Epidemiology and Health

Original Articles

Decrease in household secondhand smoking among Korean adolescents associated with smoke-free policies: grade-period-cohort and interrupted time series analyses: Hana Kim, Heewon Kang, Sung-il Cho; Epidemiol Health. 2024;46:e2024009. Published online December 13, 2023; DOI: https://doi.org/10.4178/epih.e2024009

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Smoke-free areas have expanded and related campaigns have been implemented since 1995 in Korea. As a result, household secondhand smoke (SHS) exposure has decreased over the past 15 years. We assessed the cohort effect, the effect of a 2008 campaign on household SHS exposure, and the impact of a complete smoking ban in public places along with increased penalties, as implemented in December 2011.
METHODS
Nationally representative cross-sectional 15-wave survey data of Korean adolescents were used. The 810,516 participants were classified into 6 grade groups, 15 period groups, and 20 middle school admission cohorts. An age-period-cohort analysis, conducted with the intrinsic estimator method, was used to assess the cohort effect of household SHS exposure, and interrupted-time series analyses were conducted to evaluate the effects of the smoke-free policy and the campaign.
RESULTS
For cohorts who entered middle school from 2002 to 2008, the risk of household SHS exposure decreased among both boys and girls. Immediately after implementation of the smoke-free policy, the prevalence of household SHS exposure by period decreased significantly for boys (coefficient, -8.96; p<0.05) and non-significantly for girls (coefficient, -6.99; p=0.07). After the campaign, there was a significant decrease in household SHS exposure by cohort among boys, both immediately and post-intervention (coefficient, -4.84; p=0.03; coefficient, -1.22; p=0.02, respectively).
CONCLUSIONS
A school-admission-cohort effect was found on household SHS exposure among adolescents, which was associated with the smoke-free policy and the campaign. Anti-smoking interventions should be implemented consistently and simultaneously.; Summary

Korean summary
지난 15년 동안 한국 청소년의 가정 내 간접흡연 노출은 감소했다. 가정 내 간접흡연 노출에 대하여 중학교 입학 코호트 효과가 존재하였다. 또한, 청소년의 가정 내 간접흡연 노출 감소는 2011년 12월 공공장소에서의 금연구역 규제와 2008년 시행된 캠페인과 연관되어 있었다.

Key Message
Household secondhand smoke (SHS) exposure among Korean adolescents has decreased over the past 15 years. There was a school admission cohort effect on household SHS exposure. A complete smoking ban in public space with increased penalties in December 2011 and a campaign in 2008 to avoid SHS exposure were associated with reduced household SHS exposure among adolescents.

Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-SEROSMART): findings from national representative sample: Jina Han, Hye Jin Baek, Eunbi Noh, Kyuhyun Yoon, Jung Ae Kim, Sukhyun Ryu, Kay O Lee, No Yai Park, Eunok Jung, Sangil Kim, Hyukmin Lee, Yoo-Sung Hwang, Jaehun Jung, Hun Jae Lee, Sung-il Cho, Sangcheol Oh, Migyeong Kim, Chang-Mo Oh, Byengchul Yu, Young-Seoub Hong, Keonyeop Kim, Sun Jae Jung, Mi Ah Han, Moo-Sik Lee, Jung-Jeung Lee, Young Hwangbo, Hyeon Woo Yim, Yu-Mi Kim, Joongyub Lee, Weon-Young Lee, Jae-Hyun Park, Sungsoo Oh, Heui Sug Jo, Hyeongsu Kim, Gilwon Kang, Hae-Sung Nam, Ju-Hyung Lee, Gyung-Jae Oh, Min-Ho Shin, Soyeon Ryu, Tae-Yoon Hwang, Soon-Woo Park, Sang Kyu Kim, Roma Seol, Ki-Soo Park, Su Young Kim, Jun-wook Kwon, Sung Soon Kim, Byoungguk Kim, June-Woo Lee, Eun Young Jang, Ah-Ra Kim, Jeonghyun Nam, The Korea Community Health Survey Group, Soon Young Lee, Dong-Hyun Kim; Epidemiol Health. 2023;45:e2023075. Published online August 17, 2023; DOI: https://doi.org/10.4178/epih.e2023075

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) in 258 communities throughout Korea.

METHODS

In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of antibodies to spike proteins (anti-S) and antibodies to nucleocapsid proteins (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022.

RESULTS

In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%.

CONCLUSIONS

The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

Summary

Korean summary
인구집단을 기반으로 하여 대표성 있는 표본을 추출하여 COVID-19 항체유병률 조사를 전국적으로 수행함으로 지역사회 단위에서 지속적으로 모니터링할 수 있는 COVID-19 감시체계 구축의 기반을 마련하였다. 2022년 8월 우리나라 국민의 대부분이 COVID-19에 대한 항체를 보유하고 있었고 인구 3명 중 1명은 미확진 감염자로 추정되었다.

Key Message
The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19. In August 2022, most of the Korean people had antibodies to COVID-19, and one in three people was estimated to have an unreported infection. This study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

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Infection-mediated immune response in SARS-CoV-2 breakthrough infection and implications for next-generation COVID-19 vaccine development
Sho Miyamoto, Tadaki Suzuki
Vaccine.2024; 42(6): 1401. CrossRef

Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies: Yoojin Park, Euncheol Son, Young June Choe, Cho Ryok Kang, Sangmi Roh, Young Ok Hwang, Sung-il Cho, Jihwan Bang; Epidemiol Health. 2023;45:e2023057. Published online June 9, 2023; DOI: https://doi.org/10.4178/epih.e2023057

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Abstract Summary PDF

Abstract

OBJECTIVES
Because effective decolonization options are not available, and treatment options are limited, carbapenem-resistant Enterobacterales (CRE) constitute increasingly threatening nosocomial pathogens. To prevent CRE-associated transmission and ensure patient safety, healthcare personnel and everyone in contact with CRE-infected patients must implement stringent infection control practices. This report describes a CRE outbreak, possibly related to a caregiver at a long-term care facility (LTCF), and presents a new surveillance model to improve the infection control of CRE in Seoul, Korea.

METHODS

The Seoul Metropolitan Government surveillance system identified an outbreak of CRE in an LTCF in 2022. We obtained data on the demographic characteristics and contact histories of the inpatients, medical staff, and caregivers. To isolate the inpatients and employees exposed to CRE, we used rectal swab samples and environmental sampling during the study period (May-December 2022).

RESULTS

We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE, and conducted a complete 197-day follow-up of all cases in the LTCF’s isolation wards.

CONCLUSIONS

This investigation demonstrated that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Summary

Korean summary
서울시 CRE 감시체계를 통해 2022년 한 요양병원의 집단발생을 인지하였다. 현장역학조사를 실시하여 18명의 집단발생 사례(1명 간병인, 17명 입원환자)와 12명의 산발적인 사례를 확인하였고 감염관리 컨설팅을 통해 유행을 확산을 방지하는 중재를 시행하였다.

Key Message
The Seoul Metropolitan Government surveillance system identified an outbreak of carbapenem-resistant Enterobacterales (CRE) in a long-term care facility (LTCF) in 2022. We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE. In the current study, we could demonstrate that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

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Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study
Jung-Hwan Lee, Jongbeom Shin, Soo-Hyun Park, Boram Cha, Ji-Taek Hong, Don-Haeng Lee, Kye Sook Kwon
Microorganisms.2023; 11(12): 2970. CrossRef

The association between tobacco or nicotine product use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic: a cross-sectional study in Korea: Da-eun Lee, Heewon Kang, Sung-il Cho; Epidemiol Health. 2022;44:e2022087. Published online October 7, 2022; DOI: https://doi.org/10.4178/epih.e2022087

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
It is necessary to investigate tobacco or nicotine product (TNP) use which acts as a risk factor for coronavirus disease 2019 (COVID-19) infection. Especially, wearing a mask is difficult to practice while using TNP. Therefore, this study aimed to examine the association between TNP use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic.
METHODS
The samples of 208,618 Korean adults from 2020 Community Health Survey in Korea were used. As an independent variable, TNP use behaviors such as TNP use status, changes in TNP use after the COVID-19 outbreak, TNP types, and attempt to quit were analyzed. Logistic regression was performed on gender-stratified participants.
RESULTS
Among men, the odds ratio (OR) of current and former TNP users were 2.00 (95% confidence interval [CI], 1.66 to 2.40) and 1.32 (95% CI, 1.09 to 1.60), respectively, compared to never users. In women, OR was 1.50 (95% CI, 1.00 to 2.26) for former users. Cigarette use was more associated with not wearing a mask than non-cigarette tobacco or nicotine product (NCTNP) use (OR, 1.53; 95% CI, 1.12 to 2.08). Men whose TNP use decreased had lower non-compliance (OR, 0.52; 95% CI, 0.36 to 0.74); while women whose TNP use increased had lower non-compliance (OR, 0.13; 95% CI, 0.07 to 0.26).
CONCLUSIONS
Current and former users were less likely to wear masks. Cigarette use was more associated with not wearing a mask than NCTNP use. Changes in TNP use showed association for men and women; however, in the opposite direction. Therefore, more attention should be paid to TNP use prevention and cessation support during the epidemic of respiratory infectious diseases. Moreover, it is necessary to identify risk factors of cigarette users in compliance with mask-wearing.; Summary

Korean summary
담배 또는 니코틴 제품 (Tobacco or Nicotine Products, TNPs) 현재사용자와 과거사용자는 비사용자 대비 마스크 미착용 연관성이 높고, 비궐련 담배 또는 니코틴 제품 (Non-Cigarette Tobacco or Nicotine Products, NCTNPs) 사용자보다는 일반담배 사용자의 마스크 미착용 연관성이 높다. 남성에서는 코로나19 유행 이전 대비 TNPs 사용이 감소했을 때, 여성에서는 증가했을 때 마스크 미착용 연관성이 낮았다. 따라서 호흡기 감염병 유행 시기에는 더욱 TNPs 사용 예방과 금연 지원에 관심을 가질 것을 제안한다.

Key Message
During the epidemic of respiratory infectious diseases, more attention should be paid to tobacco or nicotine products (TNPs) use prevention and cessation support.

Seroprevalence of SARS-CoV-2 antibodies during the third wave of COVID-19 in the Seoul metropolitan area of Korea: Kyuhyun Yoon, Jayeun Kim, Kyong Ran Peck, Hyun Soo Kim, Hyukmin Lee, Yoo-Sung Hwang, Soon Young Lee, Sung-il Cho, Hun Jae Lee, Yeong-gyeong Kim, Byoungguk Kim, June-Woo Lee, Ah-Ra Kim, Hyeon Nam Do, Dong-Hyun Kim; Epidemiol Health. 2022;44:e2022085. Published online September 30, 2022; DOI: https://doi.org/10.4178/epih.e2022085

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Abstract Summary PDF

Abstract

OBJECTIVES
After the third wave of coronavirus disease 2019 (COVID-19), by mid-February 2021, approximately 0.16% of the Korean population was confirmed positive, which appeared to be among the lowest rates worldwide at that time. However, asymptomatic transmission is challenging for COVID-19 surveillance. Therefore, a community-based serosurvey of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted to understand the effectiveness of Korea’s strong containment strategy.

METHODS

We collected 5,002 residual sera samples from January 30 to March 3, 2021, from 265 medical facilities in Seoul, 346 in Gyeonggi Province, and 57 in Incheon. Sixty samples from tertiary institutions were excluded. We defined the sub-regions according to the addresses of the medical facilities where the specimens were collected. Elecsys Anti-SARS-CoV-2 was used for screening, and positivity was confirmed using the SARS-CoV-2 sVNT Kit. Prevalence was estimated using sampling weights and the Wilson score interval for a binomial proportion with a 95% confidence interval.

RESULTS

Among the 4,942 specimens, 32 and 25 tested positive for COVID-19 in the screening and confirmatory tests, respectively. The overall crude prevalence of SARS-CoV-2 antibodies was 0.51%. The population-adjusted overall prevalence was 0.55% in women and 0.38% in men. The region-specific estimation was 0.67% and 0.30% in Gyeonggi Province and Seoul, respectively. No positive cases were detected in Incheon.

CONCLUSIONS

The proportion of undetected cases in Korea remained low as of early 2021. Therefore, an infection control strategy with exhaustive tracing and widespread pre-emptive testing appears to be effective in containing community spread of COVID-19.

Summary

Korean summary
코로나19바이러스 감염병(COVID-19)의 한국 내 3차 대유행기인 2020년 말 이후, 2021년 1월 우리나라 인구의 약 0.16%가 누적 확진되었으며, 이는 세계에서 매우 낮은 비율을 보이는 국가 중 하나였습니다. 그러나 COVID-19의 무증상 전파는 감염 확산방지와 감시체계에 문제점들을 초래할 수 있어 지역사회 기반 혈청 조사를 통해 그 현황을 파악했습니다. 2021년 1월 30일부터 3월 3일까지 서울, 경기, 인천 등 수도권 소재 1, 2차 의료기관에서 수집된 혈액검체의 잔여혈청표본 4942개에 대해 Roche사의 Elecsys Anti-SARS-CoV-2를 이용한 1차 항체검사와, GenScript의 SARS-CoV-2 sVNT Kit를 이용하여 2차 중화항체유무를 확인하였다. 4942명의 검체 중 1차 검사와 2차 중화항체검사에서 각각 32명과 25명이 항체 양성이었다. SARS-CoV-2 항체의 전체 수도권 조유병률은 0.51%였습니다. 인구의 연령보정 전체 유병률은 0.47%였으며, 성별로는 여성에서 0.55%, 남성에서 0.38%였습니다. 지역별 추정치는 경기도와 서울이 각각 0.67%와 0.30%였고, 인천에서는 양성사례가 발견되지 않았습니다. 한국의 미발견 사례 비율은 누적 확진율의 3배에 달하지만, 여전히 1% 미만으로 낮습니다. 철저한 추적과 광범위한 선제적 검사를 통한 감염 관리 전략이 지역사회에서 바이러스 확산을 억제하는 데 효과적이었던 것으로 보입니다.

Key Message
Around February 2021, the SARS-CoV-2 antibody test was conducted on the residual serum of adults (≥19 years) collected from primary and secondary medical institutions in the metropolitan area in South Korea. The estimated overall prevalence was 0.60% in the electrochemiluminescence immunoassay (ECLIA) detecting IgG against the nucleocapsid protein and 0.47% for the neutralization antibody. The positivity of the confirmed test using surrogate neutralizing antibodies was only 78% of the ECLIA’s results. For prevention and control measures against the spread of SARS-CoV-2 infections and new variants emerge, serosurvey targeting community-dwelling people is needed to understand the changing status in the community.

Citations

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Realistic Estimation of COVID-19 Infection by Seroprevalence Surveillance of SARS-CoV-2 Antibodies: An Experience From Korea Metropolitan Area From January to May 2022
In Hwa Jeong, Jong-Hun Kim, Min-Jung Kwon, Jayoung Kim, Hee Jin Huh, Byoungguk Kim, Junewoo Lee, Jeong-hyun Nam, Eun-Suk Kang
Journal of Korean Medical Science.2024;[Epub] CrossRef
Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-SEROSMART): findings from national representative sample
Jina Han, Hye Jin Baek, Eunbi Noh, Kyuhyun Yoon, Jung Ae Kim, Sukhyun Ryu, Kay O Lee, No Yai Park, Eunok Jung, Sangil Kim, Hyukmin Lee, Yoo-Sung Hwang, Jaehun Jung, Hun Jae Lee, Sung-il Cho, Sangcheol Oh, Migyeong Kim, Chang-Mo Oh, Byengchul Yu, Young-Seo
Epidemiology and Health.2023; 45: e2023075. CrossRef

Recent increase in pertussis incidence in Korea: an age-period-cohort analysis: Chanhee Kim, Seonju Yi, Sung-il Cho; Epidemiol Health. 2021;43:e2021053. Published online August 18, 2021; DOI: https://doi.org/10.4178/epih.e2021053

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Pertussis or whooping cough—one of the most contagious diseases—is caused by the Gram-negative bacterium <i>Bordetella pertussis</i>. Despite a high vaccination rate, Korea recently experienced a resurgence of pertussis. This study explores patterns and possible explanations for this resurgence through an age-period-cohort analysis.

METHODS

Using secondary data from the infectious disease portal of the Korea Disease Control and Prevention Agency and the Korea Statistical Information Service of Statistics Korea, this study analyzed the incidence of pertussis in Korea to determine which factors contributed to the recent increase using an age-period-cohort model.

RESULTS

Analysis of the age effect indicated that the age group most vulnerable to pertussis was 0-year to 2-year-olds. Analysis of the period effect showed a sharp increase in the incidence rate after 2016. Analysis of the cohort effect showed a significant decrease in incidence beginning with the 1955 birth cohort, with the risk increasing again with the 2000s birth cohort.

CONCLUSIONS

Previous studies have suggested 3 main possible explanations for our results. First, the increased incidence rate can be attributed to contact rates. Second, the rate of immunity through natural exposure has decreased due to the low number of circulating pathogens, in turn affecting the trend of infection. Lastly, variations in pathogens may have also contributed to the increase in incidence. Given that the most significant increase in incidence was observed among infants younger than 1 year old, sufficient maternal immunity must be prioritized to provide passive immunity to newborns via the placenta.

Summary

Korean summary
본 연구는 연령-기간-코호트 모델을 활용하여 예방접종률이 높은 국가들의 백일해 재출현에 기여하는 요인에 무엇이 있는지 살펴보았다. 연령에 따른 사회적 접촉률(contact rate)의 변화, 자연노출에 의한 면역 강화(natural boosting) 기회의 감소, 그리고 백일해 병원체의 변이가 백일해 재출현의 원인일 수 있다. 분석 결과 영아 집단에서 백일해 발병률이 가장 급격한 증가가 관찰되었으며, 이는 모성면역의 확보가 중요하다는 점을 시사한다.

Key Message
This study examined factors contribute to the re-emergence of pertussis in countries with high vaccination rates using the age-period-cohort model. Changes in social contact rates according to age, reduction in immune boosting opportunities by natural exposure, and variations in pertussis pathogens may be the cause of re-emergence. As a result of the analysis, the sharpest increase in the incidence of pertussis in the infant group was observed, suggesting that securing maternal immunity is important.

Citations

Citations to this article as recorded by

Epidemiological Characteristics of Notifiable Respiratory Infectious Diseases in Mainland China from 2010 to 2018
Lele Deng, Yajun Han, Jinlong Wang, Haican Liu, Guilian Li, Dayan Wang, Guangxue He
International Journal of Environmental Research and Public Health.2023; 20(5): 3946. CrossRef
Incidence and Healthcare Burden of Pertussis among Older Adults with and without Pre-Existing Chronic Obstructive Pulmonary Disease or Asthma in South Korea
Jing Chen, Ju-Young Shin, Hyungwoo Kim, Ju Hwan Kim, Ahhyung Choi, Hee Jin Cheong, Yeon-Mok Oh, Adrienne Guignard, Sumitra Shantakumar
COPD: Journal of Chronic Obstructive Pulmonary Disease.2023; 20(1): 126. CrossRef
Pre-Pandemic Distribution of Bacterial Species in Nasopharyngeal Swab Specimens from Pediatric and Adult Patients Detected via RT-PCR Using the Allplex Respiratory Panel
Dong-Hyun Lee, Young-Jin Choi, Jieun Kim, Eunhee Han, Mi-Hyun Bae
Life.2023; 13(9): 1840. CrossRef
Bacterial Etiology in Subacute Cough
Ji-Yong Moon, Hyun Lee, Min-Hye Kim, Woo-Jung Song, Sang Min Lee, Sae-Hoon Kim, Sang-Heon Kim, Byung-Jae Lee, Ho Joo Yoon, Sang Hoon Kim
Allergy, Asthma & Immunology Research.2023; 15(5): 673. CrossRef
Post-Marketing Surveillance of Tetravalent Diphtheria-Tetanus-Acellular Pertussis and Inactivated Poliovirus (DTaP-IPV) Vaccine in South Korea, 2009 to 2015
Young June Choe, Emmanuel Vidor, Christine Manson
Infectious Diseases and Therapy.2022; 11(4): 1479. CrossRef
ARIMA and ARIMA-ERNN models for prediction of pertussis incidence in mainland China from 2004 to 2021
Meng Wang, Jinhua Pan, Xinghui Li, Mengying Li, Zhixi Liu, Qi Zhao, Linyun Luo, Haiping Chen, Sirui Chen, Feng Jiang, Liping Zhang, Weibing Wang, Ying Wang
BMC Public Health.2022;[Epub] CrossRef
Evaluation of Whole-Cell and Acellular Pertussis Vaccines in the Context of Long-Term Herd Immunity
Ewa Szwejser-Zawislak, Mieszko M. Wilk, Piotr Piszczek, Justyna Krawczyk, Daria Wilczyńska, Daniela Hozbor
Vaccines.2022; 11(1): 1. CrossRef

Effect of tobacco outlet density on quit attempts in Korea: a multi-level analysis of the 2015 Korean Community Health Survey: Jaehyung Kong, Sung-il Cho; Epidemiol Health. 2021;43:e2021048. Published online August 3, 2021; DOI: https://doi.org/10.4178/epih.e2021048

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Abstract Summary PDF

Abstract

OBJECTIVES
This study aimed to examine whether the regional density of tobacco outlets in Korea was associated with the likelihood of attempting to quit among smokers

METHODS

This study was designed as a secondary data analysis of a cross-sectional study. Data from the 2015 Korean Community Health Survey and tobacco outlet registrations in 17 metropolitan cities and provinces with 254 communities in Korea were used for the analysis. In total, 41,013 current smokers (≥19 years of age) were included. Multi-level logistic regression analysis was conducted to investigate regional differences associated with smokers’ attempts to quit and to evaluate the effects of individual and regional characteristics on quit attempts.

RESULTS

Higher tobacco outlet density was associated with lower odds of attempting to quit. Smokers who resided in districts with the highest tobacco outlet density were 18% less likely to attempt quitting (odds ratio, 0.82; 95% confidence interval, 0.70 to 0.98) than smokers who resided in the regions with the lowest tobacco outlet density (intraclass correlation coefficient, 0.030).

CONCLUSIONS

This study showed that quit attempts were related to community-level factors, such as tobacco outlet density, as well as other individual factors. These findings support the implementation of national policies restricting the number of tobacco outlets within communities or zones and limiting tobacco marketing in tobacco outlets.

Summary

Korean summary
본 연구는 2015년 지역사회건강조사에 응답한 19세 이상 현재 흡연자 41,013명을 대상으로 금연 시도와 관련된 개인 수준의 요인과 지역 수준의 요인을 파악하기 위하여 다수준 분석을 실시하였다. 분석결과, 개인 수준의 요인뿐만 아니라 거주하는 지역의 담배소매점 밀집도가 흡연자의 금연 시도와 유의한 관계가 있는 것으로 확인되었다. 흡연조장환경 개선을 위한 담배 공급 감소 노력의 일환으로 지역사회 수준의 담배소매점 관리 정책이 필요하다.

Key Message
This study aimed to investigate whether the environment related to tobacco retailers impacts adult smokers’ attempts to quit smoking, for the first time in South Korea, using nationwide data on tobacco retailers and current smokers. Smokers who resided in districts with the highest tobacco outlet density were 18% less likely to attempt quitting (odds ratio, 0.82; 95% confidence interval, 0.70-0.98) than smokers who resided in the regions with the lowest tobacco outlet density. These findings support the implementation of national policies restricting the number of tobacco outlets within communities or zones and limiting tobacco marketing in tobacco outlets.

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Association between area deprivation index and concerns to COVID-19: A multi-level analysis of individual and area factors
Doo Woong Lee, Jieun Jang, Jaeyong Shin
SSM - Population Health.2024; 25: 101580. CrossRef
Use of geographically weighted regression models to inform retail endgame strategies in South Korea: application to cigarette and ENDS prevalence
Heewon Kang, Eunsil Cheon, Jaeyoung Ha, Sung-il Cho
Tobacco Control.2023; : tc-2023-058117. CrossRef

Associations between socioeconomic status and blood cadmium levels in Korea: Yongho Jee, Sung-il Cho; Epidemiol Health. 2019;41:e2019018. Published online May 15, 2019; DOI: https://doi.org/10.4178/epih.e2019018

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Abstract Summary PDF

Abstract

OBJECTIVES
Although smoking is associated with both low socioeconomic status and blood cadmium (Cd) levels, the association between socioeconomic status and Cd levels remains unclear. Therefore, our study aimed to examine this association and to clarify whether smoking is a confounding or mediating variable in this relationship.

METHODS

Data (n=7,734) were drawn from the Korea National Health and Nutrition Examination Survey (KNHANES, 2008- 2011), including years that contained data on blood Cd and urinary cotinine levels. We investigated the associations of income, education, and occupation with blood Cd levels. Smoking was investigated by categorizing participants by smoking status (never, former, and current) and pack-years into quartiles. The weekly frequency of rice and barley intake was analyzed to gain insights into participants’ dietary patterns. Additionally, urinary cotinine levels were used to ensure the validity of the smoking variables.

RESULTS

Participants earning a low income and with less formal education had higher blood Cd levels. After controlling for smoking, the association between income and Cd levels substantially weakened. Further controlling for education, the association between income and Cd levels disappeared. However, there was a strong negative association between education and Cd levels, even after controlling for smoking history, pack-years, and urinary cotinine levels.

CONCLUSIONS

In cross-sectional data from the KNHANES, blood Cd levels were significantly higher among those with a low income and less formal education. Smoking history contributed to, but did not fully explain, these associations.

Summary

Korean summary
흡연은 낮은 사회경제적 상태와, 높은 혈중 카드뮴 상태 등과 관련이 있다고 보고가 되어 왔지만, 사회경제적 상태와 혈중 카드뮴 상태의 연관성은 불분명하다. 따라서, 본 연구는 혈중 카드뮴 농도와 사회경제적 상태와의 관련성을 분석하고, 흡연이라는 변수가 이 관련성에 어떠한 영향을 주는지 보고자 하였다.

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Erratum

Age-period-cohort analysis of smoking prevalence among young adults in Korea: Yong Ho Jee, Sung-il Cho; Epidemiol Health. 2016;38:e2016029. Published online July 8, 2016; DOI: https://doi.org/10.4178/epih.2016029; Corrects: Epidemiol Health 2016;38:e2016010

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Abstract PDF

Abstract

This article was initially published in the Epidemiology and Health 2016;38:e2016010, with an error in Figure 1C that duplicated Figure 1E. The authors would like to correct Figure 1C as below.

Summary

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Mediation of Smoking Abstinence Self-Efficacy on the Association between Nicotine Dependence and the Intention to Quit Smoking
Yongho Jee, Gyu Ri Kim, Mikyung Ryu, Sung-il Cho
Journal of the Korean Society for Research on Nicotine and Tobacco.2023; 14(3): 110. CrossRef
Gender and tobacco epidemic in South Korea: implications from age-period-cohort analysis and the DPSEEA framework
Sera Kim, Garam Byun, Garam Jo, Dahyun Park, Sung-Il Cho, Hannah Oh, Rockli Kim, S V Subramanian, Sungha Yun, Kyungwon Oh, Jong-Tae Lee, Min-Jeong Shin
BMJ Open.2022; 12(4): e058903. CrossRef

Original Articles

Age-period-cohort analysis of smoking prevalence among young adults in Korea: Yong Ho Jee, Sung-il Cho; Epidemiol Health. 2016;38:e2016010. Published online March 19, 2016; DOI: https://doi.org/10.4178/epih.e2016010; Correction in: Epidemiol Health 2016;38(0):e2016029

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Abstract Summary PDF

Abstract

OBJECTIVES
Smoking prevalence among Korean men in their thirties is substantially high (approximately 50%). An in-depth analysis of smoking trends among young adults in their twenties is necessary to devise antismoking policies for the next 10 years. This study aimed to identify the contributions of age, period, and birth cohort effects on smoking prevalence in young adults.

METHODS

Subjects comprised 181,136 adults (83,947 men: 46.3%; 97,189 women: 53.7%) aged 19 to 30 years from the 2008-2013 Korea Community Health Survey. Smoking prevalence adjusted with reference to the 2008 population was applied to the age-period-cohort (APC) model to identify the independent effects of each factor.

RESULTS

For men, smoking prevalence rapidly escalated among subjects aged 19 to 22 years and slowed down among those aged 23 to 30 years, declined during 2008 to 2010 but stabilized during 2011 to 2013, and declined in birth cohorts prior to 1988 but stabilized in subjects born after 1988. However, in APC models, smoking prevalence increased with age in the 1988 to 1991 birth cohort. In this birth cohort, smoking prevalence at age 19 to 20 years was approximately 24% but increased to 40% when the subjects turned 23 to 24 years. For women, smoking prevalence was too low to generate consistent results.

CONCLUSIONS

Over the past six years and in recent birth cohorts, smoking prevalence in adults aged 19 to 30 years has declined and is stable. Smoking prevalence should be more closely followed as it remains susceptible to an increase depending on antismoking policies or social conditions.

Summary

Korean summary
우리나라 남자의 30대와 40대의 흡연율은 약 50% 수준으로 매우 높다. 앞으로 10년 뒤에 이들 연령대로 진입하는 20대와 30대 젊은 청년층의 흡연율의 추이를 심층 분석하는 것은 10년 뒤 금연정책 준비에 필요한 기초자료가 될 것이다. 이 연구의 목적은 젊은 청년의 흡연율의 변화추이에 영향을 주는 연령, 연도, 출생코호트 효과를 파악하고자 하였다. 지난 6년 동안 19-30세의 흡연율은 전체적으로 연도가 증가하고 최근 출생코호트로 올수록 감소하는 경향을 보였다. 그러나 최근 출생코호트의 흡연율은 앞으로 금연정책이나 사회적인 상황에 따라 여전히 증가할 여지가 있으므로 주의 깊은 관찰이 필요할 것으로 생각된다.

Citations

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An age‐period‐cohort approach to studying long‐term trends in obesity and overweight in England (1992–2019)
Magdalena Opazo Breton, Laura A. Gray
Obesity.2023; 31(3): 823. CrossRef
Age, Period, and Cohort Analysis of Smoking Intensity Among Current Smokers in Malaysia, 1996–2015
Chien Huey Teh, Sanjay Rampal, Kuang Hock Lim, Omar Azahadi, Aris Tahir
Nicotine and Tobacco Research.2023; 25(7): 1340. CrossRef
Understanding long‐term trends in smoking in England, 1972–2019: an age–period–cohort approach
Magdalena Opazo Breton, Duncan Gillespie, Robert Pryce, Ilze Bogdanovica, Colin Angus, Monica Hernandez Alava, Alan Brennan, John Britton
Addiction.2022; 117(5): 1392. CrossRef
Status of Workers’ Health Behavior and the Association between Occupational Characteristics and Health Behavior
Seung-Yeon Lee, Saemi Jung, Wanhyung Lee
International Journal of Environmental Research and Public Health.2022; 19(20): 13021. CrossRef
Factors Associated with Single-Use and Co-Use of Tobacco and Alcohol: A Multinomial Modeling Approach
Jin-Won Noh, Kyoung-Beom Kim, Jooyoung Cheon, Yejin Lee, Ki-Bong Yoo
International Journal of Environmental Research and Public Health.2019; 16(19): 3506. CrossRef
The unrealized potential: cohort effects and age-period-cohort analysis
Jongho Heo, Sun-Young Jeon, Chang-Mo Oh, Jongnam Hwang, Juhwan Oh, Youngtae Cho
Epidemiology and Health.2017; 39: e2017056. CrossRef

Test-retest reliability of health behavior items in the Community Health Survey in South Korea: Soo Jeong Kim, Jin A Han, Young Hwa Kim, Bo Youl Choi, Su Young Kim, Hun Je Lee, In Hwan Oh, Sung-il Cho, Jakyoung Lee, Soon Young Lee; Epidemiol Health. 2015;37:e2015045. Published online October 20, 2015; DOI: https://doi.org/10.4178/epih/e2015045

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Abstract Summary PDF

Abstract

OBJECTIVES
Responses to health-related items on the Community Health Survey (CHS) provide evidence that is used to develop community-based health policy. This study aimed to assess the test-retest reliability of selected health behavioral items on the CHS according to item category, response period, and response scale.

METHODS

A sample of 159 men and women 20 to 69 years of age participated in a test-retest with an interval of 14 to 21 days. A total of 28 items relating to smoking, alcohol consumption, diet and weight control, and mental health were selected. We evaluated the test-retest reliability of the items using kappa statistics.

RESULTS

Kappa values ranged from 0.44 to 0.93. Items concerning habits had higher kappa values (mean, 0.7; standard error, 0.05) than items concerning awareness or attitudes (p=0.012). The kappa value of items with two- to four-point scales was 0.63, which was higher than the value of 0.59 for items with scales involving five or more points, although this difference was not statistically significant. Different kappa values were observed for each reference period, but no statistically significant differences were noted.

CONCLUSIONS

The test-retest reliability of the CHS items that we studied was associated with item category. Further study of the relationship between item category and reliability in domains other than health behaviors is required.

Summary

Korean summary
이 연구는 지역사회건강조사의 건강행태 문항 중 28개 문항에 대하여 문항의 특성, 준거기간, 보기의 척도에 따라 조사-재조사 신뢰도의 차이를 분석하였다. 전체 문항의 카파값의 범위는 0.44-0.93이었다. 문항의 특성별로는 인지 또는 태도에 비해 습관에 관한 문항의 신뢰도가 높았으며, 보기의 척도가 5점 척도 이상에 비해 2-4점 척도의 신뢰도가 높음을 확인하였다.

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MERS-Original Article

Epidemiologic features of the first MERS outbreak in Korea: focus on Pyeongtaek St. Mary’s Hospital: Kyung Min Kim, Moran Ki, Sung-il Cho, Minki Sung, Jin Kwan Hong, Hae-Kwan Cheong, Jong-Hun Kim, Sang-Eun Lee, Changhwan Lee, Keon-Joo Lee, Yong-Shik Park, Seung Woo Kim, Bo Youl Choi; Epidemiol Health. 2015;37:e2015041. Published online September 17, 2015; DOI: https://doi.org/10.4178/epih/e2015041

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the epidemiologic features of the confirmed cases of Middle East Respiratory Syndrome (MERS) in Pyeongtaek St. Mary’s Hospital, where the outbreak first began, in order to identify lessons relevant for the prevention and control of future outbreaks.

METHODS

The patients’ clinical symptoms and test results were collected from their medical records. The caregivers of patients were identified by phone calls.

RESULTS

After patient zero (case #1) was admitted to Pyeongtaek St. Mary’s Hospital (May 15-May 17), an outbreak occurred, with 36 cases between May 18 and June 4, 2015. Six patients died (fatality rate, 16.7%). Twenty-six cases occurred in the first-generation, and 10 in the second-generation. The median incubation period was five days, while the median period from symptom onset to death was 12.5 days. While the total attack rate was 3.9%, the attack rate among inpatients was 7.6%, and the inpatients on the eighth floor, where patient zero was hospitalized, had an 18.6% attack rate. In contrast, caregivers and medical staff showed attack rates of 3.3% and 1.1%, respectively.

CONCLUSIONS

The attack rates were higher than those of the previous outbreaks in other countries. The outbreak spread beyond Pyeongtaek St. Mary’s Hospital when four of the patients were moved to other hospitals without appropriate quarantine. The best method of preventing future outbreaks is to overcome the vulnerabilities observed in this outbreak, such as ward crowding, patient migration without appropriate data sharing, and the lack of an initial broad quarantine.

Summary

Korean summary
평택성모병원에서는 총 36명의 메르스 환자가 발생하여 이중 6명이 사망하였다. 또한 평택성모병원 유행의 발병률은 기존에 알려진 것보다 높았다. 한국의 메르스 유행이 시작된 평택성모병원에서 나타난 초기 방역 부족, 적절한 정보공유 없이 환자들이 병원간에 이동하는 것, 혼잡한 병동 문제 등의 감염병 전파 취약점을 극복하는 것이 향후 새로운 감염병 유행을 막을 수 있는 최선의 방법이 될 것이다.

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Original Article

Effect change of obesity on diabetes depending on measurement: self-reported body mass index from 2012 Community Health Survey vs. directly measured from the Korea National Health and Nutrition Examination Survey: Kyuhyun Yoon, Kyungduk Min, Heeran Chun, Soong-Nang Jang, Sung-il Cho; Epidemiol Health. 2015;37:e2015001. Published online January 6, 2015; DOI: https://doi.org/10.4178/epih/e2015001

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Abstract Summary PDF

Abstract

OBJECTIVES
Obesity is a well-recognized risk factor for type 2 diabetes mellitus (DM) among young and middle-aged adults in South Korea. To elaborate on the association between obesity and DM, subjective data from self-reporting survey or objective data from health examination is generally used. This study was conducted to validate the change of association from using these different measurements.

METHODS

Community Health Survey data and Korea National Health and Nutrition Examination Survey data, as subjective and objective data respectively, were used. Population, resident in Seoul and over 45 aged, were selected for the study and the association between obesity and DM were defined by using multivariate logistic regression model.

RESULTS

In subjective data, DM prevalence was 12.4% (male, 14.7; female, 10.6) and obesity prevalence was 26.0% (male, 29.2; female, 23.4). Whereas, in objective data, DM prevalence was 15.0% (male, 17.8; female, 12.9), and obese population was 32.4% (male, 34.4; female, 30.8). Based on the effect of obesity on DM prevalence from each data, using objective data increased the impact of obesity. Difference of relative risk of obesity between from subjective data and from objective was bigger in female than male and statistically significant.

CONCLUSIONS

The differences of association pattern between subjective and objective data were found, due to higher obesity prevalence in objective data, and discrepancies of socio-economic status. These discrepancies could be inevitable Therefore we have to face them proactively, and understand the different aspect of various variables from different measurement.

Summary

Korean summary
지역사회건강조사는 각 지역의 건강관련 지표들을 제시하기 위한 기본 목적을 가지고 있으나, 자가보고를 통한 자료수집에 의존하고 있다는 면에서 연구결과의 신뢰성에 한계를 가지고 있다고 인식되어왔다. 본 연구는 실측자료와 자가보고자료에서의 분석결과차이를 파악함으로써, 이러한 인식에 대한 직접적 평가와 더불어, 자가보고자료에 대한 활용도 증진에 기여하고자 하였다. 연구 결과, 비만의 당뇨병에 대한 영향은 실측자료보다 자가보고자료에서 더 작아졌고, 이러한 차이는 남성에서보다 여성에서 더 크게 나타났다.

Citations

Citations to this article as recorded by

Comparison of estimates and time series stability of Korea Community Health Survey and Korea National Health and Nutrition Examination Survey
Ji Son Ki, Ho Kim
Epidemiology and Health.2019; 41: e2019012. CrossRef

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