Associations of physical activity at work and household income with obesity: a cross-sectional study among rural adults in Korea.

OBJECTIVES: This study was performed to identify the effect of physical activity at work on obesity and to analyze the contribution of socioeconomic factors and health behaviors to this association, which has been relatively little studied. METHODS: From the Korean National Cancer Center Community Cohort, a total of 5,587 adults (2,125 men; 3,462 women) aged more than 30 years living in rural areas were enrolled. Information on socio-demographic factors, health behaviors, and body mass index was gathered using face-to-face interviews and measurements of height and weight. RESULTS: Inverse associations were identified between vigorous-intensity physical activity at work and obesity in both men and women, while no association was found between vigorous-intensity physical activity during leisure time and obesity. High household income was independently associated with a lower risk of obesity among those who had low levels of vigorous-intensity physical activity at work. Vigorous physical activity at work showed an inverse association with obesity in rural areas where heavy manual labor is common. CONCLUSIONS: Our findings indicate the necessity to account for various types of physical activity to improve the assessment and prevention of obesity.

Gender differences in factors associated with body weight misperception.

OBJECTIVE: Gender analysis in health research is important to strengthen our health system. The current study aimed to explore factors related to body weight misperception in a national sample of the general Korean population. DESIGN: Cross-sectional study. SETTING: South Korea, general population. PARTICIPANTS: 12,900 adults enrolled from the Seventh Korea National Health and Nutrition Examination Survey (2016-2018). RESULTS: Disadvantageous socio-economic status was considered a predictor of participants' misperceptions of themselves as being of a healthy weight despite being overweight and as underweight despite being of a healthy weight, mainly in men. Favourable socio-economic status was considered a predictor of participants' misperceptions of themselves as being of a healthy weight despite being underweight and as overweight despite being of a healthy weight, mainly in women. Living in an urban area was an independent predictor of men's misperception of themselves as being of a healthy weight despite being overweight and women's misperception of themselves as being underweight despite being of a healthy weight. Physical inactivity was a predictor of most misperceptions in women. Psychological variables, such as stress and depression, were not significant predictors of misperception. CONCLUSIONS: The current study highlighted the gender differences in factors related to body weight misperception. These differences suggested that more sophisticated policies should be formulated to identify solutions to health problems related to body weight.

Nutrition Labeling Usage Influences Blood Markers in Body-Size Self-Conscious Individuals: The Korean National Health and Nutrition Examination Survey (KNHANES) 2013-2018.

This study analyzed the effects of nutrition labeling and examined whether nutrition labeling usage influences the levels of blood markers, such as high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) in body-size self-conscious individuals. The dependent variables were HDL-C and TG; the independent variables were the respondents' awareness of nutrition labeling use, sociodemographic factors, perceived health status, stress, lifestyle, frequency of eating out, family history of hyperlipidemia, survey year, body mass index, total energy intake, and cholesterol levels. Body-size perception was assessed by matching body mass index with subjective body-shape recognition using data from the Korean National Health and Nutrition Examination Survey (2013-2018). Differences were observed in HDL-C and TG levels according to nutrition labeling usage and body-image perception. The group that recognized body image correctly showed high HDL-C and low TG levels when they actively used nutrition labeling, whereas the group that recognized body image incorrectly showed no significant changes in HDL-C and TG levels even when actively using nutrition labeling. The standard nutritional information, which does not consider individual body-size perceptions, has a restrictive effect. Policies should be developed towards tailored intervention strategies considering individual body-size perception.

Associations Between the Intention to Use Early Palliative Care, Sources of Information, and Attitudes Toward a Good Death in Korean Adults.

CONTEXT: Providing hospice and palliative care (HPC) early in the course of care for patients with life-threatening illness is important for improving patient quality of life. However, little literature exists for factors affecting to the intention to use early palliative care (EPC) of general population. OBJECTIVES: This study aimed to identify the sources of information about HPC, investigate whether they affect intention to use HPC and EPC, and examine the relationship between the components of a good death and the intention to use HPC and EPC. METHODS: A stratified nationwide cross-sectional survey including 1500 participants, 20-74 years old, was conducted to investigate their intentions to use HPC and EPC, available information sources, and perceived components of a good death. RESULTS: The main sources of information about HPC were television and radio. Information acquired from health professionals was positively associated with the intention to use EPC. Although regarding a good relationship with family as a component of a good death was related to low intention to use EPC, being able to trust medical staff, being involved in decisions about care, and being respected as an individual were associated with high intention to use EPC. CONCLUSION: Information from health care providers and public awareness through education and publicity efforts are necessary to inform the public about the benefits of EPC. Furthermore, it is essential that medical staff cultivate the skills necessary to secure public trust and provide care that respects patients until the end of their lives.

Public Attitudes towards Cancer Survivors among Korean Adults.

PURPOSE: We evaluated public attitudes towards cancer survivors and identified the characteristics associated with these attitudes in Korea. MATERIALS AND METHODS: We performed this cross-sectional study using proportionate quota random sampling of the 2015 Korean Census. In May 2017, investigators conducted face-to-face interviews with 1,500 Korean volunteers aged between 20 and 79 years. The questionnaire recorded sociodemographic factors, smoking and drinking habits, cancer history in family and acquaintances, interest in cancer survivors, cancer-survivor blame, and attitudes towards cancer survivors. RESULTS: Many participants had negative attitudes towards cancer survivors. People with a monthly household income above US $7,000 were less likely to have a negative attitude than those with monthly incomes below US $1,499. People in their 70s, without a religion, living in rural areas, smokers, or those who blame cancer survivors for their own cancer were more likely to have a negative attitude than people outside these categories. People interested in cancer survivors were less likely to have a negative attitude than those who were not interested. CONCLUSION: To improve attitudes towards cancer survivors, it will be necessary to increase interest in cancer survivors through education, publicity, and advocacy using strategic messaging that focuses on social and institutional aspects and emphasizes that responsibility for cancer should not be attributed to cancer patients. Inducing the public to be interested in cancer survivors will be important for positive attitudes toward cancer survivors.

Effects of a cancer prevention education program on elementary school students' knowledge, attitude, self-efficacy, and intentions in South Korea.

OBJECTIVES: Most children and adolescents have low levels of cancer knowledge and awareness, and infrequently engage in preventive behaviors. This study examined the effects of a short classroom-based intervention for cancer prevention on knowledge, attitude toward cancer preventability, self-efficacy, and behavioral intentions of fifth-grade elementary school students. METHODS: The study was based on a pre-post-follow-up, 2-group, quasi-experimental design. Participants in the intervention group attended two 40-minute sessions on cancer prevention education and watched a music video about cancer prevention, while participants in the control group were only exposed to the music video. Self-reported knowledge, attitude toward cancer preventability, self-efficacy, and behavioral intentions were assessed 1 week pre-intervention and post-intervention, as well as 3 months post-intervention. RESULTS: The 3-month post-intervention results revealed partial effects, indicating that the education intervention improved knowledge and attitudes toward cancer preventability; however, no effects were observed on self-efficacy and behavioral intentions 3 months after the intervention. CONCLUSIONS: Long-term regular booster sessions are required to improve not only social-cognitive factors, but also behavioral intentions, which could result in behavior changes promoting cancer prevention.

Factors affecting satisfaction with cancer information provided through the social networking services of the National Cancer Information Center in Korea.

OBJECTIVES: This study aimed to identify the characteristics of social networking service (SNS) users and to assess the relationship of those factors to user satisfaction with the SNSs of the National Cancer Information Center (NCIC) in South Korea. METHODS: A Web-based survey was completed by 1,670 users of the NCIC SNSs, who provided data on the sources they consulted for information about cancer, determinants of SNS use, sources of NCIC SNS awareness, the time of day they used the SNS, and their satisfaction level. RESULTS: Facebook users mainly became aware of the NCIC SNSs through an acquaintance's recommendation, while Twitter was accessed through other SNSs or blogs. Users in their 30s were less satisfied with the NCIC SNSs than those in their teens and 20s. Browsing for cancer-related information on the Internet, prioritizing information quality, and engaging in active use were related to a high level of satisfaction with the NCIC SNSs. Individuals who were exposed to the NCIC SNSs through other SNSs or printed materials were less satisfied with their experience of the NCIC SNSs than those who received a recommendation from an acquaintance. CONCLUSIONS: These findings may act as a catalyst to guide public health agencies to enhance their use of SNSs.

Suicidal ideation and suicidal attempts among adults with chronic diseases: A cross-sectional study.

INTRODUCTION: About 14% of the global burden of disease has been attributed to neuropsychiatric disorders. The aim of this study was to show the general picture of suicidal ideation and behavior among Korean, and to test the hypothesis that there is a positive association between diseases and suicidality. METHOD: A total of 19,599 individuals were asked if they had any chronic diseases, suicidal ideation and attempts. The data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V, 2010-2012) conducted by Korea Centers for Disease Control and Prevention (KCDC) were examined. RESULTS: Stroke and osteoarthritis were associated with a 1.81 and 1.27 times increase in the odds of suicidal ideation, respectively (95% CI=1.24-2.65; 95% CI=1.09-1.48). Angina pectoris and osteoarthritis were associated with a 3.88 and 2.09 times increase in the odds of suicide attempts (95% CI=1.78-8.43; 95% CI=1.24-3.55). Having pulmonary tuberculosis increased the odds of a suicide attempt 12-fold (OR=12.47, 95% CI=1.12-138.66). Having renal failure was associated with a 4.92 times increase in the odds of suicide attempts (95% CI=1.25-19.30). Having lung cancer or cervical cancer increased the odds of suicide attempts more than 10-fold (OR=11.53, 95% CI=1.03-128.80; OR=17.66, 95% CI=1.58-197.01). CONCLUSIONS: Various diseases were risk factors for suicidality. Physicians' communication skills for frank and clear discussions about suicidality should be developed through various training courses.

News Portrayal of Cancer: Content Analysis of Threat and Efficacy by Cancer Type and Comparison with Incidence and Mortality in Korea.

How the news media cover cancer may have profound significance for cancer prevention and control; however, little is known about the actual content of cancer news coverage in Korea. This research thus aimed to examine news portrayal of specific cancer types with respect to threat and efficacy, and to investigate whether news portrayal corresponds to actual cancer statistics. A content analysis of 1,138 cancer news stories was conducted, using a representative sample from 23 news outlets (television, newspapers, and other news media) in Korea over a 5-year period from 2008 to 2012. Cancer incidence and mortality rates were obtained from the Korean Statistical Information Service. Results suggest that threat was most prominent in news stories on pancreatic cancer (with 87% of the articles containing threat information with specific details), followed by liver (80%) and lung cancers (70%), and least in stomach cancer (41%). Efficacy information with details was conveyed most often in articles on colorectal (54%), skin (54%), and liver (50%) cancers, and least in thyroid cancer (17%). In terms of discrepancies between news portrayal and actual statistics, the threat of pancreatic and liver cancers was overreported, whereas the threat of stomach and prostate cancers was underreported. Efficacy information regarding cervical and colorectal cancers was overrepresented in the news relative to cancer statistics; efficacy of lung and thyroid cancers was underreported. Findings provide important implications for medical professionals to understand news information about particular cancers as a basis for public (mis)perception, and to communicate effectively about cancer risk with the public and patients.

Happiness and health behaviors in South Korean adolescents: a cross-sectional study.

OBJECTIVES: We examined the associations between happiness and a wide range of health behaviors in South Korean adolescents. METHODS: Study data were derived from the ninth Korea Youth Risk Behavior Web-based Survey administered from June to July 2013. In addition to happiness levels, the questionnaire included items on sociodemographics and health-related lifestyle factors (smoking, drinking, eating breakfast, fruit and vegetable consumption, physical activity, sedentary behavior, and hours of sleep). RESULTS: The multivariate analysis revealed that higher levels of happiness were associated with not smoking or drinking, eating breakfast, eating fruits daily, vegetable consumption, participating in at least 60 minutes of physical activity a day, avoiding sedentary behavior, and hours of sleep. Additionally, sex differences were found in relationships between happiness and eating fruit daily, participation in physical activity, and sedentary behavior. CONCLUSIONS: These results encourage public health professionals to consider the psychological aspects of adolescent life in working to improve their health behaviors and outcomes.

Effects of a Cancer Prevention Advertisement on Beliefs and Knowledge about Cancer Prevention.

BACKGROUND: Outcome-expectation beliefs and knowledge may ultimately influence behavior for cancer prevention. The aims of this study were to measure changes in knowledge and beliefs about cancer prevention before and after viewing a television advertisement and identify the factors affecting receptivity to its messages. MATERIALS AND METHODS: A one-group pretest-posttest design was used in this study of 1,000 individuals aged 20 to 65 years who were recruited online in November 2014. The outcome variables included cancer prevention beliefs based on the Health Belief Model (five items) and knowledge about risk factors for cancer (seven items). RESULTS: Perceived susceptibility, perceived benefits, and self-efficacy increased significantly and their perceived severity and perceived barriers decreased significantly, after participants viewed the television advertisement. Correct responses to questions about risk factors also increased significantly, except for smoking. The main factors affecting changes in the outcome variables were age, interest in cancer prevention, social network, satisfaction with the ad, and pretest scores. CONCLUSIONS: Television advertisements with positive frameworks can be an efficient channel of improving beliefs and knowledge about cancer prevention in a short period. The continuous development of intervention materials that consider the demographics, needs, and satisfaction of the target group will be necessary for future studies.

What predicts the trust of online health information?

OBJECTIVES: Little attention has been paid to levels of trust in online sources of health information. The objective of this study was to investigate levels of trust in various sources of health information (interpersonal channels, traditional media, and Internet media), and to examine the predictors of trust in health information available on the Internet. METHODS: A questionnaire was administered to 1,300 people (20 years of age or older), evaluating levels of trust in various sources of health information. RESULTS: The highest level of trust was expressed regarding interpersonal channels, with hospital physicians regarded as the most trusted source of information age and income showed an association with trust in online information sources. Elderly people were not likely to trust Internet news sources, and high incomes were found to be strongly associated with trust in online sources of information overall. CONCLUSIONS: Public health organizations must consider the predictors for trust in various sources of information in order to employ appropriate media when targeting vulnerable individuals or developing messaging strategies for health professionals.

Cancer risk factors in Korean news media: a content analysis.

BACKGROUND: Little is known about the news coverage of cancer risk factors in Korea. This study aimed to examine how the news media encompasses a wide array of content regarding cancer risk factors and related cancer sites, and investigate whether news coverage of cancer risk factors is congruent with the actual prevalence of the disease. MATERIALS AND METHODS: A content analysis was conducted on 1,138 news stories covered during a 5-year period between 2008 and 2012. The news stories were selected from nationally representative media in Korea. Information was collected about cancer risk factors and cancer sites. RESULTS: Of various cancer risk factors, occupational and environmental exposures appeared most frequently in the news. Breast cancer was mentioned the most in relation to cancer sites. Breast, cervical, prostate, and skin cancer were overrepresented in the media in comparison to incidence and mortality cases, whereas lung, thyroid, liver, and stomach cancer were underrepresented. CONCLUSIONS: To our knowledge, this research is the first investigation dealing with news coverage about cancer risk factors in Korea. The study findings show occupational and environmental exposures are emphasized more than personal lifestyle factors; further, more prevalent cancers in developed countries have greater media coverage, not reflecting the realities of the disease. The findings may help health journalists and other health storytellers to develop effective ways to communicate cancer risk factors.

Perceptions of cancer risk and cause of cancer risk in korean adults.

PURPOSE: The aims of the present study were to assess the prevalence of perceived risk for cancer; to explore associations between sociodemographics and family history of cancer and perceived cancer risk; to identify perceived cause of cancer risk; and to examine the associations between sociodemographics and family history of cancer and perceived cause of cancer risk. MATERIALS AND METHODS: This cross-sectional study was conducted among 1,009 participants aged 30-69 years, selected from a population-based database in October 2009 through multiple-stratified random sampling. Information was collected about the participants' perceived cancer risk and perceived cause of cancer risk. RESULTS: Overall, 59.5% of the respondents thought they had the chance of developing cancer. Female sex, younger age, lower income, and family history of cancer were positively associated with perceived cancer risk. The most important perceived cause of cancer risk was stress. There was a difference between sociodemographics and family history of cancer and perceived cause of cancer risk. CONCLUSION: Factors affecting perceptions of cancer risk and cause of cancer risk need to be addressed in risk communications. The results provide important directions for the development of educational strategies to promote awareness and self-appraisal of cancer risk and risk factors.

Health-related determinants of happiness in Korean adults.

OBJECTIVES: Happiness has been associated with a range of favorable health outcomes. The aim of this study was to examine the relationships between happiness and health behaviors, stress, and environmental aspects of exercise in a Korean national representative sample. METHODS: This cross-sectional study was conducted using multiple-stratified random sampling on the Korea Census of 2005. In October 2009, investigators conducted 15-min face-to-face interviews with 1,530 South Korean volunteers aged between 30 and 69 years. The questionnaire included questions about sociodemographic factors, perceived stress, smoking, drinking, healthy diet, exercise, exercise environment, and happiness levels. RESULTS: The multivariate analysis revealed that middle-aged participants were less likely to be happy than younger and older participants, and higher happiness was associated with being part of a couple, higher income, lower stress, healthy diet, exercise, and certain exercise environments (e.g., mountain trails). CONCLUSIONS: Besides individual-level sociodemographic conditions, such as income or psychological status, community-level conditions, such as environment, should be considered when national and community public welfare policy is established.

Factors related to cancer information scanning and seeking behavior among high school students in Korea.

OBJECTIVE: This paper aimed to determine the relationship between cancer information scanning and seeking experience of adolescents and cancer preventive behavior, perceived cancer risk, and levels of cancer- related knowledge. METHODS: The study sample comprised 1,000 second-year students from 6 high schools: the general and vocational school systems were each represented by 1 boys', 1 girls', and 1 coeducational high school. In July 2011, trained researchers visited each classroom, explained the purpose of the study, distributed questionnaires to the students who agreed to participate, instructed them to complete the survey by self-reporting, and collected the completed questionnaires. RESULTS: The students who attended general high schools (as compared with vocational high schools), earned higher grades, consumed more vegetables, had a higher perceived cancer risk, and answered the cancer-related questions more correctly and had more cancer information scanning and seeking experience. CONCLUSION: These results reinforce the importance of cancer prevention health education. Furthermore, the results may help in preparing a strategy that enables people to acquire accurate cancer-related information easily and quickly.

Factors related to self-perception of diet quality among South Korean adults.

OBJECTIVE: Improvements in diet can decrease the cancer rates. The aim of the present study was to determine the relationships between self-perception of diet quality and personality, impulsiveness, stress, coping strategy, sense of coherence, self-efficacy, and social support. METHODS: This cross-sectional study was conducted using a multiple-stratified random sampling method based on the Korea Census of 2007. In October 2009, investigators conducted 15-minute face-to-face interviews with 1,530 South Korean volunteers who ranged from 30 to 69 years of age without a history of cancer. RESULTS: Respondents were more likely to perceive that they consumed a healthy diet if they were older than 50 years, lived with a partner, had a monthly family income greater than $4,000 USD, had a low perceived risk of cancer, consumed less alcohol, exercised regularly, had a less agreeable or conscientious personality, had low stress levels, had a high sense of coherence or self-efficacy, and had ample social support. CONCLUSION: Psychosocial factors, such as personality, stress, sense of coherence, self-efficacy, and social support, are associated with the self- perception of diet quality. Analysis of the factors that contribute to a perceived healthy diet could assist with the design of educational campaigns.

Psychosocial factors and health behavior among Korean adults: a cross-sectional study.

OBJECTIVE: This study was an attempt to identify associations between health behavior, such as smoking, alcohol consumption, healthy diet, and physical activity, and psychosocial factors. METHODS: This cross- sectional study was conducted among 1,500 participants aged between 30 and 69 years, selected from a population-based database in October 2009 through multiple-stratified random sampling. Information was collected about the participants' smoking and drinking habits, dietary behavior, level of physical activity, stress, coping strategies, impulsiveness, personality, social support, sense of coherence, self-efficacy, health communication, and sociodemographics. RESULTS: Agreeableness, as a personality trait, was negatively associated with smoking and a healthy diet, while extraversion was positively associated with drinking. The tendency to consume a healthy diet decreased in individuals with perceived higher stress, whereas it increased in individuals who had access to greater social support. Self-efficacy was found to be a strong predictor of all health behaviors. Provider-patient communication and physical environment were important factors in promoting positive healthy behavior, such as consumption of a healthy diet and taking regular exercise. CONCLUSIONS: Psychosocial factors influence individuals' smoking and drinking habits, dietary intake, and exercise patterns.

Psychological impact of health risk appraisal of Korean women at different levels of breast cancer risk: neglected aspect of the web-based cancer risk assessment tool.

OBJECTIVE: Health risk appraisal is often utilized to modify individual's health behavior, especially concerning disease prevention, and web-based health risk appraisal services are being provided to the general public in Korea. However, little is known about the psychological effect of the health risk appraisal even though poorly communicated information by the web-based service may result in unintended adverse health outcomes. This study was conducted to explore the psychological effect of health risk appraisal using epidemiological risk factor profile. METHODS: We conducted a randomized trial comparing risk factor list type health risk appraisal and risk score type health risk appraisal. We studied 60 women aged 30 years and older who had no cancer. Anxiety level was assessed using the Spielberger State-Trait Anxiety Inventory YZ. RESULTS: The results of multivariate analysis showed that risk status was the independent predictors of increase of state anxiety after health risk appraisal intervention when age, education, health risk appraisal type, numeracy, state anxiety, trait anxiety, and health risk appraisal type by risk status interaction was adjusted. Women who had higher risk status had an odd of having increased anxiety that was about 5 times greater than women who had lower risk status. CONCLUSIONS: Our findings indicate that communicating the risk status by individual health risk appraisal service can induce psychological sequelae, especially in women having higher risk status. Hospitals, institutes, or medical schools that are operating or planning to operate the online health risk appraisal service should take side effects such as psychological sequelae into consideration.

Community-based intervention to promote breast cancer awareness and screening: the Korean experience.

BACKGROUND: There are many differences in culture, community identity, community participation, and ownership between communities in Western and Asian countries; thus, it is difficult to adopt the results of community intervention studies from Western countries. In this study, we conducted a multicity, multicomponent community intervention trial to correct breast cancer myths and promote screening mammography for women living in an urban community in Korea. METHODS: A 6-month, 2-city community intervention trial was conducted. In the intervention city, 480 women were surveyed at baseline and 7 months later to evaluate the effects of the intervention program. Strategies implemented in the intervention city included community outreach and clinic and pharmacy-based in-reach strategies. RESULTS: This study showed a 20.4-percentage-point decrease in myths about the link between cancer and breast size, a 19.2-percentage-point decrease in myths concerning mammography costs, and a 14.1-percentage-point increase in intention to undergo screening mammography. We also saw a 23.4-percentage-point increase in the proportion of women at the action stage of the transtheoretical model in the intervention city. In the comparison city, smaller decreases and increases were observed. CONCLUSIONS: Our study showed the value of an intervention study aimed at reducing belief in breast cancer myths in an urban community in Korea. The invention also made women more likely to undergo mammography in future.