Factors associated with the combination of general and abdominal obesity in middle-aged and older Korean women: a cross-sectional study

Objectives@#To identify factors associated with general and abdominal obesity in middle-aged and older Korean women based on the biopsychosocial model. @*Methods@#Data from 4,076 women aged ≥45 years who participated in the Korea National Health and Nutrition Examination Survey from 2015 to 2020 were analyzed. Complex sampling analysis was performed using IBM SPSS ver. 26.0. @*Results@#The combination of general and abdominal obesity was positively associated with age≥65 years, postmenopausal status, and without breastfeeding experience among biomedical factors; depressive symptoms and prolonged (≥8 hours a day) sedentary behavior amongpsychosocial factors; and an educational level lower than middle or high school graduation andthe first and second income quantiles among biosocial factors. @*Conclusion@#Healthcare providers in communities and public societies should screen for risk factors for the combination of general and abdominal obesity while considering non-modifiable biomedical (e.g., age) and biosocial factors (e.g., educational level). In addition, intervention strategies should be developed by considering modifiable psychosocial factors such as sedentary behavior.

Sex differences in factors associated with prediabetes in Korean adults

Objectives@#Identifying the factors associated with prediabetes is necessary for the early detection and management of high-risk individuals with prediabetes. The purpose of this study was to identify the factors associated with prediabetes according to sex in Korean adults. @*Methods@#Using the Korean National Health and Nutrition Examination Survey from 2015 to 2019, a total of 13,595 adults (5,565 males and 8,030 females) aged ≥20 years were included in the data analysis. Logistic regression analysis was performed to identify the factors associated with prediabetes according to sex in Korean adults. @*Results@#In both males and females, age and a family history of type 2 diabetes were associated with prediabetes. In males, current and past smoking habits were associated with increased prediabetes. In addition, low-intensity physical activity and prolonged sedentary behavior were associated with a higher prevalence of prediabetes. Females with a lower education level (less than middle school graduation) showed a higher risk of prediabetes. @*Conclusion@#Sex-specific prevention strategies for prediabetes should be developed. In addition, older individuals and those with a family history of type 2 diabetes should be screened for prediabetes.

Factors Associated with the Weight Bias Internalization of the Girls in Early Adolescence

Purpose@#This study aimed to identify factors (biological, psychological, interpersonal, and contextual factors) associated with the weight bias internalization of the Korean girls in early adolescence. @*Methods@#This study used a cross-sectional design. Data was collected from 233 girls aged 12~14 years with a self-reported questionnaire. With multiple regression analysis, the factors associated with the weight bias internalization of the girls in early adolescence were analyzed. @*Results@#Of psychosocial factors, fear to fat (anti-fat attitude) (β=.43, p<.001) was associated with the weight bias internalization of the girls in early adolescence. In addition, attachment with teachers (β=-.11, p=.029) of an interpersonal factor and perceived socio-cultural pressure regarding weight control (β=.34, p<.001) of a contextual factor were associated with the weight bias internalization of the girls in early adolescence. @*Conclusion@#For releasing the weight bias internalization of the girls in early adolescence, decreasing anti-fat attitude and socio-cultural pressure regarding weight control should be primarily required through social efforts including community and school based interventions.

Evaluation of a Mobile-based Maternal Feeding Education Program for Overweight Prevention in Infants

Purpose@#The purpose of this study was to evaluate a mobile-based maternal feeding education program for overweight prevention in infants based on breastfeeding attitude, breastfeeding self-efficacy, breastfeeding duration, recognition of hunger and satiety cues of infants, and knowledge regarding providing solids foods. @*Methods@#A nonequivalent control group pretest-posttest design was used for the study. Participants included 15 primiparas in the experimental group and 14 primiparas in the control group in all the follow-up tests. Using self-reported questionnaires in electronic format, data were collected four times (before the intervention, 1 month after childbirth, 3 months after childbirth, and 6 months after childbirth). Using SPSS 24 version, independent t-test and repeated-measures analysis of variance were used to test the effects of the mobile-based maternal feeding education program. @*Results@#The experimental group showed significantly more positive breastfeeding attitude (F = 5.28, p = .008), higher breastfeeding self-efficacy (F = 3.50, p = .041), and increased breastfeeding duration (t = −2.09, p = .046) than the control group. In addition, the experimental group showed significantly improved knowledge regarding providing solid foods to the infants (F = 4.86, p = .009) in comparison with the control group. However, for education on recognizing hunger and satiety cues of infants, the mobile-based maternal feeding education program was not effective (F = 0.23, p = .878). @*Conclusion@#According to the results of this study, the mobile-based maternal feeding education program has the potential to contribute to overweight prevention in infants.

Evaluation of a Mobile-based Maternal Feeding Education Program for Overweight Prevention in Infants

Purpose@#The purpose of this study was to evaluate a mobile-based maternal feeding education program for overweight prevention in infants based on breastfeeding attitude, breastfeeding self-efficacy, breastfeeding duration, recognition of hunger and satiety cues of infants, and knowledge regarding providing solids foods. @*Methods@#A nonequivalent control group pretest-posttest design was used for the study. Participants included 15 primiparas in the experimental group and 14 primiparas in the control group in all the follow-up tests. Using self-reported questionnaires in electronic format, data were collected four times (before the intervention, 1 month after childbirth, 3 months after childbirth, and 6 months after childbirth). Using SPSS 24 version, independent t-test and repeated-measures analysis of variance were used to test the effects of the mobile-based maternal feeding education program. @*Results@#The experimental group showed significantly more positive breastfeeding attitude (F = 5.28, p = .008), higher breastfeeding self-efficacy (F = 3.50, p = .041), and increased breastfeeding duration (t = −2.09, p = .046) than the control group. In addition, the experimental group showed significantly improved knowledge regarding providing solid foods to the infants (F = 4.86, p = .009) in comparison with the control group. However, for education on recognizing hunger and satiety cues of infants, the mobile-based maternal feeding education program was not effective (F = 0.23, p = .878). @*Conclusion@#According to the results of this study, the mobile-based maternal feeding education program has the potential to contribute to overweight prevention in infants.

Psychosocial Factors Associated with Smoking Cessation Attempts in Korean High School Students Who Engage in Intermittent and Light Smoking

Purpose@#This study aimed to identify psychosocial factors associated with smoking cessation attempts among Korean high school students who engage in intermittent and light smoking. @*Methods@#Cross-sectional secondary data derived from the 2018 Korea Youth Risk Behavior Web-Based Survey were analyzed within the framework of the biopsychosocial model. The sample comprised 829 high school students who reported current intermittent and light smoking, which was defined as cigarette smoking on 1~29 days in a 30-day period and no more than 10 cigarettes per day. Purposeful selection logistic regression analysis was performed. @*Results@#In total, 71.7% (n=586) of the respondents had tried to stop smoking during the past 12 months. The main result was that respondents who had viewed an anti-smoking advertisement in the past year significantly more smoking cessation attempts than those who had not (adjusted odds ratio=2.59; 95% confidence interval=1.45~4.62, p=.001). @*Conclusion@#To encourage smoking cessation attempts among high school students who engage in intermittent and light smoking, healthcare providers, including school and community nurses, should develop effective interventions using anti-smoking advertisements tailored to adolescents’ interests and developmental stage.

Factors Associated with Pressure to Eat as a Feeding Practice among Mothers with Infants

Purpose@#This study aimed to identify factors-both infant-related and maternal-associated with pressure to eat as a feeding practice among mothers with infants. @*Methods@#This study used a cross-sectional design and included 163 mothers of infants aged 2~12 months. Of the 180 self-reported questionnaires that were distributed, 163 (91%) were included in the data analysis. Multiple regression analysis was used to identify the factors associated with pressure to eat as a feeding practice among the mothers. @*Results@#Infant’s temperament (β=-.17, p=.035), mother’s body mass index (β=-.16, p=.048), and concern about the infant being underweight (β=.30, p=.001) were associated with pressure to eat as a feeding practice among mothers. The explanatory power of these variables in the predictive model was 19.2%. @*Conclusion@#Educational programs should be developed for improving mother’s awareness of cues from infants with difficult temperament. In addition, educational interventions regarding the correct evaluation of infant’s weight are needed to relieve mother’s concern about their infant’s being underweight. These interventions might be helpful to reduce the prevalence of pressure to eat as a feeding practice among mothers with infants.

Risk Factors in Early Life for Preschool Children in Korea that are Associated with Being Overweight or Obese

ObjectivesThe present study addressed the risk factors in early life for Korean preschool children that are associated with being overweight or obese.MethodsA descriptive cross-sectional design was used to conduct this study, which included 507 mothers with preschool children aged 3–5 years, who attended daycare centers. Data were acquired via a self-administered questionnaire completed by the mothers. Of the 650 questionnaires that were distributed, 507 (78%) were completed and sent back. Multivariate logistic regression analyses were used to identify risk factors in early life, which may contribute to being overweight or obese in preschool children.ResultsFifty-eight (11.4%) preschool children were overweight and 41 (8.1%) were obese. Multivariate logistic regression analysis with adjustment for covariates, revealed a significant association with the introduction of solid foods before 4 months of age [adjusted odds ratio (aOR) = 9.49, p = 0.029] and a nonresponsive feeding style (aOR = 2.80, p = 0.043) with being overweight or obese in preschool children.ConclusionThe findings of this study highlighted the need for parenting education programs on feeding practices to increase their understanding of hunger and satiety cues in infants, and appropriate timing for the introduction of solid foods.

Beneficial Effects of Breastfeeding on the Prevention of Metabolic Syndrome Among Postmenopausal Women

Purpose@#This study aims to determine whether breastfeeding may have any beneficial effects onmetabolic syndrome in a cohort of postmenopausal Korean women. @*Methods@#A cross-sectional study with secondary data analysis was conducted using the cohort in theKorean Genome and Epidemiology Study. Data from 1,983 postmenopausal women were analyzed bylogistic regression analysis. Controlled covariates were chosen based on a biopsychosocial model andincluded age, family history of hypertension; type 2 diabetes mellitus; and cerebro-cardiovascular diseases,body mass index, age of menarche, parity, socioeconomic status of family, educational level, past orcurrent smoking experience, and current alcohol consumption experience. @*Results@#Breastfeeding experience and duration were not significantly associated with a decreasedlikelihood of metabolic syndrome among postmenopausal women. However, breastfeeding experience(adjusted odds ratio [AOR]: 0.52 [p= .010]) and a total duration of breastfeeding exceeding3 months were significantly associated with decreased likelihood of abdominal obesity (3and < 6 months: AOR: 0.49 [p= .014]; 6 and < 12 months: AOR: 0.51 [p= .009]; <12 months: AOR:0.56 [p= .024]). @*Conclusion@#Our findings indicate that breastfeeding might have beneficial effects on reducing abdominalobesity in postmenopausal women. Health-care providers should publicize beneficial long-term effectsof breastfeeding on the prevention of abdominal obesity, a component of metabolic syndrome.

Beneficial Effects of Breastfeeding on the Prevention of Metabolic Syndrome Among Postmenopausal Women

Purpose@#This study aims to determine whether breastfeeding may have any beneficial effects onmetabolic syndrome in a cohort of postmenopausal Korean women. @*Methods@#A cross-sectional study with secondary data analysis was conducted using the cohort in theKorean Genome and Epidemiology Study. Data from 1,983 postmenopausal women were analyzed bylogistic regression analysis. Controlled covariates were chosen based on a biopsychosocial model andincluded age, family history of hypertension; type 2 diabetes mellitus; and cerebro-cardiovascular diseases,body mass index, age of menarche, parity, socioeconomic status of family, educational level, past orcurrent smoking experience, and current alcohol consumption experience. @*Results@#Breastfeeding experience and duration were not significantly associated with a decreasedlikelihood of metabolic syndrome among postmenopausal women. However, breastfeeding experience(adjusted odds ratio [AOR]: 0.52 [p= .010]) and a total duration of breastfeeding exceeding3 months were significantly associated with decreased likelihood of abdominal obesity (3and < 6 months: AOR: 0.49 [p= .014]; 6 and < 12 months: AOR: 0.51 [p= .009]; <12 months: AOR:0.56 [p= .024]). @*Conclusion@#Our findings indicate that breastfeeding might have beneficial effects on reducing abdominalobesity in postmenopausal women. Health-care providers should publicize beneficial long-term effectsof breastfeeding on the prevention of abdominal obesity, a component of metabolic syndrome.

A Comparative Study of the Importance and Satisfaction of Emergency Room Patient-nurse Communication Needs / 의료커뮤니케이션

BACKGROUND: The purpose of this study was to identify and compare perception of importance and satisfaction regarding communication needs among patients and nurses in emergency centers.METHODS: This study used a cross sectional design and included 64 of patients and 37 of nurses in emergency centers of university hospitals located in Daejeon. Data were collected with a self-administered questionnaire between April 2017 and June in 2017. Data analysis was conducted using descriptive statistics.RESULTS: Regarding importance of communication needs, both groups of the patients and the nurses significantly recognized the importance of providing information such as performed tests and treatments and visiting time of charged physicians. Meanwhile, emotional supports and concern about social or cultural needs was recognized as less important communication needs among the patients and nurses. Regarding satisfaction of communication needs, patients were less satisfied with the needs they regarded as the most important and nurses showed moderate levels of satisfaction. This indicates that patients and nurses differ in the standards and expectations for communication performance.CONCLUSION: It is important that emergency room nurses should recognize the current situation in which the patients' desired communication needs are not being met and they should start to focus improvement effort and new directions of emergency room care systems to meet the communication needs.

Association between Maternal Feeding Practices and Excessive Weight Gain in Infants

PURPOSE: The purpose of this study is to identify the association between maternal feeding practices and excessive weight gain in infants. METHODS: This study adopted a cross-sectional design and included 240 pairs of mothers and their infants (129 boys and 111 girls) in public healthcare centers in the Daejeon area in South Korea. Via multivariate analyses, the association between maternal feeding practices and excessive weight gain in infants was identified. RESULTS: Among 240 infants in this study, 39 (16.3%) infants gained excessive weight during 12 months after birth. Using multivariate logistic regression with adjustment for covariates, more than 7 months of exclusive breastfeeding was associated with a reduced likelihood of excessive weight gain in infants during the 12 months after birth (adjusted odds ratio: 0.39, 95% confidence interval: 0.02~0.81, p=.029). CONCLUSION: Based on these results, nurses in communities and clinics should educate mothers on the importance of longer durations of exclusive breast feeding and develop strategies for encouraging such behavior. Furthermore, support for exclusive breast feeding should be provided in various settings.

Associated Factors of Ischemic Heart Disease Identified Among Post-Menopausal Women

OBJECTIVES: This study identifies associated factors of ischemic heart disease (IHD) among post-menopausal Korean women at the biomedical (age, family history of hypertension, dyslipidemia, type 2 diabetes mellitus, or cerebro-cardiovascular disease, body mass index, and metabolic syndrome), biosocial (socioeconomic status and educational level), and psychosocial levels (stress, depression, smoking, binge alcohol consumption, and physical activity). METHODS: This study used a cross-sectional design with secondary data analysis of the 2013–2016 Korean National Health and Nutrition Examination Survey. Data from 3,636 women were analyzed by logistic regression analysis using a complex sample procedure. RESULTS: Of the biomedical factors, older age [odds ratio (OR): 2.99, 95% confidence interval (CI): 1.87–4.80, p < 0.001], family history (OR: 2.29, 95% CI: 1.44–3.65, p = 0.001), and metabolic syndrome (OR: 1.93, 95% CI: 1.27–2.95, p = 0.002) were associated with IHD in post-menopausal women. Of the psychosocial factors, depression (OR: 2.56, 95% CI: 1.66–3.96, p < 0.001) and smoking (OR: 1.92, CI: 1.04–3.55, p = 0.038) were associated with IHD in post-menopausal women. CONCLUSION: These findings suggest that healthcare providers need to consider the contributing adverse effects of older age, family history, metabolic syndrome, depression and smoking when evaluating risk factors for IHD in post-menopausal women.

Factors associated with Intermittent and Light Smoking among Korean High School Students: Intermittent and Light Smoking among Korean Adolescents

PURPOSE: The purpose of this study was to identify factors associated with intermittent and light smoking among Korean high school students. METHODS: In this cross-sectional study, we employed secondary data from the 2015 Korea Youth Risk Behavior Web-Based Survey, and used the biopsychosocial model as a framework. The analysis was performed using the data of 2,851 high school students who smoked. We defined intermittent and light smoking as smoking on 1 to 29 days in a 30-day period and no more than 10 cigarettes per day. A logistic regression analysis using the complex samples procedure was conducted. RESULTS: Among all the participants, 1,231 (43.2%) were intermittent and light smokers. Factors significantly predicting intermittent and light smoking were gender and grade (biological factors); subjective stress (psychological factor); and mother's smoking, sibling's smoking and academic achievement (sociocultural factors). CONCLUSION: In smoking cessation programs, health care providers both at school and in the community should consider the unique biological, psychological, and sociocultural characteristics of intermittent and light smoking behavior among high school students.

Gender Differences in the Effects of Weight, Weight Perception, and Weight Satisfaction on Depression in Adolescents

PURPOSE: This study aims to investigate gender differences in the association between depressive symptoms and weight, weight perception, and body satisfaction among Korean adolescents. METHODS: A secondary data analysis was performed on data from 33,374 adolescents who participated in the 2015 Adolescent Health Behavior Online Survey. They were classified as underweight, normal weight, or overweight/obese; weight perception was classified into perception of being underweight, normal weight, or overweight/obese; and weight satisfaction into desire to gain weight, satisfied, and desire to lose weight. RESULTS: Among boys, perception of being underweight (adjusted odds ratio [AOR]: 1.20, 95% confidence interval [CI]: 1.07~1.35) and desire to gain weight (AOR: 1.45, 95% CI: 1.30~1.62) were associated with depression. Among girls, perception of being overweight or obese (AOR: 1.18, 95% CI: 1.07~1.29) and a desire to lose weight (AOR: 1.30, 95% CI: 1.18~1.42) were associated with depression. CONCLUSION: Gender differences were observed in the association between weight perception and depression in adolescents. The perception of being underweight among boys and the perception of being overweight/overweight among girls were associated with depression. Thus, gender-specific intervention programs to correct weight perception and weight satisfaction are needed in order to relieve depressive symptoms in adolescents.

Sex-based Association between Depression and Metabolic Syndrome in Korean Middle-aged and Older Adults

OBJECTIVES: This study aimed to identify the sex-based association between depression and the development of metabolic syndrome (Mets) among middle-aged and older Korean adults. METHODS: A cross-sectional design was used for the secondary analysis of the 2010–2014 Korean National Health and Nutrition Examination Survey. Data from 1,938 men and 2,404 women were analyzed. Mets was defined in accordance with the criteria used for clinical diagnosis. Depression was assessed with a question about having clinical depression. The association between depression and the development of Mets with or without adjustment for covariates was identified by conducting logistic regression analysis on weighted data using a complex sample procedure. RESULTS: More women than men had depression. Before covariate adjustment, depression was significantly associated with the development of Mets among women (odds ratio [OR], 1.586; 95% confidence interval [CI], 1.152–2.183) and with a higher triglyceride level among men (OR, 1.679; 95% CI, 1.001–2.818). After covariate adjustment; depression was significantly associated with higher waist circumference among women (adjusted OR [AOR], 1.532; 95% CI, 1.046–2.245) and higher triglyceride level (AOR, 1.511; 95% CI, 1.029–2.219) than was Mets. Conversely, depression did not have significant effects on the development of Mets among men. CONCLUSION: Depression was associated with the development of Mets among middle-aged and older Korean women. Healthcare providers in communities should assess women with depression for the presence of Mets components. Interventions for relieving depressive symptoms should also be provided to women at risk for Mets.

Maternal Perception of Children's Weight, Maternal Body Shape Satisfaction, and Maternal Feeding Styles in Preschool-Aged Children

PURPOSE: The purpose of this study was to explore the correlates of maternal perception (identification and satisfaction) of children's weight, maternal body shape satisfaction, and maternal feeding styles in Korean preschool-aged children. METHODS: A cross-sectional survey design was utilized. Participants consisted of 287 pairs of preschool-aged children (3-6 years) and their mothers. Data were analyzed by chi2-test, Fisher's exact test, ANOVA, and the Pearson correlation coefficient. RESULTS: Among the 287 mothers, 47.7% underestimated their children's weight, while 15.7% overestimated it. 46.7% of the mothers wished their children weighed more, while 11.1% of them wished their children weighed less. The mean score of maternal body shape satisfaction was 83.75+/-28.77. The mean score of parent-centered feeding styles was 2.95+/-0.54, and the mean score of child-centered feeding styles was 3.33+/-0.42. There were statistically significant correlations between maternal identification of children's weight and children's body mass index (BMI) (r=-.366, p<.001). In addition, there were statistically significant correlations between maternal satisfaction of children's weight and children's BMI (r=-.484, p<.001), maternal BMI (r=-.126, p=.033), and maternal body shape satisfaction (r=-.127, p=.031). CONCLUSION: The results of the study suggest that intervention programs for mothers to develop more accurate perception of their child's weight should be established.

Factors Influencing Maternal Support for Physical Activity of Preschool Children

PURPOSE: The purpose of this study was to explore maternal physical activity support for preschool children. METHODS: Survey methodology using a self-administered questionnaire was employed. Mothers with preschool children from a daycare center in Daejeon participated in the study. One hundred and fifty-six questionnaires were analyzed. RESULTS: Mothers with preschool children showed a moderate level of physical activity support for their children. Significant factors affecting physical activity support of mothers were monthly household income (beta=.417, p=.002), maternal self-efficacy for physical activity support (beta=.231, p=.003), information for physical activity support (beta=.173, p=.022), and experience of education about physical activity support (beta=.237, p=.002). These variables explained 26.4% of the variance in physical activity support (F=7.628, p<.001). CONCLUSION: To improve maternal support for increasing physical activity of preschool children, maternal education and appropriate information should be provided to improve self-efficacy for physical activity support.

Breastfeeding Knowledge, Attitude, and Nursing Practice of Nurses in Neonatal Intensive Care Units

PURPOSE: The purpose of this study was to describe breastfeeding knowledge, attitude and nursing practice of neonatal intensive care unit (NICU) nurses. METHODS: Survey methodology using a self administered questionnaire was employed as the research design. A total of 153 questionnaires from 7 university hospital NICUs in Seoul, Daejeon, and Daegu were used for data analysis. RESULTS: The percentage of correct answers on the breastfeeding knowledge questions for the NICU nurses was 59.3%. The nurses in NICU reported a somewhat positive attitude to breastfeeding, mean per item 3.70+/-0.41 on a scale of 5 points. Their breastfeeding nursing practice was at a moderate level, mean per item, 3.26+/-0.74. Breastfeeding knowledge had significant correlations with breastfeeding attitude (r=.554, p<.001) and nursing practice (r=.203, p=.002). Also, There was a significant correlation between breastfeeding attitude and nursing practice (r=.243, p=.002). CONCLUSION: These results suggest that breastfeeding educational programs and strategies for NICU nurses should be developed to increase their breastfeeding knowledge, attitude, and nursing practice.

Development and Evaluation of a Video Discharge Education Program focusing on Mother-infant Interaction for Mothers of Premature Infants

PURPOSE: This study was done to develop a video discharge education program focusing on mother-infant interaction to facilitate the development of maternal role confidence for mothers of premature infants. METHODS: The process of the program was based on the Network-based Instructional System Design suggested by Jung (1999). For the content of the program, needs and concerns of mothers of premature infants found on web sites and existing literature were analyzed. Based on this content, the scenario and the video were developed. Nurses and mothers of premature infants participated in the process of testing the content validity, scenario development, and evaluation of final video production. The final video has two parts and lasts 21 minutes. The first part focuses on mother-premature infant interaction and the second part focuses on health management of infants. RESULTS: Eleven mothers of premature infants participated in the evaluation of the appropriateness of the video as a teaching method and for educational content. They reported that the content on mother-infant interaction, maternal sensitivity, and maternal role confidence was especially beneficial. CONCLUSION: The findings indicate that video program is effective for education on maternal-premature infant interaction and the use of video in practical settings is strongly recommended.