Journal of Preventive Medicine and Public Health

Cohort Profile

Etiome Study Using Molecular Epigenetic Markers and Lung Organoid in School Meal Service Workers (Etiome study in S-meal workers): Study Protocol: Sungji Moon, Soseul Sung, Sue K. Park; Received January 8, 2025 Accepted March 27, 2025 Published online April 10, 2025; DOI: https://doi.org/10.3961/jpmph.25.020 [Accepted]

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Abstract PDF: School meal service workers may face an increased risk of lung cancer due to the nature of their work. This study aims to assess environmental exposure levels during occupational cooking among these workers in Seoul, Republic of Korea, and to examine the associations with carcinogen-associated biomarkers. Additionally, the study seeks to verify lung carcinogenesis through experiments using lung organoids treated with carcinogens, such as polycyclic aromatic hydrocarbons (PAHs) and particulate matter. Here, we introduce the study protocol and outline our research strategies. This etiome study employs molecular epidemiological approaches involving at least 200 school meal service workers from 25–30 school cafeterias in Seoul, as well as in vitro lung organoid experiments. The study includes a questionnaire survey to analyze workers’ occupational environments, focusing on exposure to hazardous substances such as cooking oil fumes and assessing the use of personal protective equipment (e.g., masks) and the presence of ventilation systems. We measure molecular epigenomic biomarkers, including PAH adducts and metabolites along with methylation markers, in the exposure and control groups. Additionally, lung organoid experiments are performed to investigate the potential for lung cancer development due to respiratory carcinogen exposure in cooks. This study is expected to contribute to health risk assessments and the establishment of preventive strategies for meal service workers.; Summary

Original Articles

Asthma Exacerbation in Indonesia: Analysis of Mental, Sociodemographic, Behavioral, and Biological Risk Factors Using the 2018 Indonesian Basic Health Research: Siti Isfandari, Sulistyowati Tuminah, Laurentia K Mihardja; Received November 23, 2024 Accepted December 16, 2024 Published online May 16, 2025; DOI: https://doi.org/10.3961/jpmph.24.719 [Accepted]

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Abstract PDF: Objectives
Asthma represents a significant global health burden, with exacerbations impacting quality of life. Although risk factors for asthma exacerbation (AE) have been identified, data specific to Indonesia remain scarce. We investigated risk factors for AE among Indonesian adolescents and adults.
Methods
A cross-sectional analysis of the 2018 National Health Survey was conducted, including Indonesian participants aged 15 and older with diagnosed asthma. Logistic regression was employed to identify risk factors for AE.
Results
The prevalence of asthma was 2.6%. Among individuals with asthma, 57.3% experienced exacerbation, and 19.6% reported symptoms indicating emotional distress (ED). Both ED and diagnosed heart disease (DHD) were linked to increased odds of AE, with adjusted odds ratios (aORs) of 1.27 (95% confidence interval [CI], 1.178 to 1.370) and 1.21 (95% CI, 1.056 to 1.385), respectively. Being diagnosed with asthma at age 15 or older was associated with an aOR of 1.56 (95% CI, 1.451 to 1.665). Those with lower socioeconomic status (SES) also faced comparatively high risk (aOR, 1.37; 95% CI, 1.230 to 1.523). In contrast, physical activity was inversely related to AE (aOR, 0.72; 95% CI, 0.642 to 0.813).
Conclusions
ED, DHD, lower SES, and later-onset asthma were identified as significant risk factors for AE. This underscores the need for comprehensive asthma management strategies that prioritize mental health, cardiovascular health, and early intervention. Addressing these factors could substantially reduce the burden of AE in Indonesia. Further longitudinal studies are necessary to elucidate the causal relationships involved and evaluate the effectiveness of targeted interventions.; Summary

Mobile App-based Care Management Training to Improve Family Caregiver Competence in Caring for Children With HIV: A Quasi-experimental Study: Nyimas Heny Purwati, Syamikar Baridwan Syamsir, Mutmainah Mutmainah, Dhea Natashia, Amelia Hartika Rani, Dwi Budiyati, Agus Setiawan; Received December 31, 2024 Accepted April 15, 2025 Published online May 7, 2025; DOI: https://doi.org/10.3961/jpmph.24.789 [Accepted]

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Abstract PDF: Objectives
Family caregivers play a crucial role in the care of children with HIV; however, they frequently face limitations in knowledge, attitudes, and skills. Mobile application (app)-based training may offer an effective solution to enhance caregiver competence. This study aimed to assess the effectiveness of mobile app-based care management training in improving the knowledge, attitudes, and skills of family caregivers caring for children with HIV.
Methods
A quasi-experimental design, including pretest, posttest, and follow-up assessments, was conducted at a national referral hospital for infectious diseases in Jakarta, Indonesia. The study involved 44 respondents, divided equally into intervention and control groups (22 per group). The intervention group received mobile app-based training, while the control group received conventional caregiver education. Questionnaires assessing caregivers\' knowledge, attitudes, and skills in managing children with HIV were utilized. Data were analyzed using Independent Sample T-tests and Repeated Measures ANOVA.
Results
Repeated Measures ANOVA revealed that the intervention group experienced significant improvements in knowledge, attitudes, and skills from pretest to posttest, which were maintained at the 1-month follow-up (p<0.001). In contrast, the control group did not exhibit significant changes in any of these variables (knowledge, attitudes, and skills) throughout the study period (p>0.05).
Conclusions
Mobile app-based care management training significantly enhances caregiving competencies among family caregivers of children with HIV. These findings underscore the potential of digital technology as an innovative and sustainable approach for caregiver training in various healthcare settings, supporting the long-term effectiveness of educational interventions.; Summary

Enhancing TNM Stage Completeness Using the SEER Summary Stage: Chang Kyun Choi, Mina Suh, Kyu-Won Jung, E Hwa Yun; Received February 6, 2025 Accepted March 27, 2025 Published online April 23, 2025; DOI: https://doi.org/10.3961/jpmph.25.099 [Accepted]

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Abstract PDF: Objectives
Accurate and complete cancer staging is essential for effective prognosis and treatment planning. This study investigated the feasibility of enhancing the completeness of tumor‐node‐metastasis (TNM) staging by integrating Surveillance, Epidemiology, and End Results (SEER) Summary Stage data.
Methods
We analyzed data from 5 cancer types (stomach, colorectum, liver, lung, and breast) in South Korea (2012–2017). The study assessed the impact of supplementing missing TNM information with SEER Summary Stage data on both staging completeness and 5‐year relative survival rates.
Results
The study included 173,061 stomach cancer, 159,199 colorectal cancer, 89,639 liver cancer, 137,103 lung cancer, and 110,286 breast cancer patients. The percentage of missing TNM stage data varied by cancer type, ranging from 65.1% (breast cancer) to 93.0% (liver cancer). Supplementation significantly reduced missing values—most notably in stomach cancer, where missing data dropped by 50.6 percentage points, followed by liver (21.5 percentage points) and breast cancers (13.6 percentage points). For stomach cancer, supplementation led to a 3.6 percentage point decrease in stage I survival rates, whereas liver cancer exhibited the most pronounced changes, with stage IV survival rates declining from 17.7% to 7.9%.
Conclusions
Integrating SEER Summary Stage data enhances TNM staging completeness. However, further evaluation incorporating treatment information is essential.; Summary

Sleep Disturbances in Early Pregnancy and the Risk of Preeclampsia: Qazvin Maternal and Neonatal Metabolic Outcomes Study (QMNMS): Sima Hashemipour, Fatemeh Lalooha, Milad Badri, Leila Modarresnia, Amirabbas Ghasemi, Sara Esmaeili Kelishomi, Sarah Mirzaeei Chopani, Seyyed Hamidreza Ghafelehbashi, Mahnaz Abbasi, Sepideh Kolaji; Received November 17, 2024 Accepted March 27, 2025 Published online April 21, 2025; DOI: https://doi.org/10.3961/jpmph.24.698 [Accepted]

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Abstract PDF: Objectives
The association between sleep disturbances and hypertension has been reported in numerous studies. However, prospective cohort data on the role of sleep disturbances in the development of preeclampsia remain limited.
Methods
This prospective cohort study was conducted on pregnant women with a in Iran. Sleep quality was assessed at the first prenatal visit (gestational age ≤14 weeks) using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Multivariate logistic regression was run to investigate the independent role of sleep abnormalities in the development of preeclampsia.
Results
The final analysis was performed on 576 participants, of whom 3.5% developed preeclampsia. In the univariate analysis, short sleep duration (< 6 hours) and prolonged sleep latency was associated with a 5.5-time and 3.5-times higher risk of developing preeclampsia (95% CI: 1.5-20.9, P=0.011, and 95% CI:1.2-10.1, P=0.019, respectively). Considering the total PSQI score, fairly bad or very bad sleep quality was a risk factor for developing preeclampsia, with a relative risk of 4.9 in the univariate analysis (95% CI: 1.4-17.8, P=0.014). In the fully adjusted model, short sleep duration and prolonged sleep latency were associated with 7.2 and 4.5 times higher risk of preeclampsia, respectivey (95% CI: 1.6-33.1, P=0.011 and 95% CI:1.4-14.6, P=0.012, respectively). In this model, pregnant women with fairly bad or very bad sleep quality had 5.9 times higher risk of preeclampsia development ( 95% CI: 1.5-22.8, P=0.011).
Conclusions
This cohort study demonstrated the role of short sleep duration and prolonged sleep latency as the main components of poor sleep quality in the development of preeclampsia.; Summary

Association of Premarital Screening Intention Among Young Adults with Higher Education in Indonesia: A Cross-Sectional Study: Yuli Amran, Tsaniya Nurul Fasya, Hilda Salamah; Received October 8, 2024 Accepted January 14, 2025 Published online April 21, 2025; DOI: https://doi.org/10.3961/jpmph.24.589 [Accepted]

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Abstract PDF: Objectives
Premarital screening can reduce the risk of genetic disorders and sexually transmitted diseases by providing early detection before conception. College students represent a group of young adults with higher education who are approaching marriageable age. However, many students still lack a strong intention to undergo premarital screening in the future. Therefore, this study examines the factors influencing screening intentions among students at one of Indonesia’s leading universities, the State Islamic University (UIN) Jakarta.
Methods
This study used a cross-sectional design, with a total sample of 563 college students obtained through a multistage random sampling technique. Descriptive statistics were used to summarize the data, and ordinal logistic regression was applied for hypothesis testing.
Results
Among the 563 students, 97.0% indicated an intention to undergo premarital screening. The intention variable was classified into three levels: no/low (13.0%), moderate (43.5%), and high (43.5%). Ordinal logistic regression revealed that lower knowledge about premarital screening was significantly associated with a reduced intention to undergo screening (OR = 2.84, 95% CI [1.58–5.10]). In addition, negative perceived behavioral control (OR = 2.85, 95% CI [1.41–5.75]), negative attitudes toward premarital screening (OR = 1.53, 95% CI [0.78–3.01]), and being enrolled in a non-health-related field of study (OR = 1.96, 95% CI [1.04–3.68]) were significantly linked to lower screening intentions.
Conclusions
Comprehensive premarital health education is essential for young adults, even those with a high level of formal education. Such education not only improves knowledge but also promotes more positive perceptions and attitudes toward premarital screening.; Summary

Are Nonstandard Work Schedules Related to Sleep Difficulty and Health-related Quality of Life? An Examination of Gender Differences: Seowoo Park, Ji Sun Park, Moo Hyuk Lee, Young Kyung Do; Received July 17, 2024 Accepted March 11, 2025 Published online April 15, 2025; DOI: https://doi.org/10.3961/jpmph.24.378 [Accepted]

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Abstract PDF: Objectives
The rise of flexible and diverse work schedules has become increasingly common in modern society. This study aims to investigate whether nonstandard work schedules are related to sleep difficulty and other aspects of health-related quality of life (HRQOL) in South Korea, with special attention to gender differences.
Methods
Data from the 2019 and 2021 National Health and Nutrition Examination Survey (Phase 8) were used, with a final sample consisting of 6,735 participants. Ordinal logistic regression analysis was performed on sleep difficulty and the other seven items of the Health-related Quality of Life Instrument with 8 items (HINT-8) to examine associations with work schedules. Linear regression analysis was also conducted using the HINT-8 index as a composite measure.
Results
Nonstandard work schedules were associated with a higher likelihood of sleep disturbances compared to the standard daytime work schedule. In particular, the negative impact of the night work schedule on sleep was greater for female workers than for male workers. Females working under the night work schedule were 12.2 percentage points more likely to report severe sleep difficulty than females under the day work schedule (9.6%). Additionally, the working, happiness, and vitality items of the HINT-8 were negatively associated with the night work schedule, whereas the other HINT-8 items and the HINT-8 index did not exhibit similar results.
Conclusions
Nonstandard work schedules are associated with increased sleep difficulty, particularly among women, and negatively affect several aspects of HRQOL, including vitality, happiness, and work performance. Given their rising prevalence and adverse impact on workers’ sleep, health, well-being, as well as workplace safety and performance, nonstandard work schedules should be recognized as a significant public health concern.; Summary

Prognostic Scoring Model for the Transition from Acute to Chronic Non-specific Low Back Pain in Primary Health Care Units: Djoko Kuswanto, Riva Satya Radiansyah, Dwinka Syafira Eljatin, Muhammad Nazhif Haykal, Rumman Karimah, Ratri Dwi Indriani, Zain Budi Syulthoni, Erna Furaidah, Andiva Satrio Rinaldi, Hafira Nushifa Putri, Jessica Felina Adi, Anak Agung Bagus Wirayuda; Received October 7, 2024 Accepted March 28, 2025 Published online April 12, 2025; DOI: https://doi.org/10.3961/jpmph.24.581 [Accepted]

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Abstract PDF: Objectives
Non-specific low back pain (NSLBP) is a prevalent health issue that can progress from acute to chronic, resulting in prolonged disability and diminished quality of life. This study aimed to develop a prognostic scoring model to predict the transition from acute to chronic NSLBP in primary care settings.
Methods
This prospective cohort study enrolled 112 adults with acute NSLBP from primary health care units in Indonesia. Participants were assessed at baseline and at a 3-month follow-up visit. Bivariate and multivariable analyses were conducted to identify significant predictors of chronicity. A scoring system was then developed based on the final logistic regression model.
Results
Three factors were found to be significant predictors of the transition to chronic NSLBP: age above 30 years, low education level, and moderate to severe pain intensity. The prognostic scoring model demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.705, 70.8% sensitivity, and 62.5% specificity at the optimal cut-off score of 2.5.
Conclusions
This simple prognostic scoring model can help clinicians identify patients at high risk of developing chronic NSLBP. Early identification of at-risk patients could guide targeted interventions to prevent chronicity. Further validation in diverse populations is necessary to confirm the broader applicability of this model.; Summary

Exposure of Volunteer Traffic Assistants to PM2.5 From Transportation: An Environmental Health Risk Analysis: Iwan Suryadi, Juherah Juherah, Siti Rachmawati, Nurlaila Fitriani, Muhammad Kahfi, Syahrul Basri; Received January 1, 2025 Accepted February 11, 2025 Published online February 25, 2025; DOI: https://doi.org/10.3961/jpmph.25.004 [Accepted]

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Abstract PDF: Objectives
PM2.5 from motor vehicle emissions has increased air pollution, negatively affecting both the environment and human health. This study aims to evaluate the concentration of fine particulate matter, assess associated health risks, and simulate the spatial distribution of PM2.5.
Methods
PM2.5 samples were collected from 36 key congestion points along the main roads of Makassar City. Measurements were taken for one hour during the morning, afternoon, and evening sessions. The hazard quotient (HQ) was calculated to estimate non-carcinogenic health risks. A total of 175 volunteer traffic assistants participated in the study. Spatial analysis was performed using the kriging method.
Results
The highest recorded PM2.5 concentration was 65 µg/m³ on Hertasning Street, while the lowest was 2 µg/m³ on AP Pettarani Street. The average concentration across all locations was 23.20 µg/m³. Although PM2.5 levels remained below Indonesia's regulatory limit of 65 µg/m³, they exceeded the WHO guideline of 15 µg/m³. The highest HQ value was 12.94, and the lowest was 0.221. The spatial analysis showed a direct correlation between higher pollutant concentrations and congested areas.
Conclusions
The findings indicate that the HQ for PM2.5 exceeds the acceptable standard (HQ > 1), signifying a health risk that increases with frequent exposure. Effective air quality management strategies—including the use of masks, promotion of green transportation, and expansion of green open spaces—are essential to reduce pollutants and minimize health risks, especially for individuals with regular exposure.; Summary

Vulnerability Assessment and Enhanced Community-based Care and Management of Patients With Tuberculosis in South Korea: A Crossover Design: Jeongmi Seo, Dawoon Jeong, In-Hyuk Lee, Jiyeon Han, Yunhyung Kwon, Eunhye Shim, Hongjo Choi; Received October 10, 2024 Accepted January 14, 2025 Published online February 25, 2025; DOI: https://doi.org/10.3961/jpmph.24.597 [Accepted]

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Abstract PDF: Objectives
People-centered care and social protection are critical for improving tuberculosis (TB) treatment outcomes. This study aimed to evaluate whether a vulnerability assessment tool, developed for an enhanced community-based care and management (ECCM) program in 2 South Korean cities, could predict and improve final TB treatment outcomes based on patients’ vulnerability levels.
Methods
Treatment outcomes in the ECCM group were compared with those in a control group, stratified by vulnerability level. During stage 1, one city served as the intervention region and the other as the control, with a crossover in stage 2. The vulnerability assessment included all notified patients with TB, and those identified as highly vulnerable in the intervention group received social support following a consultation with a case manager. Results: The vulnerability assessment tool demonstrated moderate predictive ability for unfavorable outcomes, with an area under the curve of 0.70 (95% CI, 0.63 to 0.77). The patients with high vulnerability who received ECCM treatment demonstrated a 19.8-percentage point (%p) higher treatment success rate than the high-vulnerability subcategory of the control group. ECCM also appeared to reduce LTFU and TB-related mortality by 8.4%p and 7.3%p, respectively, although these findings should be interpreted with caution. Conclusions: The results suggest that providing social support tailored to patient vulnerability at the time of diagnosis could improve TB treatment outcomes.; Summary

Rapid Antiretroviral Therapy Initiation Reduces Mortality Among People Living With HIV,: A Retrospective Observational Study: Ifael Yerosias Mauleti, Krishna Adi Wibisana, Djati Prasetio Syamsuridzal, Sri Mulyati, Vivi Lisdawati, Harimat Hendarwan, Ika Saptarini; Received October 20, 2024 Accepted January 24, 2025 Published online February 22, 2025; DOI: https://doi.org/10.3961/jpmph.24.622 [Accepted]

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Abstract PDF: Objectives
Current recommendations for managing human immunodeficiency virus (HIV) propose that initiating antiretroviral therapy (ART) promptly after diagnosis, regardless of CD4 cell count, may decrease illness and mortality risk. This study aimed to investigate factors associated with reduced mortality, including the time to ART initiation after diagnosis with HIV.
Methods
We conducted a retrospective cohort study using the medical records of 326 people living with HIV (PLHIV) aged 18 years or older who initiated ART at a tertiary hospital between January 2018 and December 2022. We employed Cox regression models to estimate survival and identify mortality predictors, considering variables with p-values less than 0.05 as statistically significant.
Results
From 2018 to 2022, 19.9% of PLHIV initiated ART within 7 days of diagnosis, and 57 participants died. The final multivariable Cox proportional hazards model indicated that earlier ART initiation significantly reduced mortality risk compared with starting ART more than 60 days after diagnosis, with adjusted hazard ratios of 0.36 for initiation within 7 days and 0.42 for initiation between 8 and 60 days. Additional characteristics associated with reduced mortality risk included a CD4 count above 200 cells/mm3 before ART initiation, a lower World Health Organization clinical stage, and tuberculosis post-exposure prophylaxis.
Conclusions
Earlier ART initiation significantly lowered mortality rates. Furthermore, a pre-ART CD4 count above 200 cells/mm3, a lower clinical stage, and tuberculosis preventive therapy were associated with reduced mortality risk among PLHIV. Future studies should investigate additional predictors of mortality within a prospective cohort study framework.; Summary

Exploring the Role of Social Welfare Expenditures in Depressive Symptoms Among Older Adults: Ji-Su Lee, Eunsil Yoon, Yeongchae Song, Seowoo Park, Young Kyung Do; Received July 27, 2024 Accepted February 3, 2025 Published online February 18, 2025; DOI: https://doi.org/10.3961/jpmph.24.403 [Accepted]

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Abstract PDF: Objectives
This study aimed to explore the role of community-level social welfare expenditures in depressive symptoms among older adults, with a particular focus on living arrangements.
Methods
Multi-level data—comprising individual-level data from the 2019 Community Health Survey and regional-level data from the Korean Statistical Information Service—were analyzed using multi-level ordered logistic regression. The dependent variable was the severity of depressive symptoms as measured by the PHQ-9 score, and the primary independent variables were per capita social welfare expenditure, living arrangements, and their cross-level interaction term.
Results
Older adults living alone exhibited more severe depressive symptoms compared to those living with others (odds ratio [OR]=1.218, p=0.006). Higher community social welfare expenditure was significantly associated with reduced depressive symptom severity (OR=0.729, p=0.019). Moreover, the protective effect of social welfare expenditure was more pronounced among older adults living alone than among those not living alone (OR=0.922, p=0.046). Social welfare expenditure was highly correlated with social cohesion, which weakened its independent association with depressive symptoms.
Conclusions
This study highlights the potential of community-level social welfare expenditure to mitigate depressive symptoms among older adults, particularly those who live alone. In light of the rising number of older adults living alone, these findings suggest that non-medical interventions, such as enhanced social welfare programs, may help alleviate depression in this vulnerable population. The strong positive correlation between social welfare expenditure and social cohesion also raises further research questions regarding their interrelationship.; Summary

The Role of Time Preferences in Compliance With COVID-19 Preventive Behaviors: A Quasi-hyperbolic Discounting Approach: Moslem Soofi, Ali Kazemi Karyan, Shahin Soltani, Zahra Alipoor, Behzad Karamimatin; Received August 17, 2024 Accepted February 3, 2025 Published online February 13, 2025; DOI: https://doi.org/10.3961/jpmph.24.453 [Accepted]

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Abstract PDF: Objectives: This study aimed to investigate the role of time preferences in compliance with COVID-19 preventive behaviors in an adult population of Iran.
Methods
A web-based questionnaire was utilized to conduct a cross-sectional survey of 672 Iranian adults. The parameters of time preferences were estimated using a quasi-hyperbolic discounting model, and the relationship between COVID-19 preventive behaviors and time preferences was examined using a Probit regression model.
Results
A significant association was observed between the preventive behaviors of COVID-19 and the levels of patience and present-biased preferences among the study participants. Individuals who exhibited low levels of patience were found to be 12.8 percentage points less inclined to follow preventive behaviors compared to those with high levels of patience. The likelihood of having good preventive behaviors of COVID-19 was found to decrease by 14.3 percentage points among individuals with a present bias as opposed to those with a bias toward future.
Conclusions
patience and present-biased preferences are important determinants of adopting preventive behaviors against COVID-19. These behavioral characteristics should be considered in the design of control and prevention programs. Considering people's discounting behavior and time (in)consistency in their preferences in the design of COVID-19 policy interventions can provide valuable insights for developing tailored public health policy interventions.; Summary

Association Between Basic Immunization Status and Stunting in Toddlers Aged 12 to 59 Months in Indonesia: Ekadesi Purwanti, Siti Masitoh, Sudarto Ronoatmodjo; Received May 6, 2024 Accepted January 13, 2025 Published online January 30, 2025; DOI: https://doi.org/10.3961/jpmph.24.230 [Accepted]

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Abstract PDF: Objectives
Immunization has been identified as a specific nutrition-related intervention to address the direct causes of stunting. This study examines the association between basic immunization status and stunting among toddlers in Indonesia.
Methods
We conducted a cross-sectional analysis using data from the 2021 Study of Indonesia’s Nutritional Status. A total of 70,267 toddlers, aged 12 to 59 months, were examined. Cox regression was employed to calculate prevalence ratios (PRs) with their 95% confidence intervals (CIs).
Results
The prevalence of stunting among children aged 12 to 59 months in Indonesia was 23.1%, while 74.92% of children under 5 years old had complete basic immunization status. Multivariable analysis revealed a statistically significant association between basic immunization status and the incidence of stunting. Relative to toddlers with complete basic immunization, those with incomplete (partial) immunization were at a 1.18 times higher risk of stunting (adjusted PR, 1.18; 95% CI, 1.15 to 1.22). Furthermore, toddlers who had not been immunized at all faced an even greater stunting risk (adjusted PR, 1.27; 95% CI, 1.17 to 1.37). This association persisted after adjusting for variables such as maternal education, economic status, and the child’s birth weight.
Conclusions
Basic immunization status influences the incidence of stunting in toddlers aged 12 to 59 months. Thus, parents must ensure that their children’s immunizations are completed according to the recommended schedule. Additionally, it is crucial to increase parental awareness regarding health service utilization, disease prevention, and the nutritional needs of toddlers.; Summary

Association of Sedentary Lifestyle with Skeletal Muscle Strength and Mass in US Adolescents: Results from the National Health and Nutrition Examination Survey (2011-2014): Kun-Hee Oh, Jin-Young Min, Kang Seo, Kyoung-Bok Min; Received October 17, 2024 Accepted December 31, 2024 Published online January 30, 2025; DOI: https://doi.org/10.3961/jpmph.24.614 [Accepted]

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Abstract PDF: Objectives
Excessive sedentary behavior in youth is a major global issue, contributing to the rise in childhood obesity and metabolic diseases. International public health authorities have issued guidelines recommending that children and adolescents limit their daily sedentary time, including screen time. However, to date, no studies have explored the relationship between sedentary behavior as an exposure factor and skeletal muscle strength and mass as outcomes in this population. The present study investigated the association of sedentary behavior with handgrip strength (HGS) and appendicular lean mass (ALM) among US adolescents.
Methods
A total of 1,449 adolescent participants from the National Health and Nutrition Examination Survey (2011-2014) were included. Information on sedentary behavior, specifically daily sedentary time, was obtained through a self-reported questionnaire. Muscular parameters, including HGS and ALM, were measured. To adjust for differences in body size, these parameters were divided by body mass index (BMI) and weight. Linear regression analyses were performed to evaluate the associations between daily sedentary time and each muscular parameter, adjusting for age, sex, ethnicity, annual family income, and moderate-to-vigorous physical activity (MVPA).
Results
The linear regression analyses revealed negative associations between daily sedentary time and all muscular parameters, apart from absolute ALM. These included HGS (β=−0.2652, standard error [SE]=0.0740; p=0.0011), HGS/BMI (β=−0.0215, SE=0.0044; p<0.0001), HGS/weight (β=−0.0079, SE=0.0016; p<0.0001), ALM/BMI (β=−0.0083, SE=0.0030; p=0.01), and ALM/weight (β=−0.0030, SE=0.0010; p=0.0047).
Conclusions
After adjusting for MVPA, daily sedentary time was inversely associated with HGS, HGS/BMI, HGS/weight, ALM/BMI, and ALM/weight in US adolescents.; Summary

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