Journal of Preventive Medicine and Public Health

Volume 55(2); March 2022

Editorial

Our Valuable Contributors: Reviewers of 2021: Sung-il Cho; J Prev Med Public Health. 2022;55(2):115-115. Published online March 31, 2022; DOI: https://doi.org/10.3961/jpmph.22.100

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Special Article

Application of Standardization for Causal Inference in Observational Studies: A Step-by-step Tutorial for Analysis Using R Software: Sangwon Lee, Woojoo Lee; J Prev Med Public Health. 2022;55(2):116-124. Published online February 11, 2022; DOI: https://doi.org/10.3961/jpmph.21.569

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Epidemiological studies typically examine the causal effect of exposure on a health outcome. Standardization is one of the most straightforward methods for estimating causal estimands. However, compared to inverse probability weighting, there is a lack of user-centric explanations for implementing standardization to estimate causal estimands. This paper explains the standardization method using basic R functions only and how it is linked to the R package stdReg, which can be used to implement the same procedure. We provide a step-by-step tutorial for estimating causal risk differences, causal risk ratios, and causal odds ratios based on standardization. We also discuss how to carry out subgroup analysis in detail.

Summary

Korean summary
본 논문에서는 standardization 방법을 이용하여 risk difference, relative risk, risk ratio와 같은 인과성 효과를 R software을 이용하여 도출하는 튜토리얼을 제공합니다. 간암환자의 치료를 예시로, 합성 데이터를 이용한 치료제의 사망에 대한 인과적 효과를 탐색하는 튜토리얼을 제공합니다. 추가적으로, 인과성 관련 기본 이론을 집약적으로 설명하였고, standardization을 이용한 subgroup analysis 수행 방법이 제공됩니다.

Citations

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Homologous and Heterologous Prime-Boost Vaccination: Impact on Clinical Severity of SARS-CoV-2 Omicron Infection among Hospitalized COVID-19 Patients in Belgium
Marjan Meurisse, Lucy Catteau, Joris A. F. van Loenhout, Toon Braeye, Laurane De Mot, Ben Serrien, Koen Blot, Emilie Cauët, Herman Van Oyen, Lize Cuypers, Annie Robert, Nina Van Goethem
Vaccines.2023; 11(2): 378. CrossRef
Improved Clinical Outcomes With Early Anti-Tumour Necrosis Factor Alpha Therapy in Children With Newly Diagnosed Crohn’s Disease: Real-world Data from the International Prospective PIBD-SETQuality Inception Cohort Study
Renz C W Klomberg, Hella C van der Wal, Martine A Aardoom, Polychronis Kemos, Dimitris Rizopoulos, Frank M Ruemmele, Mohammed Charrout, Hankje C Escher, Nicholas M Croft, Lissy de Ridder, Ivan D Milovanovich, James J Ashton, Paul Henderson, Oren Ledder, T
Journal of Crohn's and Colitis.2023;[Epub] CrossRef

Systematic Review

Challenges to Achieving Universal Health Coverage Throughout the World: A Systematic Review: Alireza Darrudi, Mohammad Hossein Ketabchi Khoonsari, Maryam Tajvar; J Prev Med Public Health. 2022;55(2):125-133. Published online March 8, 2022; DOI: https://doi.org/10.3961/jpmph.21.542

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Objectives
No systematic review has explored the challenges related to worldwide universal health coverage (UHC). This study reviewed challenges on the road to UHC.
Methods
A systematic electronic search of all studies that identified the challenges of worldwide UHC was conducted, without any restrictions related to the publication date or language. A hand search and a bibliographic search were also conducted to identify which texts to include in this study. These sources and citations yielded a total of 2500 articles, only 26 of which met the inclusion criteria. Relevant data from these papers were extracted, summarized, grouped, and reported in tables.
Results
Of the 26 included studies, 7 (27%) were reviews, 6 (23%) were reports, and 13 (50%) had another type of study design. The publication dates of the included studies ranged from 2011 to 2020. Nine studies (35%) were published in 2019. Using the World Health Organization conceptual model, data on all of the challenges related to UHC in terms of the 4 functions of health systems (stewardship, creating resource, financing, and delivering services) were extracted from the included studies and reported.
Conclusions
This study provides a straightforward summary of previous studies that explored the challenges related to UHC and conducted an in-depth analysis of viable solutions.

Summary

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David Villarreal-Zegarra, Luciana Bellido-Boza, Alfonso Erazo, Max Pariona-Cárdenas, Paul Valdivia-Miranda
Scientific Reports.2024;[Epub] CrossRef
In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia
Nurul Qalby, Dian S. Arsyad, Andriany Qanitha, Maarten J. Cramer, Yolande Appelman, Dara R. Pabittei, Pieter A. Doevendans, Idar Mappangara, Akhtar Fajar Muzakkir
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Access of older people to primary health care in low and middle-income countries: A systematic scoping review
Saydeh Dableh, Kate Frazer, Diarmuid Stokes, Thilo Kroll, Dirceu Henrique Paulo Mabunda
PLOS ONE.2024; 19(4): e0298973. CrossRef
Do national health insurance schemes guarantee financial risk protection in the drive towards Universal Health Coverage in West Africa? A systematic review of observational studies
Sydney N. N. T. Odonkor, Ferdinand Koranteng, Martin Appiah-Danquah, Lorena Dini, Ama Pokuaa Fenny
PLOS Global Public Health.2023; 3(8): e0001286. CrossRef
Universal health coverage evolution, ongoing trend, and future challenge: A conceptual and historical policy review
Chhabi Lal Ranabhat, Shambhu Prasad Acharya, Chiranjivi Adhikari, Chun-Bae Kim
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Role of family factors in provision and perception of social support for older people in Iran: a cross-sectional survey
Maryam Tajvar, Emily Grundy, Astrid Fletcher, Elizabeth Allen, Badriyeh Karami
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La enseñanza de la Salud pública para alcanzar la cobertura universal en salud.
Luis Rodolfo Morales-Rosales
Revista Científica.2023;[Epub] CrossRef
La enseñanza de la Salud pública para alcanzar la cobertura universal en salud.
Luis Rodolfo Morales-Rosales Morales-Rosales
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An Evaluation of the Philippine Healthcare System: Preparing for a Robust Public Health in the Future
Dalmacito A. Cordero
Journal of Preventive Medicine and Public Health.2022; 55(3): 310. CrossRef
The impacts of donor transitions on health systems in middle-income countries: a scoping review
Hanna E Huffstetler, Shashika Bandara, Ipchita Bharali, Kaci Kennedy Mcdade, Wenhui Mao, Felicia Guo, Jiaqi Zhang, Judy Riviere, Liza Becker, Mina Mohamadi, Rebecca L Rice, Zoe King, Zoha Waqar Farooqi, Xinqi Zhang, Gavin Yamey, Osondu Ogbuoji
Health Policy and Planning.2022; 37(9): 1188. CrossRef

Original Articles

In-depth Correlation Analysis of SARS-CoV-2 Effective Reproduction Number and Mobility Patterns: Three Groups of Countries: Mounir Ould Setti, Sylvain Tollis; J Prev Med Public Health. 2022;55(2):134-143. Published online February 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.522

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Objectives
Many governments have imposed—and are still imposing—mobility restrictions to contain the coronavirus disease 2019 (COVID-19) pandemic. However, there is no consensus on whether policy-induced reductions of human mobility effectively reduce the effective reproduction number (Rt) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several studies based on country-restricted data reported conflicting trends in the change of the SARS-CoV-2 Rt following mobility restrictions. The objective of this study was to examine, at the global scale, the existence of regional specificities in the correlations between Rt and human mobility.
Methods
We computed the Rt of SARS-CoV-2 using data on worldwide infection cases reported by the Johns Hopkins University, and analyzed the correlation between Rt and mobility indicators from the Google COVID-19 Community Mobility Reports in 125 countries, as well as states/regions within the United States, using the Pearson correlation test, linear modeling, and quadratic modeling.
Results
The correlation analysis identified countries where Rt negatively correlated with residential mobility, as expected by policymakers, but also countries where Rt positively correlated with residential mobility and countries with more complex correlation patterns. The correlations between Rt and residential mobility were non-linear in many countries, indicating an optimal level above which increasing residential mobility is counterproductive.
Conclusions
Our results indicate that, in order to effectively reduce viral circulation, mobility restriction measures must be tailored by region, considering local cultural determinants and social behaviors. We believe that our results have the potential to guide differential refinement of mobility restriction policies at a country/regional resolution.

Summary

Citations

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The effect of social movements on COVID-19 case increases and death in Turkey
Mehmet Akif Gun, Onder Hanci
Clinical Epidemiology and Global Health.2023; 20: 101260. CrossRef
The effects of weather and mobility on respiratory viruses dynamics before and during the COVID-19 pandemic in the USA and Canada
Irma Varela-Lasheras, Lilia Perfeito, Sara Mesquita, Joana Gonçalves-Sá, Ryan S. McGinnis
PLOS Digital Health.2023; 2(12): e0000405. CrossRef

Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study: Kyungsik Kim, Young-Do Jeung, Jeoungbin Choi, Sue K. Park; J Prev Med Public Health. 2022;55(2):144-152. Published online February 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.396

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Objectives
This study aimed to identify the social and policy determinants of coronavirus disease 2019 (COVID-19) infection across 23 countries.
Methods
COVID-19 indicators (incidence, mortality, and fatality) for each country were calculated by direct and indirect standardization. Multivariable regression analyses were used to identify the social and policy determinants of COVID-19 infection.
Results
A higher number of doctors per population was related to lower incidence, mortality, and fatality rates of COVID-19 in 23 countries (β=-0.672, -0.445, and -0.564, respectively). The number of nurses/midwives per population was associated with lower mortality and fatality rates of COVID-19 in 23 countries (β=-0.215 and -0.372, respectively). Strengthening of policy restriction indicators, such as restrictions of public gatherings, was related to lower COVID-19 incidence (β=-0.423). A national Bacillus Calmette–Guérin vaccination policy conducted among special groups or in the past was associated with a higher incidence of COVID-19 in 23 countries (β=0.341). The proportion of the elderly population (aged over 70 years) was related to higher mortality and fatality rates (β=0.209 and 0.350, respectively), and income support was associated with mortality and fatality rates (β=-0.362 and -0.449, respectively).
Conclusions
These findings do not imply causality because this was a country-based correlation study. However, COVID-19 transmission can be influenced by social and policy determinants such as integrated health systems and policy responses to COVID-19. Various social and policy determinants should be considered when planning responses to COVID-19.

Summary

Korean summary
본 연구는 23개국의 코로나 19 감염 지표 (발생, 사망, 치명)과 관련있는 사회적, 정책적 요소를 확인하고자 하는생태학적 연구이다. 이는 코로나 19 감염 지표에 대한 인과성을 제시하는 연구가 아니기에 주의 깊은 해석이 필요하며 본 연구에서 제시한 사회적, 정책적 요소를 통해 코로나 19 감염에 대한 국가적인 정책을 고려할 수 있을 것으로 기대된다.

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COVID 19 mortality as a reflection of the quality of health in EU countries
Beáta Stehlíková, Zuzana Vincúrová, Ivan Brezina, Ilona Švihlíková
Economics & Sociology.2023; 16(3): 138. CrossRef
Social and Policy Determinants of COVID-19
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
Journal of Preventive Medicine and Public Health.2022; 55(3): 307. CrossRef
Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study
Kyungsik Kim, Sue K. Park
Journal of Preventive Medicine and Public Health.2022; 55(3): 308. CrossRef
Country-level and regional COVID-19 burden and determinants across OECD member states and partner countries
Nlandu Roger Ngatu, Kazuto Tayama, Kanae Kanda, Tomohiro Hirao
Environmental Health and Preventive Medicine.2022; 27: 41. CrossRef
The association between tobacco or nicotine product use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic: a cross-sectional study in Korea
Da-eun Lee, Heewon Kang, Sung-il Cho
Epidemiology and Health.2022; 44: e2022087. CrossRef

A Multi-level Analysis of Factors Affecting Participation in Health Screenings in Korea: A Focus on Household and Regional Factors: So Yoon Park, Young-jeon Shin; J Prev Med Public Health. 2022;55(2):153-163. Published online October 27, 2021; DOI: https://doi.org/10.3961/jpmph.21.268

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Abstract Summary PDF Supplementary Material

Objectives
This study divided the factors that affect participation in health screenings into individual, household, and regional levels and conducted a multi-level analysis to identify the factors related to participation in health screenings.
Methods
Participants from the 2017 Community Health Survey were classified into 2 groups (under 40 and 40 or older). A multi-level logistic regression analysis was conducted to identify the factors that affected participation in health screenings.
Results
The screening rate of the participants was 69.7%, and it was higher among participants aged 40 and older (80.3%) than it was among participants younger than 40 (49.8%). At the individual level, the factors that influenced participation in health screenings included age, economic activity, smoking status, physician-diagnosed hypertension, and a moderate or high physical activity level. At the household level, the odds ratio of participation in health screenings was high for participants who lived in single-person households, lived with a spouse, earned a high monthly household income, and were not beneficiaries of national basic livelihood security. At the regional level, the odds ratio at the 95% confidence interval level of participation in health screenings was high for participants who had trust in the local community and lived in an area with a proportionally high social welfare budget.
Conclusions
This study analyzed nationalwide data and confirmed that individual, household, and regional characteristics affected participation in health screenings. Therefore, policies that prioritize the improvement of regional level factors and especially household level factors are likely to be the most effective for improving the screening rate.

Summary

Korean summary
이 연구는 건강검진 수검 여부에 영향을 미치는 요인을 개인, 가구, 지역수준으로 나누어 다수준 분석을 통해 분석하였다. 건강검진 수검여부에 개인 특성뿐만 아니라 개인을 둘러싼 가구와 지역의 특성도 영향을 미친다는 것을 확인하였다. 영향요인들의 유의성을 바탕으로, 건강검진 수검률 향상을 위한 정책을 수립할 때 지역수준 요인뿐만 아니라 특별히 가구수준 요인을 개선할 수 있는 정책을 우선하는 것이 효과적일 것이다.

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Sex-specific Associations between Body Mass Index and Thyroid Cancer Incidence among Korean Adults
Kyoung-Nam Kim, Kyungsik Kim, Sangjun Lee, Sue K. Park
Cancer Epidemiology, Biomarkers & Prevention.2023; 32(9): 1227. CrossRef
Factors Associated with Willingness toward Organ Donation in China: A Nationwide Cross-Sectional Analysis Using a Social–Ecological Framework
Mengjun Zeng, Haomiao Li, Xiaohui Song, Jipin Jiang, Yingchun Chen
Healthcare.2023; 11(6): 824. CrossRef

Spatio-temporal Distribution of Suicide Risk in Iran: A Bayesian Hierarchical Analysis of Repeated Cross-sectional Data: Seyed Saeed Hashemi Nazari, Kamyar Mansori, Hajar Nazari Kangavari, Ahmad Shojaei, Shahram Arsang-Jang; J Prev Med Public Health. 2022;55(2):164-172. Published online February 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.385

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Abstract PDF Supplementary Material

Objectives
We aimed to estimate the space-time distribution of the risk of suicide mortality in Iran from 2006 to 2016.
Methods
In this repeated cross-sectional study, the age-standardized risk of suicide mortality from 2006 to 2016 was determined. To estimate the cumulative and temporal risk, the Besag, York, and Mollié and Bernardinelli models were used.
Results
The relative risk of suicide mortality was greater than 1 in 43.0% of Iran’s provinces (posterior probability >0.8; range, 0.46 to 3.93). The spatio-temporal model indicated a high risk of suicide in 36.7% of Iran’s provinces. In addition, significant upward temporal trends in suicide risk were observed in the provinces of Tehran, Fars, Kermanshah, and Gilan. A significantly decreasing pattern of risk was observed for men (β, -0.013; 95% credible interval [CrI], -0.010 to -0.007), and a stable pattern of risk was observed for women (β, -0.001; 95% CrI, -0.010 to 0.007). A decreasing pattern of suicide risk was observed for those aged 15-29 years (β, -0.006; 95% CrI, -0.010 to -0.0001) and 30-49 years (β, -0.001; 95% CrI, -0.018 to -0.002). The risk was stable for those aged >50 years.
Conclusions
The highest risk of suicide mortality was observed in Iran’s northwestern provinces and among Kurdish women. Although a low risk of suicide mortality was observed in the provinces of Tehran, Fars, and Gilan, the risk in these provinces is increasing rapidly compared to other regions.

Summary

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Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study
Masoud Ghadipasha, Ramin Talaie, Zohreh Mahmoodi, Salah Eddin Karimi, Mehdi Forouzesh, Masoud Morsalpour, Seyed Amirhosein Mahdavi, Seyed Shahram Mousavi, Shayesteh Ashrafiesfahani, Roya Kordrostami, Nahid Dadashzadehasl
Frontiers in Psychiatry.2024;[Epub] CrossRef

Association Between Sleep Quality and Anxiety in Korean Adolescents: Hyunkyu Kim, Seung Hoon Kim, Sung-In Jang, Eun-Cheol Park; J Prev Med Public Health. 2022;55(2):173-181. Published online February 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.498

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Objectives
Anxiety disorder is among the most prevalent mental illnesses among adolescents. Early detection and proper treatment are important for preventing sequelae such as suicide and substance use disorder. Studies have suggested that sleep duration is associated with anxiety disorder in adolescents. In the present study, we investigated the association between sleep quality and anxiety in a nationally representative sample of Korean adolescents.
Methods
This cross-sectional study was conducted using data from the 2020 Korea Youth Risk Behavior Web-based Survey. The Generalized Anxiety Disorder-7 questionnaire was used to evaluate anxiety. The chi-square test was used to investigate and compare the general characteristics of the study population, and multiple logistic regression analysis was used to analyze the relationship between sleep quality and anxiety.
Results
In both sexes, anxiety was highly prevalent in participants with poor sleep quality (adjusted odds ratio [aOR], 1.56; 95% confidence interval [CI], 1.43 to 1.71 in boys; aOR, 1.30; 95% CI, 1.19 to 1.42 in girls). Regardless of sleep duration, participants with poor sleep quality showed a high aOR for anxiety.
Conclusions
This study identified a consistent relationship between sleep quality and anxiety in Korean adolescents regardless of sleep duration.

Summary

Korean summary
청소년건강행태조사를 이용하여 청소년들의 수면의 질과 불안과의 연관성을 분석하였다. 좋지 않은 수면의 질은 불안감과 연관성이 있었으며 이 연관성은 대상자들의 수면시간과 상관없이 나타났다.

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Jian Zhang, Junli Feng, Chenyu Feng
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The Association between High-Caffeine Drink Consumption and Anxiety in Korean Adolescents
Ji Ann Cho, Soyeon Kim, Haein Shin, Hyunkyu Kim, Eun-Cheol Park
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Yeon-Suk Lee, Jae Hong Joo, Jaeyong Shin, Chung Mo Nam, Eun-Cheol Park
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Adölesan Döneminde Sık Görülen Sağlık Riskleri ve Sorunları
Betül UNCU, Elif DOĞAN, Rukiye DUMAN
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The influences of mental health problem on suicide-related behaviors among adolescents: Based on Korean Youth Health Behavior Survey
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Anxious-Withdrawal and Sleep Problems during Adolescence: The Moderating Role of Peer Difficulties
Julie C. Bowker, Jessica N. Gurbacki, Chloe L. Richard, Kenneth H. Rubin
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A pooled analysis of temporal trends in the prevalence of anxiety-induced sleep loss among adolescents aged 12–15 years across 29 countries
Guodong Xu, Lian Li, Lijuan Yi, Tao Li, Qiongxia Chai, Junyang Zhu
Frontiers in Psychiatry.2023;[Epub] CrossRef
Factors Influencing Adolescent Generalized Anxiety Disorder: A Zero-Inflated Negative Binomial Regression Model
Kyung Im Kang, Chan Mi Kang
Journal of Psychosocial Nursing and Mental Health Services.2023; : 1. CrossRef
Impact of sleep dysfunction on psychological burden in patients with empty nose syndrome
Chien‐Chia Huang, Pei‐Wen Wu, Yun‐Shien Lee, Chi‐Che Huang, Po‐Hung Chang, Chia‐Hsiang Fu, Ta‐Jen Lee
International Forum of Allergy & Rhinology.2022; 12(11): 1447. CrossRef

Determinants of Optimal Breastfeeding Practices in Indonesia: Findings From the 2017 Indonesia Demographic Health Survey: Siti Nurokhmah, Setyaningrum Rahmawaty, Dyah Intan Puspitasari; J Prev Med Public Health. 2022;55(2):182-192. Published online February 23, 2022; DOI: https://doi.org/10.3961/jpmph.21.448

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Objectives
Understanding the factors influencing mothers’ decision to breastfeed their infants is essential to formulate effective breastfeeding interventions. This study explored the determinants of optimal breastfeeding indicators in Indonesia.
Methods
We used the 2017 Indonesia Demographic and Health Survey to analyze factors associated with early initiation of breastfeeding, exclusive breastfeeding (EBF), and continued breastfeeding at 1 year (CBF-1) and 2 years (CBF-2). Multivariate logistic regression models were used to examine bio-demographic, socio-cultural, and behavioral characteristics associated with breastfeeding after considering the survey design effect.
Results
The risk of delayed breastfeeding initiation was higher among infants who were born smaller, first-born children, were delivered via cesarean delivery, and did not have immediate skin-to-skin contact (p<0.01). Infant’s age, birth pattern, household wealth index, and the mother’s occupation and smoking status were predictors of EBF (p<0.05). CBF-1 was less common among first-time mothers and those working in the non-agricultural sector, mothers from wealthier families, and mothers who had cesarean deliveries (p<0.01). Infant’s age was negatively associated with CBF-2 (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.74 to 0.99). Mothers attending college were less likely to practice CBF-2 than those with no education or primary education (aOR, 0.45; 95% CI, 0.26 to 0.77). The absence of postnatal visits was a risk factor for CBF-1 and CBF-2 (p<0.05).
Conclusions
Breastfeeding interventions in Indonesia should pay particular attention to at-risk groups such as women from wealthier families, working outside the agricultural sector, and with a higher education level. Nutrition-sensitive programs (e.g., postnatal care and smoking cessation) should also be encouraged.

Summary

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Women’s Empowerment Facilitates Complete Immunization in Indonesian Children: A Cross-sectional Study: Gede Benny Setia Wirawan, Ni Luh Zallila Gustina, Putu Harrista Indra Pramana, Made Yuliantari Dwi Astiti, Jovvita Jonathan, Fitriana Melinda, Teo Wijaya; J Prev Med Public Health. 2022;55(2):193-204. Published online March 8, 2022; DOI: https://doi.org/10.3961/jpmph.21.592

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Abstract PDF

Objectives
The primary objective of this study was to examine the effect of women’s empowerment on the immunization of Indonesian children. The secondary objective was to examine the effect of wealth as a factor modifying this association.
Methods
We utilized data from the 2017 Indonesian Demographic and Health Survey (IDHS). The subjects were married women with children aged 12-23 months (n=3532). Complete immunization was defined using the 2017 IDHS definition. Multiple components of women’s empowerment were measured: enabling resources, decision-making involvement, and attitude toward intimate partner violence. The primary analysis was conducted using binomial logistic regression. Model 1 represented only the indicators of women’s empowerment and model 2 controlled for socio-demographic variables. Subgroup analyses were conducted for each wealth group.
Results
The primary analysis using model 1 identified several empowerment indicators that facilitated complete immunization. The analysis using model 2 found that maternal education and involvement in decision-making processes facilitated complete immunization in children. Subgroup analyses identified that wealth had a modifying effect. The indicators of women’s empowerment were strong determinants of complete immunization in lower wealth quintiles but insignificant in middle-income and higher-income quintiles.
Conclusions
To our knowledge, this study is the first to explore women’s empowerment as a determinant of child immunization in Indonesia. The results indicate that women’s empowerment must be considered in Indonesia’s child immunization program. Women’s empowerment was not found to be a determinant in higher wealth quintiles, which led us to rethink the conceptual framework of the effect of women’s empowerment on health outcomes.

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Gede Benny Setia Wirawan, Ngakan Putu Anom Harjana, Nur Wulan Nugrahani, Pande Putu Januraga
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Prevalence and Factors Affecting Discrimination Towards People Living With HIV/AIDS in Indonesia: Rimawati Aulia Insani Sadarang; J Prev Med Public Health. 2022;55(2):205-212. Published online March 24, 2022; DOI: https://doi.org/10.3961/jpmph.21.502

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Abstract PDF

Objectives
This study aimed to identify the behaviors associated with discrimination towards people living with HIV/AIDS (PLHA) in Indonesia and to determine the factors affecting discrimination.
Methods
Secondary data from the 2017 Indonesia Demographic and Health Survey were analyzed using a cross-sectional design. Discrimination was assessed based on the questions (1) “Should children infected with HIV/AIDS be allowed to attend school with non-infected children?” and (2) “Would you buy fresh vegetables from a farmer or shopkeeper known to be infected with HIV/AIDS?” Multivariable logistic regression was used to determine the factors affecting discrimination, with adjusted odds ratio (aOR) and 95% confidence interval (CIs) used to show the strength, direction, and significance of the associations among factors.
Results
In total, 68.9% of 21 838 individuals showed discrimination towards PLHA. The odds of discrimination were lower among women (aOR, 0.63; 95% CI, 0.55 to 0.71), rural dwellers (aOR, 0.81; 95% CI, 0.75 to 0.89), those who understood how HIV is transmitted from mother to child (aOR, 0.81; 95% CI, 0.73 to 0.89), and those who felt ashamed of their own family’s HIV status (aOR, 0.56; 95% CI, 0.52 to 0.61). The odds were higher among individuals who knew how to reduce the risk of getting HIV/AIDS (aOR, 1.27; 95% CI, 1.15 to 1.39), how HIV/AIDS is transmitted (aOR, 3.49; 95% CI, 3.09 to 3.95), and were willing to care for an infected relative (aOR, 2.78; 95% CI, 2.47 to 3.13). A model consisting of those variables explained 69% of the variance in discrimination.
Conclusions
Gender, residence, knowledge, and attitudes related to HIV/AIDS were explanatory factors for discrimination against PLHA. Improvements in HIV/AIDS education programs are needed to prevent discrimination.

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Journal of Preventive Medicine and Public Health.2023; 56(3): 238. CrossRef

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