Journal of Preventive Medicine and Public Health

Original Articles

Who Dies Alone? Demographics, Underlying Diseases, and Healthcare Utilization Patterns of Lonely Death Individuals in Korea: Haibin Bai, Jae-ryun Lee, Min Jung Kang, Young-Ho Jun, Hye Yeon Koo, Jieun Yun, Jee Hoon Sohn, Jin Yong Lee, Hyejin Lee; Received November 16, 2024 Accepted February 7, 2025 Published online March 4, 2025; DOI: https://doi.org/10.3961/jpmph.24.704 [Accepted]

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Abstract PDF: Objectives
Lonely death is defined as “a person living in a state of social isolation, disconnected from family, relatives, and others, who dies from suicide, illness, or other causes.” This study investigated the characteristics of individuals who die alone in Korea.
Methods
We constructed a database of lonely death cases by linking data from the Korea Crime Scene Investigation Unit of the Korea National Police Agency with National Health Insurance Service (NHIS) records. A descriptive analysis was performed to evaluate the demographics, underlying diseases, and healthcare utilization patterns among lonely death cases.
Results
Among the 3,122 individuals identified as lonely death cases, 2,621 (84.0%) were male and 501 (16.0%) were female. The most common age group was 50–59 years (n= 930; 29.8%). The NHIS covered 2,161 individuals (69.2%), whereas 961 individuals (30.8%) were enrolled in Medical Aid (MA). The highest number of lonely deaths occurred in Seoul areas, with 1,468 cases (47.0%). Mental and behavioral disorders were diagnosed in 1,606 individuals (51.4%), and various alcohol-related diseases, including alcoholic liver disease, were also observed. Outpatient visits increased leading up to death but declined in the final 3 months, while hospitalizations decreased and emergency room visits slightly increased.
Conclusions
Most lonely death cases involved men in their 50s, with a disproportionately high number of MA beneficiaries compared to the general population. Many of these individuals also experienced mental health issues or alcohol-related disorders. Preventing social isolation and strengthening social safety nets are critical to reducing the occurrence of lonely deaths.; Summary

Association Between Basic Immunization Status and Stunting in Toddlers Aged 12 to 59 Months in Indonesia: Ekadesi Purwanti, Siti Masitoh, Sudarto Ronoatmodjo; Received May 6, 2024 Accepted January 13, 2025 Published online January 30, 2025; DOI: https://doi.org/10.3961/jpmph.24.230 [Accepted]

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Abstract PDF: Objectives
Immunization has been identified as a specific nutrition-related intervention to address the direct causes of stunting. This study examines the association between basic immunization status and stunting among toddlers in Indonesia.
Methods
We conducted a cross-sectional analysis using data from the 2021 Study of Indonesia’s Nutritional Status. A total of 70,267 toddlers, aged 12 to 59 months, were examined. Cox regression was employed to calculate prevalence ratios (PRs) with their 95% confidence intervals (CIs).
Results
The prevalence of stunting among children aged 12 to 59 months in Indonesia was 23.1%, while 74.92% of children under 5 years old had complete basic immunization status. Multivariable analysis revealed a statistically significant association between basic immunization status and the incidence of stunting. Relative to toddlers with complete basic immunization, those with incomplete (partial) immunization were at a 1.18 times higher risk of stunting (adjusted PR, 1.18; 95% CI, 1.15 to 1.22). Furthermore, toddlers who had not been immunized at all faced an even greater stunting risk (adjusted PR, 1.27; 95% CI, 1.17 to 1.37). This association persisted after adjusting for variables such as maternal education, economic status, and the child’s birth weight.
Conclusions
Basic immunization status influences the incidence of stunting in toddlers aged 12 to 59 months. Thus, parents must ensure that their children’s immunizations are completed according to the recommended schedule. Additionally, it is crucial to increase parental awareness regarding health service utilization, disease prevention, and the nutritional needs of toddlers.; Summary

Association of Sedentary Lifestyle with Skeletal Muscle Strength and Mass in US Adolescents: Results from the National Health and Nutrition Examination Survey (2011-2014): Kun-Hee Oh, Jin-Young Min, Kang Seo, Kyoung-Bok Min; Received October 17, 2024 Accepted December 31, 2024 Published online January 30, 2025; DOI: https://doi.org/10.3961/jpmph.24.614 [Accepted]

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Abstract PDF: Objectives
Excessive sedentary behavior in youth is a major global issue, contributing to the rise in childhood obesity and metabolic diseases. International public health authorities have issued guidelines recommending that children and adolescents limit their daily sedentary time, including screen time. However, to date, no studies have explored the relationship between sedentary behavior as an exposure factor and skeletal muscle strength and mass as outcomes in this population. The present study investigated the association of sedentary behavior with handgrip strength (HGS) and appendicular lean mass (ALM) among US adolescents.
Methods
A total of 1,449 adolescent participants from the National Health and Nutrition Examination Survey (2011-2014) were included. Information on sedentary behavior, specifically daily sedentary time, was obtained through a self-reported questionnaire. Muscular parameters, including HGS and ALM, were measured. To adjust for differences in body size, these parameters were divided by body mass index (BMI) and weight. Linear regression analyses were performed to evaluate the associations between daily sedentary time and each muscular parameter, adjusting for age, sex, ethnicity, annual family income, and moderate-to-vigorous physical activity (MVPA).
Results
The linear regression analyses revealed negative associations between daily sedentary time and all muscular parameters, apart from absolute ALM. These included HGS (β=−0.2652, standard error [SE]=0.0740; p=0.0011), HGS/BMI (β=−0.0215, SE=0.0044; p<0.0001), HGS/weight (β=−0.0079, SE=0.0016; p<0.0001), ALM/BMI (β=−0.0083, SE=0.0030; p=0.01), and ALM/weight (β=−0.0030, SE=0.0010; p=0.0047).
Conclusions
After adjusting for MVPA, daily sedentary time was inversely associated with HGS, HGS/BMI, HGS/weight, ALM/BMI, and ALM/weight in US adolescents.; Summary

Association Between Digital Addiction and Physical Activity in Korean Adults Across Age Groups: An Analysis of Community Health Survey Data: Kyungsin Lee, Inmyung Song; Received November 11, 2024 Accepted January 7, 2025 Published online January 24, 2025; DOI: https://doi.org/10.3961/jpmph.24.683 [Accepted]

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Abstract PDF: Objectives
Extensive research has been conducted on digital addiction, particularly concerning internet, gaming, and smartphone use among adolescents and young adults. However, there is limited information about digital addiction in adults, especially in relation to physical activity. This study investigated the prevalence of digital addiction among Korean adults and explored its association with physical activity across various age groups.
Methods
Using data from the 2023 Community Health Survey (n=231,752), this study estimated the prevalence of digital addiction, defined as experiencing impaired daily functioning due to excessive internet, gaming, or smartphone use. Physical activity was defined as exercise and regular walking. Multiple logistic regression was conducted to examine the association between physical activity and digital addiction in the full sample and by age group (under 40, 40–59, and 60+ years).
Results
In 2023, the prevalence of digital addiction among adults was estimated to be 12.0%. Significantly higher odds of digital addiction were observed in younger age groups. Individuals who reported perceived stress or depression were at an increased risk for digital addiction. Conversely, physical activity was linked to a reduced risk of digital addiction, with odds ratios of 0.96 (p<0.05) for exercise and 0.93 (p<0.001) for regular walking. Notably, regular walking was associated with a reduced risk of digital addiction only in the 40–59 age group.
Conclusions
Physical activity, particularly regular walking, is linked to a lower risk of digital addiction in Korean adults. Encouraging regular walking may help reduce digital addiction among middle-aged adults.; Summary

Associations Between Multiple Falls and Mental Health Indices in Korean Older Adults: A Cross-sectional Study: Chaelyn Lim, Hyunjin Son, Byoung-Gwon Kim, Byengchul Yu, Jiwon Kim, Young-Seoub Hong; Received August 28, 2024 Accepted December 30, 2024 Published online January 14, 2025; DOI: https://doi.org/10.3961/jpmph.24.482 [Accepted]

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Abstract PDF: Objectives
This study was performed to investigate the prevalence of falls, mental health issues, and health behaviors among older adults, as well as to analyze the association between multiple falls and mental health status in this population.
Methods
We utilized data from the 2017, 2019, and 2021 Korean Community Health Survey, a nationwide survey organized by region and conducted by the Korea Disease Control and Prevention Agency. Participants were categorized into no-fall, single-fall, and multiple-fall groups based on responses to an index question regarding fall experiences and the number of such incidents reported in the survey. The chi-square test was applied to understand the characteristics of the elderly population in the community. Subsequently, multinomial logistic regression analysis was conducted to clarify the association between falls and mental health.
Results
Integrated data analysis revealed that 11.3% of participants experienced a single fall, while 5.7% reported multiple falls. Participants from low-education and low-income backgrounds exhibited relatively high rates of falls. Additionally, non-drinkers and non-smokers reported falls more frequently than their counterparts who consumed alcohol and smoked. Multinomial logistic regression revealed significant associations between multiple falls and mental health factors. In particular, the severity of depression was directly proportional to the likelihood of experiencing multiple falls, with an odds ratio of 2.953 (95% confidence interval, 2.493 to 3.497).
Conclusions
We identified associations between various mental health-related factors—including sleep duration, subjective stress, the presence of depression, and Patient Health Questionnaire-9 score—and the occurrence of multiple falls.; Summary

Association Between Non-adherence to Diabetes Management and Poor Sleep Quality Based on the Korean Community Health Survey: Horim Hwang, Hyunsuk Jeong, Hyeon Woo Yim; Received August 29, 2024 Accepted December 26, 2024 Published online January 14, 2025; DOI: https://doi.org/10.3961/jpmph.24.486 [Accepted]

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Abstract PDF: Objectives
Adhering to management guidelines, including routine follow-up and education, is crucial for the effective management of chronic diseases such as diabetes. Uncontrolled diabetes is linked to poor sleep quality. We used nationally representative data from community-dwelling Koreans to investigate potential associations between non-adherence to diabetes management and poor sleep quality.
Methods
Of the 228,340 participants in the 2018 Korea Community Health Survey, we analyzed data from 68,246 participants aged 65 years and older. Based on their diabetes status and adherence to diabetes-related tests (glycated hemoglobin, fundus examination, and urine microalbuminuria) and management education, study participants were divided into 3 groups: no diabetes, adherence, and non-adherence. Outcome variables included poor overall sleep quality and sleep disturbances, as measured by the Pittsburgh Sleep Quality Index. Results: The study included 934 participants in the adherence group (2.0%) and 13,420 in the non-adherence group (20.2%). Participants displaying non-adherence were significantly more likely to report poor overall sleep quality (adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 1.04 to 1.13) and to experience sleep fragmentation, nocturia, pain during sleep, and difficulty falling asleep compared to participants without diabetes. Even in the earlier stage of diabetes, non-adherent participants were more likely to report poor sleep quality (aOR, 1.06; 95% CI, 1.001 to 1.18).
Conclusions
Patients with diabetes who do not follow management guidelines are more likely to experience poor sleep quality than those without diabetes. Emphasizing diabetes management and increasing awareness of management strategies may improve sleep quality among patients with this disease.; Summary

Multi-group Causal Model of Mental Health Literacy and Helping Behavior Toward People at Risk of Depression Among Thai and Vietnamese Health Science Students: Anchalee Jansem, Ungsinun Intarakamhang, Charin Suwanwong, Krittipat Chuenphitthayavut, Sudarat Tuntivivat, Khuong Le, Le Thi Mai Lien, Pitchada Prasittichok; Received August 15, 2024 Accepted December 13, 2024 Published online January 13, 2025; DOI: https://doi.org/10.3961/jpmph.24.449 [Accepted]

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Abstract PDF: Objectives
Depression affects 23.3% of Thai and 15.2% of Vietnamese health science students, rates that exceed the global average of 4.4%. This study compared the causal models of mental health literacy and helping behavior toward individuals at risk of depression between these 2 groups.
Methods
This cross-sectional study was conducted from April to October 2023 and included 422 students from Thailand and Vietnam, who were studying medicine, nursing, psychology, and physical therapy. Stratified random sampling was used to select 211 students from each country. Data collection was performed using a Likert scale, which showed total-item correlations ranging from 0.24 to 0.83 and Cronbach’s alpha values between 0.74 and 0.86. The data were analyzed using a structural equation model.
Results
The causal models were consistent with the empirical data. The helping behavior of students toward peers at risk of depression was significantly influenced by their mental health literacy (effect size [ES]=0.91). This influence was also mediated indirectly by self-efficacy (ES=0.18), positive attitudes (ES=0.29), and social support (ES=0.77). Collectively, these factors accounted for 83% of the variance in helping behavior. Social support had a more pronounced effect on mental health literacy among Vietnamese students than among their Thai counterparts (ES=0.46 vs. 0.27, p<0.05). Conversely, positive attitudes had a stronger influence among Thai students than among Vietnamese students (ES=0.17 vs. 0.01, p<0.05).
Conclusions
The causal models of helping behavior among Thai and Vietnamese health science students exhibited no significant differences. However, improving mental health literacy is crucial, as it significantly impacts helping behavior.; Summary

The Relationship Between Park Access and Quality and Various Health Metrics in a Metropolitan Area in South Carolina Using the CDC Places Dataset: Jenna Pellizzari, Farnaz Hesam Shariati, Andrew T. Kaczynski; Received June 26, 2024 Accepted November 15, 2024 Published online December 13, 2024; DOI: https://doi.org/10.3961/jpmph.24.325 [Accepted]

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Abstract PDF: Objectives
Limited access to high-quality green spaces could contribute to growing rates of chronic diseases and unhealthy behaviors. Public parks provide numerous benefits for population well-being. However, past research has shown mixed results regarding the association between proximal parks and residents’ physical and mental health. This study examined the relationship between diverse elements of park access and quality and multiple health outcomes.
Methods
Seventy-three unique parks within 70 census tracts in 4 cities in South Carolina were analyzed. Data about 7 aspects of park quality (transportation access, facility availability, facility quality, amenity availability, park aesthetics, park quality concerns, neighborhood quality concerns) were collected via on-site observations using the Community Park Audit Tool. Health data for each tract (obesity, no leisure time physical activity, high blood pressure, coronary heart disease, high cholesterol, diabetes, depression, poor mental health) were collected from the CDC PLACES dataset. Linear regression analyses examined the association between 10 park access and quality metrics and 8 health metrics, controlling for sociodemographic characteristics.
Results
All associations were in the unexpected direction except 1 relationship involving mental health. Specifically, positive associations were found between the number of parks and obesity, the number of parks and no leisure time physical activity, transportation access and obesity, and transportation access and high blood pressure. As concerns about neighborhood quality increased, poor mental health status worsened.
Conclusions
This study provides valuable information for public health professionals and researchers. Further research is needed to expand on and elucidate these findings.; Summary

Associations of Gender and Household Area with Physical Activity and Sedentary Behavior During Total and Partial COVID-19 Lockdowns in Chile: A Study in Adults Aged 18-44 Years: Jairo Vanegas-López, Rodrigo Guzmán-Venegas, Gabriel Marzuca-Nassr, Claudio Muñoz-Poblete, Gonzalo Quiroz-Sandoval, Juan Silva-Urra, Andres Orellana-Uribe, Sebastian Dubó, Ignacio Sepúlveda-Carra, José Luis Márquez; Received August 21, 2024 Accepted October 30, 2024 Published online December 5, 2024; DOI: https://doi.org/10.3961/jpmph.24.461 [Accepted]

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Abstract PDF: Objectives
The COVID-19 pandemic led to various intensities of lockdowns, affecting lifestyles globally. This study investigates the impact of partial versus total lockdown on adult physical activity and sedentary behavior.
Methods
A cross-sectional online survey was conducted from April to October 2020, with 493 participants included in the analysis.
Results
The analysis revealed no significant differences in total physical activity or total sitting time between partial and total lockdown scenarios. However, moderate physical activity significantly decreased during total lockdowns, with more pronounced reductions among females than males. Notably, a positive correlation was found between household area and moderate physical activity, suggesting that larger living spaces may encourage more physical activity. A negative correlation was observed between sitting time and moderate physical activity during both types of lockdown.
Conclusions
Total lockdown conditions were associated with a significant decrease in moderate physical activity, highlighting gender disparities in physical activity responses. Living space size emerged as a crucial factor in maintaining physical activity levels during restricted conditions. This study emphasizes the need to consider environmental and demographic factors in public health strategies during prolonged periods of restricted movement.; Summary

Prevalence, Sources, and Correlates of Second-hand Smoke Exposure Among Non-smoking Pregnant Women in India: Farheen Ahmed, Nilesh Gawde, Sulabha Parasuraman; Received June 6, 2024 Accepted October 18, 2024 Published online December 4, 2024; DOI: https://doi.org/10.3961/jpmph.24.278 [Accepted]

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Abstract PDF: Objectives
Second-hand tobacco smoke (SHS) is a proven risk factor for negativeadverse health outcomes, especiallyparticularly among pregnant women. This study aimsaimed to address the research gap onconcerning the prevalence and correlates of SHS exposure at home and outsidein public settings among non-smoking pregnant women in India.
Methods
The dataset offrom the Global Adult Tobacco Survey (GATS) (2016-2017), India, was usedutilised to determineevaluate the prevalence of SHS exposuresexposure in pregnant women both at home and outside.in public spaces. Multivariable logistic regression analysis was usedemployed to identify the determinants of SHS exposure among pregnant women. this population.
Results
The prevalence of SHS exposure in theat home was 37% and %, while exposure outside the home was 27%. 10% of allAmong non-smokersmoking pregnant women, 10% were exposed to SHS inon public transport. The risk of SHS exposure in theat home was significantly higher forin the North (AOR-=5.33:; 95% CI-, 2.45-11.60), Central (AOR-=4.46; 95% CI-, 1.98-10.02)), and North-East (AOR-=4.18; 95% CI-, 1.78-9.81) regions compared to the South. Pregnant women aged 25-34 (AOR-=0.61; 95% CI-, 0.39-0.93) and those aged 35 and above (AOR-=0.48; 95% CI-, 0.27-0.86), as well as those with secondary (AOR-=0.50; 95% CI-, 0.30-0.85) or higher education (AOR-=0.30; 95% CI-, 0.15-0.58)), had lower odds of SHS exposuresexposure at home. For SHS exposure outside homes,the home, the North region (AOR-=2.53; 95% CI-, 1.19-5.36), employment status (AOR-=1.99; 95% CI-, 1.13-3.47), and belonging to scheduled tribes (AOR-=3.20; 95% CI-, 1.25-8.21) had were associated with higher odds.
Conclusions
The prevalence of SHS exposure among pregnant non-smoking women was high at home as well as outside. SHS exposure at home was significantly associated with age, education, and region. SHS exposure outside homes was significantly associated with employment status, scheduled tribe, and regionnotably high both at home and in external environments.; Summary

Predictors of Quality of Life among Older Residents in Rural and Urban Areas in Indonesia: An Approach Using the International Classification of Functioning, Disability, and Health: Dwi Rosella Komalasari, Chutima Jalayondeja, Wattana Jalayondeja, Yusuf Alam Romadhon; Received August 4, 2024 Accepted November 7, 2024 Published online November 29, 2024; DOI: https://doi.org/10.3961/jpmph.24.423 [Accepted]

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Abstract PDF: Objectives
The International Classification of Functioning, Disability, and Health (ICF) model provides a comprehensive framework for understanding health and quality of life (QoL) in older adults in both rural and urban settings, each presenting unique advantages and challenges. This study aimed to explore the relationship between factors based on the ICF model and QoL among older residents of these areas.
Methods
A cross-sectional study was conducted, involving 286 older adults aged 60 years or older from rural and urban areas of Surakarta, Central Java, Indonesia. The WHOQoL-BREF was utilized to assess QoL. The co-factors included personal factors, impairments, and activity limitations.
Results
Multiple linear regression analysis indicated that lower limb muscle strength was the most significant factor associated with QoL in older adults in rural areas (B=0.681, standard error [SE]=0.301, p=0.026), followed by static balance (B=0.085, SE=0.034, p=0.014). In urban areas, gender emerged as the most significant factor influencing QoL (B=-13.643, SE=2.499, p<0.001), followed by hemoglobin level (B=-1.847, SE=0.760, p=0.017), age (B=-0.935, SE=0.246, p<0.001), and cognitive function (B=0.493, SE=0.179, p=0.007).
Conclusions
Efforts to improve QoL for older adults in rural areas should focus on enhance physical performance through exercise. In urban areas, the maintenance of QoL is influenced by personal factors. It is crucial to address physical performance through exercise to enhance QoL in rural settings. Meanwhile, focusing on mental health, financial security, and social connections is recommended to improve QoL for older adults in urban areas.; Summary

The Impact of Student-led Community Health Screenings on Clients’ Health Knowledge and Outcomes: A Qualitative Study: Jia Rong Yap, Wendy Wenming Zhai, Cindy Seunghee Pak, Sharon Brownie; Received July 12, 2024 Accepted October 27, 2024 Published online November 28, 2024; DOI: https://doi.org/10.3961/jpmph.24.366 [Accepted]

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Abstract PDF: Objectives
This study investigated the impact of community health screenings (CHS) on the Asian community, focussing on the role of a student-led health and wellness centre in promoting and improving health outcomes. The CHS is a collaboration between Te Kotahi Oranga | Health and Wellness Centre and The Asian Network Incorporated, offering free health screenings to Asian migrants in the Waikato region, New Zealand.
Methods
Employing a qualitative approach, we interviewed clients who participated in the CHS to determine their perceptions regarding the effectiveness of the programme, its influence on their health knowledge and actions, and their overall satisfaction with the service. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to report the study.
Results
Data analysis utilising reflexive thematic analysis yielded 5 themes: satisfaction and appreciation for the free health screening; strengthened commitment to better personal health; barriers and challenges in accessing public healthcare services; improved knowledge and awareness of health risks; and provision of more health screening tests and health seminars. The findings highlight the significance of culturally tailored health initiatives in addressing healthcare disparities, emphasising the need for innovative strategies to ensure continuity of care and support for underserved populations.
Conclusions
This research contributes to the understanding of how student-led health interventions can enhance public health efforts and improve health outcomes in Asian and migrant communities.; Summary

Health Effects of Heavy Metal Exposure Among E-waste Workers and Community-dwelling Adults in Thailand: A Cross-sectional Study: Chonyitree Sangwijit, Parichat Ong-artborirak, Warangkana Naksen, Kraiwuth Kallawicha, Pallop Siewchaisakul; Received July 31, 2024 Accepted October 18, 2024 Published online November 21, 2024; DOI: https://doi.org/10.3961/jpmph.24.415 [Accepted]

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Abstract PDF: Objectives
Global concern is increasing about the health effects of electronic waste (e-waste). This study examines the health impacts of heavy metal (HM) exposure among e-waste workers (EWWs) and community-dwelling adults (CDAs) in Northeastern Thailand and identifies factors associated with adverse health outcomes.
Methods
A cross-sectional study was conducted of 164 EWWs and 164 CDAs. A survey was employed to collect data on participant characteristics, symptoms, anxiety, depression, and sleep quality. Urine samples were analyzed for lead (Pb) and cadmium (Cd) levels using atomic absorption spectrometry. Multiple logistic regression analysis was used to identify factors impacting health.
Results
Across all participants, urinary Pb and Cd levels ranged from 5.30 to 29.50 µg/g creatinine and from 0.60 to 4.00 µg/g creatinine, respectively. The most frequently reported health issues pertained to musculoskeletal disorders (MSDs) at 38.70%, central nervous system (CNS) issues at 36.60%, and skin disorders at 31.10%. Multivariable analysis indicated that the presence of MSDs was significantly associated with exposure to Pb and Cd. Poor sleep quality (PSQ) was significantly linked to CNS problems, while body mass index was significantly related to skin disorders. Factors including primary education level or below, smoking, cleaning the house more than 3 times weekly, and PSQ were significantly linked to depression. Anxiety was significantly associated with PSQ.
Conclusions
Environmental exposure to Pb and Cd can have adverse health impacts in the form of MSDs. Depression and anxiety are common conditions among CDAs. Public health officials should monitor HM exposure and mental health within the community.; Summary

Medication-related Burden and Experience With Medications in Indonesian Older Adults With Chronic Diseases: A Mixed-method Study: Yeni Farida, Anna Wahyuni Widayanti, Tri Murti Andayani, Probosuseno Probosuseno; Received July 16, 2024 Accepted November 7, 2024 Published online November 20, 2024; DOI: https://doi.org/10.3961/jpmph.24.374 [Accepted]

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Abstract PDF: Objectives
This study explored the specific medication-related burdens experienced by older adults with chronic disease and the contributing factors.
Methods
An exploratory mixed-method study was conducted at a teaching hospital in Surakarta City, Central Java, Indonesia. Combining the Indonesian version of the Living with Medicine Questionnaire (LMQ) and semi-structured interviews allowed for a comprehensive understanding of the medication-related burden. Differences in LMQ scores related to patient characteristics were analyzed using the t-test, F-test, or other alternatives. Quantitative and qualitative data triangulation was used to derive trustworthy and dependable results.
Results
The overall LMQ mean score was 90.4 (n=129), indicating a moderate burden. The average LMQ scores varied significantly based on the number of medications, treatment duration, and the presence of cardiovascular disease (CVD), diabetes mellitus (DM) and stroke. The qualitative study found 3 themes in the chronic medication use of older adults: experiences, challenges, and motivation. Despite their limited understanding of a medication’s name and indication, some patients managed their medications based on the physical look and packaging of the medication. The study also found that patient motivation and familial support could effectively counteract the fatigue and dissatisfaction associated with taking medication.
Conclusions
Older adults with chronic diseases faced medication-related burdens associated with the presence of CVD, DM, stroke, a treatment duration >5 years, and the use of >10 medications. Effective communication with healthcare professionals is required to understand patients\' needs and concerns, thereby helping manage the challenges of medication-related burdens.; Summary

Church Leaders’ Health Behaviors and Program Implementation in the Faith, Activity, and Nutrition Program: Kelsey Day, Sara Wilcox, Lindsay Decker, John Bernhart, Meghan Baruth, Andrew Kaczynski, Christine Pellegrini; Received July 20, 2024 Accepted October 18, 2024 Published online November 13, 2024; DOI: https://doi.org/10.3961/jpmph.24.384 [Accepted]

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Abstract PDF: Objectives
Church leaders are important to the success of faith-based health promotion interventions through the role modeling of health behaviors. However, clergy may be at a higher risk of chronic disease than their congregants and their health is understudied. This study examined church leaders’ health-related behaviors, differences in health behaviors by sociodemographic characteristics, and associations between health behaviors and church-level implementation of an ecological intervention.
Methods
Pastors (n=93) and church coordinators (n=92) reported body mass index (BMI), self-rated health, fruit and vegetable consumption (F&V), and physical activity (PA) at baseline and 12 months post-training in the intervention. Church coordinators reported program implementation for their church. Sociodemographic differences and associations between changes in health behaviors and program implementation were tested with regression models. Changes in health-related variables were examined using paired t-tests and McNemar’s test.
Results
Pastors (41% women, 42% Black/African American) had a mean BMI of 30 kg/m2; 45% met F&V guidelines and 24% met PA guidelines. Black/African American pastors were less likely to meet F&V guidelines and had lower self-rated health than their counterparts. Pastor PA improved over time, but pastor health behaviors were not associated with program implementation. Church coordinators’ (95% women, 39% Black/African American) mean BMI was 28 kg/m2; 27% met F&V guidelines and 63% met PA guidelines. Black/African American church coordinators had higher BMIs and lower self-rated health than their counterparts. Church coordinator F&V intake improved over time; self-rated health was positively associated with PA program implementation.
Conclusions
This study underscores the need for preventive interventions for church leaders.; Summary

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