Journal of Preventive Medicine and Public Health

Brief Report

Primary Healthcare Utilization of Undocumented Migrants in Busan, South Korea: A Retrospective Chart Review of a Free Clinic From 2020 to 2024: Yujin Lee, Hyunjin Moon, Saerom Kim; Received January 12, 2026 Accepted April 20, 2026 Published online July 9, 2026; DOI: https://doi.org/10.3961/jpmph.26.037 [Accepted]

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Abstract PDF: Objectives
This study examined healthcare utilization patterns and health needs among undocumented migrants attending a free clinic in Busan, South Korea.
Methods
We retrospectively analyzed clinical records from 750 undocumented migrants who made 2,111 clinic visits between 2020 and 2024. The primary outcome was the number of clinic visits. Diagnoses were classified using the International Classification of Primary Care, Second Edition. Mixed-effects negative binomial regression, with nationality specified as a random intercept, was used to model visit counts and to assess interaction effects between sex and other variables.
Results
Cardiovascular and endocrine diseases were the most prevalent conditions, with chronic diseases accounting for a substantial proportion of clinic visits. In multivariable analysis accounting for sex-based effect modification (Model 2), older age was significantly associated with increased visit frequency (β=0.030, 95% CI 0.014–0.045, p<0.001). The association between chronic disease and visit frequency differed significantly by sex (sex × chronic disease interaction, β=0.488, 95% CI 0.053–0.924, p=0.028). Linear combination testing indicated that men with chronic diseases visited the clinic 1.9 times more frequently than women with similar conditions.
Conclusions
Undocumented migrants attending the free clinic experienced a substantial burden of chronic disease, and healthcare utilization patterns differed by sex. These findings highlight the need for inclusive healthcare policies and targeted interventions for this population.; Summary

Perspective

Fine Particulate Matter (PM2.5), the Exposome, and Cumulative Health Risk: A Life-course Perspective: Sarawut Sangkham, Piyanuch Lonan, Narongsuk Munkong, Arthid Thim-Uam, Worradorn Phairuang; Received March 10, 2026 Accepted May 19, 2026 Published online July 1, 2026; DOI: https://doi.org/10.3961/jpmph.26.219 [Accepted]

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Abstract PDF: Fine particulate matter (PM2.5; aerodynamic diameter ≤2.5 µm) is a leading contributor to the global burden of disease and is associated with substantial morbidity and mortality. However, its health effects are often evaluated within single-exposure frameworks, limiting causal inference and reducing the translational relevance of evidence for policy development. In this study, we reconceptualise PM2.5 within the exposome framework by integrating external exposures, internal biological responses, and structural determinants of health across the life course. PM2.5 comprises a complex and dynamic mixture of pollutants from ambient and household sources, including biomass combustion, traffic emissions, and industrial activities. After inhalation, PM2.5 particles can penetrate the respiratory tract, and finer fractions may enter the systemic circulation, where they induce oxidative stress, inflammation, epigenetic dysregulation, and endocrine disruption. These mechanisms contribute to a broad spectrum of adverse health outcomes, including cardiovascular, respiratory, metabolic, and neurodegenerative diseases as well as cancers. The multi-level and temporally accumulated nature of these effects highlights the limitations of reductionist exposure assessment and underscores the need for integrative, systems-based approaches. Integrating cumulative impact assessment with exposome-wide approaches that leverage satellite, clinical, land-use, urban planning, and socioeconomic data can improve the characterisation of context-specific cumulative health effects. Positioning PM2.5 as a sentinel indicator of cumulative environmental risk provides a unifying framework for exposome-informed science and supports the development of more precise, equitable, and policy-relevant interventions.; Summary

Original Article

Occupational Noise Exposure and Cardiovascular Function and Lipid Profile in the Garment Industry: An Ex-Post-Facto Study: Reham Ibraheem, Ayman Fahim, Samar Mosaad Gaafar, Fathy Ahmed Nada, Adel Mishriky; Received January 22, 2026 Accepted April 27, 2026 Published online June 27, 2026; DOI: https://doi.org/10.3961/jpmph.26.077 [Accepted]

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Abstract PDF: Objectives
Occupational noise exposure is a widespread hazard across multiple industries. However, the association between occupational noise exposure and cardiovascular health outcomes remains inconclusive. This study aimed to compare cardiovascular function between workers exposed and unexposed to occupational noise and to compare lipid profiles between these groups.
Methods
An ex-post-facto (comparative cross-sectional) study was conducted in a denim garment manufacturing facility in Ismailia, Egypt. Two equal groups of workers exposed to occupational noise (≥85 dB[A] for ≥3 years, n=213) and unexposed workers (<85 dB[A], n=213) were recruited using systematic sampling, but three unexposed workers dropped out. Data collection included structured interviews, clinical examinations, 12-lead electrocardiography (ECG), blood pressure measurements, and laboratory lipid profile analyses. Noise exposure was assessed using both environmental and personal integrated sound level meters. Multiple logistic regression analysis was performed to identify potential predictors of ECG abnormalities.
Results
The mean ages of the noise-exposed and unexposed groups were 34.5±9.8 and 33.3±7.7 years, respectively, and females accounted for 67.6% and 66.2% of the groups, respectively. Noise-exposed workers had significantly higher pulse pressure, systolic blood pressure, low-density lipoprotein cholesterol (LDL-C), total cholesterol, triglyceride levels, and prevalence of dyslipidemia (59.2% vs. 48.6%, p<0.05). ECG abnormalities were more prevalent in the noise-exposed group than in the unexposed group (30% vs. 8%, p<0.001), with P mitrale and right bundle branch block being the most frequent findings. Duration of noise exposure, personal noise level, age, and systolic blood pressure were independent predictors of ECG abnormalities. Body mass index (BMI) and duration of noise exposure were significant predictors of dyslipidemia.
Conclusions
Chronic occupational noise exposure was associated with elevated blood pressure, dyslipidemia, and ECG abnormalities. Longer duration and higher intensity of noise exposure were also associated with increased cardiovascular risk indicators. These findings support workplace noise-control measures, periodic cardiovascular screening, and improved use of personal protective equipment in similar garment manufacturing settings; Summary

Review

Reassessing Early COVID-19 Strategies in East Asia: Insights from Japan and South Korea: Duk-Hee Lee, Kakeya Hideki; Received March 25, 2026 Accepted April 27, 2026 Published online June 24, 2026; DOI: https://doi.org/10.3961/jpmph.26.274 [Accepted]

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Abstract PDF: East Asian countries had remarkably low COVID-19 mortality in 2020, a pattern widely cited as evidence of effective public health interventions. However, Japan and South Korea—often classified as having followed similar early intervention strategies—adopted substantially different approaches. These differences are largely obscured by commonly used stringency indices and policy score analyses. While neither country implemented a lockdown, South Korea pursued an aggressive, government-mandated strategy based on extensive testing, isolation, quarantine, and compulsory data collection. In contrast, Japan relied on a voluntary model with limited mass testing, a policy that drew strong criticism during the early phase of the pandemic. Because asymptomatic COVID-19 infection was highly prevalent, these divergent testing policies were particularly important in shaping patterns of community transmission. Using excess mortality as a comprehensive outcome metric, Japan’s outcomes were as favorable as South Korea’s through the pre-Omicron period, despite Japan’s limited testing. In 2020, excess mortality was negligible in both countries (−1.7% in Japan vs. +0.3% to +2.1% in South Korea). In 2021, excess mortality increased modestly (+2.2% vs. +4.0% to +5.6%). However, in 2022, after both countries had achieved approximately 80% vaccination coverage, excess mortality rose substantially (+7.6% vs. +19.6% to +21.0%), threefold higher in South Korea. These similar patterns of excess mortality in 2 countries with contrasting testing strategies challenge the view that East Asia’s early success stemmed primarily from stringent virus suppression measures. They also highlight the need to consider alternative explanations, including the possibility that pre-existing immunity differed substantially across geographical regions.; Summary

Original Articles

Behavioral Segmentation of Integrative Care Use among Older Adults with Knee Osteoarthritis in a Rural District in Northern Thailand: Kitrawee Jiraratsatit, Wijittra Ubolkam, Kaysorn Sumpowthong; Received March 21, 2026 Accepted May 22, 2026 Published online June 23, 2026; DOI: https://doi.org/10.3961/jpmph.26.263 [Accepted]

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Abstract PDF: Objectives
To identify behavioral segments of integrative care use among older adults with knee osteoarthritis in a rural district in Northern Thailand and to compare these segments according to PRECEDE-related factors and baseline characteristics.
Methods
This analytical cross-sectional study included 302 community-dwelling older adults with primary knee osteoarthritis in Thoen District, Lampang Province, Northern Thailand. Data were collected through face-to-face interviews using a structured questionnaire that assessed demographic and health characteristics, PRECEDE-related factors, and behaviors across 3 care domains: professional medical care, traditional medicine, and community-based medicine. Standardized behavioral domain scores were analyzed using hierarchical cluster analysis, followed by k-means clustering. Differences among segments were examined using chi-square tests, 1-way analysis of variance, or Kruskal-Wallis tests, as appropriate.
Results
Three behavioral segments were identified: high engagement (20.9%), intermediate engagement (48.0%), and low engagement (31.1%). The 3 behavioral domains differed significantly across segments (all p<0.001; η²=0.400–0.535). Baseline demographic and health characteristics did not differ significantly among segments. In contrast, significant differences among segments were observed for the total enabling score, access, total reinforcing score, social support, and attitude, whereas perceived information showed no significant difference.
Conclusions
Older adults with knee osteoarthritis were not behaviorally homogeneous in their use of professional, traditional, and community-based care. Segment differences were more pronounced for enabling and reinforcing conditions than for perceived information alone. These findings support segment-informed health promotion strategies in primary care and community settings.; Summary

Social Networking Service Usage Behaviors and Loneliness Among Adults in Seoul, South Korea: A Population-based Cross-sectional Study: Kang Seo, Kun-Hee Oh, Baek-Yong Choi, Jin-Young Min, Kyoung-Bok Min, Seung-Woo Ryoo, Seok-Yoon Son, Ji-Hyeon Lee, Taehoon Kim; Received January 7, 2026 Accepted April 27, 2026 Published online June 23, 2026; DOI: https://doi.org/10.3961/jpmph.26.024 [Accepted]

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Abstract PDF: Objectives
Although social network services (SNS) are prevalent globally, the relationship between SNS use and loneliness remains complex, particularly regarding qualitative behavioral patterns. This study examined associations between specific SNS behaviors and loneliness among Seoul adults and explored differences by age and digital literacy.
Methods
Data from the 2024 Seoul Survey were analyzed (N=34,142; mean age, 52.3 years). Loneliness was assessed with 2 items measuring isolation in family and non-family relationships. Five SNS behavioral domains were examined: active use, information-seeking use, communication priority, social comparison, and exclusionary feeling. Digital literacy was dichotomized using an 8-item scale, with scores ≥6 considered high. Multivariable logistic regression estimated adjusted associations.
Results
Overall SNS use was associated with lower odds of loneliness than non-use (adjusted odds ratio [aOR], 0.90; 95% confidence interval [CI], 0.83 to 0.98). However, higher odds were observed for specific SNS behaviors compared with non-use: active use (aOR, 1.24), information-seeking use (aOR, 1.11), communication priority (aOR, 1.26), social comparison (aOR, 1.50), and exclusionary feeling (aOR, 1.66). A dose–response pattern peaked at 3 problematic behaviors (aOR, 3.21; 95% CI, 2.82 to 3.65). Associations between SNS behaviors and loneliness were stronger among adults aged ≥60 years and participants with high digital literacy.
Conclusions
Although overall SNS use was associated with modestly lower odds of loneliness, qualitative SNS engagement—particularly problematic behaviors—was strongly associated with higher odds. Older adults and participants with high digital literacy appeared particularly vulnerable when performing problematic SNS behaviors, underscoring the need for behavior-focused, population-tailored education and interventions.; Summary

Stage-specific Healthcare Burden of Fall-related Injuries Among Older Adults in Korea: Minseok Kim, Taekwon Kim, Kyungsub Song, Sang-hun Lee, Jonghoon Yoo; Received January 17, 2026 Accepted May 22, 2026 Published online June 22, 2026; DOI: https://doi.org/10.3961/jpmph.26.053 [Accepted]

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Abstract PDF: Objectives
This study aimed to describe the distribution of fall-related injury burden across healthcare stages and age groups in Korea, with particular emphasis on differences between young-old adults (aged 65–74 years) and old-old adults (aged ≥75 years).
Methods
Using the 14th Korea National Injury Statistics Report (2022), we analyzed data on fall-related injuries from 5 national sources: the 119 Emergency Medical Services Registry, the National Emergency Department Information System (NEDIS), the Hospital Discharge Injury Survey, the Severe Trauma Survey, and cause-of-death statistics. Five age groups (0–6, 7–18, 19–64, 65–74, and ≥75 years) were defined according to the original classifications used in the data sources. Age-specific crude rates were calculated using mid-year population denominators from Statistics Korea.
Results
Emergency department (ED) visit rates were highest among children aged 0–6 years (2,312/100,000) and adults aged ≥75 years (2,121/100,000). Despite comparable ED visit rates, the within-NEDIS ED admission rate increased from 2.6% among children aged 0–6 years to 42.9% among adults aged ≥75 years. The hospitalization rate among adults aged ≥75 years (4,852/100,000) was 2.6 times higher than that among adults aged 65–74 years (1,832/100,000). Among adults aged ≥75 years, the mortality rate was 32.5/100,000, and this age group accounted for 45.4% of all fall-related deaths.
Conclusions
Fall-related injury burden among adults aged ≥75 years was disproportionately concentrated at the hospitalization and mortality stages. These findings suggest that fall prevention strategies for aging populations should consider the downstream burden beyond ED visits.; Summary

National Trends in Healthcare Quality in Korea: A Multidimensional Assessment Using OECD Health Care Quality Indicators (2008–2023): Hyejin Lee, Soo-Hee Hwang, Sang-A Cho, Hyemin Jung, Youngs Chang, Jieun Yun, Sanghyun Cho, Un-Na Kim, Hye Yeon Koo, Eun Byul Cho, Do Hee Kim, Jin Yong Lee; J Prev Med Public Health. 2026;59(3):225-238. Published online May 20, 2026; DOI: https://doi.org/10.3961/jpmph.26.233

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Abstract Summary PDF Supplementary Material: Objectives
Assessing healthcare quality at the national level is essential for evaluating health system performance and identifying areas requiring improvement. This study examined long-term trends in healthcare quality in Korea from 2008 to 2023 using internationally comparable indicators.
Methods
We conducted a trend analysis of healthcare quality in Korea using the Organization for Economic Cooperation and Development (OECD) Health Care Quality and Outcomes framework and quality indicators. Indicators across multiple domains, including acute care, primary care, prescribing in primary care, mental healthcare, and patient experiences, were analyzed and compared with OECD averages.
Results
Healthcare quality in Korea improved across several domains. Thirty-day mortality for acute myocardial infarction decreased from 14.2% in 2008 to 10.2% in 2023, while mortality for ischemic stroke declined from 8.7% to 5.5%. Avoidable hospitalizations decreased substantially, with hospitalizations for chronic obstructive pulmonary disease declining by 59.7%. The proportion of patients with diabetes receiving cholesterol-lowering treatment increased from 44.1% to 82.5%. However, the proportion of broad-spectrum antibiotic prescriptions remained substantially higher than the OECD average (40.3 vs. 15.5%). In mental healthcare, excess mortality ratios increased from 4.3 in 2010 to 4.9 in 2023 for schizophrenia and from 3.5 to 4.3 for bipolar disorder, while post-discharge suicide rates showed little improvement. Patient experience indicators related to patient-physician communication improved and approached OECD averages.
Conclusions
Healthcare quality in Korea improved substantially between 2008 and 2023, particularly in acute care outcomes and chronic disease management. However, persistent challenges remain in areas such as antibiotic use, polypharmacy, and mental healthcare. These findings provide internationally comparable evidence to inform future health policy and healthcare quality improvement efforts.; Summary

Korean summary
이 연구는 OECD Health Care Quality Indicators(HCQI)를 활용하여 2008년부터 2023년까지 한국 의료의 질 변화를 주요 OECD 국가와 비교·분석하였다. 분석 결과, 한국의 급성기 치료 성과(급성심근경색과 허혈성·출혈성 뇌졸중의 30일 사망률)와 만성질환 관리 수준(천식·만성폐쇄성폐질환·심부전·당뇨병의 입원율 감소와 당뇨병 환자의 적절한 약물치료 증가)은 전반적으로 향상된 것으로 나타났다. 그러나 광범위 항생제 사용, 고령층 다약제 처방, 중증 정신질환자의 초과사망 및 퇴원 후 자살률 등은 여전히 OECD 평균 대비 취약한 영역으로 나타나, 지속적인 질 관리와 정책 개선이 필요하다.

Key Message
This study analyzed changes in healthcare quality in Korea from 2008 to 2023 compared with major OECD countries using the OECD Health Care Quality Indicators (HCQI). Acute care outcomes and chronic disease management improved overall, including reduced 30-day mortality for acute myocardial infarction and stroke and lower hospitalization rates for major chronic diseases. However, broad-spectrum antibiotic use, polypharmacy among older adults, excess mortality among patients with severe mental illness, and post-discharge suicide rates remained worse than the OECD average, highlighting the need for continuous quality improvement and policy reform.

Effectiveness of an Innovative Leg Support Ring for Lower Limb Muscle Rehabilitation Among Older Adults in Eastern Thailand: A Quasi-Experimental Study: Kaittisak Wataksorn, Phannathat Tanthanapanyakorn, Pitchapa Sankasem, Nattaya Rorakklang, Atitaya Samaikun, Chanthima Khumthong, Nonlapan Khantikulanon, Chaninan Praserttai, Sootthikarn Mungkhunthod; Received February 1, 2026 Accepted March 22, 2026 Published online May 20, 2026; DOI: https://doi.org/10.3961/jpmph.26.109 [Accepted]

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Abstract PDF: Objectives
Thailand is rapidly transitioning to an aged society. Lower limb muscle weakness among older adults is associated with increased fall risk, loss of independence, and reduced quality of life (QOL). Although exercise can improve strength and mobility, many community-dwelling older adults face barriers to participation. We evaluated the effectiveness of an innovative leg support ring for lower limb muscle rehabilitation among older adults in Eastern Thailand.
Methods
This quasi-experimental, repeated-measures study included 64 adults aged 60 years or older with lower limb muscle weakness and activities of daily living (ADL) scores of 9–11. The intervention group (n=32) used the leg support ring for 12 weeks (3–5 days/week), while the control group (n=32) received standard care and continued usual physical exercise. Leg motor power, range of motion (ROM), ADL, and QOL were assessed at baseline, immediately post-intervention, and at the 3-month follow-up. Data were analyzed using repeated-measures analysis of variance.
Results
Compared with control participants, the intervention group showed significantly greater improvements in motor power of the quadriceps, hamstrings, hip flexors, ankle dorsiflexors, and ankle plantar flexors (p<0.001) and ROM for hip flexion, hip extension, knee flexion, and ankle plantarflexion (p<0.05). ADL and QOL also demonstrated significantly greater improvements (p<0.001). These improvements were sustained or further increased at the 3-month follow-up.
Conclusions
The leg support ring program was associated with improvements in lower limb strength, mobility, functional independence, and QOL among older adults. Its simplicity and accessibility may support integration into community-based health promotion programs for active aging.; Summary

Spatio-temporal Distribution and Relative Risk of Dengue Fever in Peninsular Malaysia: Mohamad Afiq Amsyar Hamedin, Kamarul Imran Musa, Mohd Rahim Sulong; Received January 11, 2026 Accepted March 26, 2026 Published online May 17, 2026; DOI: https://doi.org/10.3961/jpmph.26.035 [Accepted]

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Abstract PDF: Objectives
Dengue fever remains a major public health concern in Malaysia, with marked spatial heterogeneity and evolving temporal dynamics. Although the incidence of dengue has increased substantially in recent years, district-level risk patterns and their changes over time remain insufficiently characterised. This study aimed to assess the spatio-temporal distribution of dengue risk in Peninsular Malaysia.
Methods
A retrospective analysis of dengue surveillance data was conducted using district-level monthly case counts from 2022 to 2024. Dengue risk was modelled with Bayesian spatio-temporal models incorporating spatial effects, temporal effects, and space–time interaction terms. Spatial variation was modelled using the Besag–York–Mollié 2 specification, while temporal trends were modelled using a first-order random walk. Competing models were compared using the deviance information criterion (DIC) and Watanabe–Akaike information criterion (WAIC). Relative risk (RR) and exceedance probability maps were generated from the best-fitting model.
Results
Dengue incidence increased markedly after 2022, with incidence rates nearly doubling in 2023 and remaining high in 2024. Incidence maps showed pronounced spatial heterogeneity, with persistent high-incidence districts concentrated in urban and peri-urban regions. Spatio-temporal models incorporating space–time interaction substantially outperformed the additive model, with lower DIC and WAIC values. The best-fitting model identified persistent high-risk districts with high exceedance probabilities (P[RR>1]>0.8) in Selangor, Penang, and Johor.
Conclusions
This study demonstrates substantial spatial heterogeneity and evolving temporal dynamics in dengue risk across Peninsular Malaysia. Bayesian spatio-temporal disease mapping provides robust, localised, time-specific estimates of dengue risk and may support targeted surveillance and intervention in endemic settings.; Summary

Contribution of Medication Expenditures to Catastrophic Health Expenditures in Iran: An Inequality Analysis: Abdoreza Mousav, Rajabali Daroudi, Ali Akbari Sari, Masoomeh Gholami, Saeed Mohammadpour, Ali Akbar Fazaeli; J Prev Med Public Health. 2026;59(3):298-307. Published online May 14, 2026; DOI: https://doi.org/10.3961/jpmph.26.025

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Abstract Summary PDF Supplementary Material: Objectives
Catastrophic health expenditures (CHE) is a well-established indicator of financial risk protection. This study aimed to examine the contribution of medication expenditure to CHE and the associated socioeconomic inequalities.
Methods
Data were drawn from 6 nationally representative income and expenditure surveys covering the period 2019–2024. Using the budget share method, CHE was defined as out-of-pocket (OOP) health payments exceeding 25% of a household’s total consumption expenditure. The contribution of medication expenditures to CHE was then calculated as the difference in the proportion of households experiencing CHE with and without medication payments. Socioeconomic inequalities were quantified using the Concentration Index (CI), and decomposition analysis was conducted to identify the primary drivers of overall socioeconomic inequality in the contribution of medication expenditures to CHE.
Results
During the study period, medications represented a substantial share of household health expenditures and contributed to CHE. In 2024, OOP spending on medications accounted for 31.2% of total health expenditures, while the contribution of medication expenditures to CHE was 1.28%. The CI indicated that the contribution of medication expenditures to CHE was concentrated among poorer households. Decomposition analysis further identified medium-sized households, male-headed households, households with employed heads, insured households, and urban households as the main contributors to this socioeconomic inequality.
Conclusions
In Iran, OOP payments for medications constitute a substantial share of household healthcare expenditures and contribute to CHE. Because the roots of inequality extend beyond the healthcare system, addressing this issue requires a comprehensive, cross-sectoral strategy that integrates broader social and economic policies.; Summary

Key Message
• Medications are a major component of out-of-pocket health expenditures in Iran. In 2024, they accounted for 31.2% of total health spending and contributed 1.28% to catastrophic health expenditures. • This burden is disproportionately concentrated among poorer households. • Addressing this issue requires policy actions beyond the health sector and stronger cross-sectoral strategies to improve financial risk protection.

Risk and Protective Factors for Child Sexual Abuse in Indonesia: Cross-sectional Findings From the 2024 National Survey on Child and Adolescent Life Experiences (SNPHAR 2024): Kinanthi Estu Linadi, Dian Ayubi; J Prev Med Public Health. 2026;59(3):278-288. Published online May 13, 2026; DOI: https://doi.org/10.3961/jpmph.25.777

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Abstract Summary PDF: Objectives
Child sexual abuse is the most frequently reported form of violence against children in Indonesia, with reported cases increasing over the past 5 years. This study aimed to identify risk and protective factors associated with sexual abuse among adolescents aged 13–17 years in Indonesia.
Methods
The analysis used data from the 2024 National Survey of Children’s and Adolescents’ Life Experiences (SNPHAR), including 6811 respondents. Bivariate analyses were conducted using chi-square tests to identify variables associated with sexual abuse. Variables with p-values less than 0.25 in binary logistic regression were included in multivariable logistic regression. Odds ratios, adjusted odds ratios (aORs), and 95% confidence intervals (CIs) were calculated to identify risk and protective factors associated with the experience of sexual abuse.
Results
Overall, 8.7% of respondents reported experiencing sexual abuse. Protective factors included never having worked (aOR, 0.77; 95% CI, 0.61 to 0.99; p<0.05), never having witnessed violence (aOR, 0.20; 95% CI, 0.17 to 0.24; p<0.001), and no history of sexual intercourse (aOR, 0.08; 95% CI, 0.04 to 0.15; p<0.001). Conversely, positive gender attitudes (aOR, 1.56; 95% CI, 1.29 to 1.87; p<0.001) and knowledge of child protection services (aOR, 3.85; 95% CI, 3.15 to 4.72; p<0.001) were unexpectedly associated with elevated risk.
Conclusions
Violence-free environments and limited exposure to early sexual experiences appear to represent critical protective factors. Counterintuitive associations suggest potential influences of cultural norms, patriarchy, and limited access to services.; Summary

Key Message
This study found that 7% of Indonesian adolescents aged 13–17 years reported experiencing child sexual abuse, based on the 2024 SNPHAR data. Protective factors included never having worked, never witnessing violence, and no prior sexual intercourse, while positive gender attitudes and awareness of child protection services were associated with higher reported odds of abuse. These findings highlight the need for safe environments, early prevention of violence and sexual exposure, and culturally sensitive, accessible child protection services for adolescents.

Exploring Factors Influencing Decisions to Withdraw Treatment in Iranian Patients With Metastatic Cancer: A Qualitative Content Analysis Study: Faezeh Abadi, Mostafa Bijani, Esmat Nouhi, Camelia Rohani; J Prev Med Public Health. 2026;59(3):267-277. Published online April 30, 2026; DOI: https://doi.org/10.3961/jpmph.25.872

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Abstract Summary PDF: Objectives
The decision to withdraw treatment in patients with metastatic cancer is a complex and emotionally charged process influenced by multiple interrelated factors. Despite its significant clinical and ethical implications, this phenomenon remains insufficiently explored through qualitative inquiry. This study aimed to explore the factors influencing decisions to withdraw treatment among patients with metastatic cancer.
Methods
A qualitative study using conventional content analysis was conducted. Fourteen patients with metastatic cancer were purposively selected. Data were collected through in-depth, semi-structured interviews and analyzed using the qualitative content analysis approach proposed by Graneheim and Lundman. Data organization was facilitated using MAXQDA software.
Results
The analysis yielded 1 main theme (“Finding the meaning of life, and freedom from cycles of suffering”), 4 categories, and 15 subcategories. The overarching theme suggests that understanding life’s meaning enables patients to situate their illness within a broader existential purpose, thereby affirming life’s intrinsic value beyond mere physical survival. The 4 categories were social and family influences, physical health factors, psychological determinants, and divine and spiritual beliefs.
Conclusions
This study outlines a multilevel approach to improving end-of-life care. At the clinical level, holistic nursing assessments are needed to guide transitions to palliative care. At the institutional level, implementing structured protocols with multidisciplinary support and financial counselling is essential. At the national level, policies should ensure universal health coverage and promote cultural acceptance of dignified treatment withdrawal. These findings provide actionable insights for healthcare administrators and policymakers and offer a foundation for strategies aimed at reducing barriers and improving access to supportive care services.; Summary

Key Message
This qualitative study with the conventional content analysis method explored the factors influencing treatment withdrawal decisions in 14 Iranian patients with metastatic cancer. The results revealed one overarching theme: “Finding the meaning of life and freedom from the cycles of suffering,” along with 15 subcategories and four main categories: “social and family influences,” “physical health factors,” “psychological determinants,” and “divine and spiritual beliefs.” These findings provide practical insights for healthcare administrators and policymakers to develop strategies for mitigating barriers and enhancing access to supportive care services for this vulnerable population.

Perspective

Protecting Informational Self-Determination in AI-driven Precision Oncology: Privacy, Ethics, and Governance Challenges: Minsoo Jung; Received January 29, 2026 Accepted March 26, 2026 Published online April 27, 2026; DOI: https://doi.org/10.3961/jpmph.26.094 [Accepted]

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Abstract PDF: Artificial intelligence (AI) is rapidly transforming cancer care, from diagnosis and risk prediction to treatment planning and drug development. These advances depend on the large-scale integration of genomic, imaging, and clinical data, intensifying privacy and ethical concerns. This study examines emerging challenges in AI-driven precision oncology and explores strategies for protecting patients’ informational self-determination through a narrative ethical and policy analysis informed by recent empirical and technical research. Even data considered de-identified, including molecular and imaging profiles, may enable inference of sensitive attributes through machine-learning analytics. Although many patients support the clinical promise of AI, they express concerns about secondary data use without meaningful consent, commercialization, and security breaches. Privacy violations threaten autonomy, confidentiality, and trust and may exacerbate existing inequities. Current regulatory frameworks, including the General Data Protection Regulation and the Health Insurance Portability and Accountability Act, focus primarily on identifiability and the removal of explicit identifiers. However, AI systems generate risks not only through re-identification but also through inferential analytics that derive new privacy-relevant information, such as disease susceptibility or familial risk, from ostensibly anonymized data. Addressing these gaps requires multilayered governance that combines privacy-preserving technologies, dynamic consent, data minimization, transparency, and strengthened legal safeguards to sustain public trust.; Summary

Original Articles

Modeling Fatigue and Work Stress in Aircraft Maintenance Personnel at Sultan Hasanuddin Airport, Makassar, Indonesia: A PLS-SEM Study on Quality of Life: Lalu Muhammad Saleh, Syamsiar Siang Russeng, Mahfuddin Yusbud, Tae-Gu Kim, Nurul Mawaddah Syafitri, Fatimah Azzahrah Zainuddin, Andi Alifah Kultsum Umniyah Tenri; J Prev Med Public Health. 2026;59(3):308-317. Published online April 6, 2026; DOI: https://doi.org/10.3961/jpmph.25.726

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Abstract Summary PDF: Objectives
This study aimed to develop and test a comprehensive model analyzing direct and indirect relationships among workload, demographic factors, fatigue, work stress, and quality of life among aircraft maintenance personnel (AMP).
Methods
This cross-sectional study was conducted at the maintenance, repair, and overhaul facility at Sultan Hasanuddin Airport, Makassar. Data collection combined structured interviews, standardized questionnaires (the NASA Task Load Index, Work Fatigue Feeling Measurement Questionnaire, Depression Anxiety Stress Scale-21, and World Health Organization Quality of Life-BREF), and objective measures (a Cocoro Meter for stress and an oximeter for physical workload). The model was examined using partial least squares structural equation modeling (PLS-SEM), which is well-suited to complex models with latent variables and non-normally distributed data.
Results
In the PLS-SEM analysis, physical workload (β=0.229, p=0.018) and work experience (β=0.277, p=0.007) were significantly and directly associated with fatigue. Age significantly predicted work stress (β=0.371, p=0.001). Crucially, fatigue (β=−0.344, p=0.002) and work stress (β=−0.385, p<0.001) had significant negative direct effects on quality of life and were central mediators. No direct effects of exogenous variables on quality of life were observed. Cross-tabulation supported these findings; subgroups with higher physical demands, longer tenure, and older age reported greater fatigue, higher stress, and lower quality of life.
Conclusions
Fatigue and work stress are pivotal mediators that are significantly associated with reduced quality of life among AMP. Interventions to reduce physical workload and provide targeted support for more experienced and older workers may improve well-being and safety in the aviation maintenance industry.; Summary

Key Message
Fatigue and work stress are serious occupational health concerns that can threaten aviation safety. This study showed that greater physical workload, longer work experience, and older age were associated with higher fatigue and work stress, which in turn were significantly associated with lower quality of life among AMP. Strategic interventions, such as improved ergonomic design, structured breaks, and targeted support for more experienced and older workers, may help address these risks. By investing in the well-being of AMP, aviation organizations may strengthen both worker health and the reliability and safety of flight operations.

Associations of Body Mass Index and Waist Circumference With Falls Among Community-dwelling Older Adults in Korea: Seonho Kim, Jeong-Soo Im, Beomman Ha; J Prev Med Public Health. 2026;59(3):328-336. Published online March 31, 2026; DOI: https://doi.org/10.3961/jpmph.26.092

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Abstract Summary PDF: Objectives
This study aimed to investigate the association between obesity and falls among community-dwelling older adults in Korea and to assess whether body mass index (BMI) or waist circumference (WC) more accurately predicts fall risk.
Methods
This study included 4378 community-dwelling older adults aged ≥65 years from the seventh Korea National Health and Nutrition Examination Survey (2016–2018). Complex-sample logistic regression analyses were conducted to examine the associations between general and central obesity and falls, stratified by sex and age group. Predictive accuracy was evaluated using Harrell’s C-index, and differences between WC and BMI were assessed using the ΔC-index and the DeLong test.
Results
BMI-defined general obesity was not significantly associated with falls. In contrast, WC-defined central obesity was significantly associated with falls among older adults overall (adjusted odds ratio, 1.82; 95% confidence interval, 1.20 to 2.76). In sex-stratified analyses, central obesity remained significantly associated with falls in both males and females. Age-stratified analyses showed a significant association between central obesity and falls among adults aged 65–74 years, but not among those aged ≥75 years. WC demonstrated a modest but statistically significant improvement in predictive ability compared with BMI (ΔC-index=0.047, p=0.044), although subgroup differences were not statistically significant.
Conclusions
Central obesity, but not general obesity defined by BMI, was significantly associated with falls among community-dwelling older Korean adults. WC showed slightly better predictive performance than BMI. These findings suggest that WC may be a more appropriate indicator than BMI for identifying older adults at increased risk of falls.; Summary

Korean summary
본 연구는 지역사회 거주 노인을 대상으로 비만과 낙상 간의 관련성을 분석하고, 체질량지수(BMI)와 허리둘레(WC)의 낙상 예측력을 비교하였다. 분석 결과, BMI 기반 일반 비만은 낙상과 유의한 관련이 없었으나, WC 기반 복부비만은 낙상 위험 증가와 유의하게 관련되었으며, 허리둘레가 BMI보다 낙상 예측에 더 우수한 지표로 나타났다. 따라서 노인 낙상 위험 선별 시 BMI보다 허리둘레를 우선적으로 고려할 필요가 있다.

Key Message
Central obesity defined by waist circumference was significantly associated with falls among community-dwelling older adults in Korea, whereas BMI-defined general obesity was not. Waist circumference also demonstrated slightly better predictive performance for falls than BMI. These findings suggest that waist circumference may be a more appropriate anthropometric indicator for identifying older adults at increased risk of falls.

Editorial

Our Valuable Contributors: Reviewers of 2025: Sue K. Park; J Prev Med Public Health. 2026;59(2):109-109. Published online March 30, 2026; DOI: https://doi.org/10.3961/jpmph.26.232

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PDF: Summary

Original Articles

Cross-cultural Adaptation and Psychometric Validation of 3 Health Literacy Instruments (SAHL-E, AAHLS, and HLS-EU-Q47) in Hindi Among Rural Adults in North India: Dheeraj Sharma; J Prev Med Public Health. 2026;59(2):194-203. Published online March 30, 2026; DOI: https://doi.org/10.3961/jpmph.25.893

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Abstract Summary PDF Supplementary Material: Objectives
Health literacy (HL) is a key determinant of health behaviors and health outcomes. However, the lack of validated Hindi-language instruments limits its assessment in India. This study aimed to translate, culturally adapt, and psychometrically validate 3 internationally recognized tools—the Short Assessment of Health Literacy in English (SAHL-E), the All Aspects of Health Literacy Scale (AAHLS), and the European Health Literacy Survey Questionnaire (HLS-EU-Q47)—for Hindi-speaking adults in rural North India.
Methods
A community-based cross-sectional study enrolled 250 adults from 5 villages in Uttar Pradesh. Translation followed forward–backward procedures with expert review and pretesting. Psychometric evaluation included internal consistency (Cronbach α), test–retest reliability (intraclass correlation coefficients, ICC), construct validity (exploratory factor analysis), convergent and known-groups validity, and feasibility indicators (completion rates and interview duration).
Results
All instruments demonstrated strong psychometric performance. Cronbach α values were 0.84 (SAHL-E), 0.87 (AAHLS), and 0.93 (HLS-EU-Q47), and ICCs ranged from 0.86 to 0.94. Factor structures aligned with theoretical expectations. Convergent correlations ranged from 0.42 to 0.61 (p<0.001), and known-groups validity analyses showed significant differences according to education and occupation. Completion rates exceeded 98%, and the mean interview duration was approximately 32 minutes.
Conclusions
The Hindi-adapted SAHL-E, AAHLS, and HLS-EU-Q47 demonstrated strong reliability, validity, and feasibility for assessing HL among rural adults in India.; Summary

Key Message
The Hindi versions of SAHL-E, AAHLS, and HLS-EU-Q47 showed acceptable reliability and construct validity among rural adults in North India. The instruments retained their expected factor structures and demonstrated moderate correlations with each other, indicating related but distinct dimensions of health literacy. These findings support their use for assessing health literacy in Hindi-speaking rural populations.

Repeated Health Screening Measures and Incident Ischemic Stroke: Evidence From a Korean Population Study: Inhyeok Yim, Heui Sug Jo, Seongheon Kim, Su Kyoung Kim, Gyoung-Min Lee, Yu Seong Hwang; J Prev Med Public Health. 2026;59(3):318-327. Published online March 30, 2026; DOI: https://doi.org/10.3961/jpmph.25.810

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Abstract Summary PDF Supplementary Material: Objectives
Ischemic stroke is influenced by long-term metabolic and renal deterioration; however, many risk prediction frameworks rely on single time-point measurements. We examined whether multi-period patterns in national health screening indicators are associated with incident ischemic stroke in Korea.
Methods
Using customized National Health Insurance Service data with 3 biennial screenings (P1: 2013–2014; P2: 2015–2016; P3: 2017–2018), we identified incident ischemic stroke during 2019–2023 (Korean Standard Classification of Diseases-7 I63). After applying eligibility criteria and excluding individuals with missing screening values, we performed 1:1 propensity score matching on sex, 1-year age strata, and insurance type (97 454 matched pairs; n=194 908). Multi-period indicators included waist circumference increase ≥10%, sustained blood pressure ≥130/80 mmHg, sustained fasting glucose ≥126 mg/dL, proteinuria progression, and creatinine elevation in ≥2 periods (sex-specific thresholds). Associations were evaluated using conditional logistic regression; a comparator model used P3-only indicators.
Results
In the multi-period model, stroke was associated with waist circumference increase ≥10% (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01 to 1.08), sustained blood pressure ≥130/80 mmHg (OR, 1.34; 95% CI, 1.31 to 1.37), sustained fasting glucose ≥126 mg/dL (OR, 1.66; 95% CI, 1.60 to 1.73), creatinine elevation in ≥2 periods (OR, 1.08; 95% CI, 1.06 to 1.10), and proteinuria progression (OR, 1.36; 95% CI, 1.32 to 1.39). In the P3-only model, all single-time-point indicators were associated with incident stroke (ORs, 1.08 to 1.47).
Conclusions
Multi-year patterns in metabolic screening indicators were associated with incident ischemic stroke. Repeated health screening measurements may complement single time-point assessments and support continuous risk-factor monitoring and patient-centered prevention.; Summary

Korean summary
- 본 연구는 국민건강보험공단 맞춤형 자료를 활용하여 3회 연속 국가건강검진 지표의 다년간 변화 양상과 이후 허혈성 뇌졸중 발생 간의 관련성을 분석하였다. - 분석 결과, 허리둘레 증가, 지속적 혈압 상승, 지속적 공복혈당 상승, 반복적인 크레아티닌 상승, 단백뇨 진행 등 대사 및 신장 관련 검진지표의 장기적 변화가 허혈성 뇌졸중 발생과 유의하게 관련되었다. - 이러한 결과는 반복 측정된 건강검진 자료가 단일 시점 평가를 보완하고, 뇌졸중 고위험군의 조기 식별과 지속적인 위험요인 모니터링 및 환자중심 예방전략 수립에 활용될 수 있음을 시사한다.

Key Message
- Multi-year patterns in waist circumference, blood pressure, fasting glucose, repeated creatinine elevation, and proteinuria progression were associated with incident ischemic stroke. - Repeated health screening measurements may provide clinically meaningful longitudinal information beyond single-time-point assessments. - Monitoring persistent or worsening metabolic and renal indicators may support earlier risk identification and patient-centered stroke prevention.

Review

Temporal Trends of the Obesity Epidemic in the United States: Zhen Zhang, Lei Zhang, Marinelle Payton; J Prev Med Public Health. 2026;59(3):219-224. Published online March 27, 2026; DOI: https://doi.org/10.3961/jpmph.25.973

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Abstract Summary PDF: Objectives
Obesity has emerged as a major public health concern in the United States, with prevalence increasing steadily over the past 4 decades. This mini-review summarizes recent trends and subgroup disparities using data from the National Health and Nutrition Examination Survey (NHANES) and related publications.
Methods
Data from NHANES cycles conducted between 1988 and 2023 were reviewed to examine temporal trends in adult obesity prevalence, with particular attention to differences by age, sex, race, and interactions between sex and age as well as sex and race.
Results
The prevalence of adult obesity increased from approximately 15% in the late 1970s to 42.4% in 2017–2018. For the first time in nearly 3 decades, consecutive declines were observed, with prevalence falling to 40.3% in 2021–2023. Disparities persist: middle-aged adults and non-Hispanic Black females continue to experience the highest prevalence of obesity, whereas non-Hispanic Asian populations consistently exhibit the lowest rates.
Conclusions
Recent declines may indicate progress in obesity control; however, targeted and equity-focused interventions remain essential to sustain improvements and reduce persistent disparities.; Summary

Key Message
• Recent NHANES data suggest that U.S. adult obesity prevalence may be entering a period of stabilization or modest decline after decades of continuous increase. • Significant disparities persist, particularly among middle-aged women and non-Hispanic Black women, who continue to bear the highest obesity burden. • Tailored prevention and intervention strategies are needed to sustain recent progress and reduce obesity-related health inequities.

Original Articles

Under-reporting of Childhood Tuberculosis Cases in Indonesia and Associated Factors: Kristina L Tobing, Dina Bisara Lolong, Doni Lasut, Mirna Widiyanti, Felly Philipus Senewe, Rachmalina Soerachman, Oster Suriani, Yusniar , Rita Aryati, M N Farid; J Prev Med Public Health. 2026;59(3):289-297. Published online March 25, 2026; DOI: https://doi.org/10.3961/jpmph.25.894

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Abstract Summary PDF: Objectives
Indonesia has the second-highest number of tuberculosis (TB) cases globally, after India. The estimated TB incidence in Indonesia is 1 090 000 cases (387 cases per 100 000 population), with an associated mortality of 131 000 deaths (47 deaths per 100 000 population). The 2023–2024 TB Inventory Study in Indonesia aimed to quantify the extent of under-reporting by identifying TB cases that were diagnosed and/or treated but not reported to the National TB Surveillance System (Sistem Informasi Tuberkulosis [SITB]). This study specifically assessed the magnitude of under-reporting of TB cases among children younger than 15 years in Indonesia.
Methods
This study used a cross-sectional design and analyzed data from the 2023–2024 TB Inventory Study (SIV-TB) in Indonesia. The sample included all TB cases in children younger than 15 years identified from eligible health facilities. Under-reported cases were defined as those that were diagnosed and/or treated but not reported to the SITB. Descriptive statistics were used to characterize under-reporting. A record-linkage process was performed to compare SIV-TB data with SITB data after deduplication.
Results
A total of 12 293 TB cases in children younger than 15 years were identified across health facilities in 31 districts and cities. The overall under-reporting rate for childhood TB was 23.5%. The highest under-reporting rate was observed in Eastern Indonesia (28.0%).
Conclusions
Under-reporting of childhood TB was significantly associated with both age group and type of health facility; Summary

Key Message
- In Indonesia, a substantial number of childhood TB cases remain unreported, especially in private health facilities and in children aged 5–9 years. - The 2023–2024 TB Inventory Study highlights regional gaps, with Eastern Indonesia most affected. - Enhancing TB reporting, engaging private-sector providers, and scaling active case finding are critical steps to detect cases early and accelerate TB elimination efforts.

Socioeconomic and Regional Disparities in Under-five Mortality in Indonesia: Insights From Indonesia’s 2020 Census: Asep Hermawan; J Prev Med Public Health. 2026;59(3):258-266. Published online March 20, 2026; DOI: https://doi.org/10.3961/jpmph.25.763

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Abstract Summary PDF Supplementary Material: Objectives
This study examined district-level and municipality-level socioeconomic determinants of the under-five mortality rate (U5MR) to inform equitable policies aimed at achieving Sustainable Development Goal (SDG) 3.2.
Methods
An ecological cross-sectional study was conducted using data from 514 districts and municipalities in Indonesia. U5MR estimates were obtained from Statistics Indonesia and calculated using the indirect Trussell method based on the 2020 Population Census Long Form. Poverty rate, mean years of schooling, gross regional domestic product per capita, and total fertility rate (TFR) were analyzed using bivariate and multivariable ordinary least squares regression with robust standard errors. To account for spatial dependence, a spatial autoregressive (SAR) model was additionally applied. Spatial mapping was used to illustrate geographic variation.
Results
U5MR ranged from 10.7 to 75.8 deaths per 1000 live births across districts and municipalities. Higher TFR (β=13.21, p<0.001) and higher poverty rates (β=0.61, p<0.001) were associated with higher U5MR, whereas higher educational attainment was associated with lower U5MR (β=−0.79, p=0.001). The association between poverty and mortality was stronger in rural districts than in municipalities (interaction β=−0.30, p=0.06). The SAR model identified significant spatial dependence and demonstrated improved model fit. Spatial clustering revealed an east-west divide, with the highest mortality observed in Papua and East Nusa Tenggara.
Conclusions
Fertility, poverty, and educational attainment are key predictors of child survival in Indonesia, with districts in eastern regions bearing disproportionate burdens. Policy efforts should prioritize family planning, maternal education, and targeted support for socioeconomically disadvantaged districts to accelerate progress toward achieving SDG 3.2 by 2030.; Summary

Key Message
Socioeconomic inequalities remain important determinants of under-five mortality in Indonesia at the district and municipality levels. Higher poverty and fertility rates were associated with increased mortality, whereas higher educational attainment was associated with lower mortality. Equity-oriented and geographically targeted interventions, particularly in disadvantaged eastern districts, are essential to accelerate progress toward Sustainable Development Goal 3.2.

Modeling the Impact of Behavior Changes on Mortality Attributable to Non-communicable Diseases in Canada: Laurence Tanguay, Pierre Faivre, Saïd Mekari, Pierre Philippe Wilson Registe, Emily Richard, Jennifer Russell, Mathieu Belanger; J Prev Med Public Health. 2026;59(2):152-161. Published online March 17, 2026; DOI: https://doi.org/10.3961/jpmph.25.663

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Abstract Summary PDF Supplementary Material: Objectives
In Canada, non-communicable diseases account for 88% of all deaths, most of which could be prevented through a healthier diet, regular physical activity (PA), smoking cessation, and reduced alcohol consumption. This study aims to estimate the number of deaths that could be prevented or delayed if (1) the average behaviors of Canadians aligned with recommendations for healthy behaviors, or if (2) the average behaviors of Canadians equaled those of residents in the provinces with the healthiest behaviors.
Methods
We used the Preventable Risk Integrated Model macrosimulation model to estimate the number of deaths that could be prevented through population-level behavioral changes. Information on Canadians’ health behaviors was obtained from the most recent edition of the Canadian Community Health Survey (2015), which reported diet (from 20 487 participants) as well as PA, alcohol consumption, smoking, and sedentary time (from 110 095 participants). Age-specific and gender-specific mortality data for 2015 were obtained from Canadian Vital Statistics, and 95% uncertainty intervals (UI) were calculated through Monte Carlo analyses.
Results
Following behavioral recommendations could have prevented 30 756 deaths (95% UI, 25 867 to 34 965) in 2015. Improving Canadians’ lifestyles to match the behaviors of the healthiest provinces could have prevented 6758 deaths (95% UI, 5062 to 8382). Improvements in fruit and vegetable intake alone could have prevented most of these deaths. Most preventable deaths were attributed to cardiovascular diseases.
Conclusions
These findings show that even modest, realistic lifestyle improvements at the population level could substantially reduce the burden of chronic disease in Canada.; Summary

Key Message
Small and realistic improvements in population-level fruits and vegetable consumption, physical activity level, avoidance of tobacco use, and reduction in salt ingestion could amount to nearly 7,000 lives saved per year in Canada. Given most of these lives saved could result from only a few behavioral improvements, the findings suggest that public health should prioritize interventions focused on increasing fruit and vegetable intake as well as promoting physical activity and smoking cessation.

Income-related Inequalities in Cancer Screening Among Korean Adults Aged 40 and Above: A Cross-sectional Analysis of the Age-varying Mediation of Health Literacy: Hyejin Hong, Hyun-Jin Goo, Hyebin Choi, Sin Kam, Jong-Yeon Kim; J Prev Med Public Health. 2026;59(2):184-193. Published online March 12, 2026; DOI: https://doi.org/10.3961/jpmph.25.866

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Abstract Summary PDF Supplementary Material: Objectives
This study investigated how the mediating effect of health literacy (HL) on the association between income and cancer screening participation varies by age among Korean adults aged 40 years and older, with the aim of identifying the optimal timing for HL interventions.
Methods
Data from 4171 adults aged ≥40 years in the 2023 Korea National Health and Nutrition Examination Survey were analyzed using moderated mediation analysis implemented with the lavaan.survey package, accounting for the complex sampling design. The Johnson–Neyman technique was used to identify age thresholds at which the mediation effect became statistically significant, and the number needed to benefit (NNB) was calculated to estimate the potential efficiency of interventions targeting this pathway.
Results
Each 1-quintile increase in income was associated with a 16.0% higher likelihood of undergoing cancer screening (odds ratio=1.16, p<0.001). The mediating effect of HL increased significantly with age (index of moderated mediation=0.000438, p=0.048). Mediation became statistically significant from age 54.2 years (Johnson–Neyman threshold), with the proportion of the total effect mediated rising from 0.1% among adults aged 40–49 years to 8.1% among those aged ≥70 years. The NNB for this pathway indicated substantial intervention efficiency in older adults (NNB=372 for ages ≥70), whereas the mediation effect was not statistically significant in the 50–59 age group.
Conclusions
HL significantly mediated the relationship between income and cancer screening participation from the mid-50s onward, with progressively greater contributions at older ages. These findings support age-differentiated strategies, including structural accessibility improvements for adults in their 40s and early 50s and integrated income–HL interventions for individuals aged ≥55 years. Experimental studies are warranted to confirm these associations.; Summary

Korean summary
40세 이상 한국 성인에서 소득과 암검진 참여 간 건강문해력의 매개효과는 54.2세부터 유의해지기 시작하여 연령 증가에 따라 점진적으로 강화되었다. 70세 이상에서 매개 비율은 8.1%, 중재효율(NNB=372)이 가장 높았다. 이는 55세 이상에서 소득 지원과 건강문해력 향상을 결합한 연령별 맞춤형 중재가 필요함을 시사한다.

Key Message
Health literacy mediation of the income–cancer screening relationship became statistically significant from age 54.2 years and strengthened progressively with age among Korean adults aged ≥40 years. Among adults aged ≥70 years, health literacy accounted for 8.1% of the total income effect, with the highest intervention efficiency (NNB=372). These findings suggest that integrated income support and health literacy interventions are warranted for adults aged ≥55 years.

Brief Report

Missing Occupation, Missing Risk: Insights From COVID-19 Case Investigation Data in Busan, South Korea: Jin-Hwan Kim, Daseul Moon, Changhoon Kim; J Prev Med Public Health. 2026;59(2):204-210. Published online March 12, 2026; DOI: https://doi.org/10.3961/jpmph.25.718

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Abstract Summary PDF Supplementary Material: Objectives
This study evaluated the quality and analytic utility of occupational data in coronavirus disease 2019 (COVID-19) case investigation records from Busan, South Korea, during the period of comprehensive surveillance in 2020–2021, when occupation was inconsistently integrated into routine case reporting despite its importance for infection-risk assessment.
Methods
We analyzed 25 283 confirmed COVID-19 cases reported between February 21, 2020, and December 31, 2021. Occupational information was extracted from investigation forms, epidemiological reports, and electronic medical records. We assessed completeness, internal inconsistencies, and codability to the Korean Standard Classification of Occupations (KSCO), and examined temporal trends across pandemic phases. Descriptive statistics and manual reviews of free-text entries were conducted.
Results
Occupational information was recorded for nearly all investigated cases in 2020–2021 (>99%), but entries were often vague (“unemployed,” “other”) or institutional (“school,” “hospital”), which limited their utility. A minority of entries could be standardized to KSCO 1–3-digit categories because of ambiguous wording or contradictions between occupation and workplace. Although data collection virtually ceased in 2022 and 2023 after individual-level investigations were discontinued, patterns in the 2020–2021 dataset already showed that design flaws in the occupation field reduced analytic value.
Conclusions
Busan’s early COVID-19 surveillance system recorded occupation for nearly all cases but produced limited analyzable information. The disconnect between data entry and analytic usefulness highlights the need for structured, dual occupation–industry coding, searchable picklists, and real-time quality checks so that occupational risk can be systematically identified and incorporated into future pandemic preparedness and response.; Summary

Korean summary
본 연구는 코로나바이러스감염증-19에 대한 전수감시가 이루어지던 2020-2021년 시기에 부산광역시 확진자 역학조사에 포함된 직업 정보의 질과 그 활용 가능성을 평가했다. 약 2년 동안 약 99% 이상의 확진자에서 직업 정보가 기입되어 있었으나 “무직”, “기타” 등의 모호한 기재나 “학교”, “병원”과 같은 기관 수준의 기재가 빈번해 활용 가능성은 제한적이었다. 자료 입력과 분석적 유용성 간의 괴리는 향후 감염병 대비 및 대응에서 직업적 위험을 체계적으로 파악하고 반영하기 위해, 구조화된 직업-산업 이중 입력 체계, 검색 기반 폐쇄형 입력 기능, 실시간 자료 질 점검 체계 도입이 필요함을 시사한다.

Key Message
- Occupation is critical for infection-risk assessment, yet occupation was not systematically collected during the COVID-19 pandemic. - In Busan, although occupational information was recorded for most confirmed COVID-19 cases reported between February 2020 and December 2021, many entries contained workplace names or industry categories instead of specific occupations, limiting standardization and analytic utility. - To improve the quality of occupational data in future pandemic preparedness, dual occupation–industry coding, searchable picklists, and real-time quality checks are needed.

Original Article

Associations Between Tobacco Use Behaviors and Metabolic Syndrome in Korean Adults: Analysis of the 2020–2022 KNHANES: Jinsun Kim, Seungju Kim; J Prev Med Public Health. 2026;59(2):174-183. Published online March 5, 2026; DOI: https://doi.org/10.3961/jpmph.25.684

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Abstract Summary PDF: Objectives
This study examined the association between various tobacco product use behaviors and metabolic syndrome (MetS) among Korean adults.
Methods
Data from 15 359 adults aged ≥19 years who participated in the 2020–2022 Korea National Health and Nutrition Examination Survey were analyzed. Participants were classified as dual users, e-cigarettes (EC; nicotine-containing liquid-type)/ heated tobacco products (HTP) users, cigarette-only users, ex-smokers, or non-smokers. MetS was defined according to the NCEP ATP III criteria. Subgroup analyses were conducted by survey year and age group. Complex-sample cross-tabulation and logistic regression analyses were performed.
Results
All types of tobacco product use were associated with an increased likelihood of MetS compared with non-smokers. This association was particularly evident among dual users (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.12 to 1.94) and cigarette-only users (OR, 1.19; 95% CI, 1.01 to 1.41). The highest risk was observed among adults aged 19–39 years and among dual users in 2020.
Conclusions
Dual use and cigarette smoking were associated with a higher likelihood of MetS, particularly among younger adults. Efforts are needed to reduce the misconception that EC/HTP products are less harmful alternatives and to strengthen education and prevention in order to prevent changes in tobacco use behavior from leading to new health risks.; Summary

Korean summary
이 연구는 2020–2022년 국민건강영양조사 자료를 이용하여 국내 성인의 담배 사용 형태와 대사증후군 간의 연관성을 분석하였다. 총 15,359명을 대상으로 분석한 결과, 모든 담배 사용 형태는 비흡연자에 비해 대사증후군 위험 증가와 관련되었으며, 특히 이중사용자와 궐련 단독 사용자에서 유의한 연관성이 나타났다. 이러한 연관성은 19–39세 젊은 성인에서 더욱 두드러졌다. 본 연구는 전자담배 및 가열담배의 안전성에 대한 인식을 재고하고, 변화하는 담배 사용 행태에 대응한 예방 전략의 필요성을 시사한다.

Key Message
Using data from 15,359 Korean adults in the 2020–2022 KNHANES, this study analyzed associations between tobacco use behaviors and metabolic syndrome (MetS). All tobacco use types increased MetS risk, with significant associations observed among dual users (OR 1.48) and cigarette-only users (OR 1.19). This risk was most pronounced in young adults aged 19–39. These findings suggest a need to address misconceptions about EC/HTP products and to improve education and prevention strategies in the context of evolving tobacco use patterns.

Brief Report

Long Working Hours and Risk of Ischemic Heart Disease Among Japanese Workers: The Jichi Medical School Cohort Study: Mayumi Saiki, Akizumi Tsutsumi, Jian Li; J Prev Med Public Health. 2026;59(2):211-218. Published online February 5, 2026; DOI: https://doi.org/10.3961/jpmph.25.577

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Abstract Summary PDF Supplementary Material: Objectives
Karoshi, or “death from overwork,” has been recognized for decades; however, epidemiological findings regarding long working hours (LWH) and ischemic heart disease (IHD) remain inconsistent. This study aimed to provide new evidence on the association between LWH and IHD, while accounting for job strain among Japanese workers, both male and female.
Methods
This study utilized data from 6670 workers participating in the Jichi Medical School Cohort Study. Baseline working hours were categorized as <5.0, 5.0 to 6.9, 7.0 to 8.9 (reference), 9.0 to 10.9, and ≥11.0 hr/day. Fatal and non-fatal incident IHD cases were determined during follow-up using International Classification of Diseases, 10th revision codes. Multivariable Cox proportional hazards models were used to examine associations, adjusting for socio-demographic factors, lifestyle behaviors, cardiometabolic characteristics, and job strain.
Results
During a mean follow-up of 12 years, 58 incident IHD cases (42 male and 16 female) were documented. Long working hours (≥11.0 hr/day) were significantly associated with an increased risk of IHD in the total sample (hazard ratio, 2.92; 95% confidence interval, 1.15 to 7.39), and the overall pattern of associations was similar in sex-stratified analyses.
Conclusions
These findings suggest that LWH independently increases the risk of IHD among Japanese workers, even after adjustment for job strain, underscoring the importance of managing working hours to reduce karoshi in both male and female workers.; Summary

Key Message
Our study provides new evidence on the association between long working hours (LWH) and ischemic heart disease (IHD), while accounting for job strain among Japanese workers, both male and female, utilizing data from the Jichi Medical School Cohort Study. Our study revealed that LWH (≥11.0 hr/day) were significantly associated with an increased risk of IHD in the total sample (hazard ratio, 2.92; 95% confidence interval, 1.15 to 7.39). These findings suggest that LWH increase the risk of IHD among Japanese workers, underscoring the importance of managing working hours to reduce karoshi in both male and female workers.

Original Article

Measuring Trends in Disability-adjusted Life Years and Life Expectancy in Korea: 2008 to 2021: Chung-Nyun Kim, Dawit Urgi Gurmu, Young-Eun Kim, Yoon-Sun Jung, Yongseok Choi, Minsu Ock, Seok-Jun Yoon; J Prev Med Public Health. 2026;59(1):25-34. Published online January 29, 2026; DOI: https://doi.org/10.3961/jpmph.25.604

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Abstract Summary PDF Supplementary Material: Objectives
This study, part of the ongoing Korean National Burden of Disease (KNBD) updates, assesses disability-adjusted life years (DALYs) and disability-adjusted life expectancy (DALE) in Korea, taking into account the effects of coronavirus disease 2019 and emphasizing the importance of analyzing these metrics jointly.
Methods
Data were obtained from Statistics Korea, the National Health Insurance Service, and the Korea Disease Control and Prevention Agency. DALYs and DALE were calculated using an incidence-based approach, following disease classification, disability weights, and estimation procedures consistent with prior KNBD research.
Results
Compared with earlier estimates, DALYs showed a slight decline in 2020 followed by an increase in 2021, with this pattern observed across all income quintiles. For DALE, both men and women experienced modest gains relative to earlier studies; however, a decrease occurred across all income levels in 2021 compared with 2020. Regional disparities in DALE also narrowed beginning in 2020, with a more marked reduction among women.
Conclusions
Unlike previous studies, this research presents DALYs and DALE concurrently, offering a more comprehensive perspective on summary measures of population health. The post-2020 rise in DALYs underscores the growing need for effective chronic disease management. Additionally, widening income-based disparities in DALE highlight the urgency of addressing health inequities. Continued monitoring and updates of DALYs and DALE are necessary to understand and respond to these evolving trends.; Summary

Korean summary
한국인의 질병부담과 건강수명을 2021년까지 추가적으로 측정하였다. 그 결과 2021년은 2020년에 비해 질병부담은 증가하였고 건강수명은 감소하였다.

Key Message
The burden of disease and disability-adjusted life expectancy of Korea was measured through 2021. The results showed that the burden of disease increased and disability-adjusted life expectancy decreased, compared to 2020.

Systematic Review

Association of Particulate Matter (PM_2.5) With COVID-19 Infection and Mortality in Low-and Middle-income Asian Countries: A Systematic Review and Meta-analysis: Frisca Rahmadina, Riris Andono Ahmad, Aditya Lia Ramadona; J Prev Med Public Health. 2026;59(1):12-24. Published online January 17, 2026; DOI: https://doi.org/10.3961/jpmph.25.499

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Abstract Summary PDF Supplementary Material: Objectives
Low-income and middle-income countries in Asia bear a disproportionate burden of particulate matter with an aerodynamic diameter of 2.5 micrometers or less (PM_2.5) pollution, yet data remain scarce. This systematic review and meta-analysis aimed to quantify the association between PM_2.5 exposure and the risks of coronavirus disease 2019 (COVID-19) infection and mortality in this vulnerable region.
Methods
A systematic search was conducted in PubMed, Scopus, and other major databases for studies published up to December 31, 2024. We included observational studies reporting associations between PM_2.5 and COVID-19 outcomes in low-income and middle-income Asian countries. Pooled effect sizes and 95% confidence intervals (CIs) were calculated using a random-effects model. The study was registered with PROSPERO (CRD42022316008).
Results
Fourteen studies met the inclusion criteria. Separate analyses demonstrated statistically significant positive associations between PM_2.5 exposure and COVID-19 infection for both short-term exposure (pooled risk ratio [RR], 1.12; 95% CI, 1.07 to 1.18) and long-term exposure (pooled RR, 1.41; 95% CI, 1.28 to 1.56). For mortality, the analysis identified a statistically non-significant positive association with short-term exposure (pooled RR, 1.37; 95% CI, 0.80 to 2.33). Substantial heterogeneity was observed across all analyses (I²>75%); however, sensitivity analyses confirmed that the findings for infection were robust.
Conclusions
Our findings provide robust evidence that PM_2.5 exposure is a significant risk factor for COVID-19 infection in low-income and middle-income Asian countries. The available evidence was insufficient to establish a clear association with mortality. These results underscore the urgent need for strengthened air quality control policies as a critical component of public health strategies to mitigate the burden of respiratory pandemics.; Summary

Key Message
This systematic review and meta-analysis confirms that both short-term and long-term PM 2.5 exposure significantly increase COVID-19 infection risks in Asian LMICs, with long-term exposure showing a substantially higher risk ratio. These findings highlight a critical intersection between air quality and infectious disease vulnerability. Consequently, integrating air quality management into public health strategies is essential for strengthening preparedness against future respiratory pandemics.

Scoping Review

Reporting Quality for Comorbidity Adjustment in Studies Using Korean Health Insurance Claim Data: A Scoping Review: Kyoung-Hoon Kim; J Prev Med Public Health. 2026;59(2):123-131. Published online January 6, 2026; DOI: https://doi.org/10.3961/jpmph.25.839

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Abstract Summary PDF

Objectives
Adjustment for comorbidity is essential in observational studies using administrative data to ensure the reproducibility and transparency of research findings. However, the reporting quality of comorbidity adjustment in studies using the National Health Insurance Claim Data (NHICD) has not yet been evaluated. This study aimed to assess the reporting quality of comorbidity adjustment in health outcome studies that used the NHICD.
Methods
We conducted a PubMed search in April 2025 using the terms “(Korea OR Korean) AND (‘health insurance claim*’ OR claims data OR NHIS OR HIRA) AND (2024).” Of the 239 retrieved studies, 82 outcome studies that exclusively used the NHICD and adjusted for comorbidities as confounding variables were included. Reporting quality was evaluated across 3 domains: (1) scope of data, (2) range of diagnostic codes, and (3) length of the look-back period.
Results
Among the 82 studies, 33 (40.2%) used ad hoc selection, 33 (40.2%) used the Charlson comorbidity index, and 13 (15.9%) applied both methods. The Elixhauser comorbidity measure was rarely used, appearing in only 3 studies. Only 3 studies explicitly described the scope of data used, and 6 reported the diagnostic code range. The look-back period was specified in 26 studies (31.7%), with 1 year being the most commonly reported duration.
Conclusions
The reporting quality of comorbidity adjustment in studies using the NHICD remains suboptimal. Transparent and standardized reporting of data scope, diagnostic code range, and look-back period is essential to improve the reproducibility and comparability of research findings.

Summary

Korean summary
건강보험 청구자료를 활용한 관찰연구에서 동반질환 보정은 연구 결과의 타당성을 확보하는 데 중요한 요소이나, 그 보고 수준은 충분히 평가되지 않았다. 본 연구는 2024년에 발표된 건강보험 청구자료 기반 연구를 대상으로 문헌검색을 수행하고, 데이터 범위, 진단코드 범위, 관찰기간 측면에서 동반질환 보정의 보고 수준을 평가하였다. 그 결과, 대부분의 연구에서 이러한 핵심 방법론적 정보가 충분히 보고되지 않았으며, 보고 방식에도 상당한 변이가 존재하였다. 이러한 결과는 연구의 재현성과 비교 가능성을 제한할 수 있음을 의미하며, 향후 행정자료 기반 연구의 신뢰성과 방법론적 정확성을 높이기 위해 표준화되고 투명한 보고가 필요함을 시사한다.

Key Message
The reporting quality of comorbidity adjustment in studies using Korean health insurance claims data remains suboptimal. Key methodological elements, including the scope of data, diagnostic code range, and look-back period, are frequently omitted or insufficiently described, limiting the reproducibility and comparability of findings. Transparent and standardized reporting of these components is essential to improve methodological rigor and support more reliable evidence generation in administrative data research.

Citations

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Psoriasis and Risk of Colorectal Cancer: A Nationwide Population-Based Cohort Study in Korea
Kyeong Min Han, Dae Myoung Yoo, Ho Suk Kang, Hyo Geun Choi, Joo-Hee Kim, Nan Young Kim, Kyueng-Whan Min, Mi Jung Kwon
Diseases.2026; 14(6): 200. CrossRef

Original Articles

Obstetric Outcomes of Jehovah’s Witness Women Under Patient Blood Management: A Single-center, Propensity Score–Matched Cohort Study in Korea: Jeong-Won Oh, Seug Yun Yoon, Jeong Jae Lee, Kyu Yeon Choi, Seong Soon Kwon; J Prev Med Public Health. 2026;59(2):143-151. Published online January 6, 2026; DOI: https://doi.org/10.3961/jpmph.25.596

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Abstract Summary PDF Supplementary Material: Objectives
Patient blood management (PBM) is increasingly recognized as an essential strategy in obstetric care for reducing transfusion-related risks and improving maternal safety. Jehovah’s Witness (JW) women, who categorically refuse blood transfusion, represent a unique clinical population in which to evaluate the effectiveness of PBM. This study aimed to assess obstetric outcomes of JW women compared with non-JW women at a PBM-based center in Korea.
Methods
We retrospectively reviewed delivery outcomes and PBM practices among JW women (n=205) with singleton pregnancies and non-JW women (n=601) who were matched at a 1:3 ratio using propensity scores at Soonchunhyang University Seoul Hospital between 2018 and 2023. The primary outcomes included obstetric morbidities, with particular attention to complications related to postpartum hemorrhage and the interventions used for its management.
Results
JW women were more likely to receive intravenous iron administration (7.3 vs. 2.8%, p=0.008) and had higher hemoglobin (Hb) levels during the first trimester (12.6±1.1 vs. 11.8±3.4 g/dL, p=0.012) than non-JW women. Blood loss during cesarean section and the incidence of severe postpartum anemia (Hb <7 g/dL) were lower among JW women; however, these differences did not reach statistical significance. In the hemorrhage-related high-risk subgroup, JW women were managed according to PBM protocols without transfusion, and their obstetric outcomes were comparable to those observed in non-JW women.
Conclusions
This study identified no significant differences in hemorrhage-related obstetric outcomes between JW and non-JW women at a PBM-based center. The systematic application of PBM enables safe delivery in transfusion-restricted settings and may reduce reliance on blood transfusion while maintaining maternal safety.; Summary

Korean summary
수혈을 거부하는 여호와의 증인 산모에게 환자혈액관리(PBM) 프로토콜을 적용한 결과, 일반 산모와 비교하여 산후출혈 및 중증 빈혈 등 주요 산과적 합병증에서 유의한 차이는 관찰되지 않았으며, 이는 선제적인 철분 관리의 기여로 해석된다. 비록 대량 출혈 시에는 적용에 한계가 있으나, 이는 PBM이 종교적 특수 상황을 넘어 향후 혈액 수급 위기에 대응할 수 있는 보편적이고 안전한 산과적 대안이 될 수 있음을 시사한다.

Key Message
Implementation of patient blood management (PBM) in Jehovah’s Witness women who refuse transfusion resulted in obstetric outcomes comparable to those of non-JW women, with no significant differences in postpartum hemorrhage or severe anemia. These outcomes were associated with proactive anemia management, including intravenous iron therapy. Although its applicability may be limited in cases of massive hemorrhage, PBM represents a safe and potentially generalizable obstetric strategy to mitigate future blood supply constraints.

Development of Machine Learning Models to Predict Health Insurance Claim Costs Among Older Indonesians: A Retrospective Predictive Modeling Study: Yeni Mahwati, Dhihram Tenrisau, Syarif Rahman Hasibuan, Bhirau Wilaksono, Yeni Indriyani, Andi Afdal Abdullah, Halik Malik, Andi Alfian Zainuddin; J Prev Med Public Health. 2026;59(2):132-142. Published online January 6, 2026; DOI: https://doi.org/10.3961/jpmph.25.350

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Abstract Summary PDF Supplementary Material: Objectives
The objective of this study was to develop machine learning models to predict health insurance claim costs among older adults in Indonesia.
Methods
This study utilized secondary data from the Indonesian National Health Insurance program (Jaminan Kesehatan Nasional [JKN]) spanning 2017 to 2023. Three modeling techniques—linear regression, random forest, and XGBoost—were employed to predict individual claim costs. Model performance was assessed using the root mean square error (RMSE), coefficient of determination (R²), and mean absolute error (MAE). Additionally, variable importance analysis was conducted to identify key predictors.
Results
XGBoost with 500 boosting rounds yielded the best performance, with an RMSE of 11 360 283, an R² of 0.81, and an MAE of 4 485 917, outperforming both linear regression (RMSE, 13 710 035; R²=0.72) and random forest (RMSE, 12 434 238; R²=0.78). Notably, outpatient care was identified as the most consistent predictor across all models. Other significant predictors included length of stay (LOS), diagnosis type (International Classification of Diseases, 10th revision chapter), facility type, facility classification, and severity of illness, particularly for moderate cases. Although LOS and diagnosis type were important predictors, these findings should be interpreted in the context of Indonesia’s fixed Indonesian Case-Based Groups payment system.
Conclusions
XGBoost provides reliable predictions of claim costs among older adults, capturing clinical, utilization, and structural drivers. These findings can inform targeted interventions, improve chronic disease management, optimize the referral system, and support integration of predictive tools into JKN to enhance responsiveness and promote sustainable, equitable financing.; Summary

Key Message
Machine learning models, particularly XGBoost, demonstrated superior performance in predicting healthcare costs among older adults in Indonesia. Nonlinear relationships between outpatient visits, severity, and diagnoses highlight the limitations of conventional linear approaches. These findings support the integration of advanced predictive models into national health insurance systems to improve cost management and resource allocation.

Systematic Review

Patient Education to Reduce Anxiety Among Cancer Patients Undergoing Radiotherapy Procedure: A Systematic Review of Interventional Studies: Fathiya Juwita Hanum, Rizanda Machmud, Soehartati Gondhowiardjo, Daan Khambri, Wirsma Arif Harahap, Aisyah Elliyanti, Firdawati Firdawati, Rima Semiarty; J Prev Med Public Health. 2026;59(2):110-122. Published online December 21, 2025; DOI: https://doi.org/10.3961/jpmph.25.318

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Abstract Summary PDF Supplementary Material: Objectives
Nearly 1 in 3 cancer patients undergoing radiotherapy experience anxiety, which can negatively affect both quality of life and prognosis. This systematic review aimed to synthesize evidence on patient education and its impact on anxiety levels among cancer patients undergoing radiotherapy.
Methods
We conducted a systematic review of the current literature using 3 scientific databases—PubMed, EBSCOhost, and Web of Science—to identify intervention studies. Data were analyzed using a narrative synthesis approach, integrating findings across studies to draw comprehensive conclusions.
Results
Fifteen studies involving 1988 participants were included. Baseline anxiety levels, measured using various instruments, ranged from 2.9% to 88.2% before radiotherapy and declined thereafter in both intervention and control groups. Most studies reported no significant difference in anxiety reduction between intervention groups receiving educational programs and control groups receiving standard education. However, interventions that were more intensive and delivered by professional staff were more likely to produce statistically significant reductions in anxiety.
Conclusions
This review suggests that patient education remains relevant for reducing anxiety among cancer patients undergoing radiotherapy. Routine screening for anxiety prior to radiotherapy is recommended, along with the development of more intensive and tailored educational interventions rather than passive or minimal approaches.; Summary

Key Message
Patient education plays a meaningful yet nuanced role in alleviating anxiety among cancer patients undergoing radiotherapy. While standard educational approaches show limited additional benefit over routine care, more intensive, structured, and professionally delivered interventions demonstrate greater potential for significant anxiety reduction. These findings underscore the importance of early anxiety screening and the development of tailored, high-quality educational strategies to optimize patient outcomes.

Perspective

Firefighters as a Key Alliance Group to Advocate for Tobacco Control Policies in Korea: Heewon Kang, Susan Park, Sung-il Cho; J Prev Med Public Health. 2026;59(1):105-108. Published online December 14, 2025; DOI: https://doi.org/10.3961/jpmph.25.528

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Abstract Summary PDF: Tobacco control is a public health priority. However, Korea has recently experienced a reversal in its long-term decline in smoking prevalence. To address this trend, it is essential to broaden advocacy networks by engaging new stakeholders. We propose that firefighters represent a strategic yet under-represented partner in tobacco control because their professional interests closely align with tobacco-related policy goals. First, cigarette butts have consistently been the leading cause of fire incidents, and tobacco use directly undermines firefighters’ core mission to protect life and public safety. Moreover, firefighters face elevated health risks due to occupational exposure to harmful substances, and tobacco use and exposure to tobacco smoke can further compound these risks. Additionally, a portion of tobacco tax revenue is allocated to fire service funding, creating a direct fiscal linkage between tobacco control and firefighting resources. A logical next step is to promote collaboration through intergovernmental partnerships between public health authorities and national fire services. This collaboration includes targeted health promotion initiatives that assess tobacco use among firefighters and provide cessation support. Broader strategies, such as mass media campaigns and coordinated advocacy for increases in tobacco taxes, should also be jointly implemented. Such an alliance could improve firefighters’ well-being, reduce fire-related risks, and strengthen the overall tobacco control response.; Summary

Korean summary
담배 사용이 화재 위험과 소방관의 건강에 미치는 영향을 바탕로, 소방관을 담배규제 정책 옹호를 위한 핵심 협력 집단으로 제안한다. 담배꽁초로 인한 화재, 소방관의 직업적 건강 위험, 그리고 담뱃세의 소방 재정 기여라는 구조적 연계를 통해 공중보건과 소방 안전 간의 공동 이익을 실현할 수 있다. 공중보건과 소방 조직 간의 협력은 담배 사용 감소와 화재 예방을 동시에 달성할 수 있는 전략적 기회가 될 수 있을 것이다.

Key Message
This perspective argues that firefighters represent a strategic yet underutilized alliance group for advancing tobacco control in Korea. Tobacco use directly contributes to fire incidents, exacerbates firefighters’ occupational health risks, and is fiscally linked to fire services through earmarked tobacco taxes. Strengthening collaboration between public health authorities and fire services could reduce smoking prevalence, improve firefighter well-being, and enhance fire safety, creating mutually reinforcing public health and safety gains.

Original Articles

The Effect of an Educational Program Based on Orem’s Self-care Model on Treatment Adherence, Self-care Behaviors, and Quality of Life in Hemodialysis Patients in Iran: A Randomized Controlled Clinical Trial: Samira Rezaei, Mostafa Bijani, Azizallah Dehghan, Zhila Fereidouni; J Prev Med Public Health. 2026;59(3):249-257. Published online December 12, 2025; DOI: https://doi.org/10.3961/jpmph.25.727

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Abstract Summary PDF: Objectives
Patients undergoing hemodialysis encounter a wide range of complex challenges, underscoring the essential role of self-care in disease management. The present study aimed to examine the effectiveness of an educational intervention grounded in Orem’s self-care model for enhancing treatment adherence, self-care behaviors, and quality of life among hemodialysis patients in southern Iran.
Methods
This single-blind randomized controlled trial included 120 hemodialysis patients who met the predetermined eligibility criteria. Data were collected between April 2023 and August 2023 at 2 university-affiliated teaching hospitals located in southern Iran. After providing informed consent, participants were randomly allocated to either the intervention group (n=60) or the control group (n=60) through a simple randomization procedure. Three psychometrically robust instruments were used to collect data: the End-Stage Renal Disease Adherence Questionnaire, the Kidney Disease Quality of Life Short Form, and the Self-Management Behavior Scale. Statistical analyses were performed using SPSS version 23, and p-values<0.05 were considered statistically significant.
Results
At baseline, no statistically significant differences were observed between the intervention and control groups in the mean scores of the measured variables. However, immediately following the intervention and at the 3-month follow-up, the intervention group demonstrated statistically significant improvements across all 3 variables.
Conclusions
The findings underscore the effectiveness of an educational program based on Orem’s self-care model in significantly improving self-care behaviors, treatment adherence, and quality of life among hemodialysis patients.; Summary

Key Message
Patients undergoing hemodialysis encounter a wide range of complex challenges, underscoring the essential role of self-care in disease management. The findings underscore the effectiveness of an educational program based on Orem’s self-care model in significantly improving self-care behaviors, treatment adherence, and quality of life among hemodialysis patients. The results of this trial carry implications for clinical practice and health policy. It is recommended that contemporary educational methodologies—particularly those grounded in well-established nursing theories such as Orem’s model—be systematically integrated into nursing curricula. Additionally, structured training workshops emphasizing the clinical utility and outcomes of Orem-based self-care education should be incorporated into hospital-based educational programs.

Determinants of Smoking Relapse Among Indonesian Children: A National Cross-sectional Analysis Using Global Youth Tobacco Surveillance Data: Risky Kusuma Hartono, Muhammad Abdul Rohman, Renny Nurhasana, Aryana Satrya, Salsabila Nadya, Ni Made Shellasih, Fadhilah Rizky Ningtyas, Astri Hanna Waruwu; J Prev Med Public Health. 2026;59(2):162-173. Published online December 12, 2025; DOI: https://doi.org/10.3961/jpmph.25.703

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Abstract Summary PDF: Objectives
This study aimed to identify the determinants associated with 4 smoking trajectories (never smoking, current smoking, consistently quitting smoking, and smoking relapse) among Indonesian children using pooled national data.
Methods
This study analyzed children’s smoking trajectories using pooled data from the Indonesian Global Youth Tobacco Survey (2006, 2009, 2014, and 2019). Multinomial logistic regression was applied to examine 4 categories of smoking behavior, and propensity score matching (PSM) was used to address potential selection bias related to advertising exposure.
Results
Higher prices (>IDR31 000/USD1.87) (relative risk ratio [RRR], 0.527) were protective against relapse. This policy effect was systematically undermined by single-stick purchasing, which increased relapse risk by 57.41 times (p<0.01). Peer smoking (RRR, 3.696) and exposure to advertisements in sports events (RRR, 1.477) were also significant risk factors for relapse. Free cigarette distribution demonstrated the strongest association, corresponding to a 23.1 percentage-point increase in relapse probability.
Conclusions
The findings indicate that children’s smoking relapse in Indonesia is shaped by distinct behavioral trajectories. Relapse was influenced by the widespread availability of single-stick cigarettes, pervasive marketing, peer dynamics, and relatively affordable prices. These results underscore the urgent need for a comprehensive strategy that includes substantially increasing excise taxes, eliminating single-stick sales, and fully banning tobacco advertising. Simultaneous implementation of these measures is crucial to prevent relapse and interrupt the progression toward lifelong nicotine addiction.; Summary

Key Message
- To examine factors associated with smoking relapse among Indonesian children, including price, affordability, and advertising exposure. - Pooled Global Youth Tobacco Survey data (2006–2019) were analyzed using multinomial logistic regression and propensity score matching. - Higher cigarette prices (>IDR31,000) reduced relapse risk (RRR 0.527), while single-stick purchases (>57-fold), peer smoking (RRR 3.696), sports advertising exposure (RRR 1.477), and receiving free cigarettes (+23.1 percentage points) significantly increased relapse. - Relapse is driven by accessibility, social influence, and marketing, requiring comprehensive tobacco control policies.

Feasibility and Preliminary Impacts of a Diabetes Education Chatbot Simulation on Glycemic Targets, Loneliness, and Health Beliefs in Indonesia: An Explanatory Mixed-methods Study: Yohanes Andy Rias, Wildan Akasyah, Tri Ana Mulyati, Harwina Widya Astuti, Herminio Noronha, Fakhrudin Nasrul Sani, Hsiu-Ting Tsai; J Prev Med Public Health. 2026;59(1):56-65. Published online December 3, 2025; DOI: https://doi.org/10.3961/jpmph.25.334

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Abstract Summary PDF Supplementary Material

Objectives
Chatbot technology improves access to and engagement with diabetes education. However, few studies have evaluated the feasibility and rigorously assessed the impact of chatbots among individuals with type 2 diabetes (T2DM) using theory-based approaches. This pilot study assessed the feasibility and preliminary impact of a chatbot on glycemic targets, loneliness, and perceived health beliefs among adults with T2DM.
Methods
An explanatory mixed-methods approach, comprising a one-group experimental design and qualitative interviews, was used. The chatbot simulation, named “TakonGendhis,” was developed based on conceptual models derived from the technology acceptance model and the health belief model. Feasibility included usefulness, ease of use, and intention to use. Preliminary impact was evaluated based on changes in glycemic targets, loneliness, and health beliefs from baseline to 12 weeks post-intervention. Qualitative data were gathered through individual interviews and focus group discussions and were analyzed thematically. Narrative synthesis was employed to integrate findings from the quantitative and qualitative phases of the study.
Results
The scores for usefulness, ease of use, and intention to use were 26.55, 27.32, and 34.03, respectively. Quantitative analysis revealed reduced loneliness, improved health beliefs, and lower glycemic scores after the 12-week intervention. The qualitative study identified 4 themes: feasibility, beliefs, emotional support, and areas for improvement.
Conclusions
The intervention was feasible and had beneficial preliminary impacts on glycemic targets, loneliness, and health beliefs. Addressing feasibility, beliefs, emotional support, and identified areas for improvement may increase patients’ willingness to use the chatbot.

Summary

Key Message
This mixed-methods study highlights that a diabetes education chatbot simulation is both feasible and beneficial in its preliminary impact for individuals with diabetes in Indonesia. The preliminary results indicate possible enhancements in glycemic targets, reduced feelings of loneliness, and more encouraging health beliefs, confirmed by qualitative insights about user feasibility, beliefs, emotional support, and areas for improvement.

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Peningkatan Keterampilan Wawancara Kontekstual Melalui Interaksi Siswa Dan Google Gemini Di SMP Negeri 1 Tlanakan
Habiburrahman Habiburrahman, Rofi’ati Nur Diana Islam, Nadia Fitri, Halilatur Rohemah
Indonesian Journal of Innovation Multidisipliner Research.2026; 4(2): 3651. CrossRef

The Relationship Between Social Support and Health-promoting Behaviors Among Older Adults in Fasa, Iran: A Cross-sectional Study: Afsaneh Ghasemi, Zhale Zandieh, Zahra Khiyali, Navid Alinejad, Ramin Hayati, Azizallah Dehghan, Zahra Hosseini Nejad, Mohammadreza Keshtkar; J Prev Med Public Health. 2026;59(3):239-248. Published online December 1, 2025; DOI: https://doi.org/10.3961/jpmph.25.502

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Abstract Summary PDF: Objectives
Health-promoting behaviors are essential for maintaining independence and enhancing quality of life in aging populations. This study aimed to investigate the relationship between social support and health-promoting behaviors among older adults in Fasa, Iran in 2020.
Methods
A cross-sectional study was conducted involving 300 older adults attending a specialized outpatient clinic in Fasa, Iran. Data were collected using a demographic questionnaire, the Walker Health-Promoting Lifestyle Profile, and the Canty Perceived Social Support Scale, administered either through self-report or structured interviews. Statistical analyses were performed using SPSS version 25 and included descriptive statistics, analysis of variance, the chi-square test, and multiple linear regression analyses.
Results
The mean age of participants was 68.9±7.8 years. Most participants were women (56.6%), married (81.7%), and had less than a high school education (41.3%). The mean scores for health-promoting behaviors and perceived social support were 124.2±31.3 and 24.4±9.4, respectively. A statistically significant positive association was observed between perceived social support and health-promoting behaviors (r=0.10, p=0.04). Social support, gender, and education level were identified as significant predictors of health-promoting behaviors, collectively explaining 34% of the variance.
Conclusions
These findings emphasize the pivotal role of social support in promoting health-related behaviors among older adults. Interventions that strengthen social support networks, foster enabling environments, and address gender and educational disparities are recommended to improve health outcomes and quality of life in aging populations. Policymakers and healthcare planners should incorporate these determinants into the design of targeted, evidence-based interventions for older adults.; Summary

Key Message
This study highlights that perceived social support is significantly associated with health-promoting behaviors among older adults in Fasa, Iran. Higher levels of social support, along with demographic factors such as gender and education, significantly predict engagement in healthier lifestyle behaviors. These findings underscore the importance of strengthening social support networks and developing targeted interventions to improve health behaviors and enhance quality of life in aging populations

The Role of Family Interaction Frequency on Depressive Symptoms in Korean Older Adults Aged ≥80 and Living Alone: Horim A. Hwang, Bo Yung Bae, Hyunsuk Jeong, Minsun Yun, Jungeun Choi, Yujin Jeong, Hyeon Woo Yim; J Prev Med Public Health. 2026;59(1):86-94. Published online December 1, 2025; DOI: https://doi.org/10.3961/jpmph.25.222

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Abstract Summary PDF Supplementary Material: Objectives
Korea is one of the fastest-aging societies, and a large proportion of its older population lives alone. This study examined the impact of family interaction frequency on the association between living alone and depressive symptoms among older adults aged ≥80 years using nationally representative survey data.
Methods
Among the 229 099 participants of the 2019 Korea Community Health Survey, 15 672 participants aged ≥80 years who either lived with close family or lived alone were included in the analysis. Participants living alone were classified according to the frequency of family interaction, ranging from less than once a month to more than once a week. The outcome variable was moderate to severe depressive symptoms, defined as a Patient Health Questionnaire-9 score of ≥10.
Results
The prevalence of depressive symptoms was higher among older adults living alone (9.4–14.1%, depending on the frequency of family interaction) than among those living with close family (6.5%). Older adults living alone who interacted with family less than once a month were more likely to report depressive symptoms compared with those living with close family (adjusted odds ratio [aOR], 1.71; 95% confidence interval [CI], 1.36 to 2.15). Weekly family interaction mitigated the impact of living alone on the prevalence of depressive symptoms (aOR 1.10; 95% CI, 0.84 to 1.42). The influence of family interaction on the association between living alone and depressive symptoms remained consistent across subgroups of men, women, and those with difficulty in daily activities.
Conclusions
Encouraging regular interaction among family members could serve as an effective strategy to protect the mental health of older adults.; Summary

Korean summary
본 연구는 2019년 지역사회건강조사에 참여한 만 80세 이상의 노인 15,672 명의 자료를 활용하여, 가족과의 정기적인 소통이 독거로 인한 우울증상 유병률의 증가에 미치는 요인을 확인하고자 하였다. 가까운 가족인 배우자 또는 자식과 동거하는 노인들과 비교해 보았을 때, 주 1회 이상의 소통을 하는 독거 노인들의 우울증상 교차비는 유의하게 높지 않았다. 가족과의 정기적인 소통의 보호효과는 성별 또는 일상생활에 어려움에 따른 층화 분석을 한 경우에도 일관된 효과를 보였다.

Key Message
This study explored whether sufficiently frequent family interactions mitigate the increased odds of reporting depressive symptoms due to living alone among older adults aged ≥80. Family interaction of once a week or more frequent mitigated the impact of living alone among the older adults. The protective effect of family interaction remained consistent across gender and difficulty in daily activities.

Frailty Index Predicts Future All-cause Mortality and Quality of Life: A 2-Year Follow-up Study Among Korean Older Adults From a Population-based Cohort Study: Woolim Ko, Hyunsuk Jeong, Hyeon Woo Yim; J Prev Med Public Health. 2025;58(6):572-580. Published online November 10, 2025; DOI: https://doi.org/10.3961/jpmph.25.210

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Abstract Summary PDF Supplementary Material: Objectives
The frailty index (FI), a proxy measure of accelerated biological aging, predicts adverse outcomes in older adults. We investigated whether the FI predicts mortality in a community-based Korean older adult population and its association with subjective health status over 2 years.
Methods
This prospective cohort study included 936 community-dwelling individuals aged ≥60 years. The FI, calculated from 28 self-reported baseline variables, was scored on a scale from 0 to 1 (<0.25: non-frail; 0.25-0.34: mildly frail; ≥0.35: moderately to severely frail). The primary outcome was 2-year all-cause mortality. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. Quality of life was assessed using the European Quality of Life Five-Dimension Three-Level (EQ-5D-3L), with the proportions reporting extreme problems and prevalence ratios of problems across frailty groups. Analyses were conducted using the GENMOD procedure in SAS version 9.4.
Results
Of the 936 participants, 111 (11.9%) were non-frail, 230 (24.6%) were mildly frail, and 595 (63.6%) were moderately to severely frail. The prevalence of moderate to severe frailty increased with age. The moderate-severe frailty group had a ≥5-fold increased risk of mortality compared to the non-frail group (adjusted RR, 5.79; 95% CI, 1.39 to 24.07). Among those completing follow-up, the moderate-severe frailty group reported more problems across all EQ-5D-3L domains at 2 years.
Conclusions
Frail older adults are at increased risk of mortality, but this risk was significant only for those in the moderate-to-severe frailty category at 2-year follow-up. The FI is a valuable predictor of premature death and health challenges in older adults.; Summary

Korean summary
2년의 추적 관찰 기간 동안, 기저 시점의 중등도에서 중증의 노쇠 상태에 있던 노인은 노쇠하지 않은 노인에 비해 사망 위험이 5배 이상 높았으며, EQ-5D-3L로 평가한 다양한 삶의 질 영역에서도 더 큰 어려움을 겪는 것으로 나타났다. 이러한 결과는 특히 중등도에서 중증의 노쇠 상태가 임상적 위험뿐만 아니라 주관적 삶의 질을 개선하기 위한 우선적 개입이 필요할 수 있음을 시사한다. 본 연구는 노인의 건강 결과를 향상시키기 위해서는 개별 질환 관리뿐 아니라 노쇠 상태를 체계적으로 평가하고 관리하는 것이 중요함을 제안한다.

Key Message
During the two-year follow-up period, older adults who were moderately to severely frail at baseline had a more than fivefold higher risk of death compared with those who were non-frail, and they also experienced greater difficulties across various quality-of-life domains as measured by the EQ-5D-3L. These findings suggest that moderate to severe frailty may require high-priority interventions to improve not only clinical risks but also subjective quality of life. This study indicates that, to improve health outcomes in older adults, it is important to systematically assess and manage frailty in addition to addressing individual diseases.

Exposure to Benzene, Toluene, Ethylbenzene, and Xylenes and Risk of Depression: A Cross-sectional Study of a National Sample of Korean Adults: Hyun-Wook Park, Byung-Sun Choi, Bomi Park, Wanhyung Lee, Weon-Young Lee; J Prev Med Public Health. 2026;59(1):95-104. Published online November 6, 2025; DOI: https://doi.org/10.3961/jpmph.25.522

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Abstract Summary PDF Supplementary Material

Objectives
Benzene, toluene, ethylbenzene, and xylenes (BTEX) are co-occurring neurotoxicants that are structurally similar aromatic hydrocarbons sharing common metabolic pathways and mechanisms of toxicity. This study investigated the effects of BTEX exposure on depression and aimed to identify the primary contributors to depression risk.
Methods
We conducted a cross-sectional analysis of 1733 adults from the 2020–2021 Korea National Health and Nutrition Examination Survey. BTEX exposure was quantified based on urinary metabolite concentrations: S-phenylmercapturic acid (SPMA) for benzene, benzylmercapturic acid for toluene, the sum of phenylglyoxylic acid and mandelic acid for ethylbenzene, and methylhippuric acid for xylenes. Depression was defined according to self-reported physician diagnosis. Logistic regression was used to estimate the risk associated with individual chemicals, while weighted quantile sum (WQS) regression was employed to assess mixture effects and identify the primary toxicant. Sensitivity analyses were performed to address potential confounding by tobacco smoke.
Results
Urinary SPMA concentrations were significantly higher in individuals with depression. Logistic regression revealed a significant association between SPMA levels and depression (odds ratio, 2.62; 95% confidence interval, 1.34 to 5.13). Although the overall BTEX mixture was not significantly associated with depression after covariate adjustment in WQS models, SPMA consistently emerged as the major contributor. The association between SPMA and depression remained robust in sensitivity analyses excluding participants exposed to tobacco smoke.
Conclusions
Benzene exposure was associated with an increased risk of depression in the general Korean adult population. Therefore, strengthened environmental regulations on benzene could help reduce the public health burden of depression.

Summary

Korean summary
본 연구는 2020–2021년 국민건강영양조사 자료를 활용하여 한국 성인에서 요중 벤젠, 톨루엔, 에틸벤젠, 자일렌 대사체 농도와 우울증 위험 간의 연관성을 분석하였다. 분석 결과, 벤젠의 대사체인 요중 S-phenyl-mercapturic acid는 우울증 위험 증가와 연관성을 보였다. 흡연 요인을 제외한 민감도 분석에서도 연관성은 일관되게 유지되어, 벤젠 노출 저감을 위한 환경적 관리 강화가 우울증 예방에 기여할 수 있음을 시사한다.

Key Message
This study investigated the association between urinary metabolites of benzene, toluene, ethylbenzene, and xylene and depression risk among Korean adults, using data from the Korea National Health and Nutrition Examination Survey 2020–2021. The findings indicated a significant association between urinary S-phenyl-mercapturic acid, a metabolite of benzene, and an increased risk of depression. This association remained robust after excluding smoking factors, underscoring the potential benefits of improved environmental management in reducing benzene exposure to prevent depression.

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Sensitivity of Urinary Toxicant Co-Exposure Patterns to Demographic Adjustment and Marker Type: A Methodological Analysis
Basant K. Puri, Jean A. Monro
Toxics.2026; 14(7): 546. CrossRef

Associations Between Poor Appetite, Sarcopenia, and Cognitive Function in Community-dwelling Malaysian Older Adults: Sook Yee Lim, Yoke Mun Chan, Maw Pin Tan, Shahrul Bahyah Kamaruzzaman, Rahimah Ibrahim; J Prev Med Public Health. 2025;58(6):589-598. Published online November 6, 2025; DOI: https://doi.org/10.3961/jpmph.25.196

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Abstract Summary PDF: Objectives
This study aimed to explore the associations between poor appetite, sarcopenia, and cognitive function among Malaysian older adults.
Methods
This nationwide study involved 1086 community-dwelling older adults aged 55 years and above. Poor appetite was defined using a self-reported question, while cognitive function was assessed with the Montreal Cognitive Assessment. Sarcopenia was identified based on handgrip strength, 6-meter gait speed, and muscle mass, in accordance with the Asian Working Group for Sarcopenia 2019 criteria. Associations between poor appetite, sarcopenia, and cognitive function were analyzed using both univariate and multivariate analyses.
Results
Multivariate analysis revealed that handgrip strength (β=0.067, p=0.012) and gait speed (β=1.080, p=0.017) were significantly associated with cognitive function after adjusting for confounders such as age, ethnicity, marital status, education, and alcohol and smoking consumption. However, no significant association was observed between poor appetite and cognitive function, nor was any moderation effect found between poor appetite and sarcopenia-related traits on cognitive function.
Conclusions
Our study confirms that low muscle strength and reduced physical performance are significantly associated with an increased risk of cognitive impairment among community-dwelling older adults. These findings underscore the critical importance of muscle strength and physical performance in preserving cognitive function—a decline that is not inevitable with age. Routine screening and early detection of muscle health and cognitive function are essential, and should be followed by intervention strategies targeting muscle health to mitigate cognitive decline in aging populations.; Summary

Key Message
Lower muscle strength and slower gait speed were independently associated with poorer cognitive function in Malaysian older adults, while poor appetite showed no direct or moderating effect on cognition. These findings underscore the importance of routine screening and early interventions targeting muscle health to help prevent cognitive decline in aging populations.

Psychometric Properties of the Areas of Worklife Survey in an Industrial Context in Thailand: Jate Ratanachina, Inthuon Hongsiri, Watcharakorn Chuthong, Wiroj Jiamjarasrangsi; J Prev Med Public Health. 2026;59(1):75-85. Published online October 16, 2025; DOI: https://doi.org/10.3961/jpmph.25.569

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Abstract Summary PDF Supplementary Material

Objectives
The Areas of Worklife Survey (AWS) is widely used to assess organizational factors contributing to burnout. However, evidence regarding its construct and criterion validity has been reported primarily in human service settings. This study evaluated the construct validity of the AWS measurement model and the criterion validity of the AWS–burnout relationship among industrial workers in Thailand.
Methods
In this cross-sectional study, a Thai-language electronic questionnaire was administered to 446 industrial workers between June 2024 and August 2024. Of these, 390 participants (87.4%) completed both the AWS and the Maslach Burnout Inventory–General Survey. Data were analyzed using confirmatory factor analysis within a structural equation modeling framework.
Results
A modified 6-factor (chi-square/degree of freedom [χ²/df], comparative fit index [CFI], Tucker– Lewis index [TLI], root mean square error of approximation [RMSEA], and standardized root mean square residual [SRMR]) AWS model—excluding 5 items and allowing 2 correlated error terms—demonstrated satisfactory fit (χ²(213)=436.02, p<0.001; χ²/df=2.05; CFI=0.94; TLI=0.92; RMSEA=0.053; SRMR=0.053). Convergent validity (composite reliability=0.74–0.87; average variance extracted [AVE]=0.49–0.58) and discriminant validity were acceptable for most dimensions; however, the Fairness dimension (AVE=0.36) and the Reward–Fairness correlation remained problematic. The partial mediation model demonstrated acceptable criterion validity, with all mediation paths—except reward to values—reaching statistical significance.
Conclusions
The AWS is a valid measure for assessing factors contributing to burnout among Thai industrial workers. Nevertheless, further refinement is necessary to ensure strong dimension-specific validity with minimal modification.

Summary

Key Message
• The Areas of Worklife Survey (AWS) demonstrated acceptable construct and criterion validity for assessing organizational risk factors related to burnout among Thai industrial workers after model refinement. • A modified 18-item, six-factor structure showed good model fit and meaningful associations with burnout dimensions, supporting the AWS as a useful tool beyond human service settings.

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The impact of supervisor control on employee performance and wellbeing in COVID-19 telecommuting: based on the Job Demands-Resources model
Jinhua Gan, Xiangping Zhan, Lei Yan, Chen Sun, Linchuan Yang, Yujia Wei
Frontiers in Psychology.2026;[Epub] CrossRef

Systematic Review

Digital Technologies in Hospital Pharmacy: A Systematic Review of Their Impact on Efficiency, Safety, and Inventory Management: Eka Pranata Bagus Abimanyu, Satibi , Dwi Endarti; J Prev Med Public Health. 2026;59(1):1-11. Published online October 5, 2025; DOI: https://doi.org/10.3961/jpmph.25.495

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Abstract Summary PDF Supplementary Material

Objectives
Digital transformation in hospital pharmacies is a strategic priority to improve medication safety, optimize inventory management, and streamline dispensing. Although healthcare digitalization has been widely studied, evidence of its impact on key performance indicators within hospital pharmacy operations remains limited. This review consolidates available evidence on how digital technologies affect hospital pharmacy performance, focusing on dispensing time, medication safety, and inventory practices.
Methods
A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Web of Science, PubMed, and Scopus were searched for English-language studies (2014–2024) conducted in general, academic, or tertiary hospitals. Eligible interventions included automation technologies (e.g., automated dispensing cabinets, robotic dispensing), digital systems (e.g., computerized physician order entry, electronic prescribing), or hybrid platforms. Outcomes included measures of dispensing efficiency, medication safety, and inventory management. Two reviewers independently screened studies and extracted data.
Results
Of 319 records, 9 studies met the inclusion criteria, spanning Saudi Arabia, the United States, Denmark, Iran, Jordan, Australia, and France. Most reported improvements in dispensing efficiency, safety (through lower error rates), and inventory control. Secondary gains included streamlined workflows and higher staff satisfaction. Challenges included resource-intensive implementation, workflow disruption, technological downtime, interoperability issues, and reliance on user compliance. Operational gains did not always yield measurable clinical benefits such as reduced morbidity or length of stay.
Conclusions
Digital technologies can improve efficiency, safety, and inventory control in hospital pharmacies; however, their success depends on institutional readiness, infrastructure, and human factors. Robust studies are needed to evaluate long-term impacts, cost-effectiveness, and implementation strategies.

Summary

Key Message
Digital technologies such as automated dispensing cabinets, electronic prescribing, barcode medication administration, and robotic systems can substantially improve dispensing efficiency, medication safety, and inventory control in hospital pharmacies. This systematic review shows consistent reductions in dispensing time, medication errors, stock-outs, and expired drugs across diverse healthcare settings. However, the benefits of digitalization depend on institutional readiness, adequate infrastructure, staff training, and sustained user compliance, highlighting the need for context-sensitive implementation strategies.

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Emerging advancements and expanding technological scope of education and practices in pharmacy and pharmaceutical sciences
Jaleh Barar, Karen Fiano, Matthew Seamon, Benedict Albensi, Nile Khanfar, Yadollah Omidi
BioImpacts.2026; 16: 33047. CrossRef
Drug Inventory Management in a Pharmacy Store of a Tertiary Care Hospital Using Always Better Control (ABC) and Vital, Essential, and Desirable (VED) Analysis
Gopiga Ilango, Anandabaskar Nishanthi, Vivekraj Navabalan, Vimala Ananthy, Shanthi Manickam, Chandrakumar Suryakumar
Cureus.2026;[Epub] CrossRef

Original Articles

Assessing Hospital Surgical Functions in Korea: A Functional Analysis Using the Disease Control Priorities, 3rd Edition Essential Surgery List (2013-2022): Haibin Bai, Jin-Hwan Kim, Yukyung Park; J Prev Med Public Health. 2025;58(6):635-646. Published online September 23, 2025; DOI: https://doi.org/10.3961/jpmph.25.407

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Abstract Summary PDF Supplementary Material: Objectives
Korea has achieved near-universal health coverage through a predominantly privatized healthcare system. However, this structural fragmentation has created significant ambiguity regarding the roles of different healthcare organizations, particularly in ensuring equitable provision of essential surgical services across geographic and institutional boundaries.
Methods
We conducted a retrospective study using the full national health insurance claims database provided by the Health Insurance Review & Assessment Service (2013-2022). Essential surgical procedures from the Disease Control Priorities, 3rd edition Essential Surgery List were mapped to insurance claims codes, and their provision was analyzed across healthcare facilities and regions. Functional capacity was defined using minimum annual volume thresholds of 12, 24, 60, and 120 procedures.
Results
Essential surgery more than doubled between 2013 and 2022, increasing from 2.79 million to nearly 6 million cases. Superior general hospitals and general hospitals consistently delivered high volumes of essential surgeries, while hospital-level facilities experienced marked functional decline, particularly in obstetric services. We observed increasing centralization of surgical services in higher-tier and metropolitan facilities, alongside selective decentralization for lower-risk procedures such as cataract surgery. Regional disparities were especially pronounced for obstetric care.
Conclusions
Functional capacity for essential surgery remains highly uneven across hospitals and regions, undermining equitable access. Policy efforts should focus on strengthening lower-tier hospitals in underserved areas and implementing minimum functionality standards tailored to local needs. Clarifying institutional roles within Korea’s mixed healthcare system is essential to improving accountability and ensuring equitable distribution of essential surgical services.; Summary

Korean summary
본 연구는 DCP3 Essential Surgery List를 한국의 건강보험 청구자료(2013–2022)에 적용하여 필수수술 제공기관의 기능적 변화를 평가하였다. 전체 필수수술 건수는 크게 증가했음에도 불구하고 이를 제공하는 의료기관 수는 지속적으로 감소하며 지역 간 격차도 확대되고 있었다. 필수수술 접근성을 강화하기 위해서는 우선 의료기관 수준별로 제공해야 할 필수 기능을 명확히 규정하는 정책적 가이드가 필요하며, 이를 기반으로 지역 단위의 종합병원·병원급 기능을 지속적으로 모니터링하고 관리하는 체계를 마련해야 한다.

Key Message
This study applies the DCP3 Essential Surgery List to South Korea’s national health insurance claims data (2013–2022) and shows that, despite a substantial rise in essential surgery volumes, the number of institutions providing these procedures has declined, widening regional disparities. Strengthening access to essential surgery requires first establishing clear guidance on the functions expected at each level of care, followed by systematic monitoring to ensure that general and hospital-level facilities maintain the capacity to deliver these core services. Such a combined approach is critical for securing equitable and regionally sustained surgical access.

Impact of COVID-19 on the Profitability of General Hospitals in Korea: Jun Young Park, Tae Hyun Kim, Suk-Yong Jang, Sang Gyu Lee; J Prev Med Public Health. 2026;59(1):46-55. Published online September 11, 2025; DOI: https://doi.org/10.3961/jpmph.25.303

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Abstract Summary PDF Supplementary Material: Objectives
This study was performed to quantify the impact of coronavirus disease 2019 (COVID-19) on hospital profitability in Korea by analyzing changes in the medical revenue-to-profit ratio (MRPR) and net income before reserve fund allocation (NIBR) before and after the pandemic onset. Additionally, it examined how financial outcomes varied by hospital ownership, geographic location, and type (secondary or tertiary), providing insights into the financial resilience of various hospital types during public health crises.
Methods
We conducted a longitudinal analysis using publicly available financial disclosure data from 243 general hospitals in Korea (2016–2022). We then performed a quadrant analysis to classify hospitals based on changes in MRPR and NIBR, identifying patterns of financial impact. For inferential analysis, we employed linear mixed-effects models incorporating a difference-in-differences framework, enabling estimation of both time-varying and hospital-specific effects.
Results
Following the onset of COVID-19, MRPR declined significantly, reaching −10.62% in 2020. NIBR initially dropped but later increased, reaching 21.09 billion Korean won per 100 beds in 2022. Quadrant analysis revealed substantial heterogeneity in financial responses, with national/public hospitals experiencing the most severe MRPR decline, whereas educational foundation and medical corporation hospitals displayed stronger financial recovery. Regression results confirmed significant interactions between outcomes after COVID-19 onset and hospital ownership type, indicating differential financial impacts across hospital categories.
Conclusions
The findings highlight the uneven financial effects of COVID-19 on Korean hospitals, emphasizing the importance of targeted government financial support. Policy measures should prioritize structural financial reforms to ensure hospital sustainability beyond short-term crisis management.; Summary

Korean summary
본 연구는 2016–2022년 국내 종합병원 243개소의 재무자료를 활용하여 COVID-19 팬데믹이 병원 수익성에 미친 영향을 분석하였다. 팬데믹 이후 의료수익 대비 이익률은 전반적으로 감소한 반면, 정부 지원 등의 영향으로 적립금 차감 전 순이익은 증가하는 이중적 양상이 관찰되었다. 이러한 영향은 병원 소유 형태와 규모에 따라 상이하게 나타났으며, 공공병원의 재무적 취약성이 두드러졌다.

Key Message
Using longitudinal financial data from 243 Korean general hospitals (2016–2022), this study examined the impact of COVID-19 on hospital profitability. Medical revenue-to-profit ratios declined markedly after the pandemic onset, while net income before reserve fund allocation increased, reflecting substantial heterogeneity by ownership and hospital type. These findings highlight the need for targeted and structurally differentiated financial support policies to strengthen hospital resilience during future public health crises.

Changes in Adolescents’ Compliance Rate in Response to Policy Changes: COVID-19 Toothbrushing Restrictions in Schools for Korea: Suhyun Choi, Yubeen Kim, Joo Mi Kim, Joohyeon Kim, Jaewon Jeon, Jae-Seok Song, Yeunhee Kwak, Se-Hwan Jung, Nam-jun Kim; J Prev Med Public Health. 2026;59(1):35-45. Published online September 8, 2025; DOI: https://doi.org/10.3961/jpmph.25.448

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Abstract Summary PDF: Objectives
This study investigated changes in toothbrushing in adolescents in response to public health policy changes during coronavirus disease 2019 (COVID-19) focusing on behavioral trends before, during, and after policy enforcement according to socio-demographic subgroups.
Methods
Data from the Korean Youth Risk Behavior Survey (2018–2024) were divided into 3 periods: before (2018–2019), during (2020–2022), and after (2023–2024) the implementation of COVID-19 school restrictions. A total of 354 943 middle and high school students were included. The primary outcome variable was self-reported toothbrushing after lunch at school. Multivariable logistic regression was conducted, adjusting for confounders such as sex, academic performance, school level, school type, handwashing, and oral health status (toothache and gum bleeding).
Results
The compliance rate for toothbrushing declined significantly during the restriction period across all groups. It varied by sex, school type, school level, health-related behaviors (drinking, smoking, handwashing), and oral health status. Female students, middle schoolers, students in single-sex schools, non-smokers, and those practicing hand hygiene showed higher compliance. After restrictions were lifted, toothbrushing rates improved but remained lower than pre-pandemic levels. Recovery of the toothbrushing rate was observed in most groups, particularly among female students, high schoolers, and those with positive health-related behaviors. However, academic performance and oral health status were not significantly associated with recovery rate in adjusted analyses.
Conclusions
This study highlights that adolescents’ health behaviors are highly sensitive to environmental and policy changes. Variations in compliance and recovery rates underscore the need for adolescent-centered policies that account for both compliance and recovery, especially during crises such as pandemics.; Summary

Korean summary
청소년의 점심식사 후 칫솔질 행동은 COVID-19 학교 방역 제한 기간 동안 감소하였으며, 제한 해제 이후에도 부분적인 회복에 그쳤다. 순응도와 회복 양상은 집단별 특성에 따라 다르게 나타났다. 따라서 공중보건 정책은 행동의 순응뿐 아니라 회복까지 고려하여, 집단별 특성에 맞게 설계할 필요가 있다.

Key Message
Adolescents’ toothbrushing after lunch declined during COVID-19 school restrictions and showed only partial recovery after restrictions were lifted. Patterns of compliance rate and recovery rate varied according to subgroup characteristics. Therefore, public health policies should be designed to consider both compliance and recovery rates, tailored to subgroup-specific characteristics.

Loneliness and E-cigarette Use Among Adolescents in England: Evidence From the Smoking, Drinking and Drug Use Survey 2023: Yusuff Adebayo Adebisi, Najim Z. Alshahrani, Isaac Olushola Ogunkola; J Prev Med Public Health. 2026;59(1):66-74. Published online September 6, 2025; DOI: https://doi.org/10.3961/jpmph.25.476

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Abstract Summary PDF: Objectives
Adolescent e-cigarette use is an increasing public health concern in England, yet the psychosocial drivers of this trend remain poorly understood. This study examines the association between loneliness and current e-cigarette use among secondary school students aged 11–15.
Methods
We analysed data from 13 725 pupils who participated in the 2023 wave of the nationally representative Smoking, Drinking and Drug Use among Young People in England survey. Loneliness was assessed using a validated composite score derived from 3 indirect questions on social isolation, categorised as low, medium, and high. Current e-cigarette use was defined as self-reported use “sometimes” or “every week.” Logistic regression models estimated crude and adjusted odds ratios (ORs) for the association between loneliness and vaping, adjusting for age, gender, current smoking, ethnicity, family affluence, and alcohol use.
Results
Overall, 8.0% of adolescents (n=1104) reported current e-cigarette use. Compared with those reporting low loneliness, adolescents with medium and high loneliness had significantly greater odds of vaping, with adjusted ORs of 1.48 (95% confidence interval [CI], 1.24 to 1.76; p<0.001) and 2.46 (95% CI, 2.00 to 3.04; p<0.001), respectively. Findings were consistent in sensitivity analyses using weekly e-cigarette use as the outcome. Adolescents with medium and high loneliness had significantly higher adjusted odds of weekly use (adjusted ORs, 1.39; 95% CI, 1.11 to 1.75; p=0.005; and 2.04; 95% CI, 1.55 to 2.71; p<0.001, respectively) compared with those reporting low loneliness.
Conclusions
Loneliness is a strong and graded correlate of adolescent e-cigarette use.; Summary

Key Message
This study of 13,725 adolescents in England reveals that loneliness is a powerful, independent, and graded predictor of e-cigarette use. Adolescents reporting high levels of loneliness had nearly 2.5 times the adjusted odds of current vaping compared to those with low loneliness. These findings suggest that public health strategies should prioritize social connectedness and emotional well-being as critical components of youth vaping prevention frameworks.

From Rich to Poor: A Decomposition Analysis of Socioeconomic Inequality in Health-related Quality of Life in Iran: Satar Rezaei; J Prev Med Public Health. 2025;58(5):538-547. Published online August 20, 2025; DOI: https://doi.org/10.3961/jpmph.25.383

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Abstract Summary PDF Supplementary Material

Objectives
Socioeconomic status (SES) is a well-established predictor of health outcomes across an individual’s lifespan. People from lower socioeconomic backgrounds generally have shorter life expectancies and lower levels of health-related quality of life (HRQoL) compared with those from higher-income groups. This study aimed to quantify income-related inequalities in HRQoL among adults in Iran.
Methods
A total of 3518 adults aged 18 years and older were selected using a convenience sampling method across 9 provinces in Iran. HRQoL was assessed with the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) instrument, which evaluates 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The concentration index (CI) approach was used to measure income-related inequality in worse HRQoL (disutility=1–utility value) and to identify the socioeconomic factors contributing to the observed inequality.
Results
The CI for worse HRQoL was -0.116, while the CI for the EuroQol visual analogue scale (EQ-VAS) score was 0.027. The CIs for reporting any problems in the EQ-5D-5L dimensions were: mobility (-0.122), self-care (-0.070), usual activities (-0.074), pain/discomfort (-0.139), and anxiety/depression (-0.139). Decomposition analysis showed that income (38.00%), educational level (31.53%), age (8.05%), and physical activity (7.30%) were the main factors contributing to socioeconomic inequality in poorer HRQoL in Iran.
Conclusions
This study identified a pro-poor distribution of poorer HRQoL and reported problems across all dimensions of the EQ-5D-5L in Iran. Targeted interventions should focus on reducing disparities in income, education, and physical activity levels.

Summary

Key Message
The study of 3518 adults across 9 Iranian provinces revealed significant pro-poor socioeconomic inequality in health-related quality of life (HRQoL), with worse HRQoL concentrated among lower-income groups (concentration index: -0.116). Income (38%) and education level (31.53%) were the largest contributors to this inequality, followed by age (8.05%) and physical activity (7.30%) based on decomposition analysis. All five EQ-5D-5L health dimensions showed more reported problems in lower socioeconomic groups, emphasizing the need for targeted interventions addressing income, education, and lifestyle factors to reduce HRQoL disparities in Iran.

Citations

Citations to this article as recorded by

Environmental injustice, marginalization and resistance: an intersectional analysis from Iran
Elham Hoominfar
Local Environment.2026; : 1. CrossRef

Integrating Cognitive and Motor Dual-task Training to Prevent Fall Risk Among Community-dwelling Elderly in Thailand: A Randomized Controlled Study: Wilawan Jattanond, Chatchada Sutalangka, Ploypailin Namkorn, Ekalak Sitthipornvorakul, Siripatra Atsawakaewmongkhon, Boonsita Suwannakul, Aunyachulee Ganogpichayagrai, Sitang Kongkratoke, Raksuda Taniguchi, Wilawan Chaiut; J Prev Med Public Health. 2025;58(6):609-619. Published online August 19, 2025; DOI: https://doi.org/10.3961/jpmph.25.165

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246 Download
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4 Crossref

Abstract Summary PDF

Objectives
Falls are a leading cause of morbidity and mortality among older adults, often resulting in severe injuries and a loss of independence. Dual-task training, which integrates cognitive and motor exercises, has emerged as a promising intervention for fall prevention. This study aimed to evaluate the effects of a structured cognitive and motor dual-task training program on fall risk, balance, and cognitive function in community-dwelling older adults.
Methods
Seventy-two participants aged 60 years or older were randomly assigned to either an intervention group (IG, n=36) or a control group (CG, n=36). The IG underwent 3 sessions per week for 8 weeks (totaling 24 sessions) that incorporated simultaneous cognitive and motor exercises, while the CG continued their usual total body stretching exercise. Assessments were conducted at baseline, week 4, and week 8, and included gait speed (10-meter walk test), functional performance (Timed Up and Go test), cognitive function (Montreal Cognitive Assessment), and quality of life (World Health Organization Quality of Life Assessment).
Results
Participants in the IG demonstrated significant improvements in functional performance (p<0.05) and enhanced cognitive function compared to the CG after both 4 weeks and 8 weeks of training. Functional performance and cognitive function significantly improved after 8 weeks of training (p<0.01). However, the intervention did not produce changes in gait speed or quality of life.
Conclusions
Integrating cognitive and motor dual-task training into fall prevention programs may enhance functional stability and cognitive resilience in older adults. Future studies should investigate long-term adherence and determine the optimal training intensity.

Summary

Key Message
Integrating cognitive–motor dual-task training into fall-prevention programs can significantly enhance balance, mobility, and cognitive responsiveness in older adults. This approach improves adaptability to real-world challenges, reduces fall risk, and supports independent living. Evidence-based, engaging training protocols can further promote long-term safety and quality of life in aging populations.

Citations

Citations to this article as recorded by

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