Individual-level Associations Between Indicators of Social Capital and Alcohol Use Disorders Identification Test Scores in Communities With High Mortality in Korea / 예방의학회지

Objectives@#This study examined associations among social capital indicators (social participation and generalized trust) at the individual level and alcohol use, which was quantified using Alcohol Use Disorders Identification Test (AUDIT) scores. @*Methods@#In total, there were 8800 participants in community health interviews, including 220 adults sampled systematically from a resident registration database of each of 40 sub-municipal administrative units of local (city or county) governments. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using polychotomous logistic regression. @*Results@#The aORs for abstainers versus people with AUDIT scores of 0-7, based on 3 questions on generalized trust, in comparison to those with no positive responses, were 1.15 (95% CI, 0.99 to 1.34) for 1 positive response, 1.16 (95% CI, 0.98 to 1.37) for 2 positive responses; and 1.39 (95% CI, 1.20 to 1.61) for 3 positive responses. The aORs for abstainers versus people with AUDIT scores of 0-7, in comparison to participation in no organizations, were 0.61 (95% CI, 0.54 to 0.69) for participation only in informal organizations; 2.16 (95% CI, 1.57 to 2.99) for participation only in religious organizations; 2.41 (95% CI, 1.10 to 5.29) for participation only in volunteer organizations; and 0.65 (95% CI, 0.57 to 0.74) for participation in formal organizations. Participants in formal social organizations, regardless of their participation in informal organizations, were more likely to have AUDIT scores of 8-15 (aOR, 1.29; 95% CI, 1.04 to 1.60) or ≥16 (aOR, 1.65; 95% CI, 1.22 to 2.23) than to have scores of 0-7. @*Conclusions@#Our findings may have implications for health policy to reduce alcohol problems.

Self-esteem as a Moderator of the Effects of Happiness, Depression, and Hostility on Suicidality Among Early Adolescents in Korea / 예방의학회지

OBJECTIVES: The purpose of this study was to investigate the role of self-esteem as a moderator of the factors influencing suicidality among middle-schoolers. METHODS: Moderated multiple regression analysis was applied to assess the influence of happiness, depression, and hostility on suicidality and to determine the degree to which self-esteem served as a moderator of those relationships. Data were collected from 268 students at a middle school in Busan, Korea, using a self-administered structured questionnaire. RESULTS: Happiness, depression, and hostility had significant direct effects on suicidality. Self-esteem showed no direct effect, but had a significant moderating effect on the relationship between hostility and suicidal behavior. CONCLUSIONS: These results suggest that various interventions, such as counseling programs, should be designed to alleviate hostility and depression and to enhance happiness and self-esteem among early adolescents.

Self-esteem as a Moderator of the Effects of Happiness, Depression, and Hostility on Suicidality Among Early Adolescents in Korea / 예방의학회지

OBJECTIVES@#The purpose of this study was to investigate the role of self-esteem as a moderator of the factors influencing suicidality among middle-schoolers.@*METHODS@#Moderated multiple regression analysis was applied to assess the influence of happiness, depression, and hostility on suicidality and to determine the degree to which self-esteem served as a moderator of those relationships. Data were collected from 268 students at a middle school in Busan, Korea, using a self-administered structured questionnaire.@*RESULTS@#Happiness, depression, and hostility had significant direct effects on suicidality. Self-esteem showed no direct effect, but had a significant moderating effect on the relationship between hostility and suicidal behavior.@*CONCLUSIONS@#These results suggest that various interventions, such as counseling programs, should be designed to alleviate hostility and depression and to enhance happiness and self-esteem among early adolescents.

Associations of Generalized Trust and Social Participation at the Individual Level with Unmet Healthcare Needs in Communities with High Mortality

BACKGROUND: The aim of this study was to investigate whether generalized trust and/or social participation at an individual level have negative associations with unmet healthcare needs. METHODS: Door-to-door interviews were conducted by trained interviewers to collect information. The 8,800 study participants included 220 adults sampled systematically using the resident registration database from 40 sub-municipal-level administrative units in Korea. Unmet healthcare needs were measured subjectively by the following question: “During the past 12 months, was there ever a time when you felt that you needed healthcare (excluding dental care) but did not receive it?” The responses were classified as either “yes” or “no.” RESULTS: The adjusted odds ratios (ORs) for unmet healthcare needs based on one positive response, two positive responses, and three positive responses to the three items of generalized trust compared to no positive responses were 0.92 (95% confidence interval [CI], 0.77–1.09), 0.90 (95% CI, 0.74–1.09), and 0.73 (95% CI, 0.61–0.87), respectively. The adjusted ORs for unmet healthcare needs based on social participation only in informal organizations, only in formal organizations, and in both informal and formal organizations compared to no social participation were 0.83 (95% CI, 0.71–0.98), 0.97 (95% CI, 0.77–1.21), and 0.97 (95% CI, 0.82–1.15), respectively. The covariates included in the multiple logistic regression were sociodemographic variables (gender, age, marital status, educational level, occupation, food security, and administrative unit), self-rated health, and perceived stress. CONCLUSION: Therefore, generalized trust and social participation in informal organizations can decrease the incidence of unmet healthcare needs.

The Mid-Term Outcome Evaluation of Community Organization: Three-year Experience of Health Plus Happiness Plus Projects in Gyeongsangnam-Do / 農村醫學 地域保健

OBJECTIVE: This study was performed to explore the effectiveness of community organization as a strategy for health promotion. METHODS: We used data from community health interviews from 6 administrative sections (eup, myeon, or dong) with high mortality from August to October, conducted once in both 2010 and 2013 as part of the Health Plus Happiness Plus Projects based on the concept of community empowerment in Gyeongsangnam-do Province. For 2010, the study subjects comprised a systematic sampling of 220 adults from each of the six sections for a total of 1320 subjects, and for 2013, 200 from each section for a total of 1200 subjects. We compared main health behavior indicators and empowerment score between these two years. RESULTS: Smoking prevalence in men was 47.4% in 2013, and 47.7% in 2010, respectively. Prevalence of walking 5 days or more per week was 35.6% in 2013, significantly lower than 46.2% in 2010. Also, during that period, both biennial health examination rate and biennial gastric cancer screening rate among those 40 years of age and over significantly increased from 57.7% to 63.6% and from 49.3% to 55.0%, respectively. Mean empowerment score at the community level significantly increased from 12.6 to 14.0. CONCLUSIONS: This study suggests that the three-year implementation of community organization might have helped to increase the participation rate of biennial health examinations including cancer screenings in the community. However, this was not the case for smoking cessation and walking. Further studies are needed for evidence-based health promotion.

The Effects of Health Promotion Initiatives with Community Participation and Parterships: The Case of Sabong-Myeon in Jinju City / 農村醫學 地域保健

OBJECTIVES: The objective of this study was to identify the effects of area-based health promotion initiatives with community participation and partnerships conducted in Sabong-Myeon, Jinju City for three years. METHODS: We used data from the '2008 Sabong-Myeon Health Survey' and the '2011 Health Plus Happiness Plus Community Health Survey'. The study comprised 520 systematically sampled individuals, composed of 300 adults in 2008 and 200 adults in 2011. We compared some health behavior and mental health indicators as well as social capital levels between these two surveys. RESULTS: The prevalences of smoking and walking exercise in 2011 were significantly higher than those in 2008. The prevalences of high risk alcohol consumption in men, stress perception, depressive symptoms experience, and suicide ideation were significantly lower than those in 2008. The proportion of people having a high level of social capital in 2011 was significantly higher than that in 2008, regardless of sex or marital status. However, the difference in the proportion was not statistically significant among people with a high educational background. CONCLUSIONS: This study suggested that the 3 years' implementation of area-based health promotion initiatives conducted in Sabong-Myeon might help to improve the mental health and social capital level of this community. The long-term health effects of area-based health promotion initiatives with community participation and partnerships need to be studied further, and lessons from these initiatives can be obtained by adapting proper evaluation methods.

Associations of Social Participation and Trust with Suicidal Ideation and Attempt in Communities with High Mortality / 農村醫學 地域保健

OBJECTIVES: This study was performed to identify the associations of social capital with suicidal thoughts and attempts in Korean communities with poor health. METHODS: We used the data from community health interviews conducted at 40 administrative sections (dong, eup, or myeon) with high mortality from August to October in 2010, 2011, and 2012 as part of the Health Plus Happiness Plus Projects in Gyeongsangnam-do Province. The 8,800 study subjects composed of 220 adults systematically sampled from each administrative section were asked if they had thought about suicide or had attempted suicide within 1 year. The social participation was measured with 'participation in formal and/or informal group' and trust using responses to three questions about trust of others. RESULTS: The prevalence of suicidal ideation and attempt within 1 year were 10.4% and 0.8%, respectively. The logistic regression analysis revealed that those who participated in only informal groups, or had highest trust level reported less suicidal ideation, or attempt after adjusting for socio-demographic factors (sex, age, marital status, occupation, and food affordability), self-rated health, and health behaviors (smoking, alcohol drinking, and exercise). CONCLUSIONS: This study suggested social capital such as social participation and trust was associated with less suicide ideation and attempt. More studies are warranted for the association of social capital with suicidal behavior.

The Associations of Empowerment and Social Capital with Self-Rated Health in Communities with Poor Health / 農村醫學 地域保健

OBJECTIVES: This study was performed to identify the associations of empowerment and social capital (such as social participation and trust) with self-rated health in Korean communities with poor health. METHODS: This study used the data from community health interviews conducted at 29 administrative sections (dong, eup, or myeon) with high mortality from August to October in both 2010 and 2011 as part of the Health Plus Happiness Plus Projects in Gyeongsangnam-do Province. The study subjects comprised 6,383 individuals composed of approximately 220 adults randomly sampled from each administrative section. The empowerment was measured with five-point Likert scale responses to seven perceived control questions (two at the individual level, five at the community level). The social participation was measured with 'participation in formal and/or informal group' and trust using responses to three questions about trust of others. RESULTS: The high empowerment scores at both individual and community levels, social participation in informal groups, and high trust level had independent and significant associations with good self-rated health after adjusting for socio-demographic factors (sex, age, marital status, occupation, and food affordability) and health behaviors (smoking, alcohol drinking, and exercise) in the logistic regressions. There were weak but significant associations among empowerment, social participation, and trust levels. CONCLUSIONS: Empowerment, social participation, and trust were weakly inter-related and significantly associated with self-rated health. More studies are warranted for empowerment and other social capital indices in health promotion.

Applications of the Participatory Learning Process in Health Promotion / 農村醫學 地域保健

OBJECTIVES: This study was conducted to develop a participatory learning process and apply it to community empowerment for health promotion. METHODS: The participatory learning sessions were composed of three stages according to the modified Freirean model of empowerment education. Stage 1 of generating themes (listening stage) was replaced with a community health forum. Stage 2 of problem-posing was executed via a two-session small group brainstorming discussion for selecting priority community health problems and strategies to solve them. Stage 3 of act-reflect-act, the implementation of the chosen strategies, is ongoing. We tested the feasibility of the participatory learning processes in the pilot programs for health education. Then, 14 Myeon (or Dong) Health Committee members used them in Health Plus Happiness Plus projects for community empowerment to achieve health equity in Gyeongsangnam-Do, Korea. RESULTS: In the pilot program for feasibility, more than 80% of the 95 participants gave positive responses to evaluation questionnaires after three or four participatory learning sessions. Health Committee members successfully selected various strategies relevant to their communities with facilitation, but without any teaching from outside professionals. CONCLUSIONS: We successfully applied the participatory learning process to health promotion. However, more studies are warranted to evaluate its long-term applicability.

The C677 Mutation in Methylene Tetrahydrofolate Reductase Gene: Correlation with Uric Acid and Cardiovascular Risk Factors in Elderly Korean men

The C677T mutation in the methylene tetrahydrofolate reductase (MTHFR) gene results in elevated homocysteine levels and, presumably, in increased cardiovascular risk. Moreover, elevated homocysteine levels are reportedly associated with high serum uric acid levels. We evaluated the MTHFR genotype and a panel of biochemical, hematological variables, and lifestyle characteristics in 327 elderly Korean men (age range 40-81 yr; mean, 51.87). This study shows that mutation of the MTHFR gene may be a risk for hyperuricemia. The mean uric acid levels for the C/C, C/T and T/T genotypes were 5.54, 5.91 and 6.33 mg/dL, respectively (p=0.000). The T/T genotype was significantly more frequent in subjects with high uric acid levels (p=0.003). Thus, this mutation of the MTHFR gene is implied by the study results to be a risk factor of hyperuricemia in elderly Korean men. However, the relationship between the MTHFR mutation and uric acid metabolism remains unclear. Therefore, further studies are necessary to explain the associated between the MTHFR mutation and elevated uric acid levels, and to examine potential relationships between it and conventional cardiovascular risk factors.