Differential patterns of lifestyle behaviors among low- and high-income postmenopausal women in Korea: a latent class analysis.

BACKGROUND: Healthy lifestyle behaviors among postmenopausal women are important to prevent chronic diseases and improve health later in life. Heterogeneous lifestyle patterns may exist among postmenopausal women, and socioeconomic status (SES) is a critical determinant of lifestyle behaviors. However, little is known about distinct SES-specific patterns of lifestyle behaviors among postmenopausal women. Thus, this study used latent class analysis to identify subgroups of postmenopausal women with different health behaviors according to income and to examine the predictors of income-specific subgroups. METHODS: We analyzed nationally representative data from the Eighth Korea National Health and Nutrition Examination Survey, collected in 2019 and 2020. We used nine lifestyles (i.e., current smoking and drinking, high-risk drinking, walking, muscle-strengthening exercise, sleep, vegetable and fruit intakes, and weight control efforts). We conducted a multiple-group latent class analysis using monthly household income as a proxy for SES. The monthly household income variable was calculated by standardizing monthly household income by the number of family members and then divided into quintiles. We classified the participants into low- (i.e., Q1 and Q2) and high-income (i.e., Q3, Q4, and Q5) groups. RESULTS: Although the three-class models best fit the data of low- and high-income groups, we found differential patterns by income: (a) for low-income group, "relatively healthy (RH)," "lowest physical activity, insufficient fruit intake, and no intention to control weight," and "high-risk drinking and insufficient fruit intake" classes and (b) for high-income group, "RH," "lowest physical activity," "high-risk drinking and insufficient fruit intake and sleep" classes. The proportion of the RH class was largest in both groups. However, lifestyle patterns in low-income group showed multiple and unhealthy characteristics than those in high-income group. CONCLUSIONS: This study suggests that different underlying lifestyle patterns exist in postmenopausal women with low- and high-income. To promote healthy behaviors among postmenopausal women, health professionals should develop and apply lifestyle interventions tailored to lifestyle pattern characteristics according to income.

Associations Between Gender-Specific Substance Use Patterns and Mental Health Among Adolescents in the Republic of Korea: A Latent Class Analysis.

PURPOSE: Although gender differences in adolescent substance use are complex and substance use accompanies mental health problems, most previous studies have focused on gender-specific association between single substance use and mental health. This study aimed to investigate gender-specific substance use patterns and to examine their association with mental health characteristics. METHODS: Nationally representative data from the Korea Youth Risk Behavior Survey collected in 2018 were analyzed. To identify substance use patterns among male adolescents (n = 30,463) and female adolescents (n = 29,577), multiple-group latent class analysis was conducted using eight substance use indicators. In addition, we conducted a latent class analysis with covariates to examine the association between substance use patterns and mental health characteristics. RESULTS: Among both gender samples, the four-class model best fit the data: nonusers (86.4%), frequent smokers (2.9%), risky drinkers (7.1%), and heavy tobacco and alcohol users with lifetime heated tobacco product use (3.6%) for male adolescents, and nonusers (89.8%), frequent smokers (0.5%), risky drinkers (8.0%), and heavy tobacco and alcohol users with a drunkenness episode (1.7%) for female adolescents. Depression, suicidal plans, and suicidal attempts predicted the latent class model for both genders. In addition, stress level predicted the latent class model for female adolescents. CONCLUSIONS: The findings indicate that homogeneous patterns of substance use by gender are differentially associated with mental health problems. Therefore, health professionals should develop interventions tailored to gender-specific substance use patterns, taking into account the mental health characteristics of each pattern.

Associations between the Frequency and Quantity of Heated Tobacco Product Use and Smoking Characteristics among Korean Smoking Adolescents.

PURPOSE: Although heated tobacco product (HTP) use among adolescents is an emerging public health problem, little is known about the frequency and quantity of HTP use. Thus, we investigated the associations between the frequency and quantity of HTP use and smoking characteristics (i.e., combustible cigarette [CC] and electronic cigarette [EC] use, and attempts to quit smoking) among CC-smoking adolescents. METHODS: We analyzed nationally representative data from 2,470 Korean adolescents who were current CC smokers. To investigate our aim, we conducted multinomial logistic and logistic regression analyses. RESULTS: We found that daily and heavier CC users had greater likelihoods of more frequent and heavier HTP use. In addition, dual users of CCs and ECs were more likely to use HTPs more frequently and heavily than CC users who did not use ECs. Moreover, daily EC users had the highest risk of frequent and heavy HTP use. The frequency and quantity of HTP use were not associated with attempts to quit smoking. Compared to CC-only use, dual use of CCs and HTPs was not associated with quitting attempts, and triple use of CCs, ECs, and HTPs was associated with a lower likelihood of quitting attempts. CONCLUSION: HTP use was less likely to displace CC use and promote attempts to quit smoking. Thus, strict regulations are required to prevent the promotion of HTPs as a substitute for CCs or as a means of quitting smoking. Additionally, health professionals should consider preventive interventions for HTP, as well as CC and EC use among adolescents.

Health-related quality of life associated with coexisting chronic conditions in postmenopausal women.

We aimed to examine the association between metabolic syndrome (MetS), depressive symptoms, and health-related quality of life in postmenopausal women. We conducted a descriptive cross-sectional study in naturally postmenopausal women aged 45-65 years using data from the 8th Korea National Health and Nutrition Examination Survey. We classified the participants into four groups: normal (neither MetS nor depressive symptoms), MetS, depressive symptoms, and MetS + depressive symptoms. Compared to the other three groups, the MetS + depressive symptoms group had the worst self-rated health. High fasting glucose, high triglyceride and low high-density lipoprotein-cholesterol levels were the most common in the MetS + depressive symptoms group. After adjusting for covariates, the MetS + depressive symptoms group was more likely to have problems with usual activities and pain/discomfort than the normal group.

Level of Acculturation and Acculturative Stress Perceived by Asian Immigrant Women Married to South Korean Men.

INTRODUCTION: Married immigrant women experience cultural conflicts due to different values, and customs. This study examined the factors associated with the acculturation and acculturative stress of Asian immigrant women in South Korea. METHOD: A cross-sectional descriptive study was performed. A total of 142 participants were recruited from Incheon Multicultural Centers in 2016 using a convenience sampling method. Acculturation and acculturative stress were measured by Suinn-Lew Self-Identity Acculturation Scale and Social Attitudinal Familial Environment. The data were analyzed using analysis of variance and multiple regression analysis. RESULTS: Time since immigration was negatively associated with the level of acculturation, while alcohol consumption (p < .050). Some demographic variables (age, religion, anxiety, and time since immigration) were associated with acculturative stress (p < .050). DISCUSSION: These findings can help health care providers to increase their awareness and be more sensitive when providing services to these women.

Development and effects of a high-risk pregnancy emotive role-play program for nursing students: a quasi-experimental study.

PURPOSE: This study aimed to develop an emotive role-play program for nursing students focusingon high-risk pregnancy and analyze its effects on communication skills, clinical performance, andemotional intelligence. METHODS: A quasi-experimental nonequivalent comparison group design was adopted with 83nursing students (experimental group, 45; comparison group, 38) who participated voluntarily in anextracurricular program. The preliminary survey was conducted on November 3 and November 4,2020, and the follow-up survey was conducted on November 12, 2020, for the comparison groupand on November 27, 2020, for the experimental group. A program that included five role-play scenarios related to induced labor, preeclampsia, premature rupture of membranes, preterm labor, andinfertility was developed by a group of experts and presented to the experimental group over 11 totalhours across 3 days. Each student participated in a role-play scenario as a patient, family member, ornurse and observed three other scenarios. The comparison group received a workbook after the follow-up evaluation. The independent t-test was performed to analyze changes in communicationskills, clinical performance, and emotional intelligence. RESULTS: Communication skills (t=1.84, p=.035) and clinical performance (t=2.75, p=.004) significantly increased in the experimental group compared to the comparison group. A significant difference was not observed between the experimental and comparison groups for emotional intelligence(t=1.36, p=.088). CONCLUSION: The emotive role-play program concerning high-risk pregnancy was effective in improving nursing students' communication skills and clinical performance and can be used in nursingeducation related to high-risk pregnancy and childbirth.

Psychometric evaluation of patient assessment of chronic illness care among Korean cancer survivors.

BACKGROUND: The Patient Assessment of Chronic Illness Care (PACIC) was developed in the United States to assess the implementation of the Chronic Care Model (CCM)-based intervention from the patient's perspective. Although the psychometric properties of the PACIC have been reported in other chronically ill patients, it has not been reported in cancer survivors. Our aim was to evaluate the acceptability, validity, and reliability of a Korean version of the PACIC among cancer survivors (K-PACIC-CS). METHODS: Among 204 cancer survivors at a university-based hospital in South Korea, we performed psychometric evaluation of the K-PACIC-CS according to acceptability (descriptive statistics, missing values, and floor and ceiling effects), validity (confirmative factor analysis [CFA] and convergent validity), and reliability (internal consistency, i.e., Cronbach's alpha). RESULTS: The item response was high (missing rate = 0.5%). The floor effect was 3.9%- 43.6% and the ceiling effect was 6.9%- 41.2%. The CFA revealed good indices of fit and confirmed the five structures predetermined in the original version of PACIC. The K-PACIC-CS scores had significant positive relationships with cancer survivors' self-efficacy and health-related quality of life. The total K-PACIC-CS showed excellent internal consistency (Cronbach's alpha = .94) and those of the subscales were acceptable (Cronbach's alpha = .76 -.86). CONCLUSIONS: This study suggests that the K-PACIC-CS is a valid and reliable instrument for measuring implementation of CCM-based chronic care from the survivor's perspective.

[Associations between Cigarette and Electronic Cigarette Use and Sleep Health in Korean Adolescents: An Analysis of the 14th (2018) Korea Youth Risk Behavior Surveys].

PURPOSE: This study aimed to understand the relationship between cigarette and electronic cigarette (e-cigarette) use and sleep health among Korean adolescents. METHODS: Using the 14th Korea Youth Risk Behavior Survey, we included 52,928 adolescents who responded to sleep satisfaction and sleep duration. Participants were classified into four groups: non-users, cigarette-only users, e-cigarette-only users, and dual users of both products. To examine the associations between cigarette and e-cigarette use and sleep health, data were analyzed using complex samples cross tabulation and complex samples logistic regression. RESULTS: Of the four groups, dual users reported the lowest level of sleep satisfaction and sleep duration; 57.0% and 86.9% of dual users were not satisfied with their sleep and have insufficient sleep duration, respectively. The proportion of students who were not satisfied with their sleep was higher among cigarette-only users compared to e-cigarette-only users (52.7% vs. 45.8%), but the two groups reported similar rates of insufficient sleep duration (84.2% vs. 84.3%). Compared to non-users, cigarette-only users, e-cigarette-only users, and dual users were more likely to not be satisfied with sleep (odds ratios [ORs] were 1.49, 1.36, and 1.75, respectively) and had significantly higher odds of experiencing insufficient sleep duration (ORs were 1.85, 2.06, and 2.34, respectively). CONCLUSION: E-cigarette-only use and dual use as well as cigarette-only use were associated with poor sleep health. Therefore, to improve adolescent sleep health, health professionals should provide sleep intervention strategies considering the association between smoking and sleep health.

The effects of a maternal nursing competency reinforcement program on nursing students' problem-solving ability, emotional intelligence, self-directed learning ability, and maternal nursing performance in Korea: a randomized controlled trial.

Purpose: The purpose of this study was to develop a maternal nursing competency reinforcement program for nursing students and assess the program's effectiveness in Korea. Methods: The maternal nursing competency reinforcement program was developed following the ADDIE model. This study employed an explanatory sequential mixed methods design that applied a non-blinded, randomized controlled trial with nursing students (28 experimental, 33 control) followed by open-ended interviews with a subset (n=7). Data were analyzed by both qualitative and quantitative analysis methods. Results: Repeated measures analysis of variance showed that significant differences according to group and time in maternal nursing performance; assessment of and intervention in postpartum uterine involution and vaginal discharge (F=24.04, p<.001), assessment of and intervention in amniotic membrane rupture (F=36.39, p<.001), assessment of and intervention in delivery process through vaginal examination (F=32.42, p<.001), and nursing care of patients undergoing induced labor (F=48.03, p<.001). Group and time improvements were also noted for problem-solving ability (F=9.73, p<.001) and emotional intelligence (F=4.32, p=.016). There were significant differences between groups in self-directed learning ability (F=13.09 p=.001), but not over time. The three themes derived from content analysis include "learning with a colleague by simulation promotes self-reflection and learning," "improvement in maternal nursing knowledge and performance by learning various countermeasures," and "learning of emotionally supportive care, but being insufficient." Conclusion: The maternal nursing competency reinforcement program can be effectively utilized to improve maternal nursing performance, problem-solving ability, and emotional intelligence for nursing students.

Design of a randomized controlled trial of a partnership-based, needs-tailored self-management support intervention for post-treatment breast cancer survivors.

BACKGROUND: Self-management is becoming essential for breast cancer survivors, but evidence about the effectiveness of self-management support (SMS) intervention is lacking. To address this issue, we developed a theory-based SMS intervention, the 'EMPOWER', aimed at empowering breast cancer survivors. Here we describe the rationale of the intervention and its development. METHODS: The conceptual framework of this study is the Chronic Care Model, which posits that SMS can influence patient-provider relationships and ultimately improve health outcomes. We will conduct a multi-center, 2-armed randomized controlled trial to assess the effectiveness of EMPOWER among post-treatment breast cancer survivors in South Korea. The trial will include 94 women who completed primary breast cancer treatment within the last 6 months. Participants will be randomly assigned to the intervention group or the wait-list control group (1:1). The intervention group will receive a 7-week partnership-based and needs-tailored SMS intervention via telephone counseling. The primary outcome is empowerment. The secondary outcomes include self-efficacy for post-treatment self-management behaviors, mental adjustment, psychological distress, and health-related quality of life (HRQOL). Data will be collected by self-reported questionnaire at baseline, post-intervention, and 3-month follow-up. DISCUSSION: We believe that the EMPOWER intervention could improve HRQOL of post-treatment breast cancer survivors by enhancing their empowerment. If found successful, it could aid clinicians engaged in the long-term care of breast cancer survivors. TRIAL REGISTRATION: Clinical Research Information Service, KCT0004794. Registered 5 March 2020.

Concomitants of menopause-specific quality of life in premenopausal and post-menopausal women living in South Korea.

The present study investigated the concomitants of menopause-specific quality of life among premenopausal and postmenopausal women. Based on the Wilson and Cleary model of quality of life, this cross-sectional study recruited 329 women of age 40-65 years following operational convenience. The study was conducted in the office of the Korea Population, Health and Welfare Association (KPHWA) in Incheon, South Korea. Data collected on sociodemographic characteristics, social support, biological/physiological characteristics, the Pittsburgh Sleep Quality Index (PSQI-K), and self-rated health. Menopause-specific quality of life questionnaire (MENQOL) was used in this study. Hierarchical multiple linear regression analysis was performed. The study found that social support and self-rated health were negatively correlated with MENQOL in premenopausal women, while the income level and self-rated health were negatively associated with MENQOL in postmenopausal women. Sleep quality was positively correlated with MENQOL in both premenopausal and postmenopausal women. The study results indicate the need for tailored approaches based on menopausal status. Especially, social support may help improve the MENQOL of premenopausal women, while in postmenopausal women, improved sleep quality may enhance their menopause-specific quality of life.

Efficacy of Cognitive Behavioral Treatment for Insomnia: A Randomized Controlled Trial.

This study examined the effects of cognitive behavioral treatment for insomnia. A randomized controlled trial was performed on 44 women. The intervention included one group session of sleep hygiene education and four individual sessions of counseling. The instruments included the Insomnia Severity Index, Pittsburgh Sleep Quality Index, the Center for Epidemiological Studies Depression Scale, and Menopausal quality of life. The data were analyzed using repeated measure MANOVA, followed by repeated measure ANOVA. Repeated measure MANOVA showed that time had a significant main effect on the anthropometric variables (body mass index, waist circumference, and blood pressures) and revealed significant main effects of the group and time on the psychosocial variables (sleep quality, insomnia, depressive symptoms, and quality of life) (p < .05). Repeated measure ANOVA results indicated a significant effect of the group on insomnia and sleep quality (p < .05). Overall, the intervention was effective in improving insomnia and poor sleep quality.

Coping style at diagnosis and its association with subsequent health-related quality of life in women with breast cancer: A 3-year follow-up study.

PURPOSE: The aim of this study was to describe distinct coping styles of women newly diagnosed with breast cancer and to determine whether there is an association between those styles and the women's long-term health-related quality of life (HRQOL). METHODS: Using a prospective longitudinal study design, we enrolled 101 women recently diagnosed with breast cancer in South Korea and asked them to complete a questionnaire that included the Mini-Mental Adjustment to Cancer (Mini-MAC) scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). RESULTS: From the baseline data, we identified two coping style clusters. The first ("FS cluster") had higher scores on the fighting spirit subscale and lower scores on the helpless-hopeless and anxious preoccupation subscales (n = 52, 51.5%), while the second ("HHAP cluster") scored higher on the helpless-hopeless and anxious preoccupation subscales and lower on the fighting spirit subscale (n = 49, 48.5%). In the longitudinal analysis, the FS cluster had a better HRQOL then the HHAP cluster for 2 years after diagnosis, but the HRQOLs did not differ significantly 3 years after diagnosis. CONCLUSIONS: Maladaptive coping at diagnosis may predict poor HRQOL in women with breast cancer. Regular screening of coping style and interventions to improve poor coping style should be considered for at least 2 years post initial diagnosis.

Self-management Needs of Breast Cancer Survivors After Treatment: Results From a Focus Group Interview.

BACKGROUND: Recognition of the importance of self-management (SM) for breast cancer survivors (BCSs) is increasing, but evidence from investigations of their needs focusing on SM is limited. OBJECTIVES: The aim of this study was to explore the SM needs of BCSs who had completed treatment. METHODS: Using a qualitative study design, we interviewed a focus group of 20 BCSs who underwent cancer therapy (mean time since diagnosis 3.4 years) at a university hospital in South Korea. Data were analyzed via conventional content analysis. RESULTS: The focus group interviews revealed 10 subthemes that we organized into 5 themes about the posttreatment SM needs of BCSs: (1) symptom management needs, (2) emotional management needs, (3) information acquisition needs, (4) need for a relationship with healthcare providers, and (5) adaptation needs. Specifically, participants needed to acquire SM skills to relieve symptoms (eg, peripheral neuropathy, insomnia), deal with emotional problems (eg, fear of recurrence, anxiety, depression), and adapt to changes due to cancer treatment (eg, body image, lifestyle, and role changes). In particular, participants expressed a substantial need for a constructive relationship with healthcare providers who, by respecting and communicating with them, would help empower them. Participants placed a high value on building self-confidence for successful SM. CONCLUSIONS: Our findings can contribute to the development of breast cancer survivorship care plans by emphasizing posttreatment SM. IMPLICATIONS FOR PRACTICE: Future SM support intervention for BCSs after treatment should focus on training SM skills, enhancing the survivor-provider relationship, and building survivor self-confidence.

Screen Time and Cardiovascular Risks Among Middle-Aged Women.

BACKGROUND: Screen time is a marker of sedentary behavior that threatens the health of women. Extended screen time is associated with depression, insomnia, cardiovascular disease, and decreased quality of life. OBJECTIVE: In this study, we examined the factors associated with screen time and whether screen time is associated with the physiological and psychosocial health of middle-aged women. We applied a psycho-socioeconomic biobehavioral model of health and studied the outcomes of cardiometabolic biomarkers, insomnia, and quality of life. METHODS: Secondary data analysis was performed using data from a cross-sectional study conducted with 423 women between 40 and 65 years of age. Socioeconomic, physiological, psychosocial, and behavioral characteristics were measured. Self-reported screen time during the past week was measured using an ordinal scale. The data were analyzed using multivariate analysis of covariance, analysis of covariance, and logistic regression analysis. RESULTS: Twenty-four percent of subjects had at least 3 hours per day of screen time on weekdays, whereas 30.7% had at least 3 hours per day on weekends. Older women, unemployed women, and those who do not perform regular exercise were more likely to have at least 3 hours per day of screen time (P < .05). Screen time was associated with total cholesterol and low-density lipoprotein cholesterol levels, insomnia, and menopause-specific quality of life (P < .05). CONCLUSIONS: Based on a psycho-socioeconomic biobehavioral framework, we found that screen time is associated with the physiological and psychosocial health of women independent of socioeconomic and biobehavioral variables. Efforts to reduce the amount of screen time targeting middle-aged women will help improve cardiometabolic biomarkers and quality of life.

[Mediation Effect of Self-Efficacy on the Relationship between Perceived Self-Management Support and Health-Related Quality of Life among Cancer Survivors].

PURPOSE: This study aimed to examine the levels of perceived self-management support, self-efficacy for self-management, and health-related quality of life (HRQoL) in cancer survivors, and to identify the mediating effect of self-efficacy in the relationship between perceived self-management support and HRQoL. METHODS: This study used a descriptive correlational design. Two hundred and four cancer survivors who had completed treatment participated in the study. Measurements included the Patient Assessment of Chronic Illness Care Scale, the Korean version of the Cancer Survivors' Self-Efficacy Scale, and the Medical Outcomes Study Short Form-36. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and multiple regression analysis using Baron and Kenny's method for mediation. RESULTS: The mean score for perceived self-management support was 3.35 out of 5 points, self-efficacy was 7.26 out of 10 points, and HRQoL was 65.90 out of 100 points. Perceived self-management support was significantly positively correlated with self-efficacy (r=.29, p<.001) and HRQoL (r=.27, p<.001). Self-efficacy was also significantly correlated with HRQoL (r=.59, p<.001). Furthermore, self-efficacy (ß=.55, p<.001) had a complete mediating effect on the relationship between perceived self-management support and HRQoL (Z=3.88, p<.001). CONCLUSION: The impact of perceived self-management support on HRQoL in cancer survivors was mediated by self-efficacy for self-management. This suggests that strategies for enhancing self-efficacy in cancer survivors should be considered when developing self-management interventions for improving their HRQoL.

Psychometric Evaluation of a Korean Version of the Cancer Survivors' Self-efficacy Scale.

BACKGROUND: Self-efficacy has become the target outcome of many self-management interventions for cancer survivors. However, no measurement is available that can be used to measure cancer-specific self-efficacy in Korea. OBJECTIVE: The aim of this study was to cross-culturally evaluate the reliability and validity of a Korean version of the Cancer Survivors' Self-Efficacy Scale (CSSES-K). METHODS: We translated the original version of the CSSES (11 items) and created a Korean version. We then conducted a validation study with 204 cancer survivors who had completed their primary treatment. We conducted psychometric evaluation using item analysis, factorial construct validity (exploratory factor analysis and confirmative factor analysis), hypothesis testing construct validity, and internal consistency reliability (Cronbach's α). RESULTS: Exploratory factor analysis revealed 2 subscales for which model fitting was appropriate-"self-efficacy for managing health problems" (5 items) and "self-efficacy for seeking help and support" (5 items). Hypothesis testing construct validity was confirmed showing significant moderate correlations between the CSSES-K and general self-efficacy (r = 0.511, P < .001), anxiety (r = -0.596, P < .001), depression (r = -0.554, P < .001), and health-related quality of life (r = 0.586, P < .001). The internal consistency of the CSSES-K of total scale and subscales was high (Cronbach's α = .86-.92). CONCLUSIONS: The results supported that the CSSES-K was valid and reliable in measuring self-efficacy among Korean cancer survivors after cancer treatment. IMPLICATIONS FOR PRACTICE: Our findings suggest that the CSSES-K can be effectively used for measuring self-efficacy in Korean cancer survivors.

Differences in Factors Associated with Depressive Symptoms between Urban and Rural Female Adolescents in Korea.

PURPOSE: To examine the prevalence of depressive symptoms and differentiate factors associated with them in urban and rural areas by applying the Ecological Models of Health Behavior. METHODS: We employed a cross-sectional design and convenience sample of 460 female adolescents. The instruments included the Adolescent Mental-Health Problem-Behavior Questionnaire (AMPQ-II) and the Beck Depression Inventory (BDI). RESULTS: Depressive symptoms were confirmed in 15.7% of urban adolescents and 22.9% of rural adolescents (p<.05). In the urban group, perception of health and stress associated with school performance were significantly associated with depressive symptoms. In the rural group, academic/internet related problems and rule violations were significantly associated with depressive symptoms (p<.05). General life happiness, worry/anxiety, and mood/suicidal ideation were common factors in both urban and rural areas (p<.05). CONCLUSION: Multiple factors were associated with depressive symptoms, and those significant factors differed between urban and rural female youths. Accordingly, tailored approaches are required considering urban and rural differences. The approaches should include intrapersonal, interpersonal, and organizational levels of interventions.

Behavioral Characteristics and Cardiovascular Disease Risks Associated With Insomnia and Sleep Quality Among Middle-Aged Women in South Korea.

Insomnia is the most common sleep problem in women. Increasing evidence suggests an association between insomnia and cardiovascular disease (CVD). However, information is limited on lifestyle and socio-environmental factors associated with sleep problems in women. In this study directed by Social Cognitive Theory, we examined the personal, behavioral, socio-environmental, and CVD risk factors associated with sleep characteristics (insomnia and sleep quality) in middle-aged women using a cross-sectional design. The study instruments included the Insomnia Severity Index (ISI), the Pittsburg Sleep Quality Index (PSQI), the Center for Epidemiological Studies Depression Scale (CES-D), and measures of social support and behavioral characteristics. Blood was drawn to assess serum glucose and lipids, and BMI was measured. Data were analyzed using hierarchical multiple regression and analysis of covariance (ANCOVA). Of 423 middle-aged women, 25% experienced insomnia (ISI ≥ 10) and 41.3% reported poor sleep quality (PSQI ≥ 5). Lesser education (≤middle school), more depressive symptoms, more screen time (≥ 3 hours/day), and severe stress were associated with greater severity of insomnia and/or poorer sleep quality. Total and LDL cholesterol levels were higher in women with insomnia than normal sleepers, whereas the BMI was higher in those who reported poor sleep quality. Because personal, behavioral, and socio-environmental factors were significantly associated with insomnia and poor sleep quality, multifactorial approaches should be considered in developing sleep interventions and reducing cardiovascular risk. © 2017 Wiley Periodicals, Inc.

Transtheoretical Model Based Exercise Counseling Combined with Music Skipping Rope Exercise on Childhood Obesity.

PURPOSE: The purpose was to evaluate the effects of a transtheoretical model (TTM) based exercise counseling offered with music skipping rope exercise on components of the TTM (stages of change, decisional balance, and self-efficacy), body mass index, glucose, and lipid profile of overweight/obese children in Korea. METHODS: This study used a nonequivalent pretest and posttest experimental study design. A total of 75 overweight/obese children participated in the study. Eight sessions of exercise counseling combined with music skipping rope exercise for 12 weeks were offered for children in the experimental group, while one session of exercise counseling with music skipping rope exercise for 12 weeks was offered for children in the control group. Outcomes were measured at baseline, and 6 months after the intervention. RESULTS: After the intervention, self-efficacy significantly improved among children in the experimental group (p = .049), while these children maintained their baseline BMI at 6-month follow-up (p > .05). Among children in the control group, BMI significantly increased (p < .05). Fasting blood sugar significantly increased for both groups after the intervention (p < .05). However, a greater increase was observed for the control group. CONCLUSIONS: Our study partially supports the hypothesis that a TTM-based exercise intervention is effective in maintaining BMI and improving self-efficacy of overweight/obese children. The TTM-based counseling combined with exercise classes has potential to control weight among overweight/obese children, while involvement of parents and children in the development of the theory-based intervention may generate further benefits regarding health and well-being of overweight/obese children.