Age at onset of alcohol consumption and its association with alcohol misuse in adulthood.

OBJECTIVE: This study aimed to explore the association between early age onset of alcohol consumption and alcohol misuse in adulthood. METHODS: The study sample consisted of 16 829 individuals' (8349 males, 8435 females) survey responses obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2016 through 2019. Alcohol dependence was measured using the AUDIT-C (Alcohol Use Disorder Identification Test-Consumption), and the ages at which alcohol consumption began were grouped into four categories: under 16, 16 to 18, 19 to 23, and over 24. Multiple logistic regression was used to examine the association between current alcohol misuse and age at onset of alcohol consumption. RESULTS: Compared to individuals who started drinking alcohol after the age of 24, those who began drinking alcohol before the age of 16 were more likely to score 8 or more on AUDIT-C questions (under 16: males, odds ratio [OR] 2.50, confidence interval [CI] 1.97-3.17; females, OR: 1.66, CI: 1.18-2.33). Similar to the main analysis, the earlier the onset of alcohol assumption starts, the more likely one is to develop alcohol misuse in adulthood according to subgroup analysis stratified by independent variables in both gender. CONCLUSION: The lower the age at the onset of alcohol consumption, the higher the likelihood of alcohol misuse in adulthood. While both males and females showed the same trend in response to the AUDIT-C questions, males tended to have a stronger association between early onset alcohol consumption and alcohol misuse.

Association of smartphone use with abnormal social jetlag among adolescents in Korea before and after COVID-19.

PURPOSE: This study aimed to use social jetlag to determine how smartphone overuse by adolescents before and after the COVID-19 pandemic might be associated with their circadian rhythm. METHODS: We used 2017 and 2020 Korea Youth Risk Behavior web-based Survey data and conducted a survey analysis on 100,976 adolescents. The dependent variable was abnormal social jetlag. Based on the times recorded by the survey, we calculated the weekday midpoint and weekend sleep time. The main independent variable was smartphone usage time (<2h/day, 2-3.9 h/day, 4-5.9 h/day, and ≥ 6 h/day). Multiple logistic regression and relative excess risk due to interaction (RERI) were performed. RESULTS: Abnormal social jetlag was most prevalent in male and female adolescents who used smartphones ≥ 6 h/day (adjusted odds ratio [AOR] = 2.60, 95 % confidence interval [CI] = 2.47-2.74). The longer the smartphone usage time, the higher the association with abnormal social jetlag. This association was more prominent in female adolescents. The additive interaction between longer smartphone usage time and post-COVID-19 year was statistically significant (total: RERI = 0.92, 95 % CI = 0.90-0.95; males: RERI = 0.83, 95 % CI = 0.80-0.87; females: RERI = 1.13, 95 % CI = 1.08-1.18). CONCLUSION: Our results clearly indicated that increased smartphone usage time tended to result in greater social jetlag, an association that was more pronounced in female. Moreover, the COVID-19 pandemic significantly strengthened this relationship. Further research is needed regarding the proper use of smartphones to ensure good sleep-in adolescents after the COVID-19 pandemic.

Workplace Mistreatment and Health Conditions Prior and during the COVID-19 in South Korea: A Cross-Sectional Study.

BACKGROUND: This study examined the relationship between workplace mistreatment, including discrimination, abuse, and overworking, and health problems among full-time workers prior to and during the coronavirus disease (COVID-19) outbreak in South Korea. METHODS: We analyzed data from the 2017 and 2020-2021 Korean Working Conditions Surveys, including the final sample of 44,425 participants. Multiple logistic regression was used to examine the relationship between workplace mistreatment and health problems among workers by gender. Interaction analysis was conducted to establish the association between the COVID-19 pandemic and health problems related to mistreatment. The occupational, demographic, and socioeconomic backgrounds were adjusted. RESULTS: We found a significant association between workplace mistreatment and health problems, including headaches, eyestrain, and anxiety. The association increased after the COVID-19 pandemic: "discrimination" (men (OR 2.26, 95% CI 1.93-2.65), women (OR 2.73, 95% CI 2.36-3.17)); abuse (men (OR 5.42, 95% CI 2.87-10.23), women (OR 4.70, 95% CI 3.12-7.08)); and overworking: men (OR 2.36, 95% CI 2.01-2.77), women (OR 3.52, 95% CI 2.68-4.61). The interaction indicates an increased incidence of people having health problems due to workplace mistreatment (OR 1.03, 95% CI 1.00-1.06) during the COVID-19 pandemic. CONCLUSION: Statistically, employees who experience workplace mistreatment have worse health conditions. The COVID-19 pandemic has affected the job environment and increased the association between workplace mistreatment and health problems. To eliminate the health problems related to workplace mistreatment, it is necessary to address the impact of the COVID-19 pandemic on work and employee health conditions.

A nationwide cohort study of the association of benzodiazepines with SARS-CoV-2 infection and clinical outcomes.

The evidence for the impact of benzodiazepine (BZD) use on infection or clinical outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is limited. We evaluated the association of BZD use with SARS-CoV-2 infection and the clinical outcomes of coronavirus disease 2019 (COVID-19) using a nationwide COVID-19 database from South Korea. This nationwide cohort study was performed using the COVID-19 database from the Health Insurance Review and Assessment Service of Korea, and SARS-CoV-2 positivity was investigated according to BZD use. SARS-CoV-2-positive adult patients were assessed in three groups, those who needed hospitalization, those with severe symptoms requiring intensive care, and those who died. A multivariate logistic regression model was used for all the analyses. After adjusting for potential confounding factors, there was no association between BZD use and SARS-CoV-2 positivity. SARS-CoV-2-positive patients with BZD use showed an increased risk of need for hospitalization from COVID-19 compared to those without BZD use (odds ratio [OR]: 1.33, 95% confidence interval [CI] 1.07-1.65). In addition, there was a higher risk for long-term users (OR: 2.64, 95% CI 1.08-6.47). Chronic BZD use contributed to a higher risk of the need for hospitalization among COVID-19 patients, whereas BZD use did not increase the risk of SARS-CoV-2 test positivity, severe outcomes, or mortality.

Association between years with incidence of communicable diseases focused on COVID-19 and hand hygiene among adults in South Korea: a cross-sectional study.

BACKGROUND: Handwashing is important considering the impact of communicable diseases on the public. We aimed to identify the association between years with incidence of communicable diseases during the coronavirus disease 2019 (COVID-19) pandemic and hand hygiene in South Korea. METHODS: This cross-sectional study evaluated 5 years (2013, 2015, 2017, 2019, and 2020) of data from the Korea Community Health Survey and included 1,034,422 adults. Multinomial logistic regression analysis was performed to assess handwashing frequency by year. Receiver operating characteristic analysis was used to determine the cut-off point for handwashing frequency. RESULTS: The always/frequently handwashing rate was 44.7%. This tendency was stronger in adults with each ascending year, with reference to 2013 (2015, odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.08, 1.13; 2017, OR = 1.10, 95% CI = 1.08, 1.13; 2019, OR = 1.17, 95% CI = 1.14, 1.20; 2020, OR = 3.21, 95% CI = 3.14, 3.29). Among women, the OR of frequently/always handwashing was 3.55 times higher (95% CI = 3.45, 3.66) in 2020 than in 2013. This OR was 2.95 among men (95% CI = 2.86, 3.04). In influenza-vaccinated participants, the OR of frequent/always handwashing was 3.25 times higher in 2020 than in 2013 (95% CI = 3.15, 3.36), while in non-vaccinated participants it was 3.17 (95% CI = 3.08, 3.27). Among adults who practiced physical distancing during the COVID-19 pandemic, the OR was 1.36 times higher (95% CI = 1.29, 1.42) with frequent handwashing, 1.64 times higher (95% CI = 1.57, 1.70) than those who did not practice it. CONCLUSIONS: There was a strong tendency toward frequent handwashing over the years; the trend was even greater in 2020 during the COVID-19 pandemic. Given that communicable diseases and handwashing are closely related, it is necessary to promote hand hygiene for prevention.

The Association between Working Hours Flexibility and Well-Being Prior to and during COVID-19 in South Korea.

OBJECTIVE: This study examined the relationship between the flexibility of work schedule arrangements and well-being among full-time workers prior to and after the coronavirus disease (COVID-19) outbreak in South Korea. METHODS: Data from the fifth 2017 and sixth 2020-2021 Korean Working Conditions Survey, including a final sample of 45,137 participants (22,460 males; 22,677 females), were used. Multiple logistic regression was performed to establish the association between schedule arrangement types and the 5-item World Health Organization Well-Being Index. RESULTS: The study found an association between flexible schedule arrangements and good well-being in 2017: "little flexibility" (odds ratio (OR), 1.33; 95% confidence interval (CI), 1.27-1.48), "moderate flexibility" (OR, 1.48; 95% CI, 1.28-1.71), and "high flexibility" (OR, 1.35; 95% CI, 1.06-1.72). During COVID-19, only workers with "high flexibility" were likely to have good well-being (OR, 1.49; 95% CI, 1.18-1.88), while the association between well-being and "low flexibility" (OR, 1.06; 95% CI, 0.96-1.17) and "moderate flexibility" types (OR, 0.66; 95% CI 0.59-0.75) decreased. This study found that flexible working hours may contribute to better well-being among full-time workers. However, the impact of the COVID-19 pandemic on working conditions and employee well-being should be addressed while setting working hours.

Association between perceived decline in family income due to COVID-19 and alcohol consumption among Korean adolescents.

BACKGROUND: This study examines the relationship between the perceived decline in family income due to COVID-19 and alcohol consumption among Korean adolescents. METHODS: Korea Youth Risk Behavior Web-Based Survey 2020 data were used. The study included 42,922 participants (20,672 males; 22,250 females). Multiple logistic regression estimated the relationship between the decline in family income due to COVID-19 and drinking (yes or no) and alcohol-induced blackout (yes or no) status among Korean adolescents. RESULTS: Adolescent males who perceived worsened family income due to COVID-19 had a higher OR for drinking status and alcohol-induced blackout within 30 days (drinking status: OR 1.27, CI 1.15-1.42, alcohol-induced blackout: OR 1.60, CI 1.19-2.15). Females had a higher OR for current drinking (OR 1.22, CI 1.09-1.38). 7th grade females and 10th grade males were more likely to drink alcohol when their household income decline, compared to high school students (10th grade male: OR 1.54 CI 1.18-2.00; 7th grade female: OR 1.57 CI 1.08-2.27). The male group perceiving family financial loss were likely to have an increased frequency of drinking within 30 days (1-9 days: OR 1.26 CI 1.11-1.42, 10-19 days; OR 1.70 CI 1.22-2.36 over 20 days; OR 1.74 CI 1.15-3.09). LIMITATIONS: Cross-sectional design and self-reported data are the main limitation of our study. And the cut-off points for drinking status and heavy drinking factors may be difficult to generalize our findings to different population. CONCLUSIONS: A significantly positive association of perceived decline in family income due to COVID-19 with increased risks of alcohol consumption was observed among Korean adolescents of both sexes. 7th grade females and 10th grade males were more likely to drink alcohol when their household income changed, compared to high school students. Further, adolescents who perceived family financial loss had an increased frequency of drinking.

Screening for Diabetes Complications during the COVID-19 Outbreak in South Korea.

This study aimed to investigate the implementation of diabetes complications screening in South Korea during the coronavirus disease (COVID-19) outbreak. Data from the Korea Community Health Surveys conducted in 2019 and 2020 were used. This study included 51,471 participants. Multiple level analysis was used to investigate the relationships between screening for diabetic retinopathy and diabetic nephropathy and variables of both individual- and community-level factors in 2019 and 2020, before and after the COVID-19 outbreak. Diabetes nephropathy complications screening in 2020 had a lower odds ratio. However, regions heavily affected by COVID-19 showed a negative association with diabetes complications screening after the COVID-19 outbreak. For those being treated with medication for diabetes, there was a significant negative association with diabetic nephropathy screening after the outbreak. The COVID-19 outbreak was associated with a reduction in the use of diabetes nephropathy complications screening. Additionally, only regions heavily affected by COVID-19 spread showed a negative association with diabetes complications screening compared to before the COVID-19 outbreak. In this regard, it appears that many patients were unable to attend outpatient care due to COVID-19. As such, these patients should be encouraged to visit clinics for diabetes complications screening. Furthermore, alternative methods need to be developed to support these patients. Through these efforts, the development of diabetes-related complications should be prevented, and the costs associated with these complications will be reduced.

Association between family financial decline due to COVID-19 and generalized anxiety disorder among Korean adolescents.

BACKGROUND: COVID-19 has had a worldwide economic impact. A decline in family financial level can adversely affect adolescents' mental health. This study examined the association between perceived family financial decline due to COVID-19 and generalized anxiety disorder (GAD) among South Korean adolescents. METHODS: Data from 54,948 middle and high school students from the 2020 Korea Youth Risk Behavior Survey were collected in this cross-sectional study. The effect of the perceived family financial decline due to COVID-19 related to GAD was analyzed using binary and multinomial logistic regression. RESULTS: The relationship between perceived family financial decline due to COVID-19 and GAD was linear with increasing odds ratios and confidence intervals (the possibility of GAD, no financial decline: OR 1.00, mild: OR 1.11, CI 1.05-1.17, moderate: OR 1.30, CI 1.22-1.39, severe: OR 1.48, CI 1.34-1.63). Girls, low-income class, and living with family were vulnerable to GAD. GAD levels of mild, moderate, and severe were most likely to occur in each case of mild, moderate, and severe financial decline, respectively. LIMITATIONS: As this is a cross-sectional study, causality is unknown. Because this study data was self-reported by adolescents, they may have been overestimated or underestimated. CONCLUSION: GAD in adolescents is closely related to perceived decreased family finances due to COVID-19. The dose-response of GAD according to financial decline became gradually severe. Anxious adolescents were afraid of uncertain and adverse outcomes affecting them or their families. Therefore, there is a vital need to care for financially affected adolescents.

Impact of the Acceptance of Disability on Self-Esteem among Adults with Disabilities: A Four-Year Follow-Up Study.

This study identified the acceptance of disability's impact on self-esteem among adults with disabilities in South Korea. This is a four-year follow-up study that obtained data from the Panel Survey of Employment for Persons with Disabilities from 2017 to 2020. In total, 3329 individuals participated. Logistic regression examined the acceptance of disability's effect on self-esteem. These variables were categorized based on the acceptance of disability (high→high, low→high, high→low, and low→low) and self-esteem (low and not low). Compared to the participants with a consistently high acceptance of disability, those with constantly low acceptance were 2.35 times (95% CI 1.81-3.04) more likely to have low self-esteem. When the acceptance of disability was low→high and high→low, the low self-esteem probability was 1.23 and 1.66 times, respectively. Low self-esteem was prominent for the following: men, 50-64-year olds, married, urban, economic activists, the mid-low household income category, and those with sensory disability. Acceptance of disability can adversely affect self-esteem when it is consistently low or changes from high to low. Among socio-economic factors, there were several risk factors that could make individuals more vulnerable to low self-esteem. Therefore, it is necessary to help people accept their disabilities to maintain healthy self-esteem levels.

Depression before and during-COVID-19 by Gender in the Korean Population.

This study explored the association between Coronavirus disease (COVID-19) and depression by comparing Patient Health Questionnaire-9 (PHQ-9) results pre-pandemic (2019) and after the start of the pandemic (2020). Data of 444,051 participants (200,206 male (45.1%); 243,845 female (54.9%)) were obtained from the Korean Community Health Survey conducted from 2019 to 2020. The independent variable of interest in this study was the year, divided into binary categories, 2019 and 2020. The dependent variable was depression, measured by the PHQ-9 scale. This dependent variable was also binary, dividing those who are considered depressed or not by a cut-off score of 10. A logistic regression model was employed to examine the association. Our results reveal that compared to participants in 2019, patients from the study sample of 2020 were marginally more likely to be depressed, especially female patients (male OR: 1.092, 95% CI [0.998 to 1.195], female OR: 1.066, 95% CI [1.002 to 1.134]). Moreover, using the participants from the year 2019 as a reference group, those who appeared anxious in response to the COVID-19-related questions in the survey showed more tendency to have a PHQ-9 score of 10 or more. Compared to participants from the 2019 group, those from 2020 more likely to be depressed were those with no-one to contact in case of emergency due to COVID-19 (male OR: 1.45, 95% CI [1.26 to 1.66], female OR: 1.46, 95% CI [1.33 to 1.60]), and individuals with concerns regarding economic loss (male OR: 1.18, 95% CI [1.07 to 1.30], female OR: 1.11, 95% CI [1.04 to 1.18]) and infection of a vulnerable family member at home due to COVID-19 (male OR: 1.16, 95% CI [1.05 to 1.28], female OR: 1.09, 95% CI [ 1.02 to 1.16]).

Association between the Perceived Household Financial Decline Due to COVID-19 and Smartphone Dependency among Korean Adolescents.

This cross-sectional study identified the association between COVID-19-related perceived household financial decline and smartphone dependency among adolescents in South Korea. Data from the 2020 Youth Risk Behavior Survey of Korea was used and 54,809 middle and high school students were included. COVID-19-related perceived household financial decline was categorized as no financial decline, mild, moderate, and severe. Smartphone dependency was calculated by 10 questions and was largely categorized as yes and no, and as normal, low, and high (prevalence rate: 25.0%). Binary and multinomial regression analyses were performed to analyze the association. The more severe the financial decline, the more pronounced the risk of high-risk smartphone dependency (mild financial decline: odds ratio (OR) 1.11, 95% CI 0.96-1.28; moderate: OR 1.22, 95% CI 1.04-1.43; severe: OR 2.56, 95% CI 2.06-3.17). Poor family relationships (OR 1.06, 95% CI 1.03-1.10) and severe social conflict (OR 2.99, 95% CI 2.50-3.58) were also related to smartphone dependency. The ORs were 2.63 with more than three bathrooms and 1.63 with their own bedroom. Smartphone dependency among adolescents is closely related to COVID-19-related perceived household financial decline. As smartphone dependency relates to complicated psychological issues, further evaluation is necessary, especially for vulnerable adolescents.

Post-Coronavirus Disease 2019

Coronavirus disease 2019 (COVID-19) is currently in progress. Although it is difficult to predict the end of currently increasing COVID-19, it is expected to last for a long time. The COVID-19 is making a lot of changes. Due to physical distancing and living distancing, non-contacts such as wearing facial masks, online lectures, online medical services, telecommuting, and telemarketing are becoming common. In the era of post-COVID-19, online and offline will coexist. Many countries following China’s lockdown strategy, which is agreed with the World Health Organization, should be changed to Taiwan’s facial mask strategy for reducing the economic problems. The prolonging COVID-19 will add to the economic difficulties, and the US-China confrontation will be difficult to rebound the global economy. COVID-19, such as plaque, smallpox, and Spanish influenza, will be a historical momentum. How to respond to the crisis of COVID-19 and post-COVID-19 will determine the future of the world and Korea.