Journal of Preventive Medicine and Public Health

Volume 36(3); August 2003

Original Articles

Specimen Storage and Analysis for Genomic Epidemiology.: Yun Chul Hong, Kwan Hee Lee; Korean J Prev Med. 2003;36(3):209-212.

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Abstract PDF: Because of advances of technologies in the field of genomic epidemiology in the recent years, specimen collection, storage and analysis became an essential part of research methodologies. DNA is now being used in epidemiologic studies to evaluate genetic risk factors and specimens other than the fresh whole blood can be used for PCR. Therefore, All nucleated cells, such as buccal swabs and urine specimens, are suitable for DNA analysis. For an unlimited source of genomic DNA, EBV transformation of lymphocytes can be used for immortalization. However, the type of specimen collected in genomic epidemiologic studies will depend on the study where the epidemiologist play a leading role for the design. We also briefly described various kinds of analysis for SNP that is an essential part of the genomic epidemiology.; Summary

Current Status of Genomic Epidemiology Research.: Daehee Kang, Kyoung Mu Lee; Korean J Prev Med. 2003;36(3):213-222.

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Abstract PDF: Genomic epidemiology is defined as "an evolving field of inquiring that uses the systematic application of epidemiologic methods and approaches in population-based studies of the impact of human genetic variation on health and disease (Khoury, 1998) ". Most human diseases are caused by the intricate interaction among environmental exposures and genetic susceptibility factors. Susceptibility genes involved in disease pathogenesis are categorized into two groups: high penetrance genes (i.e., BRAC1, RB, etc.) and low penetrance genes (i.e., GSTs, Cyps, XRCC1, ets.), and low penetrance susceptibility genes has the higher priority for epidemiological research due to high population attributable risk. In this paper, the summarized results of the association study between single nucleotide polymorphisms (SNPs) and breast cancer in Korea were introduced and the international trends of genomic epidemiology research were reviewed with an emphasis on internet-based case-control and cohort consortium.; Summary

Survey on the Symptoms Related to Hair Dyeing among University Freshmen.: Kwan Lee, Hyun Sul Lim; Korean J Prev Med. 2003;36(3):223-229.

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Abstract PDF: OBJECTIVES
This study was carried out to investigate the prevalence and symptoms related to hair dyeing among university freshmen. METHODS: The authors conducted a questionnaire survey among 1, 499 university freshmen from Mar 11 to 15, 2002. RESULTS: The study group contained 710 females and 789 males. Up until 2002, 62.7% of the subjects had experienced hair dyeing, and this was significantly higher in females (66.2%, p< 0.05). The period of first experience of hair dyeing was in high school for 361 cases (38.4%), after high school for 345 cases (36.7%) and before high school for 234 cases (24.9%). The major reasons of hair dyeing were 'to improve their appearance' in 466 cases (49.6%), and 'to follow the hair dyeing fashion' in 169 cases (18.0%). The prevalence of hair dyeing in 2002 was 47.8%, and again was significantly higher in females (53.7%, p< 0.05). The major symptoms related to hair dyeing were 'cleaved and nonelastic hair' in 498 cases (69.6%), and 'thin and easily breakable hair' in 353 cases (49.3%). Of those, 361 cases (50.4%) appealed to three or more symptoms related to hair dyeing. Through multiple logistic regression, factors significantly associated with symptoms related to hair dyeing were found to be female (OR=2.14, 95% CI; 1.61-2.83), use of hair dryer (OR=1.36, 95% CI; 1.004-1.854), a frequency of hair dyeing of three or more (OR=1.48, 95% CI; 1.04-2.09), and a duration of processing hair dyeing of over 60 minutes (OR=2.18, 95% CI; 1.50-3.18). CONCLUSIONS: The prevalence and experience of hair dyeing were generally high among university freshmen. Therefore, more extensive epidemiological studies on the symptoms related to hair dyeing should be conducted.; Summary

Risk-Based Damage Cost Estimation on Mortality Due to Environmental Problems.: Ye Shin Kim, Yong Jin Lee, Hoa Sung Park, Dong Chun Shin; Korean J Prev Med. 2003;36(3):230-238.

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Abstract PDF: OBJECTIVES
To estimate the value of statistical life (VSL) and health damage cost on theoretical mortality estimates due to environmental pollution. METHODS: We assessed the health risk on three environmental problems and eight sub-problems. Willingness to pay (WTP) was elucidated from a questionnaire survey with dichotomous contingent valuation method and VSL (which is the division of WTP by the change of risk reduction) calculated from WTP. Damage costs were estimated by multiplying VSL by the theoretical mortality estimates. RESULTS: VSLs from death caused by air pollution, indoor air pollution and drinking water contamination were about 0.3, 0.5 and 0.3 billion won, respectively. Damage costs of particulate matters (PM10) and radon were higher in the sub-problems and were above 100 billion won. Because damage cost depends on theoretical mortality estimate and WTP, its uncertainty is reduced in the estimating process. CONCLUSION: Health damage cost or risk benefit should be considered as one scientific criterion for decision making in environmental policy.; Summary

The Difference of Locus-of-control among Western Medical School Students, Oriental Medical School Students, and Non-Medical School Students.: Kui Son Choi, Sunhee Lee, Hanjoon Lee; Korean J Prev Med. 2003;36(3):239-247.

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Abstract PDF: OBJECTIVES
The objectives of this study were to examine the difference in attitude toward health-specific locus-of-control and medical care among western medical students, oriental medical students, and non-medical school students. METHODS: The subjects of this study were 667 students who agreed to respond the questionnaire : 212 western medical school students, 190 oriental medical school students, and 265 non-medical school students. The health-specific locus of control was measured by the structured questionnaire developed by Lau and Ware. The attitude toward western and oriental medicine was also measured by the questionnaire. RESULTS: Western medical students and non-medical school students were more likely than oriental medical students to place high value on 'the provider control over health' and 'the general threat to health' scales (F=20.47, F=19.98). But oriental medical school students ranked 'the self control of health' scale as more important than any other locus of control scale (F=19.34). The health specific locus of control was also different from the grade. When the grade was increased, 'the provider control over health' scale was slowly decreased, especially in western medical students and non medical school students. However, the 'general threat to health' scale was increased in oriental medical students. Western medical school students expressed more positive attitude toward western medicine. Oriental medical school students put a higher score on oriental medicine. Nevertheless, as the grade was increased, the positive attitude toward oriental medicine slightly decreased in oriental medical school students. CONCLUSIONS: There is a difference in health-specific locus of control and attitude toward medicine among western medical students, oriental medical students, and non-medical students. The locus of control and attitude of medical students towards medicine may affect both how they behave towards patients and how they help shape future public policy. Therefore, interdisciplinary educational initiatives may be the best way to handle this issue.; Summary

Predictors of Smoking Cessation in Outpatients.: Yune Sik Kang, Jang Rak Kim, Joung Soon Jang, Young Sil Hwang, Dae Yong Hong; Korean J Prev Med. 2003;36(3):248-254.

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Abstract PDF: OBJECTIVE
This study was conducted in order to investigate predictors of smoking cessation in outpatients. METHOD: Subjects were 401 adult smoking patients who saw their doctors in the outpatient setting at a university hospital, regardless of their willingness of otherwise in smoking cessation. Physicians delivered a brief, stop smoking prompt to all patients who smoked one or more cigarettes a day. Then they referred to on-site counselors who provided a brief, nurse assisted intervention with a survey to a randomly assigned intervention group (200 smoking patients), whom the counselors telephoned later to prevent relapse or promote the motivation to quit, or gave only a survey to a control group (201 smoking patients). After at least 5 months, self-reported current smoking cessation was confirmed later using cut-off values of 7 ppm or less in expired alveolar air after breath holding portable CO analyzer. RESULTS: After 5 months, subjects in the intervention group were 1.56 times (95% C.I. 0.89-2.73) more likely to quit smoking than those in the non-intervention group (14.0% vs. 9.0%). Willingness to quit smoking in a month, scheduled admission in a month, self efficacy score and FTND (Fagerstrom Test for Nicotine Dependence) score were all significantly related with smoking cessation. In stepwise multiple logistic regression, previous attempts to quit smoking were significant instead of self efficacy score. In the intervention group who had willingness to quit smoking in a month (132 smoking patients), FTND score, whether quit date was today, and whether quit promise paper was submitting were all significantly related with smoking cessation. In stepwise multiple logistic regression, scheduled admission in a month and whether quit date was today were significant predictor variables. Smoking cessation treatment should be tailored to individual smoking patients considering these predictors.; Summary

A Neurobehavioral Performance Assessment in Lacunar Infarction Case-control Study.: Ham Gyum Kim, Soung Hoon Chang, Sue Kyung Park, Kun Sei Lee, Hyeong Su Kim, Wha Sun Kim; Korean J Prev Med. 2003;36(3):255-262.

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Abstract PDF: OBJECTIVES
We carried out tests for neurobehavior by using WHO-NCTB (neurobehavioral core test battery) and Perdue pegboard score test to identify differences between lacunar infarction cases and controls. METHODS: Among the subjects who underwent MRI between February 2001 and March 2002 in a university hospital located in Seoul and who were diagnosed only as lacunar infarction without any intracranial disease, 46 patients were selected as cases (male: 21, female: 25). Controls were selected who had no cerebrovascular disease on MRI by matching age (5 years), gender, and education (2 years) in a ratio of 1: 1. Among WHO-NCTB, the following 5 tests and Perdue pegboard score test were used to categorize the study subjects: digit and symbol matching, simple reaction time, Benton visual retention, digit span, and Pursuit aiming test. RESULTS: Among the above 6 tests of neurobehavior, lacunar infarction cases showed lower score than controls except for the simple reaction time test. As the controlling variables of multivariate analysis in the stepwise regression analysis, the followings were selected due to their significant association: age, education, BMI, gender, drinking, exercise, and systolic blood pressure. From multivariate regression analysis, there was significant difference (p< 0.05) between lacunar infarction cases and controls in digit and symbol matching, Benton visual retention, digit span, pursuit aiming, and Perdue pegboard score test, but not in the score of simple reaction time test. CONCLUSIONS: We suggest that the above 5 tests for neurobehavior, with the exception of the simple reaction time test, might be used as the basis for recommendation of further treatment and other neurological tests by the earlier detection for neurological abnormality in lacunar infarction.; Summary

Awareness, Treatment, Control, and Related Factors of Hypertension in Gwacheon.: Youn Hee Choi, Chung Mo Nam, Mi Hyun Joo, Ki Tae Moon, Jee Seon Shim, Hyeon Chang Kim, Il Suh; Korean J Prev Med. 2003;36(3):263-270.

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Abstract PDF: OBJECTIVES
To identify the factors related to awareness, treatment, and control of hypertension in a Gwacheon population. METHODS: This study surveyed 1, 176 Gwacheon residents older than 40 years, and measured blood pressure using a standardized guideline in 1999. The study subjects were 473 adults (175 males, 298 females) with hypertension defined as a systolic blood pressure > or= 140 mmHg, diastolic blood pressure > or= 90 mmHg or reported treatment with antihypertensive medications. Information on awareness, treatment, and control of hypertension, and sociodemographic and health-related factors was collected through person-to-person interviews with a structured questionnaire. RESULTS: Overall, 252 (53.3%) of hypertensive subjects were aware of their condition, of whom as many as 193 (76.6%) were being treated, and 81 (42.0%) had their blood pressure controlled at the recommended level (< 140/90 mmHg). However, of the 473 subjects found to have hypertension, only 40.8% were being treated, and 17.1% were under control. There were no significant differences in the proportions of awareness, treatment, and control of hypertension. In multiple logistic regression models, awareness of hypertension was positively associated with age and family history of hypertension in females. Control of hypertension was also positively associated with having a partner and marital status in females. CONCLUSION: These findings demonstrate that much greater efforts on improving awareness, treatment, and control of hypertension are needed, even in urban community settings, considering related factors such as age, family history, and marital status. However, these factors should be further investigated for their causal relationship.; Summary

Smoking Status and Smoking Cessation Activity among Physicians in a Community.: So Yeon Ryu, Ki Soon Kim, Myung Gun Kang, Hyung Cheol Park, Jin Sun Kim; Korean J Prev Med. 2003;36(3):271-278.

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Abstract PDF: OBJECTIVES
The purposes of this study were to assess the smoking status, knowledge and attitude related to smoking and smoking cessation activity of the physicians in a community, and to identify their predictors of smoking cessation activity. METHOD: All physicians employed by various health facilities in a community were surveyed using a structured questionnaire. Of the physicians surveyed, 523 (69.6%) returned completed questionnaires. RESULTS: The smoking rate of physicians was 29.3% (34.2% in males, 3.6% in females) and the knowledge and attitude scores to smoking were 22.5+/-2.4 and 65.4+/-6.9, respectively. The self-efficacy score was 3.4+/-1.0 and the smoking cessation activity score was 65.4+/-6.9. The smoking cessation activity was statistically significant with working place, specialty, knowledge and attitude to smoking and self-efficacy. In stepwise multiple regression, smoking cessation activity was predicted by doctors' working place, specialty, attitudes related to smoking issues, and self-efficacy of counseling knowledge and skills. CONCLUSION: Physicians need to participate routinely and actively in smoking cessation activity. For doctors to effectively counsel and intervene in patients regarding smoking cessation, it is essential to integrate education on smoking cessation intervention into curricula in formal education and to offer continuing education including smoking cessation intervention.; Summary

A Case-control Study of the Relationships between Reproductive Factors and Degree of Dysplasia of the Colorectal Adenoma and Cancer.: Se Young Lee, Won Chul Lee, Kyu Yong Choi, Mi Kyung Kim, Jin Hee Lee, Kwang Ho Meng; Korean J Prev Med. 2003;36(3):279-288.

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Abstract PDF: OBJECTIVES
Evidence for an effect of reproductive factors on colorectal carcinogenesis is not yet consistent. Little research has been conducted to investigate whether reproductive factors were associated with colorectal adenomas that are the precursors of colorectal cancer. We evaluated the relationships between reproductive factors and the degree of dysplasia of the colorectal adenoma and cancer as colorectal adenoma-carcinoma sequence. METHODS: For this study, 241 adenoma cases with histo-pathologically confirmed incident colorectal adenoma, 76 cancer cases with colorectal cancer and 1677 controls were collected from Our Lady of Mercy Hospital, The Catholic University of Korea, during 1994-1999. Before colonoscopy, information on demographic characteristics, reproductive factors, life style habits and dietary intake were obtained by interviewed questionnaire. Adjusted OR and 95% CI were estimated by using polytomous logistic regression model. Potential confounders that were selected based on the goodness of fit statistics and interaction between risk factors were considered in this adjustment. The Wald statistic was calculated to test the heterogeneity of the odds ratios for each case. RESULTS: Postmenopausal women with natural menopause were found to be positively associated with the risk of mild dysplasia adenoma (multivariate-adjusted OR : 2.59, 95% CI=1.1-6.2). Parity was found to be negatively associated with the risk of colorectal cancer (age-adjusted OR : 0.40, 95% CI=0.2-0.9), but did not significantly decrease the risk of colorectal cancer (multivariate-adjusted OR : 0.95, 95% CI=0.3-2.9). No associations were seen between age at menarche, breast feeding, induced abortion, oral contraceptive use, menopausal types, menopausal age or hormone replacement therapy (HRT) and the degree of dysplasia of the colorectal adenoma and cancer. However, none of these associations differed significantly between the degree of dysplasia of the colorectal adenoma and cancer. CONCLUSIONS: These findings suggest that postmenopausal women with natural menopause may experience increased risk of mild dysplasia adenoma among colorectal adenoma-carcinoma sequence.; Summary

Factors Associated with Hypertension Control and Antihypertensive Medication among Hypertensive Patients in a Community.: Dong Han Lee, Youn Hee Choi, Kang Hee Lee, Dae Ryong Kang, Sun Ha Jee, Chung Mo Nam, Il Suh; Korean J Prev Med. 2003;36(3):289-297.

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Abstract PDF: OBJECTIVES
The main objectives of this study are to identify the factors associated with hypertension control and to determine the influencing factors associated with antihypertensive therapy. METHODS: The study was conducted on 107 subjects who participated in the 1999 and 2002 Gwacheon Study and who had had uncontrolled hypertension (systolic > or=140 or diastolic > or= 90mmHg) in 1999. We compared the characteristics of the controlled and uncontrolled hypertensive group and investigated the characteristics of those taking antihypertensive medication. Univariate associations between hypertension control and its characteristics and the association between antihypertension treatment and its characteristics were tested with x2-test. We also performed logistic regression analysis. RESULTS: The participants who had their blood pressure checked within 6 months before their first measurement and those who had taken the antihypertensive medication showed significantly better hypertension control during the follow-up. The multivariate analysis showed that baseline antihypertensive therapy was the most important determinant factor of hypertension control during the follow-up. Socioeconomic level and life style did not affect hypertension control when controlled by the treatment variable in this study. The factors associated with antihypertensive therapy at follow-up were previous antihypertensive therapy, old age, and high educational level. CONCLUSIONS: Those who received antihypertensive therapy and those who had their blood pressure re-checked within 6 months both showed well controlled hypertension. The subjects with high educational level complied well with the antihypertensive regimen, but those in their forties did not.; Summary

Perceptions of the Asian Dust: Analysis of the Newspaper Articles about the Asian Dust.: Hyoung June Im, Mina Ha, Soo Hun Cho, Ho Jang Kwon; Korean J Prev Med. 2003;36(3):298-301.

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Abstract PDF: OBJECTIVES
There is an increasing concern for the social, economic, environmental and health effects of the Asian dust (Hwang-sa in Korean language) in Korea. In this study, we intended to indirectly determine ordinary people's perception about the Asian dust by analyzing the contents of newspaper articles dealing with it. METHODS: By using article searching services in the internet websites of three newspaper companies, we collected newspaper articles dealing with the Asian dust during the period from January 1st of 1998 to December 31st of 2002. We classified the articles into four categories: those forecasting the occurrence of the Asian dust, those about measures to cope with it, those about its occurrence in the neighboring foreign countries, and those about its effects. In particular, we analyzed articles about the health effects of the Asian dust more distinctly. RESULTS: A total of 1, 225 articles dealing with the Asian dust were found during the 5 year period. The number of articles increased from 102 in 1998 to 518 in 2002, approximately a five-fold increase. The numbers of articles about health effects, environmental effects and economical effects were 191 (44%), 171 (41%) and 147 (34%), respectively. It was reported that various diseases such as respiratory diseases (87%), eye problems (69%), and skin diseases (12%) were associated with the Asian dust. CONCLUSION: The increasing concern for the negative effects of the Asian dust necessitates more studies about this field. As the effects of the Asian dust are various, the information on the major concern of ordinary people could help establish the research agendas and measures for the Asian dust.; Summary

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