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Special Article
Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis
Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park
Epidemiol Health. 2023;45:e2023092.   Published online October 16, 2023
DOI: https://doi.org/10.4178/epih.e2023092
  • 4,786 View
  • 380 Download
  • 2 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.
METHODS
Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.
RESULTS
Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.
CONCLUSIONS
Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.
Summary
Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.
Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

Citations

Citations to this article as recorded by  
  • Exploring genetic associations of Crohn’s disease and ulcerative colitis with extraintestinal cancers in European and East Asian populations
    Chengdong Yu, Jiawei Xu, Siyi Xu, Lei Tang, Qinyuan Han, Xiaoqiang Zeng, Yanxiao Huang, Tenghua Yu, Zhengkui Sun
    Frontiers in Immunology.2024;[Epub]     CrossRef
COVID-19: Original Article
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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AbstractAbstract AbstractSummary PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • 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
Original Articles
Physical activity, sedentary behavior, and cardiovascular disease risk in Korea: a trajectory analysis
Jina Han, Yeong Jun Ju, Soon Young Lee
Epidemiol Health. 2023;45:e2023028.   Published online February 22, 2023
DOI: https://doi.org/10.4178/epih.e2023028
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AbstractAbstract PDF
Abstract
OBJECTIVES
To identify the distinct trajectories of sedentary behavior (SB) and explore whether reduced cardiovascular disease (CVD) risk was associated with a distinct trajectory of physical activity (PA).
METHODS
We analyzed data from 6,425 people who participated in the Korean Health Panel Survey over a period of 10 years. The participants’ self-reported SB and PA were assessed annually, and trajectory groups were identified using a group-based trajectory model for longitudinal data analysis. Logistic regression analysis was performed to assess the association between CVD risk (10-year cumulative incidence) and the trajectories of SB and PA. The adjusted variables included socio-demographic factors, the predisposing diseases of CVD, and baseline health behaviors.
RESULTS
Trajectory analysis identified 4 SB trajectory groups: SB group 1 (low and slightly increasing trend, 53.1%), SB group 2 (high and rapidly decreasing trend, 14.7%), SB group 3 (high and slightly decreasing trend, 9.9%), and SB group 4 (low and rapidly increasing trend, 22.2%). The 3 PA trajectory groups were PA group 1 (moderate and slightly decreasing trend, 32.1%), PA group 2 (low and slightly decreasing trend, 57.3%), and PA group 3 (maintained inactivity, 10.7%). By the 10-year follow-up, 577 cases of incident CVD had occurred. We also noted a 50% reduction in the risk of CVD when SB group 4 was accompanied by PA group 1 (odds ratio, 0.50; 95% confidence interval, 0.28 to 0.90).
CONCLUSIONS
Despite increased time spent in SB, maintaining PA about 2 days to 3 days per week reduced the occurrence of CVD.
Summary

Citations

Citations to this article as recorded by  
  • Effects of physical activity and sedentary behaviors on cardiovascular disease and the risk of all-cause mortality in overweight or obese middle-aged and older adults
    Yongqiang Zhang, Xia Liu
    Frontiers in Public Health.2024;[Epub]     CrossRef
Viral shedding patterns of symptomatic SARS-CoV-2 infections by periods of variant predominance and vaccination status in Gyeonggi Province, Korea
Gawon Choi, Ah-Young Lim, Sojin Choi, Kunhee Park, Soon Young Lee, Jong-Hun Kim
Epidemiol Health. 2023;45:e2023008.   Published online December 21, 2022
DOI: https://doi.org/10.4178/epih.e2023008
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We compared the viral cycle threshold (Ct) values of infected patients to better understand viral kinetics by vaccination status during different periods of variant predominance in Gyeonggi Province, Korea.
METHODS
We obtained case-specific data from the coronavirus disease 2019 (COVID-19) surveillance system, Gyeonggi in-depth epidemiological report system, and Health Insurance Review & Assessment Service from January 2020 to January 2022. We defined periods of variant predominance and explored Ct values by analyzing viral sequencing test results. Using a generalized additive model, we performed a nonlinear regression analysis to determine viral kinetics over time.
RESULTS
Cases in the Delta variant’s period of predominance had higher viral shedding patterns than cases in other periods. The temporal change of viral shedding did not vary by vaccination status in the Omicron-predominant period, but viral shedding decreased in patients who had completed their third vaccination in the Delta-predominant period. During the Delta-predominant and Omicron-predominant periods, the time from symptom onset to peak viral shedding based on the E gene was approximately 2.4 days (95% confidence interval [CI], 2.2 to 2.5) and 2.1 days (95% CI, 2.0 to 2.1), respectively.
CONCLUSIONS
In one-time tests conducted to diagnose COVID-19 in a large population, although no adjustment for individual characteristics was conducted, it was confirmed that viral shedding differed by the predominant strain and vaccination history. These results show the value of utilizing hundreds of thousands of test data produced at COVID-19 screening test centers.
Summary
Korean summary
코로나19 선별진료소에서는 확진 검사를 위해 수십만 건에서 수백만 건까지의 일회성 검사를 시행해왔다. 검사를 받은 개인의 특성과 관련된 데이터 제한으로 인해 분석 시 이를 보정할 수는 없지만, 대규모 인구집단에서 얻어진 검사 결과는 SARS-CoV-2 배출 특성을 평가하는 데 활용될 수 있다. 이번 연구에서는 바이러스 변이의 종류와 백신 접종 이력에 따라 증상 발생 후 시간 경과에 따라 바이러스 배출량이 달라지는 것을 확인하였다. 이러한 대규모 선별 검사자료는 향후에도 유용하게 활용 가능하다.
Key Message
The screening center for COVID-19 has conducted hundreds of thousands to millions of one-time confirmation tests for diagnosis. Although individual characteristics cannot be adjusted for due to data limitations, the test results from a large population can still be utilized to evaluate SARS-CoV-2 shedding. We confirmed that viral shedding varied over time after symptom onset, depending on the type of virus variant and vaccination history.
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
  • 5,056 View
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AbstractAbstract AbstractSummary 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

Citations to this article as recorded by  
  • 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-Sero SMART): 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;[Epub]     CrossRef
Does having various types of fear related to COVID-19 disrupt individuals’ daily life?: Findings from a nationwide survey in Korea
Woorim Kim, Yeong Jun Ju, Soon Young Lee
Epidemiol Health. 2022;44:e2022004.   Published online January 3, 2022
DOI: https://doi.org/10.4178/epih.e2022004
  • 10,102 View
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Unexpected changes in daily routines caused by the coronavirus disease 2019 (COVID-19) pandemic may affect psychological health. This study investigated the association between various types of COVID-19-related fear and the subjective level of disturbance in daily activities experienced by individuals.
METHODS
This cross-sectional study used the Korea Community Health Survey conducted from August through November 2020. COVID-19-related fear included fear of infection, death, public criticism, family members getting infected, and economic loss. The subjective level of disruption in daily activities was measured using a 0-100 numeric rating scale developed by the Korea Disease Control and Prevention Agency. Multivariable linear regression was used to analyze the associations between the independent and dependent variables. A subgroup analysis was performed based on income level.
RESULTS
Participants who reported fear of infection (β=-3.37, p<0.001), death (β=-0.33, p=0.030), public criticism (β=-1.63, p<0.001), a family member getting infected (β=-1.03, p<0.001), and economic loss (β=-3.52, p<0.001) experienced more disturbances in daily activities. The magnitude of this association was most significant in the lowest-income group.
CONCLUSIONS
Individuals reporting COVID-19-related fear experienced higher levels of subjective disruption in daily activities.
Summary
Korean summary
이 연구는 COVID-19 팬데믹과 관련된 심리적염려가 일상생활 활동에 부정적인 영향을 줄 수 있음을 관찰하였다. COVID-19 감염으로 인한 감염, 사망, 대중의 비판, 가족 중 건강취약자의 감염, 경제적 손실에 대해 염려하는 사람은 그렇지 않은 사람에 비해 일상생활에 더 부정적인 영향을 받고 있는 것으로 관찰되었다. 특히 다양한 유형의 감염염려를 동시에 경험하고 있을수록 일상생활 지장 정도가 더 증가하는 경향이 관찰되었으며 소득수준이 낮을수록 부정적인 영향정도가 더 두드러졌다.
Key Message
Our results revealed that fear related to the COVID-19 pandemic was associated with increased levels of subjective disruptions in daily activities. Compared to individuals without fear, those with fears of COVID-19 infection, dying from infection, public criticism, a family member getting infected, and economic loss reported higher levels of disruption in daily activities. Those who reported fear of COVID-19 infection and economic loss due to infection had particularly higher levels of disturbances. Considering the various types of fear concurrently, the level of disruption experienced tended to increase with the number of reported fears.

Citations

Citations to this article as recorded by  
  • Is fear of COVID-19 higher in individuals residing in more deprived areas? A nationwide study
    Woorim Kim, Soon Young Lee, Yeong Jun Ju
    Journal of Public Health.2023; 45(2): 402.     CrossRef
  • Association Between Changes in Family Life Due to COVID-19 and Depressive Mood and Stress Perception
    Min-Su Kim, Mi Ah Han, Jong Park, So Yeon Ryu
    Asia Pacific Journal of Public Health.2023; 35(1): 14.     CrossRef
  • Public perception of the appropriateness of COVID-19 management strategies and level of disturbances in daily activities: A focus on educational level
    Yeong Jun Ju, Woorim Kim, Soon Young Lee, Jordi Gumà
    PLOS ONE.2023; 18(6): e0287143.     CrossRef
A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death
Yeong Jun Ju, Seungho Lee, Seungsoo Sheen, Dong-Woo Choi, Jong-Han Leem, Soon Young Lee
Epidemiol Health. 2021;43:e2021091.   Published online November 1, 2021
DOI: https://doi.org/10.4178/epih.e2021091
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We aimed to determine the characteristics of the deceased victims of deaths caused by exposure to humidifier disinfectants, and present the distribution of the victims’ data submitted for damage application, demographic characteristics, imaging findings, characteristics of humidifier disinfectant exposure, and distribution of the causes of death.
METHODS
An integrated database of victims was established using the medical records data of 1,413 victims submitted during the application for death damage caused by exposure to humidifier disinfectants, and the demographic characteristics, medical records, imaging findings, exposure characteristics, and cause of death were examined.
RESULTS
The average numbers of data submissions of each applicant for death damage were 3.0 medical use records. A total of 608 (43.0%) victims had more than one finding of acute, subacute, or chronic interstitial lung diseases. The average daily and cumulative use times of the victims were 14.40 and 24,645.81 hours, respectively, indicating greater exposure in this group than in the survivors. The humidifier disinfectants’ components comprised polyhexamethylene guanidine (72.8%), chloromethylisothiazolinone/methylisothiazolinone (10.5%), other components (15.0%), and oligo-[2-(2-ethoxy)-ethoxyethyl] guanidine chloride (1.5%). The components’ distribution was 67.8% for single-component use, which was higher than that in the survivors (59.8%). The distribution of the causes of death were: respiratory diseases (54.4%), neoplasms (16.8%), and circulatory diseases (6.3%). Other interstitial lung diseases (65.5%) were the most common cause of death among those who died due to respiratory diseases.
CONCLUSIONS
Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.
Summary
Korean summary
가습기 살균제 사망 피해 신청자 들 중 건강피해를 인정받지 못한 신청자들이 여전히 많이 남아있으며 (약 40%), 피해판정의 복잡성과 다양한 이슈들이 산적해 있어 사망 피해 신청자들의 적정 구제를 위해 종합적인 특성파악을 바탕으로 세심한 관점에서의 검토가 필요하다. 특히, 가습기 살균제 사망 피해 신청자의 특수성과 피해구제의 제한점을 고려하여야 하며, 기계적인 건강피해 판정을 지양하고 사망 피해 신청자 중심의 세밀한 특성 파악을 바탕으로 다양한 전문가집단이 참여하는 종합적인 논의를 통해 적정구제를 이루어 나가야 함을 제안한다.
Key Message
Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.

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Why do some Korean parents hesitate to vaccinate their children?
Kyujin Chang, Soon Young Lee
Epidemiol Health. 2019;41:e2019031.   Published online July 9, 2019
DOI: https://doi.org/10.4178/epih.e2019031
  • 14,264 View
  • 296 Download
  • 17 Web of Science
  • 24 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Vaccinations for infectious diseases are opposed despite their achievement, and this opposition has recently been revealed in Korea. However, research in Korea has not been vigorous. The authors studied why some Korean parents hesitate to vaccinate their children by applying the health belief model.
METHODS
Parents who hesitate to vaccinate and parents who do not were surveyed in alternative education preschools and elementary schools. They were classified into four types of hesitancy and statistically compared.
RESULTS
Among the 129 subjects, 43 vaccinated without hesitancy, 20 vaccinated on time with hesitancy, 32 vaccinated with a deliberate delay of one month or longer, and 34 did not vaccinate. Vaccination increased with an increase in the awareness that severe outcomes can occur when unvaccinated. Concerns about adverse reactions from vaccinations or direct/indirect experiences affected refusal. Furthermore, perceptions of the lack of meaningfulness of vaccinations, distrust of policy and safety management, influence of leaders or activists in joined organizations, and experts of Korean traditional or alternative medicine affected refusal. Explanations by doctors, text messages and mails from institutions, and concerns about disadvantages caused by not complying with government policies increased vaccination.
CONCLUSIONS
The reasons for vaccine hesitancy and acceptance were similar to the results of international research. Health authorities and professionals should communicate sufficiently and appropriately with hesitant parents and find ways to rationally resolve social conflicts. However, this sample was small and there is little Korean research, so more in-depth and diverse researchs are needed.
Summary
Korean summary
한국에도 있는 일부 소아 예방접종 망설임 부모들이 왜 그렇게 생각하고 결정하는지, 대안교육시설에서 129명을 대상으로 연구하였다. 예방접종 부작용 우려나 경험, 의미 격하, 정책 및 안전관리 불신, 관련 활동가, 한의학이나 대체의학 전문가가 미접종에 영향을 주었다. 보건관계자들은 망설임 부모들과 충분하고 적절한 의사소통을 하여, 사회적 갈등을 합리적으로 해소하는 방안을 찾아야 한다.

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Asymptomatic Middle East Respiratory Syndrome coronavirus infection using a serologic survey in Korea
Yeong-jun Song, Jeong-Sun Yang, Hee Jung Yoon, Hae-Sung Nam, Soon Young Lee, Hae-Kwan Cheong, Woo-Jung Park, Sung Han Park, Bo Youl Choi, Sung Soon Kim, Moran Ki
Epidemiol Health. 2018;40:e2018014.   Published online April 15, 2018
DOI: https://doi.org/10.4178/epih.e2018014
  • 17,317 View
  • 301 Download
  • 15 Web of Science
  • 16 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The rates of asymptomatic infection with Middle East Respiratory Syndrome (MERS) coronavirus vary. A serologic study was conducted to determine the asymptomatic MERS infection rate in healthcare workers and non-healthcare workers by exposure status.
METHODS
Study participants were selected from contacts of MERS patients based on a priority system in 4 regions strongly affected by the 2015 MERS outbreak. A sero-epidemiological survey was performed in 1,610 contacts (average duration from exposure to test, 4.8 months), and the collected sera were tested using an enzyme-linked immunespecific assay (ELISA), immunofluorescence assay (IFA), and plaque reduction neutralization antibody test (PRNT). Among the 1,610 contacts, there were 7 ELISA-positive cases, of which 1 exhibited positive IFA and PRNT results.
RESULTS
The asymptomatic infection rate was 0.060% (95% confidence interval, 0.002 to 0.346). The asymptomatic MERS case was a patient who had been hospitalized with patient zero on the same floor of the hospital at the same time. The case was quarantined at home for 2 weeks after discharge, and had underlying diseases, including hypertension, angina, and degenerative arthritis.
CONCLUSIONS
The asymptomatic infection was acquired via healthcare-associated transmission. Thus, it is necessary to extend serologic studies to include inpatient contacts who have no symptoms.
Summary
Korean summary
2015년 국내 MERS 유행시에 자가격리를 시행하였던 접촉자 약 15,000명 (의료인과 비의료인 포함) 중에서 주요 유행지역, 노출 강도 등을 고려하여 선별된 3,291명을 대상으로 무증상 감염여부를 확인하기 위한 혈청 역학조사를 수행하였다. 최종 검사에 참여한 1,610명 중에서 7명이 ELISA 양성 반응을 보였고, 그 중 1명이 IFA와 PRNT에서도 양성 반응을 보여 무증상 감염률은 0.060%(95% CI: 0.002-0.346)로 기존 연구에 비하여 낮았다. 최종 양성을 보인 1명은 노출 당시 1번환자와 가까운 병실에 입원하였던 환자였다.

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MERS-Original Article
Preventive behaviors by the level of perceived infection sensitivity during the Korea outbreak of Middle East Respiratory Syndrome in 2015
Soon Young Lee, Hee Jeong Yang, Gawon Kim, Hae-Kwan Cheong, Bo Youl Choi
Epidemiol Health. 2016;38:e2016051.   Published online November 16, 2016
DOI: https://doi.org/10.4178/epih.e2016051
  • 15,893 View
  • 247 Download
  • 16 Web of Science
  • 16 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study was performed to investigate the relationship between community residents’ infection sensitivity and their levels of preventive behaviors during the 2015 Middle East Respiratory Syndrome (MERS) outbreak in Korea.
METHODS
Seven thousands two hundreds eighty one participants from nine areas in Gyeonggi-do including Pyeongtaek, the origin of the outbreak in 2015 agreed to participate in the survey and the data from 6,739 participants were included in the final analysis. The data on the perceived infection sensitivity were subjected to cluster analysis. The levels of stress, reliability/practice of preventive behaviors, hand washing practice and policy credibility during the outbreak period were analyzed for each cluster.
RESULTS
Cluster analysis of infection sensitivity due to the MERS outbreak resulted in classification of participants into four groups: the non-sensitive group (14.5%), social concern group (17.4%), neutral group (29.1%), and overall sensitive group (39.0%). A logistic regression analysis found that the overall sensitive group with high sensitivity had higher stress levels (17.80; 95% confidence interval [CI], 13.77 to 23.00), higher reliability on preventive behaviors (5.81; 95% CI, 4.84 to 6.98), higher practice of preventive behaviors (4.53; 95% CI, 3.83 to 5.37) and higher practice of hand washing (2.71; 95% CI, 2.13 to 3.43) during the outbreak period, compared to the non-sensitive group.
CONCLUSIONS
Infection sensitivity of community residents during the MERS outbreak correlated with gender, age, occupation, and health behaviors. When there is an outbreak in the community, there is need to maintain a certain level of sensitivity while reducing excessive stress, as well as promote the practice of preventive behaviors among local residents. In particular, target groups need to be notified and policies need to be established with a consideration of the socio-demographic characteristics of the community.
Summary
Korean summary
2015년 한국에서 발생한 메르스 유행 시 지역 주민이 인식하는 민감도와 예방행위 수준을 파악하고 연관성을 밝히고자 2015년 경기도 9개 시의 지역사회건강조사 대상자 6,739명을 대상으로 감염 민감도와 예방행위 등을 조사 분석하였다. 감염 민감도는 성별, 연령, 직업, 건강행위와 연관성이 있었으며, 감염에 대한 민감도가 높을수록 스트레스를 많이 받는 한편, 예방행위 실천에 긍정적인 영향을 미침을 알 수 있었다. 따라서 감염병 유행 시 지나친 스트레스는 줄이되 공중보건 위기에 대한 적정 수준의 민감도를 유지하고, 인구사회학적 특성을 고려한 관리정책이 요구된다.

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    Seung Hoo Lee, Hyun Dae Shin, Soo Min Cha, Eun Seok Choi
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    Mi Ah Han
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    Sunhee Kim, Seoyong Kim
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Brief Communication
Evaluation report on the causal association between humidifier disinfectants and lung injury
Mina Ha, Soon Young Lee, Seung-sik Hwang, Hyesook Park, Seungsoo Sheen, Hae Kwan Cheong, Bo Youl Choi
Epidemiol Health. 2016;38:e2016037.   Published online August 18, 2016
DOI: https://doi.org/10.4178/epih.e2016037
  • 22,032 View
  • 519 Download
  • 6 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
As of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences.
METHODS
A careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee.
RESULTS
We found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets.
CONCLUSIONS
Although only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.
Summary
Korean summary
본 논문에서는 Hill의 기준과 US Surgeon General 전문위원회에서 제시하는 기준에 근거하여 가습기살균제와 폐손상과의 인과성을 검토하였다. 검토결과, 11개 조건(관련성의 강도, 일관성, 특이성, 시간적 선후관계, 생물학적 용량-반응 관계, 개연성, 기존 지식과의 일치성, 실험, 유사성, 다른 가능한 해석에 대한 고려 및 노출의 중단) 을 모두 충족함을 확인하므로 써, 2011년 발생한 원인미상 폐손상의 원인이 가습기살균제 노출로 인한 것임을 알 수 있었다. 무엇보다도 가습기살균제 시판 전에는 원인미상 폐손상이 보고된 바가 없었고, 2011년 11월 가습기살균제 판매중지 이후 폐손상이 한 건도 발생하지 않은 것은 원인미상의 폐손상이 가습기살균제로 인한 것임을 강력하게 지지하는 것으로 판단된다.

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  • New-Onset and Exacerbation of Lung Diseases after Short-Term Exposures to Humidifier Disinfectant during Hospitalization
    Seula Lee, Kyunghee Han, Jeonggyo Yoon, Eun-Kyung Jo, Wonho Yang, Yoon-Hyeong Choi
    Toxics.2022; 10(7): 371.     CrossRef
  • Characterizing Subjects Exposed to Humidifier Disinfectants Using Computed-Tomography-Based Latent Traits: A Deep Learning Approach
    Frank Li, Jiwoong Choi, Xuan Zhang, Prathish K. Rajaraman, Chang-Hyun Lee, Hongseok Ko, Kum-Ju Chae, Eun-Kee Park, Alejandro P. Comellas, Eric A. Hoffman, Ching-Long Lin
    International Journal of Environmental Research and Public Health.2022; 19(19): 11894.     CrossRef
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    Tae Yoon Kwon, Jaeseong Jeong, Eunyoung Park, Youngbin Cho, Dongyoung Lim, Ung Hyun Ko, Jennifer H. Shin, Jinhee Choi
    Toxicology and Applied Pharmacology.2021; 424: 115589.     CrossRef
  • Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries
    Hyeong-Cheol Kim, Hyunil Kim, Eun-Chan Mun, Yesung Lee, Soyoung Park
    Annals of Occupational and Environmental Medicine.2021;[Epub]     CrossRef
  • Strength of Association. Report 1. Graduations of Relative Risk
    А. Котеров, A. Koterov, Л. Ушенкова, L. Ushenkova, Э. Зубенкова, E. Zubenkova, А. Вайнсон, A. Vaynson, М. Калинина, M. Kalinina, А. Бирюков, A. Biryukov
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Original Article
Factors affecting screening for diabetic complications in the community: a multilevel analysis
Jin A Han, Soo Jeong Kim, Gawon Kim, Eun Ji Kim, Soon Young Lee
Epidemiol Health. 2016;38:e2016017.   Published online May 3, 2016
DOI: https://doi.org/10.4178/epih.e2016017
  • 15,946 View
  • 220 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The objective of the present study was to identify the factors that affect screening for diabetic complications by sex in the community.
METHODS
This study used individual-level data from the 2013 Community Health Survey (CHS) for 20,806 (male, 9,958; female, 10,848) adults aged 30 years or older who were diagnosed with diabetes. Community-level data for 253 communities were derived from either CHS or national statistics. A chi-square test and multilevel logistic regression analysis was performed.
RESULTS
There were significant differences in the rate of screening for diabetic complications according to individual-level and community-level variables. In the multilevel analysis, the community-level variance ratio of the null model was 7.4% and 9.2% for males and females, respectively. With regard to community-level variables, males were affected by the city type, number of physicians, and their living environment, while females were affected by number of physicians, natural and living environments, and public transportation.
CONCLUSIONS
The factors that influenced individual willingness to undergo screening for diabetic complications differed slightly by sex; however, both males and females were more likely to undergo screening when they recognized their health status as poor or when they actively sought to manage their health conditions. Moreover, in terms of community-level variables, both males and females were affected by the number of physicians. It is essential to provide sufficient and ongoing opportunities for education on diabetes and its management through collaboration with local communities and primary care medical centers.
Summary
Korean summary
본 연구는 지역사회의 당뇨병 환자들의 성별에 따른 합병증검사 수진율을 파악하고 개인의 특성과 지역사회의 특성이 합병증 검사 수진여부에 어떻게 영향을 미치는지 다수준 분석을 통해 살펴보고자 하였다. 당뇨병 치료자 중 약 1/3만이 합병증검사를 받았다. 성별에 따라 개인의 당뇨병 합병증 검사 수진행위에 영향을 미치는 요인이 다르긴 하지만 남성과 여성 모두 본인의 건강상태가 좋지 않다고 인지하거나 질병관리에 적극적인 행동을 취하는 경우, 그리고 지역변수로는 내과전문의 수에 영향을 받았다. 이는 지역사회와 1차 의료기관의 협업을 통해 당뇨병과 당뇨병 관리에 대한 충분하고 지속적인 학습기회의 제공이 중요하다고 할 수 있다.

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  • Factors Influencing the Utilization of Diabetes Complication Tests Under the COVID-19 Pandemic: Machine Learning Approach
    Haewon Byeon
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Effects of Diabetes Quality Assessment on Diabetes Management Behaviors Based on a Nationwide Survey
    Chang Kyun Choi, Jungho Yang, Ji-An Jeong, Min-Ho Shin
    International Journal of Environmental Research and Public Health.2022; 19(23): 15781.     CrossRef
MERS-Epidemiologic Investigation
Epidemiological investigation of the 119th confirmed Middle East Respiratory Syndrome coronavirus case with an indefinite mode of transmission during the Pyeongtaek outbreak in Korea
Jong Hyuk Choi, Byoungin Yoo, Soon Young Lee, Eun Gyu Lee, Moran Ki, Woncheol Lee, Jong Rak Jung, Kyujin Chang
Epidemiol Health. 2015;37:e2015054.   Published online December 10, 2015
DOI: https://doi.org/10.4178/epih/e2015054
  • 17,423 View
  • 225 Download
  • 5 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Since the first case was diagnosed on May 20, 2015, there were 186 confirmed cases of Middle East Respiratory Syndrome (MERS) until the end of outbreak in South Korea. Although medical institutions were the most identifiable sources of MERS transmission in South Korea, similar to other countries, in-depth epidemiological investigation was required for some confirmed cases with indefinite contact history or hospital visit records. The subject of epidemiological investigation in the present study was a 35 year-old male patient diagnosed with MERS (#119) who lived in Asan-city and worked in Pyeongtaek-city. Various potential sources of transmission were carefully investigated. While he could have been exposed to MERS through a friend from Saudi Arabia or confirmed MERS cases in his workplace, neighboring areas, and medical institutions, as well as contacts in his home, the chances of transmission were low; however, the potential for transmission through his local community could not be excluded. Practically, it was difficult to determine the modes of transmission for all outbreak cases in communicable disease that occurred in this short period of time. The investigation to identify the mode of transmission in this case was ultimately unsuccessful. However, the various data collected and analyzed to reveal modes of transmission provided detailed information that could not be collected using only interview surveys.
Summary
Korean summary
2015년 한국에서 유행한 메르스 환자들 중, 감염 경로가 불분명한 119번째 환자에 대한 심층 역학조사를 통해 다양한 감염경로의 가능성을 검토하였다. 감염경로를 명확하게 밝혀내지 못한 한계점이 있지만, 지역사회 전파에 대한 가능성을 제시하였다. 감염병 대유행시 효율적인 감염경로 파악을 위해서는 다방면의 자료에 대한 확보체계와 이를 신속히 분석하고 판단할 수 있는 전문 인력 확충이 필요하다.

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  • A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences
    Rebecca E. Ramshaw, Ian D. Letourneau, Amy Y. Hong, Julia Hon, Julia D. Morgan, Joshua C. P. Osborne, Shreya Shirude, Maria D. Van Kerkhove, Simon I. Hay, David M. Pigott
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Original Articles
Community mental health status six months after the Sewol ferry disaster in Ansan, Korea
Hee Jung Yang, Hae Kwan Cheong, Bo Youl Choi, Min-Ho Shin, Hyeon Woo Yim, Dong-Hyun Kim, Gawon Kim, Soon Young Lee
Epidemiol Health. 2015;37:e2015046.   Published online October 23, 2015
DOI: https://doi.org/10.4178/epih/e2015046
  • 18,872 View
  • 248 Download
  • 21 Web of Science
  • 21 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The disaster of the Sewol ferry that sank at sea off Korea’s southern coast of the Yellow Sea on April 16, 2014 was a tragedy that brought grief and despair to the whole country. The aim of this study was to evaluate the mental health effects of this disaster on the community of Ansan, where most victims and survivors resided.
METHODS
The self-administered questionnaire survey was conducted 4 to 6 months after the accident using the Korean Community Health Survey system, an annual nationwide cross-sectional survey. Subjects were 7,076 adults (≥19 years) living in two victimized communities in Ansan, four control communities from Gyeonggi-do, Jindo and Haenam near the accident site. Depression, stress, somatic symptoms, anxiety, and suicidal ideation were measured using the Center for Epidemiologic Studies-Depression Scale, Brief Encounter Psychosocial Instrument, Patient Health Questionnaire-15, and Generalized Anxiety Disorder 7-Item Scale, respectively.
RESULTS
The depression rate among the respondents from Ansan was 11.8%, and 18.4% reported suicidal ideation. Prevalence of other psychiatric disturbances was also higher compared with the other areas. A multiple logistic regression analysis revealed significantly higher odds ratios (ORs) in depression (1.66; 95% confidence interval [CI], 1.36 to 2.04), stress (1.37; 95% CI, 1.10 to 1.71), somatic symptoms (1.31; 95% CI, 1.08 to 1.58), anxiety (1.82; 95% CI, 1.39 to 2.39), and suicidal ideation (1.33; 95% CI, 1.13 to 1.56) compared with Gyeonggi-do. In contrast, the accident areas of Jindo and Haenam showed the lowest prevalence and ORs.
CONCLUSIONS
Residents in the victimized area of Ansan had a significantly higher prevalence of psychiatric disturbances than in the control communities.
Summary
Korean summary
본 연구는 2014년 4월 16일 발생한 세월호 침몰 사고가 지역사회의 정신건강 수준에 미친 영향을 평가하기 위해 실시하였다. 2014년 지역사회건강조사를 활용, 사고 후 6개월 시점에 조사를 시행하였다. 대부분의 희생자가 발생한 안산시 대상자의 11.8%가 우울군으로 분류되었으며, 18.4%가 자살생각을 호소하였고, 그 밖의 유병률도 대조 지역에 비해 높았다.

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    Katelyn O'Donohue, Emily Berger, Louise McLean, Matthew Carroll
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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
  • 19,431 View
  • 143 Download
  • 7 Web of Science
  • 6 Crossref
AbstractAbstract AbstractSummary 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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Epidemiol Health : Epidemiology and Health