Factors that Influence Sexual Intercourse among Middle School Students: Using Data from the 8th (2012) Korea Youth Risk Behavior Web-based Survey

PURPOSE: The purpose of this study was to investigate factors that influence sexual intercourse among middle school students in South Korea. METHODS: Using statistics from the 8th (2012) Korea Youth Risk Behavior Web-based Survey, hierarchical logistic regression analysis was conducted. The study sample comprised 37,297 middle school students aged primarily 12 to 15. RESULTS: The significant predictors of sexual intercourse were grade, ever smoking, ever drinking, habitual or purposeful drug use, economic status, weekly allowance, cohabitation with family, and type of school. CONCLUSION: The results suggest that intensified sex education is needed not only in the 1st grade of middle school, but also in the upper grades of elementary school. Sexual health interventions for high-risk groups may be needed, given the factors predicting sexual intercourse.

The Relationships between Social Determinants of Health and Health-related Quality of Life among the Community-dwelling Elderly

PURPOSE: The purpose of this study was to examine the social determinants of health (SDH) associated with health-related quality of life (HQOL) among the community-dwelling elderly, based on the conceptual framework of the Commission on Social Determinants of Health (CSDH). METHODS: A survey was conducted with 199 elders aged 65 years or older sampled through convenient sampling. Data were collected through face to face interviews by trained interviewers using a structured questionnaire, which included scales of the residential area, social support, sense of community, social network, health behaviors, and HQOL. Data were analyzed by ANOVA and stepwise multivariate regression. RESULTS: Major SDH affecting HQOL included the participants' residential area, sense of community, and health behavior. The HQOL of the elderly residing in the B area with a low rate of basic livelihood security recipients was higher than that of those residing in other areas. CONCLUSION: CSDH framework was useful to determine the factors associated with HQOL among the community-dwelling elderly. In addition to their health behavior, their sense of community was found to be a SDH of HQOL, indicating the need of health promotion programs tailored to the characteristics of residential areas and strategies to enhance involvement in community activities.

Development and Psychometric Evaluation of the Korean Version of the Cultural Competence Scale for Clinical Nurses

PURPOSE: To develop and psychometrically test the Korean version of the Cultural Competence Scale for Nurses (K-CCSN). METHODS: A multi-phase questionnaire development method was used to develop the scale from November 2012 to April 2013. The item pool was generated based on literature review, existing scales and in-depth interviews. The content validity was evaluated twice by an expert panel. The scale validation was conducted with a convenience sample of 456 general hospital nurses recruited from five general hospitals and a nursing college in the Seoul Metropolitan Area of South Korea. The construct-related and criterion-related validity and internal consistency reliability of the scale were tested. RESULTS: The 33-item K-CCSN comprised four subscalesdcultural awareness, cultural knowledge, cultural sensitivity and cultural skillsdexplaining 53.96% of the total variance. The criterion-related validity was supported by a known-group comparison. The reliability analysis showed an acceptable-to-high Cronbach's alpha in total and for subscales ranging from .879 to .932. CONCLUSION: This preliminary evaluation of psychometric scale properties demonstrated acceptable validity and reliability. The K-CCSN is able to provide scientific and empirical data regarding the cultural competence of clinical nurses. However, further studies are needed to test the applicability of the scale in different settings and contexts.

A Study on Gender Differences in Influencing Factors of Office Workers' Physical Activity

PURPOSE: The purpose of this study was to determine gender differences in effects of self-efficacy, exercise benefits and barriers, and demographic factors on the physical activity. METHODS: Seventy sedentary office workers, 35 male and 35 female, from a major airline company, completed a questionnaire from March 28 to April 5, 2012. Steps and body mass indices were measured using a CW-700/701 (Yamax) pedometer and Inbody 720 (Biospace), respectively. Data were analyzed using t-test, chi2-test, multiple linear regression, and simultaneous quantile regression. RESULTS: For male workers, exercise self-efficacy had a significant effect on physical activity, but only when respondents were at 10%(3,431 steps/day, p=.018) and 25%(4,652 steps/day, p=.044) of the physical activity distribution. For female workers, marital status was significantly related to physical activity, but only when respondents were at 10% (3,537 steps/day, p=.013) and 25%(3,862 steps/day, p=.014) of the physical activity distribution. CONCLUSION: Quantile regression highlights the heterogeneous effect of physical activity determinants among office workers. Therefore intervention strategies for increasing physical activity should be tailed to genders as well as physical activity levels.

Analysis of Factors Affecting Unmet Healthcare Needs of Married Immigrant Women

PURPOSE: The purpose of this study was to identify the factors affecting the unmet healthcare needs of married immigrant women. METHODS: This study was a secondary data analysis using data from the 2009 National Survey of Multicultural Families. Data collected from 58,735 married immigrant women who had spouses were analyzed using descriptive statistics, Chi-square test, and logistic regression. RESULTS: Overall, 9.9% of married immigrant women have unmet healthcare needs. The significant predictors related to unmet healthcare needs were young age, high level of education, employed, country of origin, long period of residence, low income, uninsured, urban area, low level of subjective health status, and illness experience over past two weeks. In particular, four variables (long period of residence, low income, subjective health status, and illness experience over past two weeks) significantly predicted unmet healthcare needs for women from all countries of origin. CONCLUSION: The results of the study indicate that common predictors related to unmet healthcare needs of married immigrant women are a long period of residence, low income, subjective health status, and illness experience over past two weeks. Therefore intervention strategies to decrease unmet healthcare needs should focus on these significant predictors.

Factors Influencing Medication Adherence in Patients with Hypertension: Based on the 2008 Korean National Health and Nutrition Examination Survey

PURPOSE: The purpose of this study is to examine factors influencing medication adherence in patients with hypertension. METHODS: This study carried out a secondary analysis of data from the 2008 Korean National Health and Nutrition Examination Survey (KNHANES). Stratified sampling was used to select a participant sample that was representative of patients with hypertension throughout the country. Using the SPSS/WIN 18.0 program, data were analyzed using descriptive statistics, chi2 test, t-test, and logistic regression. RESULTS: Of the patients with hypertension, 8.8% had showed non-adherence to medication. Medication adherence was associated with age, spouse, Medicare insurance, number of other diseases, and current smoking status. The cases with older age, a spouse, Medicare insurance, higher number of other diseases, and no current smoking status showed significantly high medication adherence. CONCLUSION: Nursing interventions and further studies are needed to achieve high levels of medication adherence based on factors influencing medication adherence such as age, spouse, Medicare insurance, number of other disease, and current smoking status.

Comparison of Preventive Health Behaviors in Adults Aged 50~64 in Korea and the United States

PURPOSE: The purpose of this study was to compare Preventive Health Behaviors (PHBs) in adults in Korea and the United States and identify factors influencing PHBs. METHODS: This was a secondary data analysis study using data from the 2008 Korean National Health and Nutrition Examination Survey and the 2008 USA Behavioral Risk Factor Surveillance System. The PHBs were predicted using multiple linear regression analysis. RESULTS: 1) The total score of PHBs was significantly higher in American males (5.11) than in Korean males (4.78). There was also a significant difference between Korean females' total score (6.57) and American females'(6.75). 2) Age, marriage, monthly income, subjective health status, and cardiovascular disease were significant factors of PHBs in Korean males (p<.001). However, age, marriage, education, monthly income, health insurance, subjective health status, and cardiovascular disease were significant factors in American males (p<.001). In Korean females, only age and education were significant predictors (p<.001). However, six variables(age, marriage, education, monthly income, health insurance, and subjective health status) were significant predictors in American females (p<.001). CONCLUSION: There were different variables in predicting PHBs between Koreans and Americans. Each country should focus on those significant predictors to promote the PHBs for adults.

Evaluation of a Community Health Practitioner Self-care Program for Rural Korean Patients with Osteoarthritis

PURPOSE: The purpose of this study was to evaluate a self-care program for elders with osteoarthritis managed by primary health care workers, Community Health Practitioners (CHPs), in rural Korea. METHODS: The self-care program, consisting of 7 areas, was evaluated with a randomized experimental study for patients over age 60 with osteoarthritis in which 150 participants in the experimental group and 140 in the control group were compared. The self-care program was implemented for six weeks, 2 hours per week, at community health posts by CHPs. Data were collected using an interview questionnaire given by the CHPs and laboratory tests before and after the intervention for both groups. Propensity score matching analysis was done to test effectiveness after controlling for confounding variables. RESULTS: The intervention group showed a significant decrease in the number of painful joints (p<.001) and a significant increase in self-care ability (p<.05) compared to the control group. CONCLUSION: Study results indicate that training and utilizing primary health care workers in rural areas is valuable in increasing the generalization and continuity of intervention programs. As arthritis should be managed life-long, CHP directed self-care programs are useful interventions for rural elders with arthritis to learn self-care management.

The Effects of an Aerobic Exercise Program on Mobility, Fall Efficacy, Balance, and Stress in the Elderly at Senior Centers

PURPOSE: This study was conducted in order to investigate the effects of an aerobic exercise program on mobility, fall efficacy, balance, and stress in the elderly at senior centers. METHODS: This research was conducted as a quasi-experimental pretest and posttest control and experimental comparison study. The subjects were 41 senior residents (Exp.=18, Cont.=23) who aged above 65 at senior centers in S City. The period of time for data collection and intervention was from August 25 to December 5, 2008. RESULTS: Mobility (t=-3.10, p<.01) in the experimental group were significantly higher than those in the control group without an aerobic exercise program. However, fall efficacy (t=1.28, p=.207), balance (t=-.53, p=.602; t=.36, p=.723), stress (t=-1.32, p=.199) in the experimental group was not significantly higher than that in the control group. CONCLUSION: These findings confirmed that aerobic exercise programs make a contribution to improving mobility in the elderly at senior centers.

Correlates of Physical Activity among Korean Navy Personnel: An Ecological Approach

PURPOSE: This study was conducted to measure the relationships between ecological factors and Navy personnel's physical activity (PA) based on McLeroy's Ecological model. METHODS: A cross-sectional survey was conducted with a convenience sample of 184 Navy personnel working in 10 Navyships. A self-reporting questionnaire consisted of measures of intrapersonal, interpersonal, organizational and community factors related to Navy personnel's PA. Data were analyzed by descriptive statistics, chi2-test, t-test, analysis of variance, and hierarchical multiple regression using SPSS/WIN 17.0 programs. RESULTS: Their mean PA level was 2,848.1+/-3,344.5 MET-min/week, and mostly moderate level (50.5%). Hierarchical multiple regression analysis showed that religion, working department, working type, perceived health status and community environment were significant PA correlates. CONCLUSION: Community environmental factors as well as intrapersonal factors were significantly associated with Navy personnel's PA, indicating that community health nurses should expand an approach for individual-level behavioral change to incorporate Navy personnel specific community environmental barriers into PA interventions.

Comparison of the Hospice Systems in the United States, Japan and Taiwan

PURPOSE: The aim of hospice care is to provide the best possible quality of life both for people approaching the end of life and for their families and carers. The Korean government has been implementing a pilot project for hospital hospice services and trying to develop the national hospice system. To assist in the development of the Korean hospice system, the Korean government supported the present study comparing the hospice systems of three countries, United States, Japan, and Taiwan, which currently have a developed hospice system. METHODS: Data from three countries were collected in the following ways: reviewing hospice related literature, searching government documents on the Internet, collecting government hospice data, surveying six hospice institutions in each country, and conducting an international workshop. RESULTS: The hospice system was evaluated by comparing hospice management systems and hospice cost systems. The comparison of the hospice management system included five items of hospice infra structures and four items of hospice services. The hospice cost system included four items: funding source, hospital hospice cost, day care hospice cost, and home hospice cost. CONCLUSIONS: Based on the comparison of three countries, the most interesting thing was that home hospice care accounted for more than 90% of all hospice services in the United States and Taiwan. The results of this study will aid the countries that are in the process of developing a hospice system including Korea, which has been implementing a pilot project only for hospital hospice services.

A Comparison of Stress Levels of Elementary Students by Geographical Regions / 간호학회지

PURPOSE: The purpose of this study was to compare stress levels of elementary students according to three regional levels: a large city, a medium-sized city, and a rural area. METHODS: This was a descriptive comparative survey using a convenience sample of 1,161 5th-and 6th-grade students. The stress level was measured by a stress scale that consisted of 65 items regarding personal characteristics, family, school, and peer factors. The data were analyzed by chi-square-test, t-test, ANOVA and multiple regression using the SPSS 10.0 statistical program. RESULTS: Overall, the mean stress scores reported by the participants were near the middle of a 5-point scale and the level of familyrelated stress was highest, followed by peer, school, and individual-related stress. Sixth-graders and female students showed higher stress levels than 5th-graders and male students, respectively. The participants reporting unsatisfaction with their lives and those living in large cities tended to have significantly higher stress levels. CONCLUSION: Grade, gender, life satisfaction, and regional levels were all significant factors associated with high stress levels among elementary students. Development of stress management programs for this specific population, especially targeting students who are female and living in large cities, is needed.

The Effects of a Cognitive Behavior Program on Cognition, Depression, and Activities of Daily Living in Elderly with Cognitive Impairment / 간호학회지

PURPOSE: This study was conducted to investigate the effects of a cognitive behavior program on cognition, depression, and activities of daily living in elderly with Cognitive Impairment. METHOD: The research design was a nonequivalent control group pretest-posttest design. There were 21 subjects in the experimental group and 19 in the control group among 40 senior residents in a Hall for the elderly in the city of S. The subjects scores ranged from 15 to 23 on the MMSE-K(Korean Version of Mini-Mental State Examination) over age 65. The length of time for data collection and intervention was from Jun 26 to September 1, 2006. The cognitive behavior program consisted of 'Facing problem behavior', 'Searching for a coping skill', and 'Training in the coping skill'. It was applied to the experimental group twice a week, fifty minutes per session for six weeks. RESULT: Cognition(t=-4.232, p< .001) and IADL(t=-2.939, p< .01) in the experimental group were significantly higher than those of the control group. Depression in the experimental group was significantly less than the control group(t=3.870, p< .01). However, ADL in the experimental group was not significantly higher than the control group. CONCLUSION: These findings confirmed that a cognitive behavior program contributed to improving cognition and IADL, and to reducing depression in the elderly with Cognitive Impairment.

Current Status of Community Health Nursing Practicum in Bachelor Program in Korea

PURPOSE: This study was to investigate the current situation of community health nursing practicum in bachelor programs. METHOD: Data were collected using a questionnaire consisting of questions on education goals, teaching items, teaching methods, and evaluation methods and items. Forty five nursing departments/colleges or 84.9% of four-year nursing schools in Korea responded to the survey. RESULT: Nursing process application and understanding about the role and function of community health nurses were major goals of practice education. Community health centers were the most significant practice fields because all nursing schools mentioned them as places for practice. All nursing schools used a specific evaluation tool to measure students outcomes and utilized guidebooks to help students. CONCLUSION: The results of this study suggest that the goals of practice education should be standardized to improve the quality of education. Besides, evaluation tools that can be used commonly at all nursing schools should be developed to measure the effectiveness of practice education of community health nursing.

Health Behaviors between a Health Promotion Demonstration Health Center and a General Health Center / 간호학회지

PURPOSE: The purpose of the study was to compare community residents' perceptions, participation, satisfaction, and behavioral changes between a health promotion demonstration health center and general health center. METHOD: The design of the study was ex-post facto that compared community residents in demonstration health centers and general health centers. The sample included 2,261 community residents who were conveniently selected from demonstration (792 participants) and general health centers (1,496 participants). RESULT: The results of the study were as follows: 1) Perception and participation rates of exercise, nutrition, and hypertension management programs were significantly higher in the participants of demonstration health centers than those of general health centers.; 2) Satisfaction rates of all programs except the smoking cessation program were significantly higher in the participants of demonstration health centers than those of general health centers. However, only the exercise rate among risk behaviors of participants was significantly higher in demonstration health centers than general health centers. CONCLUSION: Systematic efforts for health promotion were effective not only in improving the community's awareness, participation, and satisfaction of the program, but also in changing health behaviors. This evidence should be used to foster and disseminate health promotion programs toother health centers to improve community residents' health status and quality of life.

Health Problems and Health Behaviors of Preschoolers / 간호학회지

PURPOSE: This study was conducted to understand the health status and health behaviors of preschoolers to provide baseline data for developing health promotion programs. METHOD: Parents of children attending day-care centers were recruited for the study. Participating day-care centers were selected using a stratified sampling method. Data was collected from June to August 2002 using a questionnaire. RESULT: Among 754 preschoolers, 17.3% were overweight, while 18.2% were underweight. The most frequent infectious diseases that children have had previously were hand-foot-mouth disease (20.2%) and chicken pox (18.7%). Current health conditions that children have frequently are respiratory disease (28%) and atopic dermatitis (23.8%). Only 61% brush their teeth everyday at bedtime, 54.3% wash their hands every time after returning home, 8.8% wear bicycle helmets, 9.3% use a child car seat, and 8.1% eat fruits and vegetables five times a day. Children residing in the metropolitan area were more likely to have positive health behaviors, and children of parents with an advanced college level education were more likely to have positive health behaviors than those with only a high school level education. CONCLUSION: Based on the study results, health professionals could plan and develop health promotion programs to change unhealthy behaviors of preschoolers targeting high-risk groups.

A Comparison of Smoking Control Strategies in Korea and the United States / 간호학회지

The purpose of this study was to compare smoking control strategies between Korea and the United States. Korea and other developing countries may learn from the experience of the United States in dealing with the growing epidemic of cigarettes. In particular, smoking control objectives, structures, laws and regulations, funds, programs and activities, research, and surveillance systems were compared. The comparison was conducted at the federal, states/provincial, and county levels of the two countries. The data were collected through various governmental websites, contact with people directly, and a literature review. Based on the comparison, seven recommendations for smoking control strategies were made primarily for Korea.

Evaluation of a Community-Based Program for Breast Self-Examination Offered by the Community Health Nurse Practitioners in Korea / 간호학회지

BACKGROUND: Breast cancer is the most common form of cancer among Korean women. Only 14% of urban women and 10% of rural women in Korea, however, participated in breast cancer screening behavior in 1998 (Korean Ministry of Health & Welfare, 1999). PURPOSE: The aim of this study was to evaluate the effect of community-based breast self-examination (BSE) education programs in Korea. METHODS: First, breast cancer risk appraisals were done with 1,977 rural women. Of the 1,977 women, nearly 30% (n= 494) had a higher or equal to borderline risk of developing breast cancer. This quasi-experimental study was conducted to target these women with a high or equal to borderline risk of breast cancer. The risk appraisal feedback and breast self-examination education were used as an intervention for breast cancer prevention and early detection. RESULTS: After a 3-month follow-up, 30.5% of the women in the intervention group performed regular BSE compared to 10.2% of women in the control group. The mean knowledge score related to breast cancer and BSE was significantly higher for the women in the intervention group than that in the control group.

Health status of urban and rural elders in Korea

The main purpose of this study was to describe the differences in health status between urban and rural elders in Korea. The sample consisted of one thousand one hundred non-institutionalized individuals, aged 65 or over, living in three metropolitan cities and two rural provinces. The modified Cornell Medical Index, ADL, IADL, and existing medical diagnosis were used to measure the health status of the elders. Rural elders reported significantly more health problems than urban elders. Differences in ADL and IADL scores were not statistically significant. There was a difference in the types of health problems between the urban and rural elders. While more rural elders reported that they were diagnosed as having neuralgia and arthritis, more urban elders reported that they had diabetes. The results of this study demonstrated that rural elders had significantly more health problems than urban elders even after all the other variables were controlled. However, in Korea, most health care resources available to elders are concentrated in large urban cities. This study suggests that it is important to invest more health care resources in rural areas to meet the needs of all elders in Korea.

A randomized controlled trial to motivate worksite fecal occult blood testing. Lee CY

Colorectal cancer is second only to lung cancer as a cause of cancer death in the United States. Studies have shown that fecal occult blood (FOB) tests are effective in detecting colorectal cancer in its early stages. To increase the participation in the FOB test among the working population, a randomized controlled trial was conducted. A total 278 federal employees 40 years or older in Washington State were randomly divided into a intervention group which received a Colorectal Cancer Risk Appraisal and a control group which received a simple information letter. After three months a follow-up questionnaire was sent to all participants to measure the effectiveness of the intervention. As a result of the study, the intervention group had a 4.3% higher compliance rate with the FOB test during the three month follow-up period (p = .10). The largest effect of the intervention was on the employees' intention to get a FOB test within the next year (62.6% in the intervention group vs. 36.2% in the control group, OR = 3.18, p less than .001).