Journal of Preventive Medicine and Public Health

Original Articles

Social Networking Service Usage Behaviors and Loneliness Among Adults in Seoul, 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; J Prev Med Public Health. 2026;59(4):381-391. Published online June 23, 2026; DOI: https://doi.org/10.3961/jpmph.26.024

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Abstract Summary 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), communication priority (aOR, 1.26), social comparison (aOR, 1.50), and exclusionary feeling (aOR, 1.66); information-seeking use was not significant (aOR, 1.11). 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

Korean summary
기존 연구는 SNS 이용량에 주로 주목해, 어떤 이용 방식이 외로움과 관련되는지는 분명하지 않았다. 서울 성인 34,142명에서 SNS 이용자는 비이용자보다 외로움 오즈가 다소 낮았으나, 일상 공유·온라인 소통 우선·사회적 비교·소외감을 보이는 이용자는 오히려 높았고 세 가지가 겹칠 때 가장 높았다. 이 경향은 60세 이상과 기능적 디지털 문해력이 높은 집단에서 더 뚜렷했으므로, 외로움 예방은 SNS 이용 여부가 아니라 이용 방식과 자기조절 역량을 다루어야 한다.

Key Message
Most population evidence treats social network service (SNS) use as a matter of quantity, leaving unclear which qualitative patterns of engagement matter for loneliness. In 34 142 Seoul adults, any SNS use was associated with slightly lower odds of loneliness, whereas self-presentation, prioritizing online contact, social comparison, and feeling excluded were each associated with higher odds - peaking when three such behaviors co-occurred, and strongest in adults aged 60 years or older and in those with high functional digital literacy. Loneliness prevention should therefore address how people use SNS, and digital education should cultivate self-regulation rather than technical skill alone.

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.

Citations

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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

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.

Who Dies Alone? Demographics, Underlying Diseases, and Healthcare Utilization Patterns of Lonely Death Individuals in Korea: Haibin Bai, Jae-ryun Lee, Min Jung Kang, Young-Ho Jun, Hye Yeon Koo, Jieun Yun, Jee Hoon Sohn, Jin Yong Lee, Hyejin Lee; J Prev Med Public Health. 2025;58(2):218-226. Published online March 4, 2025; DOI: https://doi.org/10.3961/jpmph.24.704

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Abstract Summary PDF Supplementary Material

Objectives
Lonely death is defined as “a person living in a state of social isolation, disconnected from family, relatives, and others, who dies from suicide, illness, or other causes”. This study investigated the characteristics of individuals who die alone in Korea.
Methods
We constructed a database of lonely death cases by linking data from the Korea Crime Scene Investigation Unit of the Korea National Police Agency with National Health Insurance Service (NHIS) records. A descriptive analysis was performed to evaluate the demographics, underlying diseases, and healthcare utilization patterns among lonely death cases.
Results
Among the 3122 individuals identified as lonely death cases, 2621 (84.0%) were male and 501 (16.0%) were female. The most common age group was 50-59 years (n=930, 29.8%). The NHIS covered 2161 individuals (69.2%), whereas 961 individuals (30.8%) were enrolled in Medical Aid (MA). The highest number of lonely deaths occurred in Seoul areas, with 1468 cases (47.0%). Mood disorders were diagnosed in 1020 individuals (32.7%), and various alcohol-related diseases, including alcoholic liver disease, were also observed. Outpatient visits increased leading up to death but declined in the final 3 months, while hospitalizations decreased and emergency room visits slightly increased.
Conclusions
Most lonely death cases involved male in their 50s, with a disproportionately high number of MA beneficiaries compared to the general population. Many of these individuals also experienced mental health issues or alcohol-related disorders. Preventing social isolation and strengthening social safety nets are critical to reducing the occurrence of lonely deaths.

Summary

Korean summary
한국에서 고독사란 법적으로 “가족, 친척 등 주변 사람들과 단절된 채 사회적 고립상태로 생활하던 사람이 자살ㆍ병사 등으로 임종”하는 것으로 정의하고 있다. 고독사 사망자는 대체적으로 50대 남성이었고, 의료급여 수급권자의 비율이 일반 인구보다 월등히 높았으며, 사망자 대다수는 정신건강 문제 또는 알코올성 질환을 앓고 있었다. 사회적 고립의 예방 및 사회안전망 구축은 고독사 예방에 있어 매우 중요한 역할을 할 것으로 보인다.

Key Message
Lonely death is defined as “a person living in a state of social isolation, disconnected from family, relatives, and others, who dies from suicide, illness, or other causes”. This study investigated the characteristics of individuals who die alone in Korea. Most lonely death cases involved male in their 50s, with a disproportionately high number of MA beneficiaries compared to the general population. Many of these individuals also experienced mental health issues or alcohol-related disorders. Preventing social isolation and strengthening social safety nets are critical to reducing the occurrence of lonely deaths.

Citations

Citations to this article as recorded by

Comparison of health care utilisation and spending among National Health Insurance and Medical Aid beneficiaries in Korea
Agnus M. Kim, Doojin Ryu, Jin Yong Lee
BMC Health Services Research.2026;[Epub] CrossRef
Lonely Deaths in Korea, 2017–2023: Records of Social Disconnection
Agnus M. Kim, Doojin Ryu
Behavioral Medicine.2026; : 1. CrossRef
Descriptive Epidemiology of solitary death (kodokushi) in Tokyo’s 23 wards, Japan, 2016–2023
Haruka Ninomiya, Ryusuke Ae, Hideto Suzuki
Journal of Epidemiology.2026;[Epub] CrossRef
Understanding of solitary death in people living in the community: A scoping review
Chung Min Cho, Hyeun Jun Moon, Jee-Hye Yoo
Global Public Health.2025;[Epub] CrossRef

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