Journal of Preventive Medicine and Public Health

Original Articles

The Associations Between Physical Activity and Mental Health Problems in Middle-aged Indonesians: Sri Handayani, Siti Isfandari, Diyan Ermawan Effendi, Rozana Ika Agustiya, Irfan Ardani, Arief Priyo Nugroho, Yunita Fitrianti; Received January 1, 2024 Accepted May 11, 2024 Published online July 12, 2024; DOI: https://doi.org/10.3961/jpmph.24.003 [Accepted]

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Abstract PDF: Objectives
Mental health issues have become a growing concern worldwide. Research has shown that regular physical activity can positively affect mental health. This study investigated the associations between physical activity and mental health problems in middle-aged Indonesians.
Methods
The study utilized data from the 2018 Indonesian Basic Health Research Survey and used a cross-sectional approach. The participants included individuals aged 40-60 years who completed the 20-question Self-Reporting Questionnaire (SRQ-20). A logistic regression was performed to analyze a sample of 263,930 data points.
Results
Nearly 10.4% of the participants suffered from mental health issues. Notably, among those who did not engage in moderate and vigorous physical activity, a sign of mental health problems was found in 12.5% of participants. Those who met World Health Organization standards for physical activity were less likely to experience mental health problems (10.1%). This study found a significant association between physical activity and mental health. After adjusting for smoking, alcohol consumption, non-communicable diseases, and sociodemographic variables like age, sex, education, occupation, marital status, and residence, the connection between physical activity and mental health became even stronger (adjusted odds ratio, 0.81; 95% confidence interval, 0.78 to 0.85; p<0.001).
Conclusions
Regular physical activity has been shown to affect mental health positively. Therefore, it is important to improve health education and efforts to raise awareness among middle-aged Indonesians about the importance of physical activity in maintaining good mental health.; Summary

Smoking-attributable Mortality in Korea, 2020: A Meta-analysis of Four Databases: Eunsil Cheon, Yeun Soo Yang, Suyoung Jo, Jieun Hwang, Keum Ji Jung, Sunmi Lee, Seong Yong Park, Kyoungin Na, Soyeon Kim, Sun Ha Jee, Sung-il Cho; Received October 23, 2023 Accepted May 3, 2024 Published online July 3, 2024; DOI: https://doi.org/10.3961/jpmph.23.471 [Accepted]

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Abstract PDF: Objectives
Estimating the number of deaths caused by smoking is crucial for developing and evaluating tobacco control and smoking cessation policies. This study aimed to determine smoking-attributable mortality (SAM) in Korea in 2020.
Methods
Four large-scale cohorts from Korea were analyzed. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) of smoking-related death. By conducting a meta-analysis of these HRs, the pooled HRs of smoking-related death for 41 diseases were estimated. Population-attributable fractions (PAFs) were calculated based on the smoking prevalence for 1995 in conjunction with the pooled HRs. Subsequently, SAM was derived using the PAF and the number of deaths recorded for each disease in 2020.
Results
The pooled HR for all-cause mortality attributable to smoking was 1.73 for current male smokers (95% CI, 1.532-1.954) and 1.631 for current female smokers (95% CI, 1.371-1.94). Smoking accounted for 33.2% of all-cause deaths in men and 4.6% in women. Additionally, it was a factor in 71.8% of male lung cancer deaths and 11.9% of female lung cancer deaths. In 2020, smoking was responsible for 53,930 male deaths and 6,283 female deaths, totaling 60,213 deaths.
Conclusions
Cigarette smoking was responsible for a significant number of deaths in Korea in 2020. Monitoring the impact and societal burden of smoking is essential for effective tobacco control and harm prevention policies.; Summary

Assessing COVID-19 Vulnerability among HIV-Positive Men Who Have Sex with Men in Korea: The Role of Vaccination and Sexual Behaviors: Minsoo Jung; Received April 11, 2024 Accepted June 12, 2024 Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.196 [Accepted]

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Abstract PDF: Objectives
Comorbidities increase susceptibility to severe coronavirus disease 2019 (COVID-19) infections, but limited information has been published regarding HIV and COVID-19 co-infections. This study explored the relationships among socioeconomic characteristics, sexual behaviors, and COVID-19 infection rates among Korean men who have sex with men (MSMs) who are also living with HIV.
Methods
Data were collected through a web survey aimed at members of the largest gay portal site in Korea, supported by the National Research Foundation of Korea (n=1,005). The primary independent variables included COVID-19-related vaccinations and sexual behaviors. The dependent variable was the incidence of COVID-19 infection among respondents during the pandemic. For statistical analysis, hierarchical multiple logistic regression was performed, controlling for potential confounding variables.
Results
Model I indicated that older MSM were less likely to contract COVID-19 (adjusted odds ratio [aOR], 0.975; 95% CI, 0.962-0.989). Model II demonstrated that HIV-positive MSM were nearly twice as likely to be infected with COVID-19 compared to their HIV-negative counterparts (aOR, 1.974; 95% CI, 1.144-3.408). Furthermore, even after accounting for COVID-19 vaccination status in model III, HIV-positive MSM continued to show a higher risk of infection (aOR, 1.934; 95% CI, 1.118-3.346).
Conclusions
The findings of this study indicate that HIV-positive MSM are at an increased risk of contracting COVID-19, even when their vaccination status is considered. Therefore, it is essential to prioritize the prevention of COVID-19 infections in HIV-positive individuals by administering appropriate antiretroviral therapy and ensuring adherence to public health guidelines.; Summary

Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients with Cancer: Binh Thang Tran, Dinh Duong Le, Thanh Gia Nguyen, Minh Tu Nguyen, Thanh Nhan Nguyen Pham, Minh Hanh Nguyen, The Due Ong; Received February 21, 2024 Accepted June 12, 2024 Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.090 [Accepted]

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Abstract PDF: Objectives
This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients.
Methods
This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cutoff scores, FT was classified as none/mild (≥26), moderate (14–25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking.
Results
The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female sex, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (32.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT.
Conclusions
FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.; Summary

Causal Model of Herb Use Behavior Among Working-age Adults in Thailand: Pitchada Prasittichok, Patcharee Duangchan, Sattawat Prapasiri, Ungsinun Intarakamhang; Received December 1, 2023 Accepted May 30, 2024 Published online June 21, 2024; DOI: https://doi.org/10.3961/jpmph.23.554 [Accepted]

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Abstract PDF: Objectives
This study developed a causal relationship model of herb use from observational data and analyzed the direct and indirect effects of herb use on health according to the model.
Methods
A cross-sectional study was conducted with 400 participants aged 26-59 years, selected through multistage random sampling. The instruments used for data collection included demographic information, herb use, health literacy (HL), perceived social support, societal values, and attitudes toward herb use. The conceptual model, hypothesized based on prior evidence, was tested using confirmatory factor analysis through structural equation modeling. Path coefficients were estimated using the maximum likelihood method.
Results
The final model utilized empirical data, which showed that perceived social support had the most significant impact on herb use. This was followed by HL, positive attitudes toward herbal remedies, and societal values, with coefficients of 0.31, 0.18, and 0.16, respectively. When analyzing variables that indirectly affected herb use, it was clear that positive attitudes, perceived social support, and societal values significantly influenced herb use through HL, with influence coefficients of 0.08, 0.16, and 0.04, respectively. Together, these variables accounted for 68% of the variance in herb use.
Conclusions
The findings from this study can be utilized to develop and implement strategies that guide the use of herbal products, ultimately aiming to improve human health.; Summary

Common Mental Disorders and Associated Factors During Pregnancy and the Postpartum Period in Indonesia: An Analysis of Data From the 2018 Basic Health Research: Arum Ariasih, Besral Besral, Meiwita Budiharsana, Sudarto Ronoatmodjo; Received February 16, 2024 Accepted May 22, 2024 Published online June 19, 2024; DOI: https://doi.org/10.3961/jpmph.24.082 [Accepted]

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Abstract PDF: Objectives
A substantial proportion of women experience mental health challenges during pregnancy or the postpartum period. Common mental disorders (CMDs), including depression, anxiety, and obsessive-compulsive disorder, are prevalent. Identifying causes and associated risk factors is imperative for early intervention and the prevention of mental health issues.
Methods
This study utilized data from the 2018 Basic Health Research, which was conducted nationwide in Indonesia, using a cross-sectional approach. We focused on women aged 13-49 years who were currently or previously married, and had experienced pregnancy, including 8,889 pregnant women and 77,012 women who had delivered between January 1, 2013, and August 31, 2018. The Self-Reporting Questionnaire-20 was employed to assess CMDs. Multivariate logistic regression was performed.
Results
The prevalence of CMDs in pregnant women was 12.6%, while postpartum mothers exhibited a prevalence of 10.1%. Poor health status displayed the strongest impact on CMDs during both pregnancy (Adjusted Odds Ratio [AOR]: 12.23, 95% Confidence Interval [CI]: 9.06-16.60) and the postpartum period (AOR: 16.72, 95% CI: 14.85-18.82). Additional significant factors for both group include young maternal age, lack of education, unemployment, hystory of hypertension, and smoking status. Among pregnant women, CMDs was also associated with first-trimester pregnancy, previous pregnancy complications, and small upper arm circumference. For postpartum mothers, significant factors include history of abortion, unwanted pregnancy, pregnancy complications, lack of antenatal care, spontaneous delivery, postpartum complications and contraceptive use.
Conclusions
CMDs can impact in pregnant and postpartum women. Early diagnosis and management must be seamlessly integrated into primary healthcare practices.; Summary

Modern Contraception and Anaemia Among Reproductive-age Women in India: Results From a Household Survey: Mihir Adhikary, Poulami Barman, Bharti Singh, Abhishek Anand; Received November 7, 2023 Accepted May 3, 2024 Published online June 19, 2024; DOI: https://doi.org/10.3961/jpmph.23.504 [Accepted]

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Abstract PDF: Objectives
Chronic anaemia is a significant health concern, particularly among women of childbearing age. Factors such as menstrual blood loss, childbirth, inadequate nutrition, closely spaced pregnancies, and recurrent gastrointestinal bleeding increase the risk of anaemia. This study investigated whether current contraceptive methods are associated with anaemia in Indian women of reproductive age.
Methods
Cross-sectional data from the fifth round of the National Family Health Survey, conducted in 2019–21, were used for this investigation (NFHS-5). We included only non-pregnant and non-amenorrhoeic women in our analysis, resulting in a final analytical sample of 673,094 women aged 15-49. Bivariate cross-tabulations and multivariable logistic regression were employed to analyse the data.
Results
The prevalence of anaemia was 57%, and the adjusted regression models found no significant association between the use of any contraceptive methods and women’s haemoglobin status. Women using traditional contraceptive methods had 1.08 (95% confidence interval, 1.048-1.113) times higher odds of having anaemia. Among the modern methods, other than injectables, all other methods—such as an intrauterine device (IUD), barrier use, and sterilisation—were associated with higher odds of anaemia compared to women who used contraceptive pills.
Conclusions
This study explored the relationship between modern contraceptives and haemoglobin levels in India, revealing that injectables were associated with a notable reduction in the odds of anaemia, whereas traditional contraceptives and other modern methods exhibited positive associations with anaemia. These findings prompt policymakers to focus on anaemia reduction and safe contraceptives. More research is needed to inform decisions, given the scant literature.; Summary

The Impact of COVID-19 on Healthcare Services in Bangladesh: A Qualitative Study on Healthcare Providers’Perspectives: Sharmin Parveen, Md. Shahriar Mahbub, Nasreen Nahar, KAM Morshed, Nourin Rahman, Ezzat Tanzila Evana, Nazia Islam, Abu Said Md. Juel Miah; Received February 16, 2024 Accepted May 22, 2024 Published online June 9, 2024; DOI: https://doi.org/10.3961/jpmph.24.081 [Accepted]

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Abstract PDF: Objectives
The objective of this study was to explore healthcare providers' experiences in managing the coronavirus disease 2019 (COVID-19) pandemic and its impact on healthcare services.
Methods
A qualitative study was conducted with 34 healthcare professionals across 15 districts in Bangladesh. Among the participants, 24 were health managers or administrators stationed at the district or upazila (sub-district) level, and 10 were clinicians providing care to patients with COVID-19. The telephone interviews were conducted in Bangla, audio-recorded, transcribed, and then translated into English. Data were analyzed thematically.
Results
Most interviewees identified a range of issues within the health system. These included unpreparedness, challenges in segregating COVID-19 patients, maintaining isolation and home quarantine, a scarcity of intensive care unit (ICU) beds, and ensuring continuity of service for non-COVID-19 patients. The limited availability of personal protective equipment, a shortage of human resources, and logistical challenges, such as obtaining COVID-19 tests, were frequently cited as barriers to managing the pandemic. Additionally, changes in the behavior of health service seekers, particularly increased aggression, were reported. The primary motivating factor for healthcare providers was the willingness to continue providing health services, rather than financial incentives.
Conclusions
The COVID-19 pandemic presented a unique set of challenges for health systems, while also providing valuable lessons in managing a public health crisis. To effectively address future health crises, it is crucial to resolve a myriad of issues within the health system, including the inequitable distribution of human resources and logistical challenges.; Summary

Mental Health of Medical Students Combating the COVID-19 Epidemic: A Cross-sectional Study in Vietnam: Duc Cap Minh, Anh Nguyen Quang, Tham Nguyen Thi; Received February 28, 2024 Accepted May 9, 2024 Published online May 22, 2024; DOI: https://doi.org/10.3961/jpmph.24.108 [Accepted]

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Abstract PDF: Objectives
This study was conducted to investigate the prevalence of mental health (MH) symptoms and associated factors among medical students who were engaged in combating the coronavirus disease 2019 (COVID-19) epidemic in 4 provinces/cities of Vietnam.
Methods
A cross-sectional study with 580 participants was conducted at a medical university in Northern Vietnam. MH was assessed using the 21-item Depression, Anxiety, and Stress Scale, which was previously standardized in Vietnam. Data were collected through a structured self-administered questionnaire. Multivariate logistic regression was employed to examine the association between MH symptoms and relevant factors.
Results
Of 2,703 total medical students, 21.5% responded to the questionnaire. Among the 580 respondents, the prevalence rates of depression, anxiety, and stress were 43.3%, 44%, and 24.7%, respectively. Factors significantly associated with self-reported depression included female sex and infection with COVID-19. Similarly, female sex and COVID-19 infection were significantly associated with self-reported anxiety. Factors linked to self-reported stress included female sex, a personal or family history of MH symptoms, working more than 8 hours per day, and COVID-19 infection.
Conclusion
COVID-19 has adversely impacted the MH of medical students. Our findings are valuable in their potential to motivate universities, MH professionals, and authorities to offer mental healthcare services to this group. Furthermore, there is a pressing need for training courses designed to equip future healthcare workers with the skills to manage crises effectively.; Summary

Psychometric Characteristics of the Fear of Cancer Recurrence Inventory-Severity Subscale Among Korean Cancer Survivors: So-Young Park; Received February 22, 2024 Accepted April 24, 2024 Published online May 16, 2024; DOI: https://doi.org/10.3961/jpmph.24.096 [Accepted]

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Abstract PDF: Objectives
Despite the importance of choosing and using a valid assessment tool for fear of cancer recurrence (FCR) for early detection and interventions, the validity of the FCR inventory has yet to be thoroughly investigated in Korea. This study explored the psychometric properties of the Fear of Cancer Recurrence Inventory-Severity (FCRI-S) subscale and assessed its applicability to cancer survivors in Korea.
Methods
The survey involved 93 Korean individuals who had survived cancer. The reliability of the FCRI-S subscale was assessed using Cronbach’s α and composite reliability (CR). Confirmatory factor analysis (CFA), along with tests for discriminant and convergent validity, was conducted to evaluate the construct validity of the FCRI-S subscale.
Results
The FCRI-S subscale showed excellent internal consistency (Cronbach’s α = 0.88; CR = 0.89). CFA showed a good factor structure for the FCRI-S subscale, and the correlations of the FCRI-S subscale with FCR-related measures (r = 0.69 to 0.80) and other psychosocial measures (r = -0.23 to 0.37) confirmed both the convergent and discriminant validity of the FCRI-S subscale.
Conclusions
This study confirmed the robust psychometric characteristics of the FCRI-S subscale among cancer survivors in Korea. The use of the FCRI-S subscale would be helpful for health professionals to rapidly screen FCR levels in clinical settings.; Summary

Review

Assessment of Epidemiologic Data and Surveillance in South Korean Substance Use Research: Insights and Future Directions: Meekang Sung, Vaughan W. Rees, Hannah Lee, Mohammad S Jalali; Received March 28, 2024 Accepted May 29, 2024 Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.171 [Accepted]

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Abstract PDF: Objectives
Effective data collection and surveillance of epidemiological trends are essential in confronting the growing challenges associated with substance use (SU), especially in light of emerging trends and underreporting of cases. However, research and data are scarce regarding SU and substance use disorder (SUD) in Korea.
Methods
We conducted a scoping review to identify data sources and surveillance methods used in SU research in Korea up to December 2023. This review was complemented by semi-structured consultations with experts in this area in Korea, whose feedback led to revisions of previously identified data sources and assessments.
Results
Our review identified 32 publications conducting secondary analyses on existing data to examine the epidemiology of SU and SUD in Korea. Of these, 14 studies utilized clinical databases to explore the prescription patterns of addictive substances, particularly opioids. Eleven data sources showed promise for advancing SU research; however, they face substantial limitations, including a lack of available data, missing data, the absence of key variables, the exclusion of marginalized populations not captured within the clinical system, and complexities in matching individual-level data across time points and datasets.
Conclusions
Current surveillance methods for SU in Korea face considerable challenges in accessibility, usability, and standardization. Moreover, existing data repositories may fail to capture information on populations not served by clinical or judicial systems. To systematically improve surveillance approaches, it is necessary to develop a robust and nationally representative survey, refine the use of existing clinical data, and ensure the availability of data on treatment facilities.; Summary

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