Is Nonstandard Employment Hazardous to Workers' Health Status?A Focus on Special Employment in South Korea

Purpose@#Workers in special employment relationship (WSERs) are workers in nonstandard employment arrangements who lack worker protection accorded in standard employment arrangements. This study aimed to describe self-rated health (SRH) and depressive symptoms (DS) among Korean WSERs in comparison to regular wage workers (RWW) and identify associations between working conditions and those outcomes. @*Methods@#In this study, secondary data analysis using the 5th Korean Working Conditions Survey was used. The sample totaled 29,120, including 1,538 WSERs and 27,564 RWWs. Sociodemographic and work-related characteristics were employed as explanatory variables and SRH and DS as dependent variables. Using multiple logistic regression, the determinants of fair/poor SRH and DS were identified. @*Results@#The prevalence rates for fair/poor SRH and DS in WSERs were 25.2% and 28.3%, respectively, and 20.7% and 25.0% in RWWs, respectively. Compared to RWWs, WSERs had 31% (aOR=1.31, 95% CI=1.14~1.49) and 20% (aOR=1.20, 95% CI=1.06~1.36) higher odds of SRH and DS, respectively.Some factors, such as a lack of rest guarantee and sickness presenteeism, had a larger influence in the WSER than in the RWW group. @*Conclusion@#Compared to RWWs, WSERs reported having poorer working conditions and were more likely to report poor general and mental health. Therefore, in Korea, public health policymakers should consider measures to protect the working conditions and health of WSERs, a growing segment of the working population. The study produced new epidemiological evidence regarding the relationships between employment arrangements and health.

Multilevel Effects of Community Capacity on Active Aging in Community-Dwelling Older Adults in South Korea

Purpose@#This study aimed at identifying the level of active aging in older adults and the influence of the individual and community levels of community capacity on active aging. @*Methods@#A cross-sectional survey was conducted on a stratified sample of 380 older adults living in 35 neighborhoods of five regions in Seoul, the capital of South Korea. The structured questionnaire included the Korean version of instruments that measure active aging and community capacity at the individual level. Secondary data including metropolitan statistical information, a public data portal, and a city plan were used to acquire community-capacity factors at the community level. Data were analyzed with multilevel models. @*Results@#The overall active aging mean score was 3.00 ± 0.55 out of 5; the highest mean score was in the security domain (3.46 ± 0.65) and the lowest one was in the participation domain (2.71 ± 0.66). Individual factors associated with active aging included age, education, income, and community capacity at the individual level. At the community level, two community-capacity factors (senior leisure welfare facilities and cooperative unions) were significantly associated with active aging. In active aging, 6.4% and 4.1% of total variance could be explained by 35 neighborhoods, after considering individual and community level variables, respectively. @*Conclusion@#This study showed that community capacity is important for active aging among older adults. Appropriate strategies that consider both individual and community factors, such as contextual indicators of community capacity, are necessary to improve active aging.

Is Nonstandard Employment Hazardous to Workers' Health Status?A Focus on Special Employment in South Korea

Purpose@#Workers in special employment relationship (WSERs) are workers in nonstandard employment arrangements who lack worker protection accorded in standard employment arrangements. This study aimed to describe self-rated health (SRH) and depressive symptoms (DS) among Korean WSERs in comparison to regular wage workers (RWW) and identify associations between working conditions and those outcomes. @*Methods@#In this study, secondary data analysis using the 5th Korean Working Conditions Survey was used. The sample totaled 29,120, including 1,538 WSERs and 27,564 RWWs. Sociodemographic and work-related characteristics were employed as explanatory variables and SRH and DS as dependent variables. Using multiple logistic regression, the determinants of fair/poor SRH and DS were identified. @*Results@#The prevalence rates for fair/poor SRH and DS in WSERs were 25.2% and 28.3%, respectively, and 20.7% and 25.0% in RWWs, respectively. Compared to RWWs, WSERs had 31% (aOR=1.31, 95% CI=1.14~1.49) and 20% (aOR=1.20, 95% CI=1.06~1.36) higher odds of SRH and DS, respectively.Some factors, such as a lack of rest guarantee and sickness presenteeism, had a larger influence in the WSER than in the RWW group. @*Conclusion@#Compared to RWWs, WSERs reported having poorer working conditions and were more likely to report poor general and mental health. Therefore, in Korea, public health policymakers should consider measures to protect the working conditions and health of WSERs, a growing segment of the working population. The study produced new epidemiological evidence regarding the relationships between employment arrangements and health.

Multilevel Effects of Community Capacity on Active Aging in Community-Dwelling Older Adults in South Korea

Purpose@#This study aimed at identifying the level of active aging in older adults and the influence of the individual and community levels of community capacity on active aging. @*Methods@#A cross-sectional survey was conducted on a stratified sample of 380 older adults living in 35 neighborhoods of five regions in Seoul, the capital of South Korea. The structured questionnaire included the Korean version of instruments that measure active aging and community capacity at the individual level. Secondary data including metropolitan statistical information, a public data portal, and a city plan were used to acquire community-capacity factors at the community level. Data were analyzed with multilevel models. @*Results@#The overall active aging mean score was 3.00 ± 0.55 out of 5; the highest mean score was in the security domain (3.46 ± 0.65) and the lowest one was in the participation domain (2.71 ± 0.66). Individual factors associated with active aging included age, education, income, and community capacity at the individual level. At the community level, two community-capacity factors (senior leisure welfare facilities and cooperative unions) were significantly associated with active aging. In active aging, 6.4% and 4.1% of total variance could be explained by 35 neighborhoods, after considering individual and community level variables, respectively. @*Conclusion@#This study showed that community capacity is important for active aging among older adults. Appropriate strategies that consider both individual and community factors, such as contextual indicators of community capacity, are necessary to improve active aging.

Factors Influencing the Initiation of Treatment after the Diagnosis of Korean Patients with HIV

PURPOSE: This study has been conducted to identify factors that influence the initiation of treatment after the diagnosis of Korean patients with HIV. METHODS: A cross-sectional study design was used, and 290 patients with HIV from outpatient departments of 7 hospitals participated. Self-report questionnaires included items on the days from the primary diagnosis to the initiation of treatment, and the patients' demographic and disease related characteristics. Negative binomial regression model (NBR) was utilized to determine risk factors influencing the initiation of treatment after the diagnosis of the patients with HIV. RESULTS: The skewness of days was 6.62, and the degree of asymmetry of distribution was severe. In NBR, patients who were in their 40s and 50s, female, unmarried and living with their family, jobless, in a middle or high level of economic status, and diagnosed before 2014 showed a higher risk of delayed treatment than patients who were younger, male, married and living with family, in a low level of economic status, and diagnosed in 2014 or afterwards. CONCLUSION: The findings suggest the necessity of intervention to promote HIV patients' early entry into treatment based on the participants' characteristics.

Births to Parents with Asian Origins in the United States, 1992–2012

Despite a remarkable increase in Asian births in the U.S., studies on their birth outcomes have been lacking. We investigated outcomes of births to Asian parents and biracial Asian/White parents in the U.S. From the U.S. birth data (1992–2012), we selected singleton births to Korean, Chinese, Japanese, Filipino, Asian Indian, and Vietnamese. These births were divided into three groups; births to White mother/Asian father, Asian mother/White father, and births to the both ethnic Asian parents. We compared birth outcomes of these 18 subgroups to those of the White mother/White father group. Mean birthweights of births to the Asian parents were significantly lower, ranging 18 g to 295 g less than to the White parents. Compared to the rates of low birthweight (LBW) (4.6%) and preterm birth (PTB) (8.5%) in births to the White parents, births to Filipino parents had the highest rates of LBW (8.0%) and PTB (11.3%), respectively, and births to Korean parents had the lowest rates of both LBW (3.7%) and PTB (5.5%). This pattern of outcomes had changed little with adjustments of maternal sociodemographic and health factors. This observation was similarly noted also in births to the biracial parents, but the impact of paternal or maternal race on birth outcome was different by race/ethnicity. Compared to births to White parents, birth outcomes from the Asian parents or biracial Asian/White parents differed depending on the ethnic origin of Asian parents. The race/ethnicity was the strongest factor for this difference while other parental characteristics hardly explained this difference.

Neonatal and Infant Mortality in Korea, Japan, and the U.S.: Effect of Birth Weight Distribution and Birth Weight-Specific Mortality Rates

Difference in crude neonatal and infant mortality rates (NMR and IMR) among different countries is due to the differences in its two determinants: birth weight distribution (BWD) and birth weight-specific mortality rates (BW-SMRs). We aimed to determine impact of BWD and BW-SMRs on differences in crude NMR and IMR among Korea, Japan, and the U.S. Our study used the live birth data of the period 2009 through 2010. Crude NMR/IMR are the lowest in Japan, 1.1/2.1, compared to 1.8/3.2, in Korea, and 4.1/6.2, in the U.S., respectively. Japanese had the best BW-SMRs of all birth weight groups compared to the Koreans and the U.S. The U.S. BWD was unfavorable with very low birth weight (< 1,500 g) rate of 1.4%, compared to 0.6% in Korea, and 0.8% in Japan. If Koreans and Japanese had the same BWD as in the U.S., their crude NMR/IMR would be 3.9/6.1 for the Koreans and 1.5/2.5 for the Japanese. If both Koreans and Japanese had the same BW-SMRs as in the U.S., the crude NMR/IMR would be 2.0/3.8 for the Koreans and 2.7/5.0 for the Japanese. In conclusion, compared to the U.S., lower crude NMR or IMR in Japan is mainly attributable to its better BW-SMRs. Koreans had lower crude NMR and IMR, primarily from its favorable BWD. Comparing crude NMR or IMR among different countries should include further exploration of its two determinants, BW-SMRs reflecting medical care, and BWD reflecting socio-demographic conditions.

Psychometric Properties of Korean Version of Self-Efficacy of Evidence-Based Practice Scale

PURPOSE: This study is to evaluate the psychometric properties of the Korean version of the Self-Efficacy of Evidence-Based Practice (SE-EBP) scale, which was originally developed by Chang and Crowe. The beta-version of the SE-EBP is a modified version of the original SE-EBP, which measures the clinical nurses' confidence in finding, appraising, and implementing evidence into practice. Although the original SE-EBP has been validated, no study has been conducted to validate the Korean version of SE-EBP. METHODS: The original scale was translated into Korean through a process of forward and back translation of the original scale. After getting confirmation of the equivalence of the Korean forward translation by the original author, exploratory factor analysis and confirmatory factor analysis of data from 212 clinical nurses were used to test construct validity. Internal consistency was examined using Cronbach α coefficients. For the statistical analysis, STATA version 13.0 software program was used. RESULTS: Exploratory factor analysis of the 28 items revealed three factors with eigenvalues above 1, accounting for 60.2% of the total variance. Confirmatory factor analysis showed good fit of the three-factor structure which was statistically significant (χ2 = 718.61, df = 330, p < .01). For internal consistency, Cronbach a coefficient for the total scalewas .95, and itwas greater than .80 for each of the three subscales. CONCLUSIONS: The Korean version of SE-EBP scale showed evidence of adequate construct validity and reliability. This study might have contributed to a wider application of the SE-EBP scale, but further studies are needed to provide more evidence on the structure of the scale.

Psychometric Properties of the Korean Version of the HIV Self-Management Scale in Patients with HIV

PURPOSE: The purpose of this study was to examine validity and reliability of Webel and colleagues' HIV Self-Management Scale when used with a Korean sample. METHODS: The original 20-item HIV Self-Management Scale was translated into Korean using translation and back-translation. Nine HIV nurse experts tested content validity. Principal component analysis (PCA) and confirmatory factor analysis (CFA) of data from 203 patients was used to test construct validity. Concurrent validity was evaluated using correlation with patients' self-rating as a "smart patient" measured using a visual analogue scale. Internal consistency was tested by Cronbach's alpha coefficients. RESULTS: All items were rated as having satisfactory content validity. Based on PCA and consideration of conceptual meaning, a three-factor solution was selected, explaining 48.76% of the variance. CFA demonstrated the adequacy of the three-domain structure of the construct HIV self-management: daily self-management health practices, social support and HIV self-management, and chronic nature of HIV self-management. Goodness-of-fit indices showed an acceptable fit overall with the full model (chi2/ df(164)=1.66, RMSEA=0.06, SRMR=0.05, TLI=0.91, and CFI=0.92). The Korean version of the HIV Self-Management Scale (KHSMS) was significantly correlated with patients' self-rated smart patient (r=.41). The subscale Cronbach's alpha coefficients ranged from .78 to .81; alpha for the total scale was .89. CONCLUSION: The KHSMS provides a valid and reliable measure of self-management in Korean patients with HIV. Continued psychometric testing is recommended to provide further evidence of validity with this population.

Validation of Yoon's Critical Thinking Disposition Instrument

PURPOSE: The lack of reliable and valid evaluation tools targeting Korean nursing students' critical thinking (CT) abilities has been reported as one of the barriers to instructing and evaluating students in undergraduate programs. Yoon's Critical Thinking Disposition (YCTD) instrument was developed for Korean nursing students, but few studies have assessed its validity. This study aimed to validate the YCTD. Specifically, the YCTD was assessed to identify its cross-sectional and longitudinal measurement invariance. METHODS: This was a validation study in which a cross-sectional and longitudinal (prenursing and postnursing practicum) survey was used to validate the YCTD using 345 nursing students at three universities in Seoul, Korea. The participants' CT abilities were assessed using the YCTD before and after completing an established pediatric nursing practicum. The validity of the YCTD was estimated and then group invariance test using multigroup confirmatory factor analysis was performed to confirm the measurement compatibility of multigroups. RESULTS: A test of the seven-factor model showed that the YCTD demonstrated good construct validity. Multigroup confirmatory factor analysis findings for the measurement invariance suggested that this model structure demonstrated strong invariance between groups (i.e., configural, factor loading, and intercept combined) but weak invariance within a group (i.e., configural and factor loading combined). CONCLUSIONS: In general, traditional methods for assessing instrument validity have been less than thorough. In this study, multigroup confirmatory factor analysis using cross-sectional and longitudinal measurement data allowed validation of the YCTD. This study concluded that the YCTD can be used for evaluating Korean nursing students' CT abilities.

Comparison of Neonatal and Infant Mortality Rates between Infants Born in South Korea and Those Born in the United States

PURPOSE: The neonatal (NMR) or infant mortality rate (IMR) in South Korea is lower than that in the United States. We aimed to investigate the contributing factors to this difference in mortality rates. METHODS: The study populations consisted of five groups, namely group A, comprising live births in South Korea during 2009-2011 (n=1,383,806), and groups B (live births to Korean parents, n=107,309), C (Caucasian births, n=31,588,183), D (African-origin, n=4,381,664), and E (all live births, n=49,384,187) comprising various US live births during 2000-2011. Maternal characteristics, birth outcomes, and mortality rates in these five groups were compared according to birth weight (BW) and gestational age (GA). RESULTS: Maternal characteristics such as BW distribution and very low and low BW rates among infants in South Korea and those in the United States were quite similar. Both rates were significantly lower among the Korean live births than among Caucasian and African-origin live births in the United States. However, the mortality rates of these small birth weight groups were significantly higher in the Korean infants born in South Korea than in those born in the United States, or in Caucasian and African-origin infants born in the United States. Similar results were noted when analyzed according to gestational age. CONCLUSIONS: The NMR or IMR in South Korea is lower than that in the United States, primarily due to the overwhelming favorable BW and GA distribution, despite the lower BW- and GA-specific survival rates in the live births in South Korea than in the United States.

Factors Associated with Colorectal Cancer Screening of Blue-Color Workers

PURPOSE: Even though the incidence of colorectal cancer (CRC) has increased in Korea, the colorectal cancer screening (CRCS) is lower than that of other cancer screenings. The purpose of this study was to identify CRCS rate and to predict factors in blue-color workers. METHODS: A descriptive survey design was employed. Data were collected with 327 workers, recruited from 32 companies, aged 40 and over using questionnaire from August 2010 to January 2011. Collected information included CRCS, demographic characteristics, job characteristics, health behaviors, and interpersonal relationship. The definition of CRCS included fecal occult blood test (FOBT), colonoscopy, or double contrast barium enema (DCBE). RESULTS: Among 94 workers receiving CRCS, workers having FOBT were 37, colonoscopy were 28, and DCBE was 6 in the past. Workers who aged over 50 (OR=2.30, 95% CI=1.11-4.77), middle school educated (OR=0.30, 95% CI=0.14-0.65), less working hours (OR=0.98, 95% CI=0.96-0.99), and had family members who carried out regular cancer screening (OR=1.89, 95% CI=1.01-3.55) were more likely to perform CRCS. CONCLUSION: The findings suggest that the information and notice about CRCS to increase screening uptake, providing the accessible screening method, and involving company administrators or health managers might be useful to increase the CRCS rate in workers.

Erratum: Factors Associated with Colorectal Cancer Screening of Blue-Color Workers

This erratum is being published to correct the error in author information on page 166.

Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea

PURPOSE: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. METHODS: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. RESULTS: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. CONCLUSION: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

Individual and Environmental Factors Influencing Questionable Development among Low-income Children: Differential Impact during Infancy versus Early Childhood

PURPOSE: From the holistic environmental perspective, individual and environmental influences on low-income children's questionable development were identified and examined as to differences in the influences according to the child's developmental stage of infancy (age 0-35 months) or early childhood (age 36-71 months). METHODS: This study was a cross-sectional comparative design using negative binominal regression analysis to identify predictors of questionable development separately for each developmental stage. The sample was comprised of 952 children (357 in infancy and 495 in early childhood) from low-income families in South Korea. Predictors included individual factors: child's age and gender; proximal environmental influences: family factors (family health conditions, primary caregiver, child-caregiver relationship, depression in primary caregiver) and institution factors (daycare enrollment, days per week in daycare); and distal environmental influences: income/resources factors (family income, personal resources and social resources); and community factors (perceived child-rearing environment). The outcome variable was questionable development. RESULTS: Significant contributors to questionable development in the infancy group were age, family health conditions, and personal resources; in the early childhood group, significant contributors were gender, family health conditions, grandparent as a primary caregiver, child-caregiver relationships, daycare enrollment, and personal resources. CONCLUSION: Factors influencing children's questionable development may vary by developmental stage. It is important to consider differences in individual and environmental influences when developing targeted interventions to ensure that children attain their optimal developmental goals at each developmental stage. Understanding this may lead nursing professionals to design more effective preventive interventions for low-income children.

Risk Factors Influencing Probability and Severity of Elder Abuse in Community-dwelling Older Adults: Applying Zero-inflated Negative Binomial Modeling of Abuse Count Data

PURPOSE: This study was conducted to identify risk factors that influence the probability and severity of elder abuse in community-dwelling older adults. METHODS: This study was a cross-sectional descriptive study. Self-report questionnaires were used to collect data from community-dwelling Koreans, 65 and older (N=416). Logistic regression, negative binomial regression and zero-inflated negative binomial regression model for abuse count data were utilized to determine risk factors for elder abuse. RESULTS: The rate of older adults who experienced any one category of abuse was 32.5%. By zero-inflated negative binomial regression analysis, the experience of verbal-psychological abuse was associated with marital status and family support, while the experience of physical abuse was associated with self-esteem, perceived economic stress and family support. Family support was found to be a salient risk factor of probability of abuse in both verbal-psychological and physical abuse. Self-esteem was found to be a salient risk factor of probability and severity of abuse in physical abuse alone. CONCLUSION: The findings suggest that tailored prevention and intervention considering both types of elder abuse and target populations might be beneficial for preventative efficiency of elder abuse.

Statistical Methods to Control Response Bias in Nursing Activity Surveys

PURPOSE: The aim of this study was to compare statistical methods to control response bias in nursing activity surveys. METHODS: Data were collected at a medical unit of a general hospital. The number of nursing activities and consumed activity time were measured using self-report questionnaires. Descriptive statistics were used to identify general characteristics of the units. Average, Z-standardization, gamma regression, finite mixture model, and stochastic frontier model were adopted to estimate true activity time controlling for response bias. RESULTS: The nursing activity time data were highly skewed and had non-normal distributions. Among the 4 different methods, only gamma regression and stochastic frontier model controlled response bias effectively and the estimated total nursing activity time did not exceeded total work time. However, in gamma regression, estimated total nursing activity time was too small to use in real clinical settings. Thus stochastic frontier model was the most appropriate method to control response bias when compared with the other methods. CONCLUSION: According to these results, we recommend the use of a stochastic frontier model to estimate true nursing activity time when using self-report surveys.

Psychosocial Factors and Work-related Musculoskeletal Disorders among Southeastern Asian Female Workers Living in Korea

OBJECTIVES: A rapid increase in the population of migrant workers in Korea has brought new challenges regarding the possible effects of acculturation on health. The purpose of this study was to examine the influence of acculturation- and work-related psychosocial factors on work-related musculoskeletal disorders among migrant female workers living in Korea. METHODS: A cross-sectional survey design was used. A translated, structured questionnaire was administrated to 156 southeastern Asian female full-time workers living in Korea. RESULTS: About 35% of the participants experienced some type(s) of work-related musculoskeletal disorder(s), which were more prevalent in Vietnamese women than in Thai and Filipino women. Women who preferred to maintain their own heritage and to reject the host country heritage were at risk for work-related musculoskeletal disorders. CONCLUSION: Acculturation strategy and nationality were found to be significant factors associated with work-related musculoskeletal disorders. Health professionals need to accommodate acculturation contexts into risk assessment and intervention development for work-related musculoskeletal disorders separately for different nationalities.

Analysis of Cost and Efficiency of a Medical Nursing Unit Using Time-Driven Activity-Based Costing

PURPOSE: Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. METHODS: Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. RESULTS: The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. CONCLUSION: These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

Comparison of Benefit Estimation Models in Cost-Benefit Analysis: A Case of Chronic Hypertension Management Programs

PURPOSE: Cost-benefit analysis is one of the most commonly used economic evaluation methods, which helps to inform the economic value of a program to decision makers. However, the selection of a correct benefit estimation method remains critical for accurate cost-benefit analysis. This paper compared benefit estimations among three different benefit estimation models. METHODS: Data from community-based chronic hypertension management programs in a city in South Korea were used. Three different benefit estimation methods were compared. The first was a standard deterministic estimation model; second, a repeated-measures deterministic estimation model; and third, a transitional probability estimation model. RESULTS: The estimated net benefit of the three different methods were $1,273.01, $-3,749.42, and $-5,122.55 respectively. CONCLUSION: The transitional probability estimation model showed the most correct and realistic benefit estimation, as it traced possible paths of changing status between time points and it accounted for both positive and negative benefits.