage truck route does not exert any significant effect on various domains of QOL, except for the environmental domain. On the multivariate analysis, the residents living near the garbage dumping site tended to have a significantly negative QOL in the physical and environmental domains. However, the distance from the garbage truck route did not show a significant nor substantial effect on the QOL. The demographic and socioeconomic control variables are associated with a number of the QOL domains, and their patterns are consistent with the general expectations. CONCLUSIONS: The results indicated that a garbage dumping site is considered to be an environmental hazard among the nearby residents according to the lower scores on the physical and environmental domains of the QOL. The findings from this study provide comprehensive understanding on the residents&QOL, and they may help politicians and policy makers make decisions for appropriate interventions.; Summary

Effects of Air Pollution on Asthma in Seoul: Comparisons across Subject Characteristic.: Sun Young Kim, Ho Kim, Jaiyong Kim; J Prev Med Public Health. 2006;39(4):309-316.

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Abstract PDF: OBJECTIVES
Korean epidemiological studies have used reduced samples according to the subject's characteristics, such as the health services provided, the historical note with asthma, and age, to examine the acute effect of air pollution on asthma using the Korean National Health Insurance records. However, there have been few studies on whether the effects shown in these reduced samples are different from those of all samples. This study compared the effects of air pollution on asthma attacks in three reduced samples with those of entire samples. METHODS: The air pollution data for PM10, CO, SO2, NO2, and O3 and weather conditions including temperature, relative humidity, and air pressure in Seoul, 2002, were obtained from outdoor monitoring stations in Seoul. The emergency hospital visits with an asthma attack in Seoul, 2002 were extracted from the Korean National Health Insurance records. From these, the reduced samples were created by health service, historical notes with asthma, and age. A case-crossover design was adopted and the acute effects of air pollution on asthma were estimated after adjusting for weather, time trend, and seasonality. The model was applied to each reduced sample and the entire sample. RESULTS: With respect to the health service, the effects on outpatients were similar to those for the total sample but were different for inpatients. These similar effect sizes were also observed in the reduced samples according to the historical note with asthma and age. The relative risks of PM10, CO, SO2, NO2, and O3 among the reduced and entire samples were 1.03, 1.04-1.05, 1.02-1.03, 1.04-1.06, and 1.10-1.17, respectively. CONCLUSIONS: There was no clear evidence to show a difference between the reduced samples and the entire samples.; Summary

Estimation of Smoking Prevalence among Adolescents in a Community by Design-based Analysis.: Soon Woo Park, Jong Yeon Kim, Sang Won Lee, Jung Han Park, Yeon Oh Yun, Won Kee Lee; J Prev Med Public Health. 2006;39(4):317-324.

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Abstract PDF: OBJECTIVES
This study was conducted to estimate the unbiased smoking prevalence and its standard errors among adolescents in a large city in Korea, by designbased analysis. METHODS: All the students in Daegu city were stratified by grade, gender and region, and then schools as primary sampling units (PSU) were selected by probability proportional to size (PPS) sampling. One or two classes were sampled randomly from each grade, from 5th grade in elementary schools to the 3rd grade in high schools. The students anonymously completed a standardized selfadministered questionnaire from October to December 2004. The total number of respondents was 8,480 in the final analysis, excluding the third graders in the general high schools because of incomplete sampling. The sampling weight was calculated for each student after poststratification adjustment, with adjustment being made for the missing cases. The data were analyzed with Stata 8.0 with consideration of PSU, weighting and the strata variables. RESULTS: The smoking prevalence (%) and standard errors for male students from the fifth grade in elementary schools to the second grade in high schools were 0.93[0.47, 1.83[ 0.74, 3.16[1.00, 5.12[1.02, 10.86[1.13, 15.63[2.44 and 17.96[2.67, and those for the female students were 0.28[ 0.28, 1.17[0.73, 3.13[0.60, 1.45[0.58, 3.94[0.92, 8.75 [1.86 and 10.04[1.70, sequentially. CONCLUSIONS: The smoking prevalence from this study was much higher than those from the other conventional studies conducted in Korea. The point estimates and standard errors from the design-based analysis were different from those of the model-based analysis. These findings suggest the importance of design-based analysis to estimate unbiased prevalence and standard errors in complex survey data and this method is recommended to apply to future surveys for determining the smoking prevalence for specific population.; Summary

Distribution of Airborne Fungi, Particulate Matter and Carbon Dioxide in Seoul Metropolitan Subway Stations.: Ki Youn Ki, Jae Beom Park, Chi Nyon Kim, Kyung Jong Lee; J Prev Med Public Health. 2006;39(4):325-330.

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Abstract PDF: OBJECTIVES
The aims of this study were to examine the level of airborne fungi and environmental factors in Seoul metropolitan subway stations and to provide fundamental data to protect the health of subway workers and passengers. METHODS: The field survey was performed from November in 2004 to February in 2005. A total 22 subway stations located at Seoul subway lines 1-4 were randomly selected. The measurement points were subway workers' activity areas (station office, bedroom, ticket office and driver's seat) and the passengers' activity areas (station precincts, inside train and platform). Air sampling for collecting airborne fungi was carried out using a one-stage cascade impactor. The PM and CO2 were measured using an electronic direct recorder and detecting tube, respectively. RESULTS: In the activity areas of the subway workers and passengers, the mean concentrations of airborne fungi were relatively higher in the workers' bedroom and station precinct whereas the concentration of particulate matter, PM10 and PM2.5, were relatively higher in the platform, inside the train and driver's seat than in the other activity areas. There was no significant difference in the concentration of airborne fungi between the underground and ground activity areas of the subway. The mean PM10 and PM2.5 concentration in the platform located at underground was significantly higher than that of the ground (p<0.05). CONCLUSIONS: The levels of airborne fungi in the Seoul subway line 1-4 were not serious enough to cause respiratory disease in subway workers and passengers. This indicates that there is little correlation between airborne fungi and particulate matter.; Summary

Women's Willingness to Pay for Cancer Screenin.: Min Son Kwak, Na Young Sung, Jeong Hee Yang, Eun Cheol Park, Kui Son Choi; J Prev Med Public Health. 2006;39(4):331-338.

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Abstract PDF: OBJECTIVES
The goal of this study is to measure women's willingness to pay for cancer screening and to identify those factors associated with this willingness to pay METHODS: A population-based telephone survey was performed on 1,562 women (aged 30 years or over) for 2 weeks (9-23th, July, 2004). Data about sociodemographic characteristics, health behaviors, the intention of the cancer screenings and willingness to pay for cancer screening were collected. 1,400 respondents were included in the analysis. The women's willingness to pay for cancer screening and the factors associated with this willingness to pay were evaluated. RESULTS: The results show that 76% of all respondents have a willingness to pay for cancer screening. Among those who are willing to pay, the average and median amount of money for which the respondents are willing to pay are 126,636 (s.d.: 58,414) and 120,000 won, respectively. As the status of education & the income are higher, the average amount that women are willing to pay becomes much more. The amount of money women are willing to pay is the highest during the 'contemplation' stage. Being willing to pay or not is associated with a change of behavior (transtheoretical model), the income, the concern about the cancer risk, the family cancer history, the marital status, the general health exam, age and the place of residence. Income is associated with a greater willingness to pay. Old age was associated with a lower willingness to pay. CONCLUSIONS: According to the two-part model, income and TTM are the most important variables associated with the willingness to pay for cancer screening. The cancer screening participation rate is low compared with the willingness to pay for cancer screening. It is thought that we have to consider the participants' behavior that&s associated with cancer screening and their willingness to pay in order to organize and manage cancer screening program.; Summary

Changes in Smoking Status among Current Male Smokers and Factors Associated with Smoking Cessation Success.: Jin Seok Lee, Yangjung Kim, Won Nyon Kim, Seung Sik Hwang, Yong Ik Kim; J Prev Med Public Health. 2006;39(4):339-345.

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Abstract PDF: OBJECTIVES
This study (a) investigated the rate of smoking cessation sucess for current male smokers, and (b) identified the factors that are associated with the smoking cessation success. METHODS: Data were collected from four follow-up surveys of 700 current male smokers. The follow-up period was from December 2004 to June 2005. Success of smoking cessation was defined as "maintaining a smoking cessation status for six months". The demographic and socioeconomic factors included age, the household income level and, occupation. The smoking behavioral factors were composed of the amount of smoking, the duration of smoking, the age of initiating smoking, the willingness to quit, the frequency of trying to quit smoking and the smoker`s attitude toward the anti-smoking policies. RESULTS: The proportion of quitters increased from 6.6% to 11.0% during the follow-up period. The majority of quitters answered that the increase of tobacco price acted as cue to achieve smoking cessation. The agestandardized experience and success rate of smoking cessation were 16.0% (95% C.I.=13.0% to, 19.0%) and 4.5% (95% C.I.=3.0% to, 6.0%), respectively. On the multivariate analysis, success for smoking cessation was associated with the willingness to quit smoking, low prior tobacco consumption, and agreement on the tobacco price increase. CONCLUSIONS: The results of this study suggest that the recent anti-smoking policies provided an opportunity to quit smoking. The results of this study can be used to establish evidence for further anti-smoking policies.; Summary

A Study on Scheduling Periodic Examinations for the Early Detection of Breast Cancer in Korea.: Seong Hwa Jeong, Dae Ryong Kang, Nam Wook Hur, Jinheum Kim, Soon Young Lee, Sang Hyuk Jung, Chung Mo Nam; J Prev Med Public Health. 2006;39(4):346-352.

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Abstract PDF: OBJECTIVES
The purposes of this study were to propose a screening schedule for the early detection of breast cancer among Korean women, as based on the statistical model, and to compare the efficacy of the proposed screening schedule with the current recommendations. METHODS: The development of the screening schedule for breast cancer closely followed the work of Lee and Zelen (1998). We calculated the age-specific breast cancer incidence rate from the Korea Central Cancer Registry (2003), and then we estimated the scheduling of periodic examinations for the early detection of breast cancer, using mammography, and based on the threshold method. The efficacy of the derived screening schedule was evaluated by the schedule sensitivity. RESULTS: For estimating the screening schedule threshold method, we set the threshold value as the probability of being in the preclinical stage at age 35, the sensitivity of mammography as 0.9 and the mean sojourn time in the preclinical stage as 4 years. This method generated 14 examinations within the age interval [40, 69] of 40.0, 41.3, 42.7, 44.1, 45.4, 46.7, 48.0, 49.3, 51.0, 53.2, 55.3, 57.1, 59.0 and 63.6 years, and the schedule sensitivity was 75.4%. The proposed screening schedule detected 85.2% (74.5/87.4) of the cases that could have been detected by annual screening, but it required only about 48.7% (14.0/30.0) of the total number of examinations. We also examined the threshold screening schedules for a range of sensitivities of mammography and the mean sojourn time in the preclinical stage. CONCLUSIONS: The proposed screening schedule for breast cancer with using the threshold method will be helpful to provide guidelines for a public health program for choosing an effective screening schedule for breast cancer among Korean women.; Summary

Serum Gamma-glutamyltransferase Levels and the Risks of Impaired Fasting Glucose in Healthy Men: A 2-year Follow-up.: Joo Youn Shin, Jong Han Lim, Dai Ha Koh, Keun Sang Kwon, Yong Kyu Kim, Hwan Chul Kim, Yeui Cheol Lee, Ju Hyoung Lee, Moon Suk Nam, Sung Bin Hong, Shin Goo Park; J Prev Med Public Health. 2006;39(4):353-358.

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Abstract PDF: OBJECTIVES
An increase in the serum gammaglutamyltransferase (GGT) concentration has been regarded as a marker of alcohol drinking or liver disease. Some reports, however, have suggested that the serum GGT may be a sensitive and early biomarker for the development of prediabetes and diabetes. In this study we investigated whether serum GGT is a reliable predictor of the incident impaired fasting glucose (IFG), including diabetes. METHODS: We performed a prospective study for two years (2002-2004). We analyzed the periodic health examination data from a total of 4,711 men. The examinations were done in the years 2002 and 2004. The analyzed data included a self-questionnaire, a physical examination and the laboratory results. Both IFG and diabetes were defined as a serum fasting glucose concentration of more than 100 mg/dL and 126 mg/dL, respectively. RESULTS: A total of 738 cases (15.7%) of incident IFG and 13 cases (0.3%) of diabetes occurred. The mean serum GGT concentrations were quite different between the normal (38.0 IU) and incident IFG groups (50.3 IU), and the incident diabetes group (66.0 IU) (p <0.001). After multivariable adjustment, the relative risks for incident IFG or diabetes across the baseline GGT categories (<10th, 10th-20th, 30th-40th, 50th-60th, 70th-80th and >90th percentile) were 1.0, 1.172 (0.769-1.785), 1.107 (0.725- 1.689), 1.444 (0.934-2.232), 2.061 (1.401-3.031) and 2.545 (1.784-3.631) (p-value for trend: <0.001). The risks significantly increased with increasing levels of GGT for 2 years; when comparing the increased groups (<10%, 10- 20%, >20%) versus the decreased over 20% group of GGT, the risks for IFG or diabetes were 1.334 (1.002-1.776), 1.613 (1.183-2.199) and 1.399 (1.092-1.794). CONCLUSIONS: Our findings suggest that serum GGT concentrations within its normal range may be an early predictor of the development of IFG and diabetes. As serum GGT is a relatively inexpensive test and a reliable marker, it might have important implications in public health promotion.; Summary

The Relationship Between Socioeconomic Position and the Predicted Risk of Ischemic Heart Disease with Using Health Risk Appraisal.: Dong Hee Koh, Hyoung Ryoul Kim, Sun Shil Han, Sun Ha Jee; J Prev Med Public Health. 2006;39(4):359-364.

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Abstract PDF: OBJECTIVES
The object of this study is to assess the relationship between socioeconomic factors and the predicted 10-year risk of cardiovascular disease by using health risk appraisal of ischemic heart disease. METHODS: The study population was taken from The 2001 Korea National Health and Nutrition Survey, and it consisted of 1,566 men and 1,984 women aged 30-59. We calculated 10-year risk using the risk function of ischemic heart disease as developed by Jee. The educational level and equivalized household income were dichotomized by a 12 years education period and the median income level. Occupation was dichotomized into manual/non-manual work. We stratified the population by age(10 years) and sex, and then we rated the risk differences according to socioeconomic factors by performing t-tests for each strata. RESULTS: There were gradients of the predicted 10-year risk of ischemic heart disease with the educational level and the equivalized household income, and thet was an increasing tendency of risk differences with age. Manual workers didn't show significant risk difference from nonmanual workers. CONCLUSIONS: There was definite relationship between low socioeconomic position and the predicted risk of ischemic heart disease in the future.; Summary

Occupational Differentials in Cigarette Smoking in South Korea: Findings from the 2003 Social Statistics Survey.: Hong Jun Cho, Young Ho Khang, Sung Cheol Yun; J Prev Med Public Health. 2006;39(4):365-370.

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Abstract PDF: OBJECTIVES
The purpose of this study was to investigate the differences in smoking rates according to the major occupational categories in South Korea. METHODS: The study subjects were a weighted sample of 24,495 men and 26,121 women aged 25-64 from the 2003 Social Statistics Survey, which was conducted by the Korea National Statistical Office. Occupation was classified according to the Korean Standard Occupation Classification. We computed the age-standardized smoking rates according to gender and occupations after adjusting for the education level, marital status, and self-rated health. RESULTS: For men, the smoking rate in elementary occupations was two times higher than that of clerks (OR= 1.98, 95% CI=1.74-2.26). In general, a more prestigious job(professionals) correlated with lower smoking rates, and less prestigious jobs correlated with higher smoking rates, except for legislators, senior officials and managers. For women, smoking among service workers was 4.1 times higher than among clerical workers (OR=4.11, 95% CI= 2.87-5.88). For women, their occupations, except elementary workers, and the unemployed, the retired and the armed forces, failed to show significant differences in smoking compared with the clerical workers. After adjusting for education, occupational differences in the smoking rate for men were attenuated in most occupations, except for legislators, professionals, and technicians. Further adjustment for marital status and self-rated health had a minimal effect on the occupational differences in the smoking rate for men. For women workers with service or elementary occupations, the ORs of smoking were attenuated with adjustment of the educational levels. However, the ORs of smoking were increased in workers with service, sales or elementary occupations, as well as for legislators, and the unemployed, the retired and the armed forces, after additionally adjusting for marital status. CONCLUSIONS: More prestigious jobs generally correlated with lower smoking rates in both sexes. The anti-tobacco policy should consider smoking rate differentials by occupations.; Summary

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