Journal of Preventive Medicine and Public Health

Original Article

Health Behaviors Before and After the Implementation of a Health Community Organization: Gangwon’s Health-Plus Community Program: Joon-Hyeong Kim, Nam-Jun Kim, Soo-Hyeong Kim, Woong-Sub Park; J Prev Med Public Health. 2023;56(6):487-494. Published online August 17, 2023; DOI: https://doi.org/10.3961/jpmph.23.121

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Abstract Summary PDF: Objectives
Community organization is a resident-led movement aimed at creating fundamental social changes in the community by resolving its problems through the organized power of its residents. This study evaluated the effectiveness of health community organization (HCO), Gangwon’s Health-Plus community program, implemented from 2013 to 2019 on residents’ health behaviors.
Methods
This study had a before-and-after design using 2011-2019 Korea Community Health Survey data. To compare the 3-year periods before and after HCO implementation, the study targeted areas where the HCO had been implemented for 4 years or longer. Therefore, a total of 4512 individuals from 11 areas with HCO start years from 2013 to 2016 were included. Complex sample multi-logistic regression analysis adjusting for demographic characteristics (sex, age, residential area, income level, education level, and HCO start year) was conducted.
Results
HCO implementation was associated with decreased current smoking (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.57 to 0.95) and subjective stress recognition (aOR, 0.79; 95% CI, 0.64 to 0.97). Additionally, the HCO was associated with increased walking exercise practice (aOR, 1.39; 95% CI, 1.13 to 1.71), and attempts to control weight (aOR, 1.36; 95% CI, 1.12 to 1.64). No significant negative changes were observed in other health behavior variables.
Conclusions
The HCO seems to have contributed to improving community health indicators. In the future, a follow-up study that analyzes only the effectiveness of the HCO through structured quasi-experimental studies will be needed.; Summary

Korean summary
건강주민운동은 지역사회 건강지표 향상에 기여한 것으로 보여진다. 따라서 주민참여형 건강증진사업이 주민들의 건강을 향상하기 위해서는 주민이 주체가 되어 조직화된 힘으로 지역사회의 근본적인 변화를 만들어가는 주민운동의 관점으로 시행될 필요가 있다.

Key Message
The Health Community Organization (HCO) appears to contribute to the enhancement of community health indicators. Therefore, in order to improve the health of residents through community-based participatory health promotion programs, it is necessary to implement them from the perspective of the HCO in which residents organize themselves as a mobilized force to bring about fundamental changes in the community.

Special Article

Measuring Trends in the Socioeconomic Burden of Disease in Korea, 2007-2015: Tae Eung Kim, Ru-Gyeom Lee, So-Youn Park, In-Hwan Oh; J Prev Med Public Health. 2022;55(1):19-27. Published online January 31, 2022; DOI: https://doi.org/10.3961/jpmph.21.594

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Abstract Summary PDF Supplementary Material

This study estimated the direct and indirect socioeconomic costs of 238 diseases and 22 injuries from a social perspective in Korea from 2007 to 2015. The socioeconomic cost of each disease group was calculated based on the Korean Standard Disease Classification System. Direct costs were estimated using health insurance claims data provided by the National Health Insurance Service. The numbers of outpatients and inpatients with the main diagnostic codes for each disease were selected as a proxy indicator for estimating patients’ medical use behavior by disease. The economic burden of disease from 2007 to 2015 showed an approximately 20% increase in total costs. From 2007 to 2015, communicable diseases (including infectious, maternal, pediatric, and nutritional diseases) accounted for 8.9-12.2% of the socioeconomic burden, while non-infectious diseases accounted for 65.7-70.7% and injuries accounted for 19.1-22.8%. The top 5 diseases in terms of the socioeconomic burden were self-harm (which took the top spot for 8 years), followed by cirrhosis of the liver, liver cancer, ischemic heart disease, and upper respiratory infections in 2007. Since 2010, the economic burden of conditions such as low back pain, falls, and acute bronchitis has been included in this ranking. This study expanded the scope of calculating the burden of disease at the national level by calculating the burden of disease in Koreans by gender and disease. These findings can be used as indicators of health equality and as useful data for establishing community-centered (or customized) health promotion policies, projects, and national health policy goals.

Summary

Korean summary
2007년에서 2015년 기간의 건강보험 자료 등을 이용하여, 해당기간의 경제적 질병부담을 측정하였으며, 해당 기간동안 경제적 질병부담은 20%의 증가를 나타내었다. 동 기간동안 비감염성 질환의 경제적 질병부담의 비율은 약 70%로 나타났으며, 감염성 질환은 약 10%, 손상은 20%로 나타났다. 한편 개별 질병군 기준으로는 자살을 포함한 자해가 1위를 차지한 해가 가장 많았다.

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Original Articles

The Effect of an Empowerment Program on the Health-promoting Behaviors of Iranian Women Workers: A Randomized Controlled Trial: Fatemeh Noori, Zahra Behboodimoghadam, Shima Haghani, Shahzad Pashaeypoor; J Prev Med Public Health. 2021;54(4):275-283. Published online June 24, 2021; DOI: https://doi.org/10.3961/jpmph.21.088

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Abstract PDF

Objectives
The workplace is an ideal place for encouraging health-promoting behaviors. Therefore, the aim of the present study was to determine the effect of an empowerment program on the health-promoting behaviors of women workers.
Methods
This randomized clinical trial was conducted with 80 women workers employed at a food packaging facility in 2020. The subjects were selected using convenience sampling and were classified into intervention and control groups using block randomization. An empowerment program for women workers was conducted across 6 sessions based on an empowerment model. Data collection tools included a demographic questionnaire and the Health Promoting Lifestyle Profile-II, which participants completed both before the program and 8 weeks after the last session. Data analysis was performed in SPSS version 16 using descriptive analysis and inferential statistics.
Results
There were no significant differences between the 2 groups in various health-promoting behaviors before the program. However, the intervention group’s scores for nutrition (34.92±1.09 vs. 27.87±4.23), physical activity (24.40±2.94 vs. 17.40±5.03), stress management (26.35±2.60 vs. 23.05±4.27), spiritual growth (34.02±3.00 vs. 30.22±5.40), interpersonal relationships (30.82±2.38 vs. 27.60±4.61), and health responsibility (31.60±2.71 vs. 28.22±4.59) were significantly higher than the control group’s 8 weeks after the program had ended. Moreover, there was a significant difference in the total score of health-promoting behaviors for the intervention group compared to the control group (179.00±9.22 vs. 151.42±20.25, p=0.001).
Conclusions
An empowerment program for women workers led to significant improvements in the health-promoting behaviors of the participants. Similar programs can ultimately improve women’s health in the workplace.

Summary

Citations

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Effectiveness of Multicomponent Interventions and Physical Activity in the Workplace to Reduce Obesity: A Systematic Review and Meta-Analysis
M. Rocío Jiménez-Mérida, Manuel Vaquero-Abellán, José M. Alcaide-Leyva, Vanesa Cantón-Habas, Elena Raya-Cano, Manuel Romero-Saldaña
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Meeting Recommended Levels of Physical Activity in Relation to Preventive Health Behavior and Health Status Among Adults: Peter D. Hart, Gabriel Benavidez, James Erickson; J Prev Med Public Health. 2017;50(1):10-17. Published online December 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.080

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Abstract PDF

Objectives
The purpose of this study was to examine the relationship of meeting the recommended levels of physical activity (PA) with health status and preventive health behavior in adults.
Methods
A total of 5630 adults 18 years of age or older were included in this study. PA was assessed using a series of questions that categorized activities based on their metabolic equivalent values and then categorized individuals based on the reported frequency and duration of such activities. Participants reporting 150 minutes or more of moderate-intensity PA per week were considered to have met the PA guidelines. Multiple logistic regression was used to model the relationships between meeting PA guidelines and health status and preventive health behavior, while controlling for confounding variables.
Results
Overall, 53.9% (95% confidence interval [CI], 51.9 to 55.9%) of adults reported meeting the recommended levels of PA. Among adults with good general health, 56.9% (95% CI, 54.7 to 59.1%) reported meeting the recommended levels of PA versus 43.1% (95% CI, 40.9 to 45.3%) who did not. Adults who met the PA guidelines were significantly more likely not to report high cholesterol, diabetes, chronic obstructive pulmonary disease, arthritis, asthma, depression, or overweight. Furthermore, adults meeting the PA guidelines were significantly more likely to report having health insurance, consuming fruits daily, consuming vegetables daily, and not being a current cigarette smoker.
Conclusions
In this study, we found meeting the current guidelines for PA to have a protective relationship with both health status and health behavior in adults. Health promotion programs should focus on strategies that help individuals meet the current guidelines of at least 150 minutes per week of moderate-intensity PA.

Summary

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Perspective

Implementation of Quaternary Prevention in the Korean Healthcare System: Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea: Jong-Myon Bae; J Prev Med Public Health. 2015;48(6):271-273. Published online November 24, 2015; DOI: https://doi.org/10.3961/jpmph.15.059

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Abstract PDF

Quaternary prevention should be implemented to minimize harm to patients because the ultimate goal of medicine is to prevent disease and promote health. Primary care physicians have a major responsibility in quaternary prevention, and the establishment of clinical epidemiology as a distinct field of study would create a role charged with minimizing patient harm arising from over-medicalization.

Summary

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Original Articles

A Study of Predictive Factors Affecting Health: Promoting Behaviors of North Korean Adolescent Refugees: Jin-Won Noh, Hyo-Young Yun, Hyunchun Park, Shi-Eun Yu; J Prev Med Public Health. 2015;48(5):231-238. Published online September 6, 2015; DOI: https://doi.org/10.3961/jpmph.14.045

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Abstract PDF

Objectives
The present study aimed to analyze the factors that could affect the health-promoting behaviors of North Korean adolescent refugees residing in South Korea.
Methods
Questions about their sociodemographic variables, subjective health status, healthy living habits, and health-promoting behaviors were asked.
Results
Statistically significant differences were found in religion (t=2.30, p<0.05), having family members in South Korea (t=2.02, p<0.05), and subjective health status (t=4.96, p<0.01). Scores on health-responsible behaviors were higher with higher age (t=2.90, p<0.01) and for subjects without family or friends (t=2.43, p<0.05). Higher physical-activity behaviors were observed in males (t=3.32, p<0.01), in those with better subjective health status (t=3.46, p<0.05) and lower body mas index (t=3.48, p<0.05), and in smokers (t=3.17, p<0.01). Nutritional behaviors were higher in those who followed a religion (t=2.17, p<0.05). Spiritual growth behaviors were higher in those who followed a religion (t=4.21, p<0.001), had no family in South Korea (t=2.04, p<0.05), and had higher subjective health status (t=5.74, p<0.01). Scores on interpersonal relationships and stress-management behaviors were higher for those with higher subjective health status. A multiple regression analysis showed greater effects on health-promoting behaviors when subjective health status was better. Older people and non-smokers exhibited more health-responsible behaviors, while more physical-activity behaviors and spiritual growth activities were observed when subjective health status was better. Interpersonal relationship behaviors had positive effects on those with good subjective heath status and on non-smokers.
Conclusions
Based on the results of the current study, an alternative was suggested for promoting health in North Korean adolescent refugees.

Summary

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Factors Predicting the Physical Activity Behavior of Female Adolescents: A Test of the Health Promotion Model: Hashem Mohamadian, Mohammad Ghannaee Arani; J Prev Med Public Health. 2014;47(1):64-71. Published online January 29, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.1.64

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Abstract PDF

Objectives

Physical activity behavior begins to decline during adolescence and continues to decrease throughout young adulthood. This study aims to explain factors that influence physical activity behavior in a sample of female adolescents using a health promotion model framework.

Methods

This cross-sectional survey was used to explore physical activity behavior among a sample of female adolescents. Participants completed measures of physical activity, perceived self-efficacy, self-esteem, social support, perceived barriers, and perceived affect. Interactions among the variables were examined using path analysis within a covariance modeling framework.

Results

The final model accounted for an R² value of 0.52 for physical activity and offered a good model-data fit. The results indicated that physical activity was predicted by self-esteem (β=0.46, p<0.001), perceived self-efficacy (β=0.40, p<0.001), social support (β=0.24, p<0.001), perceived barriers (β=-0.19, p<0.001), and perceived affect (β=0.17, p<0.001).

Conclusions

The findings of this study showed that the health promotion model was useful to predict physical activity behavior among the Iranian female adolescents. Information related to the predictors of physical activity behavior will help researchers plan more tailored culturally relevant health promotion interventions for this population.

Summary

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Perceived Relevance of Educative Information on Public (Skin) Health: A Cross-sectional Questionnaire Survey: Daniela Haluza, Renate Cervinka; J Prev Med Public Health. 2013;46(2):82-88. Published online March 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.2.82

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Abstract PDF

Objectives

Unprotected leisure time exposure to ultraviolet radiation from the sun or artificial tanning beds is the most important environmental risk factor for melanoma, a malignant skin cancer with increasing incidences over the past decades. The aim of the present study was to assess the impact of skin health information provided by several sources and different publishing issues on knowledge, risk perception, and sun protective behavior of sunbathers.

Methods

A cross-sectional questionnaire survey was conducted among Austrian residents (n=563) spending leisure time outdoors in August 2010.

Results

Print media, television, and family were perceived as the most relevant sources of information on skin health, whereas the source physician was only ranked as fourth important source. Compared to other sources, information provided by doctors positively influenced participants' knowledge on skin risk and sun protective behavior resulting in higher scores in the knowledge test (p=0.009), higher risk perception (p<0.001), and more sun protection (p<0.001).

Regarding gender differences, internet was more often used by males as health information source, whereas females were more familiar with printed information material in general.

Conclusions

The results of this survey put emphasis on the demand for information provided by medical professionals in order to attain effective, long-lasting promotion of photoprotective habits.

Summary

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Special Article

Promoting Mobility in Older People: Taina Rantanen; J Prev Med Public Health. 2013;46(Suppl 1):S50-S54. Published online January 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.S.S50

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Abstract PDF

Out-of-home mobility is necessary for accessing commodities, making use of neighborhood facilities, and participation in meaningful social, cultural, and physical activities. Mobility also promotes healthy aging as it relates to the basic human need of physical movement. Mobility is typically assessed either with standardized performance-based tests or with self-reports of perceived difficulty in carrying out specific mobility tasks. Mobility declines with increasing age, and the most complex and demanding tasks are affected first. Sometimes people cope with declining functional capacity by making changes in their way or frequency of doing these tasks, thus avoiding facing manifest difficulties. From the physiological point of view, walking is an integrated result of the functioning of the musculoskeletal, cardio-respiratory, sensory and neural systems. Studies have shown that interventions aiming to increase muscle strength will also improve mobility. Physical activity counseling, an educational intervention aiming to increase physical activity, may also prevent mobility decline among older people. Sensory deficits, such as poor vision and hearing may increase the risk of mobility decline. Consequently, rehabilitation of sensory functions may prevent falls and decline in mobility. To promote mobility, it is not enough to target only individuals because environmental barriers to mobility may also accelerate mobility decline among older people. Communities need to promote the accessibility of physical environments while also trying to minimize negative or stereotypic attitudes toward the physical activity of older people.

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Research Support, Non-U.S. Gov't

Assessment of Village Health Worker Training Program in Tuguegarao, Philippine.: Jung Min Kim, Kwang Wook Koh, Chul Ho Oak, Woo Hyuk Jung, Sung Hyun Kim, Dae Hee Park; J Prev Med Public Health. 2009;42(6):377-385.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.377

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Abstract PDF

OBJECTIVES
This study was performed to evaluate the effectiveness of 'village health worker training program' which aimed to build community participatory health promotion capacity of community leaders in villages of low developed country and to develop methods for further development of the program. METHODS: The intervention group were 134 community leaders from 25 barangays (village). Control group were 149 form 4 barangays. Intervention group participated 3-day training program. Questionnaire was developed based on 'Health Promotion Capacity Checklist' which assessed capacity in 4 feathers; 'knowledge', 'skill', 'commitment', and 'resource'. Each feather was assessed in 4 point rating scale. Capacity scores between intervention group and control group were examined to identify changes between the pre- and post-intervention periods. A qualitative evaluation of the program was conducted to assess the appropriateness of the program. The program was conducted in Tuguegarao city, Philippine in January, 2009. RESULTS: The result showed significant increases in the total health promotion capacity and each feather of health promotion capacities between pre and post assessment of intervention group. But there was no significant change in that of control group. Participants marked high level of satisfaction for preparedness, selection of main subjects and education method. Qualitative evaluation revealed that training program facilitated community participatory health promotion capacity of participants. CONCLUSIONS: This study suggested that the Village health worker training program is effective for building health promotion capacity of community leaders and it can be a main method for helping low developed countries with further development.

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What do we mean by individual capacity strengthening for primary health care in low- and middle-income countries? A systematic scoping review to improve conceptual clarity
Mairéad Finn, Brynne Gilmore, Greg Sheaf, Frédérique Vallières
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English Abstract

Lifestyle and Metabolic Syndrome among Male Workers in an Electronics Research and Development Company.: Jun Pyo Myong, Hyoung Ryoul Kim, Yong Kyu Kim, Jung Wan Koo, Chung Yill Park; J Prev Med Public Health. 2009;42(5):331-336.; DOI: https://doi.org/10.3961/jpmph.2009.42.5.331

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Abstract PDF

OBJECTIVES
The objectives of this study were to determine the relationship between lifestyle-implementation and metabolic syndrome in an electronics research and development company, and to provide a foundation for health providers of health management programs for setting priorities. METHODS: From July 1 to July 16, 2008 we carried out a descriptive cross-sectional survey. Consecutive workers of one R & D company in Seoul, Korea (N=2,079) were enrolled in study. A checklist for lifestyle (from the National Health Insurance Corporation) consisted of questions regarding diet, drinking, smoking and exercise. After the survey, researchers obtained data from health profiles for metabolic syndrome(waist-circumference, triglycerides, HDL cholesterol, blood pressure and fasting blood sugar level). Lifestyle was recorded as good or not good. Statistical analysis of metabolic syndrome and the lifestyle of subjects was done using multiple logistic regression analysis. RESULTS: The prevalence of metabolic syndrome in our study gropu was 13.3% (N=277). After adjustment for age, the adjusted odds ratios (odds ratio, 95% confidence intervals) for metabolic syndrome increased in proportion to the number of bad habits: two (1.72, 1.23-2.44), three (2.47, 1.73-3.56), and four (3.63, 2.03-6.34). Relative to subjects eating both vegetables and meat', the OR for 'meat' eaters was 1.66 (1.18-2.31). Compared with 'non-smokers and ever-smoker', the OR for 'current-smoker' was 1.62 (1.25-2.10). Compared with 'Healthy drinker', the OR for 'unhealthy drinker' was 1.38 (1.05-1.83). CONCLUSIONS: Poor lifestyle was associated with an increased likelihood of metabolic syndrome. These findings suggest that lifestyle-based occupational health interventions for young employees should include a specific diet, smoking cessation, and healthy-drinking programs.

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Prince Osei Akumiah, Kwabena Opoku-Addai, Adwoa Safowaa, Akosua Serwaa Akumiah
SN Comprehensive Clinical Medicine.2023;[Epub] CrossRef
Factors associated with metabolic syndrome among Korean office workers
Hosihn Ryu, Dal Lae Chin
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Relation of Health Promotion Behaviors and Metabolic Syndrome in Daytime Workers
Dae-Sik Ko, Bu-Yeon Park, Gyeong-Hyu Seok
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Jong Uk Won, Oi Saeng Hong, Won Ju Hwang
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Research Support, Non-U.S. Gov't

Assessment of Community Capacity Building Ability of Health Promotion Workers in Public Health Centers.: Jung Min Kim, Kwang Wook Koh, Byeng Chul Yu, Man Joong Jeon, Yoon Ji Kim, Yun Hee Kim; J Prev Med Public Health. 2009;42(5):283-292.; DOI: https://doi.org/10.3961/jpmph.2009.42.5.283

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Abstract PDF

OBJECTIVES
This study was performed to assess the community capacity building ability of health promotion workers of public health centers and to identify influential factors to the ability. METHODS: The subjects were 43 public officers from 16 public health centers in Busan Metropolitan City. Questionnaire was developed based on 'Community Capacity Building Tool' of Public Health Agency of Canada which consists of 9 feathers. Each feather of capacity was assessed in 4 point rating scale. Univariate analysis by characteristics of subjects and multivariate analysis by multiple regression was done. RESULTS: The mean score of the 9 features were 2.35. Among the 9 feathers, 'Obtaining resources' scored 3.0 point which was the highest but 'Community structure' scored 2.1 which was the lowest. The mean score of the feathers was relatively lower than that of Canadian data. The significant influential factors affecting community capacity building ability were 'Service length', 'Heath promotion skill level', 'Existence of an executive department' and 'Cooperative partnership for health promotion'. According to the result of multiple linear regression, the 'Existence of an executive department' had significant influence. CONCLUSIONS: Community capacity building ability of subjects showed relatively lower scores in general. Building and activating an executive department and cooperative partnerships for health promotion may be helpful to achieve community capacity building ability.

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English Abstracts

The Determinants of the Use of Opportunistic Screening Programs in Korea.: Sungwook Kang, Chang Hoon You, Young Dae Kwon; J Prev Med Public Health. 2009;42(3):177-182.; DOI: https://doi.org/10.3961/jpmph.2009.42.3.177

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Abstract PDF

OBJECTIVES
Both organized and opportunistic screening programs have been widely used in Korea. This paper examined the determinants of the use of opportunistic screening programs in Korea. METHODS: The subjects were a national stratified random sample of 10,254 people aged 45 or older from the first wave of the Korean Longitudinal Study of Ageing in 2006. A logit model was used to examine the determinants of the use of opportunistic screening programs in terms of the demographic and socioeconomic characteristics, the type of health insurance and the health status. RESULTS: Thirteen point seven percent of the individuals received opportunistic screening programs within 2 years from the time the survey was conducted in 2006. The individuals who graduated from college or who had even more education were 3.0 times more likely to use opportunistic screening programs compared with the individuals who were illiterate. The individuals who resided in urban areas and who had religious beliefs were more likely to receive opportunistic screening programs compared with their counterparts. Those who were in the first quartile for the total household assets were 2.6 times more likely to use opportunistic screening programs than those who were in the fourth quartile for the total household assets. Privately insured people were 1.6 times more likely to use opportunistic screening programs than those who were not insured. Finally, the individuals who self-assessed their health status as worst were 2.1 times more likely to use opportunistic screening programs compared individuals who self-assessed their health status as best. CONCLUSIONS: This study suggests that opportunistic screening programs can be an indicator for whether or not an individual is among the advantaged group in terms of their socioeconomic characteristics and type of health insurance.

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The Proposal of Policies Aimed at Tackling Health Inequalities in Korea.: Tae Ho Yoon; J Prev Med Public Health. 2007;40(6):447-453.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.447

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Abstract PDF

Although the New National Health Promotion Plan 2010 target to reduce health inequalities, whether the program will be effective for reducing the health inequalities in Korea remains quite unclear. More and more developed countries have been started to concentrate on comprehensive policies for reducing health inequalities. The health policies of the UK, Netherlands, and Sweden are the most wellknown. I propose that a comprehensive blueprint for tackling health inequalities in Korea should be made and that it must contain five domains: a target, structure and process, life-course approach, area-based approach, and reorganization of health care resources. The target should be based on determinants of health and more attention should be paid to socioeconmic factors. The structure and process require changes from the national health care policy based on medical services to the national health policy that involves the establishment of a Social Deputy Prime Minister and the strengthening multidisciplinary action. A life-course approach especially focused on the early childhood years. Area-based approach such as the establishment of healthy communities, healthy schools, or healthy work-places which are focused on deprived areas or places is also required. Finally, health care resources should be a greater investment on public resources and strengthening primary care to reduce health inequalities. The policy or intervention studies for tackling health inequalities should be implemented much more in Korea. In addition, it is essential to have political will to encoruage policy action.

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Original Article

Customer's Intention to Use Hospital-based Health Promotion Services.: Myung Il Hahm, Myung Geun Kang, Choon Sun Park, Woo Hyun Cho; Korean J Prev Med. 2003;36(2):108-116.

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Abstract PDF: OBJECTIVE
To determine the relationships between customer's attitude, the subjective norm and the intention to use hospital-based health promotion services. METHODS: This study was based on the theory of reasoned action, suggested by Fishbein and Ajzen. The subjects of this study were 501 residents of Seoul, Bun-dang, Il-san and Pyung-chon city, under 65 years, who were stratified by sex and age. A covariance structural analysis was used to identify the structural relationships between attitude towards health promotion programs or services, their subjective norm and their intention to use the aforementioned services. RESULTS: The subjective norm for using the health promotion programs or services provided by hospitals was a significant predictor of the intention to use, but the attitude towards the services was not significant. CONCLUSIONS: Our results suggest that a customer's reference group affects their use of the hospital-based health promotion services. Because the subjects of this study were restricted to specific urban areas, there are limitations to generalizing the study results. Despite the limitations of these results, they can serve as baseline information for the understanding of consumer's behavior toward hospital-based health promotion services.; Summary

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