Journal of Preventive Medicine and Public Health

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.

Association Between Disability and Participation in Sports or Physical Activities: Evidence From a Chilean Population-based Survey: Renzo Gianmarco Avila-Terrones, Leslie Paulina Quiroga-Morales, J. Jhonnel Alarco; J Prev Med Public Health. 2025;58(6):599-608. Published online July 12, 2025; DOI: https://doi.org/10.3961/jpmph.25.249

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Objectives
This study aimed to estimate the association between disability and participation in sports or physical activity during the past month among individuals in Chile.
Methods
A cross-sectional analysis was conducted using data from the Second National Disability Study (ENDISC II) of Chile. The dependent variable was defined as participation in sports or physical activity in the last month, while the independent variable was disability status, as determined by the ENDISC II methodology. Crude and adjusted ordinal logistic regression models were employed to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs).
Results
The analysis included data from 12 236 Chilean participants. Individuals with mild or moderate disability were 54% more likely to participate in lower levels of sports or physical activity (OR, 1.54; 95% CI, 1.27 to 1.87). Those with severe disability exhibited a 73% increased likelihood (OR, 1.73; 95% CI, 1.19 to 2.52) compared to individuals without disabilities, after adjusting for multiple confounding factors.
Conclusions
In Chile, individuals with disabilities participated less frequently in sports or physical activity during the past month than those without disabilities.

Summary

Key Message
This study analyzed national data from Chile to examine the relationship between disability and participation in sports or physical activity. Individuals with disabilities, particularly those with severe limitations, were significantly less likely to engage in physical activity than those without disabilities, even after adjusting for multiple confounders. These findings highlight a critical public health gap and underscore the need for inclusive and accessible physical activity strategies to reduce inequalities.

Citations

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Riding toward inclusion: the journey of adapted cycling
Stephanie Sorraghan, Sally Logan, Valerie Watchorn, Dion Williams, Danielle Hitch, Joanne M. Watson, Kathryn Aedy, Therese Dogra, Pearse Fay, Matthew Haanappel, Aarti Shukla, Glen Lebeau, James Little, John McKenna, Kerry Townsend, Kate L. M. Anderson
Frontiers in Sports and Active Living.2026;[Epub] CrossRef

Mapping Asbestos Vulnerability in Indonesia Using Earthquake Vulnerability: Anna Suraya, Osama Priharto, Bintang Raihan Putra, Husen , Defi Arjuni, Uci Sulandari, Yunita Sari Purba, Maryuni , Lelitasari; J Prev Med Public Health. 2025;58(5):475-483. Published online June 29, 2025; DOI: https://doi.org/10.3961/jpmph.24.749

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Abstract Summary PDF: Objectives
This study aims to create Indonesia’s first asbestos exposure risk map by analyzing asbestos roofing prevalence, population density, and earthquake vulnerability. This represents a significant innovation by providing valuable insights to support the prevention of asbestos-related diseases in Indonesia.
Methods
This semi-quantitative study was conducted between June 2024 and September 2024. Data on asbestos roof usage and population density were obtained from the Indonesian Central Statistics Agency, while earthquake risk data were sourced from the Geological Disaster Mitigation Portal. Risk categorization was applied to each variable, and a matrix was developed to evaluate combined risks. Validation was conducted through cross-referencing, and maps were generated using Geographic Information System software.
Results
Nationally, asbestos roofing use is approximately 8.10%, although prevalence varies significantly among provinces. Bangka Belitung has the highest prevalence at 55.16%, followed by DKI Jakarta (52.10%), Riau Islands (31.99%), and Banten (21.22%). DKI Jakarta also has the highest population density, with 16 158 inhabitants per square kilometer. Combining these factors, DKI Jakarta emerges as the province with the highest asbestos exposure risk. Based on asbestos roofing prevalence, population density, and earthquake risk, provinces classified at very high asbestos exposure risk include DKI Jakarta, West Java, DI Yogyakarta, East Java, Banten, Bali, and West Nusa Tenggara. Provinces categorized as high-risk include North Sumatra, Bengkulu, Lampung, and Central Java.
Conclusions
This map supports the development of future public health policies by identifying high-risk areas, optimizing resource allocation, and informing targeted intervention strategies.; Summary

Key Message
This study developed Indonesia’s first asbestos exposure risk map by integrating asbestos roof prevalence, population density, and earthquake vulnerability. Using GIS-based semi-quantitative analysis, the authors identified significant disparities across provinces. Bangka Belitung (55.16%) and Jakarta (52.10%) had the highest asbestos roof usage, with Jakarta also exhibiting the country’s highest population density (16,158/km²). These overlapping factors placed Jakarta, West Java, DI Yogyakarta, East Java, Banten, Bali, and West Nusa Tenggara in the “very high-risk” category. The findings emphasize the urgent need for targeted public health interventions and disaster risk mitigation.

Enhancing TNM Stage Completeness Using the SEER Summary Stage: A Nationwide Study From Korea: Chang Kyun Choi, Mina Suh, Kyu-Won Jung, E Hwa Yun; J Prev Med Public Health. 2025;58(4):415-421. Published online April 23, 2025; DOI: https://doi.org/10.3961/jpmph.25.099

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Accurate and complete cancer staging is essential for effective prognosis and treatment planning. This study investigated the feasibility of enhancing the completeness of tumor‐node‐metastasis (TNM) staging by integrating Surveillance, Epidemiology, and End Results (SEER) Summary Stage data.
Methods
We analyzed data from 5 cancer types (stomach, colorectum, liver, lung, and breast) in Korea (2012-2017). The study assessed the impact of supplementing missing TNM information with SEER Summary Stage data on both staging completeness and 5‐year relative survival rates.
Results
The study included 173 061 stomach cancer, 159 199 colorectal cancer, 89 639 liver cancer, 137 103 lung cancer, and 110 286 breast cancer patients. The percentage of missing TNM stage data varied by cancer type, ranging from 65.1% (breast cancer) to 93.0% (liver cancer). Supplementation significantly reduced missing values—most notably in stomach cancer, where missing data dropped by 50.6 percentage points (%p), followed by liver (21.5%p) and breast cancers (13.6%p). For stomach cancer, supplementation led to a 3.6%p decrease in stage I survival rates, whereas liver cancer exhibited the most pronounced changes, with stage IV survival rates declining from 17.7% to 7.9%.
Conclusions
Integrating SEER Summary Stage data enhances TNM staging completeness. However, further evaluation incorporating treatment information is essential.; Summary

Korean summary
본 연구는 한국 등록통계에서 SEER 요약 병기 데이터를 활용해 TNM 병기 분류 완전성 향상 가능성을 평가하였다. 데이터 보완을 통해 다섯 가지 암종에서 누락률이 최대 50.6%포인트 감소하였으나, 5년 상대 생존율은 대체로 큰 변화가 없었다. 다만 간암 등 일부 암종에서 생존율 변화가 현저하여 치료 정보 등의 추가적인 통합 평가가 필요하다.

Key Message
This study evaluated the feasibility of improving the completeness of tumor-node-metastasis (TNM) staging by integrating Surveillance, Epidemiology, and End Results (SEER) Summary Stage data. Data supplementation significantly reduced the proportion of missing TNM information across five cancer types, including a 50.6 percentage point decrease for stomach cancer, while generally resulting in minimal changes to 5-year relative survival rates. However, notable changes were observed in liver cancer, where stage IV survival rates markedly declined from 17.7% to 7.9%, highlighting the need for further evaluation that incorporates treatment information.

Vulnerability Assessment and Enhanced Community-based Care and Management of Patients With Tuberculosis in Korea: A Crossover Design: Jeongmi Seo, Dawoon Jeong, In-Hyuk Lee, Jiyeon Han, Yunhyung Kwon, Eunhye Shim, Hongjo Choi; J Prev Med Public Health. 2025;58(3):317-325. Published online February 25, 2025; DOI: https://doi.org/10.3961/jpmph.24.597

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Objectives
People-centered care and social protection are critical for improving tuberculosis (TB) treatment outcomes. This study aimed to evaluate whether a vulnerability assessment tool, developed for an enhanced community-based care and management (ECCM) program in 2 Korean cities, could predict and improve final TB treatment outcomes based on patients’ vulnerability levels.
Methods
Treatment outcomes in the ECCM group were compared with those in a control group, stratified by vulnerability level. During stage 1, one city served as the intervention region and the other as the control, with a crossover in stage 2. The vulnerability assessment included all notified patients with TB, and those identified as highly vulnerable in the intervention group received social support following a consultation with a case manager.
Results
The vulnerability assessment tool demonstrated moderate predictive ability for unfavorable outcomes, with an area under the curve of 0.70 (95% confidence interval, 0.63 to 0.77). The patients with high vulnerability who received ECCM treatment demonstrated a 19.8-percentage point (%p) higher treatment success rate than the high vulnerability subcategory of the control group. ECCM also appeared to reduce loss to follow-up and TB-related mortality by 8.4%p and 7.3%p, respectively, although these findings should be interpreted with caution.
Conclusions
The results suggest that providing social support tailored to patient vulnerability at the time of diagnosis could improve TB treatment outcomes.

Summary

Korean summary
결핵 진단 시점의 임상적, 사회적, 그리고 결핵 관련 취약성 평가는 부정적인 치료 결과를 예측하는 데 유의미한 지표가 될 수 있다. 높은 취약성을 지닌 집단에 대해 지역사회 기반의 맞춤형 사례관리를 시행한 결과, 부정적 치료 결과를 일정 수준 감소시킬 수 있었다. 결핵의 사회적 결정요인과 노년 결핵환자 증가라는 역학적 상황은 지역사회 기반의 사회적 지원을 통해 개선 가능할 것이다.

Key Message
Clinical, social, and tuberculosis-related vulnerabilities assessed at the time of TB diagnosis can serve as meaningful predictors of unfavorable treatment outcomes. Community-based, ehnahced case management for highly vulnerable groups has been shown to reduce such negative outcomes to some extent. The social determinants of tuberculosis and the increasing prevalence of TB among the elderly may be addressed through community-based social support.

Citations

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Suicide risk in people with tuberculosis in Republic of Korea: a nationwide cohort, 2012–2021
Chiwook Chung, Seung Won Lee, Dawoon Jeong, Hongjo Choi, Hojoon Sohn, Young Ae Kang
Infectious Diseases of Poverty.2026;[Epub] CrossRef

A Comparison of Green, Delta, and Monte Carlo Methods to Select an Optimal Approach for Calculating the 95% Confidence Interval of the Population-attributable Fraction: Guidance for Epidemiological Research: Sangjun Lee, Sungji Moon, Kyungsik Kim, Soseul Sung, Youjin Hong, Woojin Lim, Sue K. Park; J Prev Med Public Health. 2024;57(5):499-507. Published online September 6, 2024; DOI: https://doi.org/10.3961/jpmph.24.272

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Abstract Summary PDF Supplementary Material

Objectives
This study aimed to compare the Delta, Greenland, and Monte Carlo methods for estimating 95% confidence intervals (CIs) of the population-attributable fraction (PAF). The objectives were to identify the optimal method and to determine the influence of primary parameters on PAF calculations.
Methods
A dataset was simulated using hypothetical values for primary parameters (population, relative risk [RR], prevalence, and variance of the beta estimator ) involved in PAF calculations. Three methods (Delta, Greenland, and Monte Carlo) were used to estimate the 95% CIs of the PAFs. Perturbation analysis was performed to assess the sensitivity of the PAF to changes in these parameters. An R Shiny application, the “GDM-PAF CI Explorer,” was developed to facilitate the analysis and visualization of these computations.
Results
No significant differences were observed among the 3 methods when both the RR and p-value were low. The Delta method performed well under conditions of low prevalence or minimal RR, while Greenland’s method was effective in scenarios with high prevalence. Meanwhile, the Monte Carlo method calculated 95% CIs of PAFs that were stable overall, though it required intensive computational resources. In a novel approach that utilized perturbation for sensitivity analysis, was identified as the most influential parameter in the estimation of CIs.
Conclusions
This study emphasizes the necessity of a careful approach for comparing 95% CI estimation methods for PAFs and selecting the method that best suits the context. It provides practical guidelines to researchers to increase the reliability and accuracy of epidemiological studies.

Summary

Korean summary
본 연구는 인구 기여 분율(PAF)의 95% 신뢰구간을 추정하는 데 있어 Delta, Greenland, Monte Carlo 방법을 비교하여 최적의 방법을 찾고, 주요 매개변수의 변화가 PAF 계산에 미치는 영향을 분석했음. Delta 방법은 상대적으로 낮은 유병률이나 위험도(RR)가 낮을 때 적합하며, Greenland 방법은 높은 유병률에서 효과적이고, Monte Carlo 방법은 전반적으로 안정적인 결과를 제공하지만, 많은 계산 자원이 필요할 수 있음.

Key Message
This study compared Delta, Greenland, and Monte Carlo methods for calculating the 95% confidence intervals (CIs) of population-attributable fractions (PAFs). While all three methods demonstrated comparable performance under conditions of low prevalence or relative risk (RR), they diverged under other scenarios. The Delta method is effective for low-prevalence or minimal RR, Greenland for high-prevalence scenarios, and Monte Carlo is robust but computationally intensive. This research offers practical guidance for selecting the appropriate method based on study conditions, enhancing the reliability of epidemiological studies in estimating PAFs.

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Special Article

National Cancer Control Plan of the Korea: Current Status and the Fourth Plan (2021-2025): Kyu-Tae Han, Jae Kwan Jun, Jeong-Soo Im; J Prev Med Public Health. 2023;56(3):205-211. Published online May 31, 2023; DOI: https://doi.org/10.3961/jpmph.23.115

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Abstract Summary PDF

Cancer management has become a major policy goal for the government of the Korea. As such, the government introduced the National Cancer Control Plan (NCCP) to reduce the individual and social burdens caused by cancer and to promote national health. During the past 25 years, 3 phases of the NCCP have been completed. During this time, the NCCP has changed significantly in all aspects of cancer control from prevention to survival. The targets for cancer control are increasing, and although some blind spots remain, new demands are emerging. The government initiated the fourth NCCP in March 2021, with the vision of “A Healthy Country with No Concerns about Cancer Anywhere at Any Time,” which aims to build and disseminate high-quality cancer data, reduce preventable cancer cases, and reduce gaps in cancer control. Its main strategies include (1) activation of cancer big data, (2) advancement of cancer prevention and screening, (3) improvement in cancer treatment and response, and (4) establishment of a foundation for balanced cancer control. The fourth NCCP has many positive expectations, similar to the last 3 plans; however, cross-domain support and participation are required to achieve positive results in cancer control. Notably, cancer remains the leading cause of death despite decades of management efforts and should continue to be managed carefully from a national perspective.

Summary

Korean summary
- 기존 1~3차 국가암관리계획의 전반적인 성과를 소개합니다. - 제4차 국가암관리계획의 목표 및 내용을 기존 계획과 비교하여 설명합니다.

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Review

A Review of the Types and Characteristics of Healthy Life Expectancy and Methodological Issues: Young-Eun Kim, Yoon-Sun Jung, Minsu Ock, Seok-Jun Yoon; J Prev Med Public Health. 2022;55(1):1-9. Published online January 16, 2022; DOI: https://doi.org/10.3961/jpmph.21.580

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Abstract Summary PDF

An index that evaluates the health level of a population group considering both death and loss of function due to disease is called a summary measure of population health (SMPH). SMPHs are broadly divided into life year indices and life expectancy indices, the latter of which comprise healthy life expectancy (HLE). HLE is included as a policy target in various national and regional level healthcare plans, and the term “HLE” is commonly used in academia and by the public. However, the overall level of understanding of HLE—such as the precise definition of HLE and methods of calculating HLE—still seems to be low. As discussed in this study, the types of HLE are classified into disability-free life expectancy, disease-free life expectancy, quality-adjusted life expectancy, self-rated HLE, and disability-adjusted life expectancy. Their characteristics are examined to facilitate a correct understanding and appropriate utilization of HLE. In addition, the Sullivan method, as a representative method for calculating HLE, is presented in detail, and major issues in the process of calculating HLE, such as selection of the population group and age group, estimation of death probability, calculation of life years, and incorporation of health weights, are reviewed. This study will help researchers to select an appropriate HLE type and evaluate the validity of HLE research results, and it is expected to contribute to the vitalization of HLE research.

Summary

Korean summary
건강수명의 유형은 무장애기대수명, 질병 없는 기대수명, 질보정기대수명, 자가평가보정 기대수명, 장애보정기대수명으로 분류된다. 건강수명의 올바른 이해와 적절한 활용을 돕기 위해 이들의 특성을 검토하였다. 이번 연구는 연구자들이 적절한 건강수명 유형을 선택하고 건강수명 연구 결과의 타당성을 평가하는 데 도움이 될 것이며, 건강수명 연구의 활성화에 기여할 것으로 기대된다.

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Original Articles

Ethnic Variation and Its Association With Malaria Awareness: A Cross-sectional Study in East Nusa Tenggara Province, Indonesia: Robertus Dole Guntur, Jonathan Kingsley, Fakir M. Amirul Islam; J Prev Med Public Health. 2022;55(1):68-79. Published online November 15, 2021; DOI: https://doi.org/10.3961/jpmph.21.367

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Abstract PDF

Objectives
This study investigated associations between ethnicity and malaria awareness in East Nusa Tenggara Province (ENTP), Indonesia.
Methods
A community-based cross-sectional study was conducted upon 1503 adults recruited by multi-stage cluster random sampling. A malaria awareness questionnaire was used to collect data, according to which participants were classified as aware or unaware of malaria. Logistic regression was applied to quantify the strength of associations of factors with malaria awareness.
Results
The participation rate in this study was high (99.5%). The participants were distributed relatively evenly among the Manggarai, Atoni, and Sumba ethnicities (33.0, 32.3, and 30.2%, respectively). Malaria awareness was significantly different amongst these groups; it was most common in the Manggarai ethnicity (65.1%; 95% confidence interval [CI], 59.9 to 70.3) and least common in the Sumba ethnicity (35.0%; 95% CI, 27.6 to 42.4). The most prominent factor influencing the malaria awareness in the Sumba and Manggarai ethnicities was education level, whilst it was socioeconomic status (SES) in the Atoni ethnicity. The likelihood of malaria awareness was significantly higher in adults with an education level of diploma or above (adjusted odds ratio [aOR], 21.4; 95% CI, 3.59 to 127.7 for Manggarai; aOR, 6.94; 95% CI, 1.81 to 26.6 for Sumba). Malaria awareness was significantly more common amongst high-SES adults in the Atoni group (aOR, 24.48; 95% CI, 8.79 to 68.21).
Conclusions
Low education levels and low SES were prominent contributors to lower levels of malaria awareness in rural ENTP. Interventions should focus on improving malaria awareness to these groups to support the Indonesian government’s national commitment to achieve a malaria elimination zone by 2030.

Summary

Citations

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Community perceptions and acceptance of ivermectin for malaria control on Sumba Island, Indonesia
Diana Timoria, Christa Dewi, Claus Bøgh, Tri Baskoro, Wisnu Nurcahyo, Vincentius Arca Testamenti, Lorenz von Seidlein, Kevin Kobylinski, Mary Chambers, Pyae Linn Aung
PLOS One.2026; 21(2): e0326646. CrossRef
Health Education Campaign to Improve Malaria Knowledge, Prevention, and Treatment Behaviors in Rural East Nusa Tenggara Province, Indonesia: Protocol for a Cluster-Assigned Quasi-Experimental Study
Robertus Dole Guntur, Maria Lobo, Dony Martinus Sihotang, Yulianti Paula Bria, Damai Kusumaningrum
JMIR Research Protocols.2025; 14: e66982. CrossRef
The Declined Trend of Malaria over a Ten-year Period in the Rural East Nusa Tenggara Province, Indonesia: A Medical Record Analysis
Maria Lobo, Robertus Dole Guntur, Damai Kusumaningrum, Yulianti Paula Bria
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Robertus Dole Guntur, Maria A. Kleden, Damai Kusumaningrum, Fakir M. Amirul Islam
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Socio-demographic Determinants of Low Physical Activity in Peruvian Adults: Results of a Population-based Survey Performed in 2017-2018: Akram Hernández-Vásquez, Rodrigo Vargas-Fernández; J Prev Med Public Health. 2021;54(6):461-470. Published online November 7, 2021; DOI: https://doi.org/10.3961/jpmph.21.418

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Abstract PDF

Objectives
The objective of this study was to determine the prevalence of low physical activity (PA) in Peruvian adults and to identify associated factors.
Methods
An analytical study was performed using data from the 2017-2018 Nutritional Food Surveillance by Life Stages survey. The outcome variable was low PA (yes or no), assessed using the International Physical Activity Questionnaire-short form. Prevalence ratios were estimated as a measure of association.
Results
Among the 1045 persons included in the analysis, the age-standardized prevalence of low PA was 61.9%. The adjusted model showed that being female and migrating from a rural to an urban area in the last 5 years were associated with a higher probability of having low PA than males and individuals who had not migrated, while residing in rural highlands and jungle areas was associated with a reduced probability of having low PA compared to people residing in other geographic domains.
Conclusions
Being a female and migration from a rural to an urban area in the last 5 years were associated with a higher likelihood of having low PA. Therefore, promotion and prevention strategies related to PA are required, especially in the female and migrant populations.

Summary

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Neha Balapal, Margaret Chi, Dinesh Timalsena, Lindy Reynolds, Niroj Bhandari, Archana Shrestha
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Jung-Eun Lee, Anthony Kityo, Sang-Ah Lee
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Individualized Biological Age as a Predictor of Disease: Korean Genome and Epidemiology Study (KoGES) Cohort
Seokyung An, Choonghyun Ahn, Sungji Moon, Eun Ji Sim, Sue-Kyung Park
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Association between Altitude and the Framingham Risk Score: A Cross-Sectional Study in the Peruvian Adult Population
Akram Hernández-Vásquez, Rodrigo Vargas-Fernández, Manuel Chacón-Diaz
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Regional Differences in the Effects of Social Relations on Depression Among Korean Elderly and the Moderating Effect of Living Alone: Chanki Kim, Eun Jee Chang, Chang-yup Kim; J Prev Med Public Health. 2021;54(6):441-450. Published online October 22, 2021; DOI: https://doi.org/10.3961/jpmph.21.337

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Abstract Summary PDF Supplementary Material

Objectives
Socioeconomic disadvantages interact with numerous factors which affect geriatric mental health. One of the main factors is the social relations of the elderly. The elderly have different experiences and meanings in their social lives depending on their socio-cultural environment. In this study, we compared the effects of social relations on depression among the elderly according to their living arrangement (living alone or living with others) and residential area.
Methods
We defined social relations as “meetings with neighbors” (MN). We then analyzed the impact of MN on depression using data from the Korean Longitudinal Study of Aging Panel with the generalized estimating equation model. We also examined the moderating effect of living alone and performed subgroup analysis by dividing the sample according to which area they lived in.
Results
MN was associated with a reduced risk of depressive symptoms among elderlies. The size of the effect was larger in rural areas than in large cities. However, elderly those who lived alone in rural areas had a smaller protective impact of MN on depression, comparing to those who lived with others. The moderating effect of living alone was significant only in rural areas.
Conclusions
The social relations among elderlies had a positive effect on their mental health: The more frequent MN were held, the less risk of depressive symptoms occurred. However, the effect may vary depending on their living arrangement and environment. Thus, policies or programs targeting to enhance geriatric mental health should consider different socio-cultural backgrounds among elderlies.

Summary

Korean summary
본 연구는 사회적 관계가 노인의 우울에 미치는 영향이 독거 상태 및 거주 지역에 따라 달라지는지 확인하였다. 사회적 관계를 이웃과의 만남 빈도로 정의하고 고령화연구패널자료를 분석한 결과 사회적 관계의 효과 크기는 대도시에서 가장 작었고 독거의 조절효과는 농어촌에서만 유의하였다.

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COVID-19: Original Article

Associations Between Compliance With Non-pharmaceutical Interventions and Social-distancing Policies in Korea During the COVID-19 Pandemic: Yu Seong Hwang, Heui Sug Jo; J Prev Med Public Health. 2021;54(4):230-237. Published online June 16, 2021; DOI: https://doi.org/10.3961/jpmph.21.139

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Abstract Summary PDF Supplementary Material

Objectives
This study explored changes in individuals’ behavior in response to social distancing (SD) levels and the “no gatherings of more than 5 people” (NGM5) rule in Korea during the coronavirus disease 2019 (COVID-19) pandemic.
Methods
Using survey data from the COVID-19 Behavior Tracker, exploratory factor analysis extracted 3 preventive factors: maintenance of personal hygiene, avoiding going out, and avoiding meeting people. Each factor was used as a dependent variable. The chi-square test was used to compare differences in distributions between categorical variables, while binary logistic regression was performed to identify factors associated with high compliance with measures to prevent transmission.
Results
In men, all 3 factors were significantly associated with lower compliance. Younger age groups were associated with lower compliance with maintenance of personal hygiene and avoiding meeting people. Employment status was significantly associated with avoiding going out and avoiding meeting people. Residence in the capital area was significantly associated with higher compliance with personal hygiene and avoiding venturing out. Increasing SD levels were associated with personal hygiene, avoiding going out, and avoiding meeting people. The NGM5 policy was not significantly associated with compliance.
Conclusions
SD levels, gender, age, employment status, and region had explanatory power for compliance with non-pharmaceutical interventions (NPIs). Strengthening social campaigns to inspire voluntary compliance with NPIs, especially focused on men, younger people, full-time workers, and residents of the capital area is recommended. Simultaneously, efforts need to be made to segment SD measures into substrategies with detailed guidance at each level.

Summary

Korean summary
이 연구에서는 대한민국 정부가 COVID-19 방역 정책으로 시행한 ‘사회적 거리두기 단계 조절’과 ‘5인 이상 집합 금지 조치’에 대한 개인의 순응도를 파악하였다. 이를 위해 영국 임페리얼 대학이 2020년 4월부터 2021년 4월까지 24회에 걸쳐 한국인 총 13,300명에게 개인 행동을 조사한 공개 데이터를 분석하였다. 그 결과, 더 높은 수준의 사회적 거리두기 단계 – 특히 다중이용시설들이 폐쇄되는 2.5 단계 -에서 비약물적 중재 조치의 순응도와 더 강한 상관관계를 보였다. 그러나 5인 이상 집합금지는 순응도와 유의한 상관관계를 보이지 않아 사람들이 모임 인원을 제한할 뿐 지속적으로 모임을 하는 것으로 해석된다. 연령, 성별, 직업 구분, 거주지와 같은 인구-사회학적 특성들이 순응도에 영향을 주는 것으로 나타났으므로, 낮은 순응도를 보이는 인구집단의 순응도를 고취시킬 수 있도록 세부적인 전략 (예: 재택근무, 온라인회의, 온라인 수업 권장 등)이 필요하다.

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Original Articles

The Association of Perceived Neighborhood Walkability and Environmental Pollution With Frailty Among Community-dwelling Older Adults in Korean Rural Areas: A Cross-sectional Study: Mi-Ji Kim, Sung-Hyo Seo, Ae-Rim Seo, Bo-Kyoung Kim, Gyeong-Ye Lee, Yeun-Soon Choi, Jin-Hwan Kim, Jang-Rak Kim, Yune-Sik Kang, Baek-Geun Jeong, Ki-Soo Park; J Prev Med Public Health. 2019;52(6):405-415. Published online October 24, 2019; DOI: https://doi.org/10.3961/jpmph.19.166

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Abstract Summary PDF Supplementary Material

Objectives
The aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas.
Methods
The participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants’ frailty.
Results
The overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy.
Conclusions
More studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.

Summary

Korean summary
본 연구는 우리나라 농촌지역 노인들이 인지하는 지역 환경과 노쇠의 연관성을 확인하기 위하여 자기보고식 설문지로 인지된 보행편의성 및 환경오염을 측정하였고, Kaigo-Yobo 평가척도로 노쇠를 평가하였다. 연구 결과, 노쇠에 영향을 미칠 것으로 예상되는 변수들을 통제한 후에도 인지된 보행편의성의 감소와 인지된 환경오염의 증가는 노쇠와 관련성이 있었다.

Citations

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Risk prediction model of physical frailty for a rural older population: a cross-sectional study in Hunan Province, China
Xiuyan Guo, Chunhong Shi
Frontiers in Public Health.2025;[Epub] CrossRef
The influence of the built environment and perceived neighborhood on physical frailty and sarcopenia in older adults: A systematic review
Lucas dos Santos Ferreira, Thais Evelin Marques da Silva, Eliziane Batista dos Santos, Felipe Fank, João Araújo Barros Neto, Enaiane Cristina Menezes
Archives of Gerontology and Geriatrics.2025; 137: 105910. CrossRef
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Rishabh Sharma, Tanaya Sharma, Brent McCready-Branch, Arshia Chauhan, Caitlin Carter, SooMin Park, Imra Hudani, Prapti Choudhuri, Tejal Patel
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Federica Gaglione, Caitlin Cottrill, Carmela Gargiulo
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Frailty Status and Transport Disadvantage: Comparison of Older Adults’ Travel Behaviours between Metropolitan, Suburban, and Rural Areas of Japan
Takumi Abe, Akihiko Kitamura, Satoshi Seino, Yuri Yokoyama, Hidenori Amano, Yu Taniguchi, Mariko Nishi, Yu Nofuji, Tomoko Ikeuchi, Takemi Sugiyama, Shoji Shinkai
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Blood Pressure and the Risk of Death From Non-cardiovascular Diseases: A Population-based Cohort Study of Korean Adults: Jeoungbin Choi, Jieun Jang, Yoonsuk An, Sue K. Park; J Prev Med Public Health. 2018;51(6):298-309. Published online November 14, 2018; DOI: https://doi.org/10.3961/jpmph.18.212

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Abstract Summary PDF Supplementary Material

Objectives
The objective of this study was to assess the relationship between systolic and diastolic blood pressure (SBP, DBP) and the risk of death from specific causes other than cardiovascular diseases.
Methods
We calculated the risk of specific death by SBP and DBP categories for 506 508 health examinees in 2002-2003 using hazard ratios (HRs) and 95% confidence intervals (CIs) in a Cox proportional hazards model.
Results
Compared to normal levels (SBP <120 or DBP <90 mmHg), stage I systolic and diastolic hypertension (SBP 140-159, DBP 85- 89 mmHg, respectively) were associated with an increased risk of death from diabetes mellitus, alcoholic liver disease, and renal failure (HR, 1.83; 95% CI, 1.51 to 2.22; HR, 1.24; 95% CI, 1.06 to 1.46; HR, 2.30; 95% CI, 1.64 to 3.21; HR, 1.67; 95% CI, 1.27 to 2.20; HR, 1.99; 95% CI, 1.41 to 2.81; HR, 1.31; 95% CI, 0.99 to 1.73, respectively), but a decreased risk of death from intestinal pneumonia (HR, 0.64; 95% CI, 0.42 to 0.98; HR, 0.59; 95% CI, 0.39 to 0.91). Only stage II systolic hypertension (SBP ≥160 mmHg) was associated with an increased risk of death from pneumonia, liver cirrhosis, and intestinal ischemia (HR, 1.54; 95% CI, 1.19 to 1.98; HR, 1.46; 95% CI, 1.00 to 2.15; HR, 3.77; 95% CI, 1.24 to 11.40, respectively), and stage I and II diastolic hypertension (SBP 140-159 and ≥160 mmHg) were associated with an increased risk of death from intestinal ischemia (HR, 3.07; 95% CI, 1.27 to 7.38; HR, 4.39; 95% CI, 1.62 to 11.88, respectively).
Conclusions
An increase in blood pressure levels may alter the risk of death from certain causes other than cardiovascular diseases, a well-known outcome of hypertension, although the mechanism of these associations is not well documented.

Summary

Korean summary
2002년 및 2003년 한국 국민건강보험공단 건강검진 수검자 코호트(NHIS-HEALS) 중 506,508명을 대상으로 2013년 말일까지의 통계청 사망자료 기반 심뇌혈관질환을 제외한 기타 사망원인으로의 사망위험을 콕스회귀모형으로 분석한 결과에서 1단계 수축기 고혈압 군과 1단계 이완기 고혈압 군에서 당뇨, 알코올성 간질환, 콩팥부전 사망의 위험도가 통계적으로 유의하게 증가함을 보인 반면, 간질성 폐렴의 사망위험은 유의하게 감소함을 보였다. 2단계 수축기 고혈압 군에서는 폐렴, 간경화 및 허혈성 장질환의 사망위험이 증가하는 것을 보였다. 혈압의 증가가 기존에 알려진 심뇌혈관 질환 이외의 사망위험도에도 연관된 것으로 보이며, 고혈압의 질병부담 연구 및 보건정책 수립시 이 같은 점에 대한 고려가 필요하다.

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Brief Report

Throat Carriage Rate and Antimicrobial Resistance of Streptococcus pyogenes In Rural Children in Argentina: Gastón Delpech, Mónica Sparo, Beatriz Baldaccini, Gisela Pourcel, Sabina Lissarrague, Leonardo García Allende; J Prev Med Public Health. 2017;50(2):127-132. Published online January 4, 2017; DOI: https://doi.org/10.3961/jpmph.15.073

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Abstract PDF

Objectives
The aim of this study was to determine the prevalence of asymptomatic carriers of group A β-hemolytic streptococci (GAS) in children living in a rural community and to investigate the association between episodes of acute pharyngitis and carrier status.
Methods
Throat swabs were collected from September to November 2013 among children 5-13 years of age from a rural community (Maria Ignacia-Vela, Argentina). The phenotypic characterization of isolates was performed by conventional tests. Antimicrobial susceptibility was assayed for penicillin, tetracycline, chloramphenicol, erythromycin, and clindamycin (disk diffusion). The minimum inhibitory concentration was determined for penicillin, cefotaxime, tetracycline, and erythromycin.
Results
The carriage of β-hemolytic streptococci was detected in 18.1% of participants, with Streptococcus pyogenes in 18 participants followed by S. dysgalactiae ssp. equisimilis in 5. The highest proportion of GAS was found in 8 to 10-year-old children. No significant association between the number of episodes of acute pharyngitis suffered in the last year and the carrier state was detected (p>0.05). Tetracycline resistance (55.5%) and macrolide-resistant phenotypes (11.1%) were observed. Resistance to penicillin, cefotaxime, or chloramphenicol was not expressed in any streptococcal isolate.
Conclusions
The present study demonstrated significant throat carriage of GAS and the presence of group C streptococci (S. dysgalactiae ssp. equisimilis) in an Argentinian rural population. These results point out the need for continuous surveillance of GAS and non-GAS carriage as well as of antimicrobial resistance in highly susceptible populations, such as school-aged rural children. An extended surveillance program including school-aged children from different cities should be considered to estimate the prevalence of GAS carriage in Argentina.

Summary

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Original Articles

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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C-reactive Protein Concentration Is Associated With a Higher Risk of Mortality in a Rural Korean Population: Jung Hyun Lee, Hyungseon Yeom, Hyeon Chang Kim, Il Suh, Mi Kyung Kim, Min-Ho Shin, Dong Hoon Shin, Sang-Baek Koh, Song Vogue Ahn, Tae-Yong Lee, So Yeon Ryu, Jae-Sok Song, Hong-Soon Choe, Young-Hoon Lee, Bo Youl Choi; J Prev Med Public Health. 2016;49(5):275-287. Published online August 23, 2016; DOI: https://doi.org/10.3961/jpmph.16.025

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Abstract PDF Supplementary Material

Objectives
C-reactive protein (CRP), an inflammatory biomarker, has been widely used as a preclinical marker predictive of morbidity and mortality. Although many studies have reported a positive association between CRP and mortality, uncertainty still remains about this association in various populations, especially in rural Korea.
Methods
A total of 23 233 middle-aged participants (8862 men and 14 371 women) who were free from cardiovascular disease, cancer, and acute inflammation (defined by a CRP level ≥10 mg/L) were drawn from 11 rural communities in Korea between 2005 and 2011. Blood CRP concentration was analyzed as a categorical variable (low: 0.0-0.9 mg/L; intermediate: 1.0-3.0 mg/L; high: 3.1-9.9 mg/L) as well as a continuous variable. Each participant’s vital status through December 2013 was confirmed by death statistics from the National Statistical Office. Cox proportional hazard models were used to assess the independent association between CRP and mortality after adjusting for other risk factors.
Results
The total quantity of observed person-years was 57 975 for men and 95 146 for women, and the number of deaths was 649 among men and 367 among women. Compared to the low-CRP group, the adjusted hazard ratio for all-cause mortality of the intermediate group was 1.17 (95% confidence interval [CI], 0.98 to 1.40) for men and 1.27 (95% CI, 1.01 to 1.61) for women, and the corresponding values for the high-CRP group were 1.98 (95% CI, 1.61 to 2.42) for men and 1.41 (95% CI, 1.03 to 1.95) for women. Similar trends were found for CRP evaluated as a continuous variable and for cardiovascular mortality.
Conclusions
Higher CRP concentrations were associated with higher mortality in a rural Korean population, and this association was more prominent in men than in women.

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Review

Alcohol as a Risk Factor for Cancer: Existing Evidence in a Global Perspective: Nina Roswall, Elisabete Weiderpass; J Prev Med Public Health. 2015;48(1):1-9. Published online January 27, 2015; DOI: https://doi.org/10.3961/jpmph.14.052

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Abstract PDF

The purpose of the present review is to give an overview of the association between alcohol intake and the risk of developing cancer. Two large-scale expert reports; the World Cancer Research Fund (WCRF)/American Institute of Cancer Research (AICR) report from 2007, including its continuous update project, and the International Agency for Research of Cancer (IARC) monograph from 2012 have extensively reviewed this association in the last decade. We summarize and compare their findings, as well as relate these to the public health impact, with a particular focus on region-specific drinking patterns and disease tendencies. Our findings show that alcohol intake is strongly linked to the risk of developing cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum (in men), and female breast. The two expert reports diverge on the evidence for an association with liver cancer and colorectal cancer in women, which the IARC grades as convincing, but the WCRF/AICR as probable. Despite these discrepancies, there does, however, not seem to be any doubt, that the Population Attributable Fraction of alcohol in relation to cancer is large. As alcohol intake varies largely worldwide, so does, however, also the Population Attributable Fractions, ranging from 10% in Europe to almost 0% in countries where alcohol use is banned. Given the World Health Organization’s prediction, that alcohol intake is increasing, especially in low- and middle-income countries, and steadily high in high-income countries, the need for preventive efforts to curb the number of alcohol-related cancers seems growing, as well as the need for taking a region- and gender-specific approach in both future campaigns as well as future research. The review acknowledges the potential beneficial effects of small doses of alcohol in relation to ischaemic heart disease, but a discussion of this lies without the scope of the present study.

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Original Articles

Pattern of Hepatitis A Incidence According to Area Characteristics Using National Health Insurance Data: Joo Youn Seo, Jae Hee Seo, Myoung Hee Kim, Moran Ki, Hee Suk Park, Bo Youl Choi; J Prev Med Public Health. 2012;45(3):164-173. Published online May 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.3.164

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Abstract PDF

Objectives

Over the past several years, the incidence of hepatitis A infection has been increasing rapidly in the young-adult population in Korea. We examined the effects of area-level socioeconomic status and environmental hygiene on the incidence of hepatitis A.

Methods

This study is based on the registered national population of Korea and the national health insurance data from 2004 to 2008. A total of 73 459 individuals were confirmed to have had hepatitis A. The standardized incidences of hepatitis A in 232 districts adjusted for sex and age of people were calculated for each year, and the rate ratios of the incidence rates were estimated according to area-level socioeconomic status and environmental hygiene using multiple Poisson regression models.

Results

The incidence rates of hepatitis A infection were 15.6 (per 100 000) in 2004, 19.0 (per 100 000) in 2005, 27.2 (per 100 000) in 2006, 25.1 (per 100 000) in 2007, and 61.7 (per 100 000) in 2008. The analysis of the area-level effects showed that residential areas of the less deprived than other regions, areas with higher levels of education, and heavily populated areas were significantly associated with increased risk.

Conclusions

There is a very strong possibility that both area-level socioeconomic status and environmental hygiene play a role in increasing the risk of hepatitis A infection in Korea. Therefore, to reduce hepatitis A infection, we need a nationwide strategy that considers these area-level characteristics.

Summary

Citations

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Piotr Rzymski, Dorota Zarębska-Michaluk, Agnieszka Genowska, Piotr Tyszko, Birute Strukcinskiene, Robert Flisiak
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Exposure to acifluorfen induces developmental toxicity in the early life stage of zebrafish
Taeyeon Hong, Junho Park, Hahyun Park, Garam An, Hojun Lee, Gwonhwa Song, Whasun Lim
Comparative Biochemistry and Physiology Part C: Toxicology & Pharmacology.2024; 281: 109909. CrossRef
Investigating the spatio-temporal variation of hepatitis A in Korea using a Bayesian model
Jaehong Jeong, Mijeong Kim, Jungsoon Choi
Frontiers in Public Health.2023;[Epub] CrossRef
Impact of urbanization on morbidity of hepatitis A: a national panel study in China during 2005–2018
Bo-Wen Ming, Zhou Yang, Ze-Lin Yan, Chen Shi, Xiao-Han Xu, Li Li, Chun-Quan Ou
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The chronological changes in the seroprevalence of anti-hepatitis A virus IgG from 2005 to 2019: Experience at four centers in the capital area of South Korea
Dae Hyun Lim, Won Sohn, Jae Yoon Jeong, Hyunwoo Oh, Jae Gon Lee, Eileen L. Yoon, Tae Yeob Kim, Seungwoo Nam, Joo Hyun Sohn
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Chang-Gue Son
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Hyunsuk Kim, Jiwon Ryu, Young-Ki Lee, Myung Jin Choi, Ajin Cho, Ja-Ryong Koo, Sae Yun Baik, Eun Hee Lee, Jong-Woo Yoon, Jung-Woo Noh
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Age-period-cohort analysis of hepatitis A incidence rates in Korea from 2002 to 2012
Joo Yeon Seo, Sungyong Choi, BoYoul Choi, Moran Ki
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Assessment of Applicability of Standardized Rates for Health State Comparison Among Areas: 2008 Community Health Survey.: Geun Yong Kwon, Do Sang Lim, Eun Ja Park, Ji Sun Jung, Ki Won Kang, Yun A Kim, Ho Kim, Sung Il Cho; J Prev Med Public Health. 2010;43(2):174-184.; DOI: https://doi.org/10.3961/jpmph.2010.43.2.174

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Abstract PDF

OBJECTIVES
This study shows the issues that should be considered when applying standardized rates using Community Health Survey(CHS) data. METHODS: We analyzed 2008 CHS data. In order to obtain the reliability of standardized rates, we calculated z-score and rank correlation coefficients between direct standardized rate and indirect standardized rate for 31 major indices. Especially, we assessed the change of correlations according to population composition (age and sex), and characteristics of the index. We used Mantel-Haenszel chi-square to quantify the difference of population composition. RESULTS: Among 31 major indices, 29 indices' z-score and rank correlation coefficients were over 0.9. However, regions with larger differences in population composition showed lower reliability. Low reliability was also observed for the indices specific to subgroups with small denominator such as 'permanent lesion from stroke', and the index with large regional variations in age-related differences such as 'obtaining health examinations'. CONCLUSIONS: Standardized rates may have low reliability, if comparison is made between areas with extremely large differences in population composition, or for indicies with large regional variations in age-related differences. Therefore, the special features of standardized rates should be considered when health state are compared among areas.

Summary

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Illustration of Calculating Standardized Rates Utilizing Logistic Regression Models: The National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS)
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English Abstracts

Scientific Basis of Environmental Health Contingency Planning for a Coastal Oil Spill.: Young Min Kim, Hae Kwan Cheong, Jong Ho Kim, Jong Hun Kim, Kumsook Ko, Mina Ha; J Prev Med Public Health. 2009;42(2):73-81.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.73

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Abstract PDF

OBJECTIVES
This study presents a scientific basis for the establishment of an environmental health contingency plan for dealing with accidental coastal oil spills and suggests some strategies for use in an environmental health emergency. METHODS: We reviewed the existing literature, and analyzed the various fundamental factors involved in response strategies for oil spill. Our analysis included data derived from Hebei Spirit oil spill and used air dispersion modeling. RESULTS: Spill amounts of more than 1,000 kl can affect the health of residents along the coast, especially those who belong to vulnerable groups. Almost 30% of South Korean population lives in the vicinity of the coast. The area that is at the highest risk for a spill and that has the greatest number of people at risk is the stretch of coastline from Busan to Tongyeong. The most prevalent types of oil spilt in Korean waters have been crude oil and bunker-C oil, both of which have relatively high specific gravity and contain volatile organic compounds, polycyclic aromatic hydrocarbons, and metals. In the case of a spill of more than 1,000 kl, it may be necessary to evacuate vulnerable and sensitive groups. CONCLUSIONS: The government should establish environmental health planning that considers the spill amount, the types of oil, and the distance between the spot of the accident and the coast, and should assemble a response team that includes environmental health specialists to prepare for the future oil spill.

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The Decline of Health-Related Quality of Life Associated with Some Diseases in Korean Adults.: Seol Ryoung Kil, Sang Il Lee, Sung Cheol Yun, Hyung Mi An, Min Woo Jo; J Prev Med Public Health. 2008;41(6):434-441.; DOI: https://doi.org/10.3961/jpmph.2008.41.6.434

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Abstract PDF

OBJECTIVES
This study was conducted to measure the decline in the health-related quality of life (HRQoL) associated with some diseases in South Korean adults. METHODS: The EQ-5D health states in the 2005 National Health and Nutrition Examination Survey (NHNES) and the Korean EQ-5D valuation set were used to obtain the EQ-5D indexes of the study subjects. Each disease group was defined when the subjects reported to the NHNES that they were diagnosed with the corresponding disease during the previous 1 year by physicians. Since the distributions of the EQ-5D indexes in each subgroup were negatively skewed, median regression analysis was used to estimate the effects of specific diseases on the HRQoL. Median regression analysis produced estimates that approximated the median of the EQ-5D indexes and there are more robust for analyzing data with many outliers. RESULTS: A total of 16,692 subjects (6,667 patients and 10,025 people without any disease) were included in the analysis. As a result of the median regression analysis, stroke had the strongest impact on the HRQoL for both males and females, followed by osteoporosis, osteoarthritis, rheumatic arthritis, and herniation of an intervertebral disc. While asthma had a significant impact on the HRQoL only in men, cataract, temporo-mandibular dysfunction, and peptic ulcer significantly affected the HRQoL only in women. CONCLUSIONS: Stroke and musculoskeletal diseases were associated with the largest losses of the HRQoL in Korean adults.

Summary

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Cancer Registration in Korea: The Present and Furtherance.: Yoon Ok Ahn; J Prev Med Public Health. 2007;40(4):265-272.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.265

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Abstract PDF

It was not until 1975 that cancer registration was initiated in Korea; voluntary registration of cancer patients of training hospitals throughout the country began under the auspices of the Korean Cancer Society(KCS). However, an official cancer registration, the Korea Central Cancer Registry(KCCR), began on July 1st, 1980. Forty-five training and two non-training hospitals throughout the country initiated registration of patients in whom neoplasms had been found. Data related to case information specified are to be sent to the KCCR at the National Medical Center(it moved at National Cancer Center in 2000). The initial cancer registration of KCS was merged to the KCCR in 1980. Although the KCCR covers most all the large training hospitals in Korea, it cannot provide incidence data. It is, however, the only of its kind in the world, being neither hospital nor population based. The first population based cancer registry(PBCR) was launched in a small county, Kangwha(it has around 80,000 inhabitants), by Yonsei University Medical College in 1983. All data were collected by active methods, and incidence statistics for 1986-1992 appeared in Vol VII of the CI5. Another PBCR, Seoul Cancer Registry(SCR), started in 1991. It was supported by a civilian foundation, the Korean Foundation for Cancer Research. The basic idea of case registration of SCR was the incorporation of KCCR data to PBCR, e. g. dual sources of case registration, i.e., from the KCCR and also including cases diagnosed in small hospitals and other medical facilities. Assessing completeness and validity of case registration of SCR, the program and methodology used by the SCR was later extended to other large cities and areas in Korea, and the PBCR in each area was established. Cancer incidence statistics of Seoul for 1993- 1997, Busan for 1996-1997, and Daegu for 1997-1998, as well as Kangwha for 1993-1997, appeared eventually in Vol VIII of the CI5. The Korean or 'pillar' model for a PBCR is a new one. The KCCR data file is a reliable basis, as a pillar, for a PBCR in each area. The main framework of the model for such a registry is the incorporation of a KCCR data file with data from additionally surveyed cases; the data related to cancer deaths, medical insurance claims, and visit-and abstract surveillance of non-KCCR medical facilities. Cancer registration has been adopted as a national cancer control program by Korean government in 2004 as the Anti-Cancer Act was enacted. Since then, some officers have tried to launch a nation-wide PBCR covering whole country. In the meantime, however, cancer registration was interrupted and discontinued for years due to the Privacy Protection Law, which was solved by an amendment of the Anti-Cancer Act in 2006. It would be premature to establish the nation-wide PBCR in Korea. Instead, continuous efforts to improve the completeness of registration of the KCCR, to progress existing PBCRs, and to expand PBCRs over other areas are still to be devoted. The nation-wide PBCR in Korea will be established eventually with summation of the PBCRs of the Korean model.

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

Medical Expenditure of National Health Insurance Attributable to Smoking among the Korean Population.: Sang Yi Lee, Sun Ha Jee, Ji Eun Yun, Su Young Kim, Jakyung Lee, Jonathan M Samet, Il Soon Kim; J Prev Med Public Health. 2007;40(3):227-232.; DOI: https://doi.org/10.3961/jpmph.2007.40.3.227

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Abstract PDF

OBJECTIVES
The purpose of this study was to determine the population-attributable risk (PAR) and estimate the total medical expenditure of the Korean National Health Insurance (KNHI) due to smoking. METHODS: We used data from the Korean Cancer Prevention Study of 1,178,138 Koreans aged 30 to 95. These data were available from 1992 to 2003 and covered a long-term follow-up period among the Korean population. RESULTS: The total medical expenditure of KNHI related to smoking increased by 27% from $324.9 million in 1999 to $413.7 million in 2003. By specific diseases, smokingattributable KNHI medical expenditure was the highest for lung cancer ($74.2 million), followed by stroke ($65.3 million), COPD ($50.1 million), CHD ($49 million) and stomach cancer ($30 million). A total of 1.3 million KNHI patients were suffering from smoking-related diseases in 2003. We predicted rises in total KNHI medical expenditure related to smoking to $675.1 million (63% increase compared with that of 2003) and in the total number of KNHI patients suffering from smoking-related diseases to about 2.6million (an approximate 100% increase compared with those in 2003) in 2015. CONCLUSIONS: We found a substantial economic burden related to the high smoking prevalence in South Korea.

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English Abstract

Survival Rates of the 5 Major Cancers in Jeju Island Residents, 2000-2001.: Yeong Ja Yang, Jong Myon Bae; J Prev Med Public Health. 2007;40(3):213-217.; DOI: https://doi.org/10.3961/jpmph.2007.40.3.213

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OBJECTIVES
This study aimed to calculate the survival rates of cancer patients in Jeju Island residents from 2000 to 2001, based on their major primary sites of occurrence. METHODS: Data were extracted from the database of the Jejudo Cancer Registry (JCR). The eligible population comprised 2,382 cancer cases, whose cancers were diagnosed from 1 January 2000 through 31 December 2001. Of the eligible population, 1,438 patients with 5 major cancers defined by the level of incidence rates were selected as the study participants. The period of survival for each case was calculated from the date of first diagnosis to the date of death, or the end of follow-up, i.e., 31 December 2003. The observed survival rates (OSR) and relative survival rates (RSR) were calculated according to sex, age-group, and primary sites of occurrence. RESULTS: The 3-year OSR and RSR in 5 major cancers were higher in women than in men except 75 year-old over group. The 3-year RSR of stomach, colorectum, liver, and lung in both sexes were 61.0%, 62.6%, 24.7%, and 22.8%, respectively. The respective rates in JCR showed some statistically significant differences from those in the Korea Central Cancer Registry (KCCR). CONCLUSIONS: These results would suggest some clues about prognostic factors of major cancers in Korean, and could apply to planning and evaluating of cancer control strategies in Jeju Island.

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Original Articles

Awareness, Treatment, Control, and Related Factors of Hypertension in Gwacheon.: Youn Hee Choi, Chung Mo Nam, Mi Hyun Joo, Ki Tae Moon, Jee Seon Shim, Hyeon Chang Kim, Il Suh; Korean J Prev Med. 2003;36(3):263-270.

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Abstract PDF: OBJECTIVES
To identify the factors related to awareness, treatment, and control of hypertension in a Gwacheon population. METHODS: This study surveyed 1, 176 Gwacheon residents older than 40 years, and measured blood pressure using a standardized guideline in 1999. The study subjects were 473 adults (175 males, 298 females) with hypertension defined as a systolic blood pressure > or= 140 mmHg, diastolic blood pressure > or= 90 mmHg or reported treatment with antihypertensive medications. Information on awareness, treatment, and control of hypertension, and sociodemographic and health-related factors was collected through person-to-person interviews with a structured questionnaire. RESULTS: Overall, 252 (53.3%) of hypertensive subjects were aware of their condition, of whom as many as 193 (76.6%) were being treated, and 81 (42.0%) had their blood pressure controlled at the recommended level (< 140/90 mmHg). However, of the 473 subjects found to have hypertension, only 40.8% were being treated, and 17.1% were under control. There were no significant differences in the proportions of awareness, treatment, and control of hypertension. In multiple logistic regression models, awareness of hypertension was positively associated with age and family history of hypertension in females. Control of hypertension was also positively associated with having a partner and marital status in females. CONCLUSION: These findings demonstrate that much greater efforts on improving awareness, treatment, and control of hypertension are needed, even in urban community settings, considering related factors such as age, family history, and marital status. However, these factors should be further investigated for their causal relationship.; Summary

Association between Snoring and Hypertension in a Rural Population.: Hee Young Shin, Jin Su Choi, Jung Ae Rhee; Korean J Prev Med. 2001;34(3):284-290.

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Abstract PDF: OBJECTIVES
To evaluate the association of snoring and hypertension in a rural population. METHODS: A population-based sample of 1,763 adults in Chonnam, Korea was investigated with questionnaires and height, weight, and blood pressure measurements. Information on the demographic characteristics, cigarette smoking, alcohol consumption, hypertension and snoring was collected through a person-to-person interview using a structured questionnaire. The level of obesity was measured by the body mass index (BMI). Hypertension was considered to be present if the average of two blood pressure measurements was greater than 140mmHg systolic or 90mmHg diastolic, or if they were currently on antihypertensive treatments. RESULTS: The prevalence of snoring was 42.7% in men and 39.8% in women. With regard to age, snoring prevalence was 44.3% in the middle-aged group (45 to 64 years), greater than 33.9% in the younger (<45 years) group or 38.7% in the elderly(> or =65 years) group. The snoring prevalence increased progressively with increasing BMI, but cigarette smoking and alcohol consumption was not associated with snoring. Hypertension occurred more frequently in snorers than in non-snorers (Odds ratio: 1.25, 95% confidence interval = 1.01-1.55). However after adjusting for sex, age, obesity, smoking, and alcohol use, an effect of snoring on hypertension was no longer present (Odds ratio: 1.13, 95% confidence interval = 0.90-1.41). CONCLUSION: These results suggest that snoring might not be associated with hypertension.; Summary

Estimation of Attributable Burden due to Premature Death from Smoking in Korea.: Seok Jun Yoon, Beom Man Ha, Jong Won Kang, Hye Chung Chang; Korean J Prev Med. 2001;34(3):191-199.

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Abstract PDF: OBJECTIVE
In this study, we focused on estimating the burden of premature death in Korea caused by smoking using the YLL (years of life lost due to premature death) measurement. METHODS: First, we determined parameters: such as age-specific standard life expectancy, age on death, sex, and cause of death by analyzing the national death certificate data and life table collected during 1997. These were provided by the National Statistical Office. Secondly, we estimated the age group- specific years of life lost due to premature death by employing the standard expected years of life lost (SEYLL) measurement. Thirdly, the burden of premature death caused by smoking was estimated using the YLLs measurement which was developed by the global burden of disease study group. Fourthly, We calculated the risk related to smoking using the population attributable risk. RESULTS: The following results were obtained in this study:1) Premature death that is attributable to smoking in males could be prevented in 60.9% (513,582 person-year) by non-smoking.2) The burden of premature death by smoking for female was prevented to 17.7% (513,582 person-year) by non-smoking. CONCLUSION: We found that the YLL method employed in this study was appropriate in quantifying the burden of premature death. This provides a rational basis for planning a national health policy regarding premature deaths caused by smoking and other related risk factors.; Summary

a study on The Effect of The Tobacco Price Raise on The Smoking Rate and Smoking Attributable Death.: Jong Won Kang, Joung Soom Kim; Korean J Prev Med. 1997;30(4):697-707.

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Abstract PDF: This study was performed to estimate the quantity of the effects of tobacco price raise on the smoking rate, and the smoking attributable deaths in Korea. The data were collected by questionnaire survey from 538 male office workers. The questionnaire contained items on age, sex, living place, status of education, smoking history, the intention to quit smoking when the tobacco price be raised. The questionnaire were distributed to the offices of enterprises, hospitals, research centers, and public agencies and then collected. Data were analyzed by using the age specific smoking rate, relative risks of eight major smoking related diseases, vital statistics, and the population attributable risk of deaths of smoking males. On the other hand, the impact of the tobacco price raise on the population attributable risk of death due to smoking in Korea was estimated by applying the presumed smoking rate after the price raise. The results obtained were as follows: 1. The smoking rate of male white color workers in large cities was 59.5%. 2. The proportion of male smokers who has the intention to quit smoking when the tobacco price be raised was 61.5%. 3. The proportion of male smokers who has the intention to quit smoking if the price of tobacco be raised was proportional to the degree of increasing tobacco price. It is estimated that if the tobacco price were raised more than four times as now, the presumed smoking rate goes down as low as 26.7%. If the tobacco price be raised 20% each year, presumed smoking rate is 46.2%. 4. The number of attributable male death of smoking estimated by using 8 major smoking related diseases(lung cancer, laryngeal cancer, esophageal cancer, stomach cancer, pancreatic cancer, cerebrovascular disease, ischemic heart disease, chronic obstructive pulmonary disease) was 25,863 death each year. That is 20.1% of total age over 20 male deaths. 5. If the tobacco price were raised more than four times as now and all smokers who has intention to quit smoking quits smoking, 12,336 lives, or 47.7% of smoking related deaths could be saved. 6. If the actual practice rate of quitting smoking among male smokers with intention to stop smoking when the price of tobacco be raised is 10%, 25%, or 50%, then the expected decrease of death numbers when the tobacco price were raised more than four times as now can be 1,112, 3,483, 5,796 respectively.; Summary

Perspective on Population Characteristics and Health Problems of Koreans in 21st Century.: Joung Soon Kim; Korean J Prev Med. 1994;27(2):175-185.

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Abstract PDF: In order to anticipate disease pattern and health problems of Koreans in the 1st part of 21st century(by the year 2020), transition of population characteristics, mortality and morbidity data during the last 30 years Koreans have experienced were reviewed. On the actual basis of epidemiolgic transition process that has undergone during last 30 years since 1960 along with socioeconomic development and successful implementation of selective national health policies(family planning, medical insurance and etc.), following changes can be expected in the 21st century in Korea, under the assumption that the current rate of progress is maintained. The population of South Korea alone will be doubled the population of 1960 by the year 2013;aged population older than 65 years will be increased from 3.3% in 1960 to 11.4% in 2020 with increased average age of the population from 23.6 year in 1970 to 39.2 year in 2020;urban population from 28% in 1960 to 83% in 2005. GNP/capita has increased tremendously from U.S. $120 in 1970 to $6,749 in 1992, and the government estimated it would be $19,350 in 2010 and $29,460 in 2020. Growth and developmental indices of children, educational achievement and social status of women also showed a remarkable improvement and anticipated to make further progress. Leading causes of mortality and morbidity have shown a striking change during the last 30 years, from infectious diseases to chronic degenerative diseases and man-made injuries. Occurrence of communicable diseases may become minimal although viral hepatitis, venereal diseases including AIDS, and well adapted herpes virus infections will maintain their endemic level. Newly evolving infectious agents, however, should be carefully monitored because of rapidly changing environments and human behaviors. Tuberculosis may increase up to the epidemic level when AIDS prevails. Ischemic heart diseases may increase steadily with increasing occurrence of hypertension and diabetes mellitus whereas cerebrovascular diseases may be decreased slowly. Musculaskeletal diseases which contribute a lot to the disability of aged people may be a major health problems due to increased aged population. Mental diseases, particularly that caused by alcohol and drug abuse, and senile dementia may become a prominent health problem. On the other hand injuries caused by traffic and industrial accidents that have shown most striking increase till now may be decreased considerably by intensive intervention. The health policies in the 21st century will be oriented to the health promotion for good quality life rather than life-savings.; Summary

Effects of Regional Medical Insurance on Utilization of Medical Care in Urban Population.: Seok Beom Kim, Pock Soo Kang; Korean J Prev Med. 1994;27(1):117-134.

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Abstract PDF: The effects of regional medical insurance on utilization of medical care in urban population was examined in this study. The data was collected in a 2-year follow-up household survey conducted at Taegu city before and after implementation of the regional medical insurance. The study population was divided into 2 groups. Cohort I was the uninsured in 1989 and cohort II was the insured in 1989. After the coverage of medical insurance, physician visit rate per 1,000 population, use-disability ratio and use-restricted activity ratio in cohort I were increased compared to cohort II in both of acute and chronically ill people. The use-disability ratio and use-restricted activity ratio of the insured poor were lower than those of the insured nonpoor in both of cohort I and cohort II. The major reasons for pharmacy use were accessibility and affordability before the coverage of medical insurance in cohort I, however, after the coverage of medical insurance, the important reason was accessibility rather than affordabifity. In logistic regression analysis of physician visit, the significant independent variables were acute illness episode(+), chronic illness episode(+) and income(+) in both of cohort I and cohort II. In cohort I, after the coverage of medical insurance, more people replied that the medical cost of hospital and clinic was reasonable. The people who covered by the regional medical insurance were more dissatisfied with the imposed premium than those who covered by other types of medical insurance in both of cohort I and cohort II. More people in cohort II than cohort I were dissatisfied with the services from hospitals and clinics after implementation of the regional medical insurance. In conclusion. after the coverage of medical insurance, the gap between the poor and the nonpoor still exists in terms of medical care utilization.; Summary

The Projection of Medical Care Expenditure in View of Population Age Change.: Seung Hum Yu, Sang Hyuk Jung, Jeung Mo Nam, Hyohn Joo Oh; Korean J Prev Med. 1992;25(3):303-311.

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Abstract PDF: It is very important to estimate the future medical care expenditure, because medical care expenditure escalation is a big problem not only in the health industry but also in the Korean economy today. This study was designed to project the medical care expenditure in view of population age change. The data of this study were the population projection data based on National Census Data (1990) of the National Statistical Office and the Statistical Reports of the Korea Medical Insurance Corporation. The future medical care expenditure was eatimated by the regression model and the optional simulation model. The significant results are as follows; 1. The future medical care expenditure will be 3,963 billion Won in the year 2000, 4,483 billion Won in 2010, and 4,826 billion Won in 2020, based on the 1990 market price considering only the population age change. 2. The proportion of the total medical care expenditure in the elderly over 65 will be 10. 4% in 2000, 13.5% in 2010, and 16.9% in 2020. 3. The future medical care expenditure will be 4,306 billion Won in the year 2000, 5,1101 billion Won in 2010, and 5, 699 billion Won in 2020 based on the 1990 market price considering the age structure change and the change of the case-cost estimated by the regression model. 4. When we consider the age-structure change and inflation compared with the preceding year, the future medical care expenditurein 2020 will be 21 trillion Won based on a 5% inflation rate, 42 trillion Won based on a 7.5% inflation rate, and 84 trillion Won based on a 10% inflation rate. Consideration of the aged (65 years old and over)will be essential to understand the acute increase of medical care expenditure due to changes in age structure of the population. Therefore, alternative policies and programs for the caring of the aged should be further studied.; Summary

English Abstract

Epidemiology and Social Epidemiology.: Yun Mi Song; J Prev Med Public Health. 2005;38(3):237-240.

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Abstract PDF: Social epidemiology is a sub-discipline of epidemiology explicitly investigating social determinants of population distributions of health, disease, and well-being. Persistent pattern of social inequalities in health in spite of the broad improvement in the physical environment over the last centuries necessitated the development of this field as an approach to understand disease etiology that incorporates social experiences as more direct determinant of health. Social epidemiology incorporates theories, measurement tools, and techniques from a wide variety of other social sciences. A population perspective, the social context of behavior, contextual multilevel analysis, a developmental and life-course perspective, and general susceptibility to disease are the most important guiding concepts in social epidemiology.; Summary

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