Journal of Preventive Medicine and Public Health

Special Article

Development of an Integrated 6-Year Preventive Medicine Curriculum for Medical Students in Korea: An Expert-informed Deliberative Curriculum Development Study: Junmoo Ahn, Yune Sik Kang, Kwan Lee, Jae-Hyun Park, So Yeon Ryu, Mina Ha, Yong-jun Choi, Juhwan Oh, Seung-Hee Lee; Received July 14, 2026 Accepted August 30, 2026 Published online September 8, 2026; DOI: https://doi.org/10.3961/jpmph.26.706 [Accepted]

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Abstract PDF: In Korea, preventive medicine education has remained fragmented across the undergraduate curriculum, with limited longitudinal continuity and increasing pressure to incorporate population health, healthcare systems, community practice, planetary health, and digital health. This study aimed to develop an integrated 6-year preventive medicine curriculum for medical students that would support health promotion, disease prevention, and social accountability at the individual and population levels. We conducted an expert-informed deliberative curriculum development study framed by Walker’s deliberative (naturalistic) model and supplemented by Kern’s 6-step approach. The development process comprised a literature review and planning activities, 2 curriculum development workshops, 2 structured group deliberation sessions with preventive medicine faculty leaders, small-group meetings, a confirmation workshop, and signature-course development meetings. Development records and curriculum artifacts generated through this process were subjected to descriptive synthesis. The final curriculum specified 1 educational purpose, 4 educational objectives, 7 competencies, 5 curricular domains, 3 learning levels, 102 instructional hours, Foundational and Applied course labels, 6 signature courses, and instructional guidebooks. It arranges healthcare systems, determinants of health and disease, planetary health, community-based preventive medicine practice, and complex health matters along a progression from foundational concepts to advanced integrative application. Expert deliberation refined course terminology, clarified learning progression and course placement, and identified issues relevant to anticipated implementation feasibility. The proposed curriculum positions preventive medicine as a longitudinal, spiral, competency-linked component of undergraduate medical education. As a national reference framework, it is intended to help future physicians connect evidence, systems, communities, and emerging public health challenges with proactive health promotion and disease prevention.; Summary

Original Articles

Comparative Risk Perceptions of Alternative Nicotine Products Among People Who Smoke Cigarettes and Dual Products: Findings From the 2024 ITC Korea Survey: Hoang Le Tu, Jin-Kyoung Oh, Hong-Gwan Seo, Gil-Yong Kim, Sung-Il Cho, Sungkyu Lee, Yeol Kim, Gang Meng, Anne C.K. Quah, Geoffrey T. Fong, Yoon-Jung Choi; Received April 15, 2026 Accepted August 3, 2026 Published online September 1, 2026; DOI: https://doi.org/10.3961/jpmph.26.338 [Accepted]

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Abstract PDF: Objectives
Heated tobacco products (HTPs) and e-cigarettes (ECs) have rapidly expanded in the Republic of Korea. This study aimed to examine differences in comparative risk perceptions of HTPs and ECs relative to cigarettes among Korean adults and to identify factors associated with these perceptions.
Methods
Data were drawn from the KRA4–Cohort 3 dataset of the nationally representative International Tobacco Control Korea Survey and were analyzed for respondents who currently used cigarettes, HTPs, or ECs. Two ordinal outcomes measured perceived comparative harm of HTPs and ECs relative to cigarettes. Multivariable Bayesian ordinal logistic regression models were fitted, and robustness was assessed using Bayesian Metropolis-Hastings and frequentist sensitivity analyses.
Results
Compared with cigarette-only users, respondents who used both cigarettes and HTPs had lower odds of perceiving HTPs as equally or more harmful than cigarettes (adjusted odds ratio [aOR], 0.43; 95% credible interval [CrI], 0.36 to 0.50). Similarly, respondents who used both cigarettes and ECs had lower odds of perceiving ECs as equally or more harmful than cigarettes (aOR, 0.31; 95% CrI, 0.19 to 0.47). Adults aged 40–59 years had higher odds of perceiving both products as equally or more harmful than cigarettes (HTPs: aOR, 1.35; 95% CrI, 1.12 to 1.61; ECs: aOR, 1.42; 95% CrI, 1.18 to 1.73). Noticing tobacco advertising was associated with lower perceived harm. Findings were consistent across the 3 analytic approaches.
Conclusions
Lower perceived harm of HTPs and ECs relative to cigarettes was common among Korean adults who smoked cigarettes, especially among dual-product users and those exposed to marketing. Stronger advertising regulation, standardized warnings, and comparative risk education are needed to address misperceptions about relative harmfulness and support cessation.; Summary

Physical Inactivity and Non-communicable Disease Burden in ASEAN: A 12-Year Panel Analysis Using Structural Equation Modelling and Machine Learning Projections: Moch Yunus, Mahalul Azam, Endang Sri Wahjuni, Ronal Surya Aditya, Reem Iafi AlMutairi, Supriyadi Supriyadi; Received June 5, 2026 Accepted August 19, 2026 Published online August 29, 2026; DOI: https://doi.org/10.3961/jpmph.26.543 [Accepted]

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Abstract PDF: Objectives
Non-communicable diseases (NCDs) are a leading cause of preventable mortality in Southeast Asia, but population-level evidence linking physical inactivity to NCD burden across Association of Southeast Asian Nations (ASEAN) member states remains limited. This study quantified associations between physical inactivity prevalence and NCD-related disability-adjusted life years (DALYs), cardiovascular mortality, and diabetes prevalence across five ASEAN countries from 2010 to 2021 and projected 2025 NCD burden trajectories under an exploratory business-as-usual scenario.
Methods
A longitudinal panel dataset of 60 country-year observations was analyzed using fixed-effects regression with Driscoll–Kraay standard errors, partial least squares structural equation modeling, and XGBoost machine learning with Shapley additive explanations. Missing data (2.1%–6.4%) were handled using multiple imputation by chained equations.
Results
Physical inactivity was independently associated with NCD DALYs (β = 0.421; 95% confidence interval: 0.251–0.591; P < 0.001). A significant attenuating interaction with the universal health coverage (UHC) index was observed (β = −0.183; P = 0.041), suggesting that each 10-point increase in the UHC index reduced the inactivity–NCD association by approximately 18%. The structural equation model explained 78.2% of the variance in NCD burden and identified a significant exploratory longitudinal indirect association through health system resilience, with 19.8% of the total association mediated through this pathway. Under the exploratory business-as-usual scenario, NCD DALYs were projected to increase by 7.8%–20.9% by 2025, with Indonesia and the Philippines showing the highest projected increases. Conclusions: UHC expansion may attenuate inactivity-related NCD burden. For ASEAN countries undergoing rapid epidemiological transition, coordinated investment in health system capacity and multisectoral physical activity promotion may help limit projected DALY increases and support progress toward Sustainable Development Goal 3.; Summary

Perspective

When Deepfakes Meet Herd Immunity: Artificial Intelligence, Vaccine Avoidance, and the Next Infodemic Threat: Minsoo Jung; Received June 6, 2026 Accepted August 10, 2026 Published online August 27, 2026; DOI: https://doi.org/10.3961/jpmph.26.549 [Accepted]

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Abstract PDF: Vaccination remains among the most effective public health interventions, but its impact increasingly depends on public trust and a reliable information environment. During the coronavirus disease 2019 (COVID-19) pandemic, misinformation became a major obstacle to vaccine uptake and disease control. The rapid development of generative artificial intelligence (AI)—including synthetic text generators, conversational chatbots, deepfake images, synthetic audio, and AI-generated videos—has changed how misinformation can be produced, personalized, and disseminated. This Perspective argues that AI-generated misinformation may represent a new stage in the evolution of the infodemic. Compared with earlier forms of vaccine misinformation, AI-generated content can be produced automatically, tailored to individual audiences, made visually persuasive, and distributed at unprecedented speed and scale. Drawing on historical vaccine controversies, health communication research, and epidemiological principles of herd immunity, we propose that AI-driven misinformation should be examined not only as a communication problem but also as a potential epidemiological risk factor that may weaken population immunity. The implications extend beyond vaccine hesitancy to the preparedness and resilience of public health systems during future pandemics. We discuss how anti-vaccination movements may change in the AI era and propose responses centered on trust-building, digital health literacy, information surveillance, and community engagement to support vaccine confidence and pandemic preparedness.; Summary

Original Article

Agreement Between Artificial Intelligence Platforms and the UpToDate Lexidrug Database in Identifying Antihypertensive Drug–Drug Interactions in Older Adults: Januarius Tomi Kiik, Agung Endro Nugroho, Soni Siswanto; Received April 21, 2026 Accepted August 10, 2026 Published online August 24, 2026; DOI: https://doi.org/10.3961/jpmph.26.359 [Accepted]

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Abstract PDF: Objectives
This study aimed to compare the agreement and consistency of classifications generated by ChatGPT-4.5 and Meta AI (Llama 4 Scout) with those of the UpToDate Lexidrug reference standard for identifying potential drug interactions involving antihypertensive medications in older adults.
Methods
A cross-sectional study was conducted using electronic medical record data from January to December 2024. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess agreement between classifications generated by ChatGPT-4.5 or Meta AI and those of UpToDate Lexidrug as the reference standard. In addition, Cohen kappa values were used to assess inter-rater agreement regarding the severity of the identified drug interactions.
Results
ChatGPT-4.5 showed greater agreement with the reference standard (UpToDate Lexidrug), with an accuracy of 0.804, sensitivity of 0.862, specificity of 0.779, PPV of 0.628, and NPV of 0.929, compared with Meta AI, which had an accuracy of 0.706, sensitivity of 0.750, specificity of 0.686, PPV of 0.509, and NPV of 0.863. Cohen kappa analysis showed fair agreement between both platforms and the reference standard (0.367 and 0.359, respectively).
Conclusions
ChatGPT-4.5 demonstrated greater alignment with the UpToDate Lexidrug classification compared to Meta AI across all evaluated metrics. However, both artificial intelligence platforms showed only fair agreement in severity classification, indicating substantial differences between the classifications generated by the platforms and those of the reference database.; Summary

Systematic Review

Dual Use of Electronic and Combustible Cigarettes and Stroke Risk: A Systematic Review and Meta-analysis: Ah-Ram Sul, Tae-Hyeok Kim, Heejin Kimm, Yu-Jin Paek; Received March 16, 2026 Accepted August 3, 2026 Published online August 10, 2026; DOI: https://doi.org/10.3961/jpmph.26.243 [Accepted]

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Abstract PDF: Objectives
Dual use of electronic cigarettes and combustible cigarettes is increasingly prevalent, yet its association with stroke and other cardiovascular outcomes remains unclear. This study evaluated the association of dual use with stroke and other cardiovascular outcomes compared with never smoking through a systematic review and meta-analysis.
Methods
Ovid-MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, KoreaMed, and the International Clinical Trials Registry Platform were searched from 2003 to September 2025. Comparative studies reporting adjusted effect estimates for cardiovascular or cerebrovascular outcomes among adults were eligible. When at least five methodologically comparable studies were available, a random-effects meta-analysis using restricted maximum likelihood estimation was conducted. Heterogeneity was assessed using Cochran’s Q and Higgins’ I² statistics. Leave-one-out analyses evaluated robustness.
Results
Ten observational studies were included (four prospective cohort and six cross-sectional studies). Seven studies reported stroke outcomes. In pooled analyses of cross-sectional studies, dual use was associated with higher odds of stroke compared with never smoking (adjusted odds ratio, 1.90; 95% confidence interval [CI], 1.50-2.40), with substantial heterogeneity (I²=91.3%). Leave-one-out analyses showed consistent results. Composite cardiovascular outcomes suggested elevated risk but were not pooled because of substantial variability in outcome definitions. One prospective cohort study reported increased all-cause mortality (adjusted hazard ratio, 2.44; 95% CI, 1.90-3.13).
Conclusions
Dual use of electronic and combustible cigarettes was associated with increased odds of stroke compared with never smoking, although the evidence was predominantly cross-sectional and showed substantial heterogeneity. Prospective studies with standardized exposure definitions and validated cardiovascular outcomes are needed to clarify long-term cardiovascular risk.; Summary

Original Articles

Association Between Serum Trace Elements and Obstructive Sleep Apnea: Multiple-Exposure Models: Habibolah Khazaie, Samaneh Nakhaee, Zohreh Manoochehri, Omran Davarinejad, Ayoob Rezaei, Borhan Mansouri, Adele Elahi, Saba Kakaei; Received November 12, 2025 Accepted June 22, 2026 Published online August 8, 2026; DOI: https://doi.org/10.3961/jpmph.25.904 [Accepted]

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Abstract PDF: Objectives
The association between trace elements and obstructive sleep apnea (OSA) remains an active area of research, and further studies are needed to clarify these relationships. This study examined correlations between serum essential trace element concentrations and polysomnography-confirmed OSA.
Methods
This cross-sectional study included patients recruited from the Sleep Disorders Center of Farabi Hospital in western Iran. Participants were classified as patients with OSA (n = 54) or controls without OSA (n = 45).
Results
Iron (Fe) levels were significantly higher in participants with OSA than in controls (P = 0.04). Higher Fe levels were associated with greater odds of OSA (P for trend = 0.02). Participants in the fourth Fe quartile had higher odds of OSA than those in the lowest quartile, although this association was of borderline statistical significance (odds ratio [OR] = 3.00; 95% confidence interval [CI]: 0.96–10.00; P = 0.06). In contrast, participants in the second and third magnesium (Mg) quartiles had lower odds of OSA than those in the first quartile (Q2: OR = 0.31; 95% CI: 0.09–0.96; Q3: OR = 0.26; 95% CI: 0.07–0.82). In the generalized weighted quantile sum (GWQS) regression model, the association between the metal mixture and OSA was not statistically significant β= - 0.22, P = 0.59).
Conclusions
Serum concentrations of selected micronutrients may be associated with OSA. The findings suggested a positive association between higher Fe concentrations and OSA, whereas intermediate Mg concentrations were associated with lower odds of OSA.; Summary

Non-restorative Sleep and Functional Limitation in Adults Aged 25–74 Years: A Propensity Score–matched Analysis: Philips Okeagu, Godisgreat Okeke, Yabets Tesfaye Kebede; Received March 31, 2026 Accepted July 8, 2026 Published online August 3, 2026; DOI: https://doi.org/10.3961/jpmph.26.293 [Accepted]

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Abstract PDF: Objectives
This study examined the association between non-restorative sleep (NRS) and functional limitation among US adults aged 25–74 years, assessed dose–response patterns, and estimated the population attributable fraction (PAF). Methods: This cross-sectional study used nationally representative Midlife in the United States Refresher 2 data from 2022–2024 (n=1,699). NRS was categorized as none or rare (never/rarely), intermediate (sometimes), or frequent (often/almost always). A secondary exposure quantified cumulative sleep burden as the count of 3 problems—trouble falling asleep, night waking, and feeling unrested—reported as often or almost always. Functional limitation comprised difficulty with basic or instrumental activities of daily living. Propensity score matching balanced 15 covariates. The PAF was estimated using a generalized Miettinen approach. Results: Frequent NRS was associated with higher odds of functional limitation than no or rare NRS (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.61 to 3.18). Each 1-category increase was associated with 45% higher odds (OR, 1.45; 95% CI, 1.24 to 1.70). Odds also increased with cumulative sleep problems: 1 problem (OR, 1.66; 95% CI, 1.14 to 2.41), 2 problems (OR, 2.50; 95% CI, 1.63 to 3.81), and 3 problems (OR, 2.50; 95% CI, 1.51 to 4.11), suggesting a plateau at higher burden levels. Under causal assumptions, the PAF was 23.9% (95% CI, 14.3 to 34.3), corresponding to approximately 6.9 million affected US adults. Conclusions: RS and cumulative sleep problems were associated with functional limitation in graded patterns that plateaued at higher levels. Sleep disturbance may represent a scalable target for intervention when addressed in middle adulthood.; Summary

Special Article

The Humidifier Disinfectant Disaster in Korea: Implications for Preventive Medicine and Public Health: Sue K. Park, Woojin Lim, Dong-Wook Lee, Mina Ha, Chang Hyun Lee, Hae-Kwan Cheong; J Prev Med Public Health. 2026;59(4):337-342. Published online July 21, 2026; DOI: https://doi.org/10.3961/jpmph.26.248

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Abstract Summary PDF: The humidifier disinfectant disaster in Korea was one of the most severe environmental health disasters of recent decades. It showed that indoor household chemical products used in daily life can cause fatal health effects at the population level when inhalation risks are not adequately assessed before marketing. The disaster also reaffirmed the central role of epidemiology in detecting emerging environmental health threats and guiding public health responses. Fifteen years after the disaster was recognized, major challenges remain, including defining the full spectrum of health damage, providing compensation, and ensuring long-term support. The Special Act on Remedy for Damage Caused by Humidifier Disinfectants, fully amended in 2026, represents an important institutional advance. By explicitly defining the joint liability of the state and relevant companies, the amended Act reflects a shift toward a more public, state-administered system of compensation and health support. This disaster also highlights the roles of public health professionals in generating epidemiological evidence on delayed or newly recognized diseases and sequelae, applying that evidence in clinical and policy contexts, and establishing life-course–based lifelong health management programs. For the 2026 comprehensive amendment to produce meaningful progress, continued efforts are needed to clarify long-term health effects and refine health data–based surveillance systems so that scientific evidence can be translated effectively into policy.; Summary

Korean summary
가습기살균제 참사로 인한 지연성 및 다계통 건강영향을 규명하고, 역학적 근거를 배상과 장기 지원으로 연결하는 데에는 여전히 해결해야 할 과제가 남아 있다. 본 논문은 국가와 기업의 책임, 포용적 배상, 건강데이터 기반 감시체계, 생애주기별 건강관리를 강조하면서, 참사의 정책적 교훈과 2026년 「가습기살균제 피해구제를 위한 특별법」 전부개정의 함의를 검토한다. 이러한 체계의 강화는 예방의학과 공중보건이 사후적 재난 대응을 넘어 향후 환경보건 위기의 사전 예방으로 나아가는 데 기여할 수 있다.

Key Message
Unmet needs remain in identifying delayed and multisystem health effects from the humidifier disinfectant disaster and translating epidemiological evidence into compensation and long-term support. This article reviews the disaster’s policy lessons and the implications of the 2026 full amendment of the Special Act, emphasizing state–corporate responsibility, inclusive compensation, health-data–based surveillance, and life-course health management. Strengthening these systems can help preventive medicine and public health move from post-disaster response toward proactive prevention of future environmental health crises.

Original Articles

Effect of Education Based on the Common-sense Model of Self-regulation on Illness Perception among Older Patients With Hypertension: A Randomized Controlled Clinical Trial: Saeed Hamidizadeh, Mohammad-Rafi Bazrafshan, Omid Barghi, Saleh Vadipeima, Mohammadreza Razavi, Ali Mohammad Parviniannasab; Received February 9, 2026 Accepted May 22, 2026 Published online July 21, 2026; DOI: https://doi.org/10.3961/jpmph.26.136 [Accepted]

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Abstract PDF: Objectives
Effective blood pressure management requires sustained medication adherence and health-related behavior change. However, limited research has examined hypertension management from the patient’s perspective. This study aimed to evaluate the effect of an educational program based on the Common-Sense Model (CSM) on illness perception among older adults with hypertension.
Methods
This randomized controlled clinical trial included 62 patients with hypertension who were referred to Khalil-Azad Health Center in Larestan, Iran, from March to July 2024. Participants were selected and randomly assigned to the intervention group (n = 31) or control group (n = 31). The intervention group participated in a CSM-based educational program consisting of five 45–60-minute sessions over 1 month, whereas the control group received routine care only. Participants completed the Brief Illness Perception Questionnaire before the intervention and 8 weeks after the start of the intervention.
Results
Before the intervention, illness perception subscale scores did not differ significantly between the intervention and control groups (P > 0.05). After the intervention, illness perception subscale scores improved in the intervention group compared with the control group, except for illness consequences, illness concern, and emotional representation (P < 0.05 for the remaining subscales).
Conclusions
A CSM-based educational program may help nurses and health care providers improve illness perception among patients with primary hypertension.; Summary

Global, Regional, and National Burden of Chronic Obstructive Pulmonary Disease and Comorbid Heart Failure from 1990 to 2021, with Projections to 2050: Xiaojing Deng, Huiqing Xu, Yeping Bian, Yunting Xu, Guofeng Ao, Luyan Yang, Ying Ji, Jian Xu, Fei Xu; Received March 3, 2026 Accepted June 5, 2026 Published online July 14, 2026; DOI: https://doi.org/10.3961/jpmph.26.200 [Accepted]

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Abstract PDF: Objectives
Heart failure (HF), a common comorbidity of chronic obstructive pulmonary disease (COPD), is associated with an increased risk of death among patients with COPD. However, no systematic assessment has quantified the population-level burden of comorbid COPD and HF, hereafter referred to as COPD-HF comorbidity, worldwide. This study assessed the global, regional, and national burden of COPD-HF comorbidity from 1990 to 2021 and projected this burden to 2050.
Methods
Data on the non-fatal burden of COPD-HF comorbidity, including prevalence and years lived with disability (YLDs), were obtained from the Global Burden of Disease Study 2021. Temporal trends in age-standardized rates (ASRs) for COPD-HF comorbidity from 1990 to 2021 were examined using joinpoint models. Bayesian age-period-cohort models were used to project ASRs to 2050.
Results
From 1990 to 2021, the absolute numbers of prevalent cases and YLDs for COPD-HF comorbidity increased globally, and the ASRs for prevalence and YLDs also increased. These upward trends were projected to continue to 2050. The burden of COPD-HF comorbidity was consistently higher in men than in women and higher in older adults than in younger individuals. By severity level, the burden of COPD-HF comorbidity was mainly attributable to the treated and severe subtypes of HF. The burden varied substantially across regions, with low-development regions having the highest age-standardized burden.
Conclusions
The global non-fatal burden of COPD-HF comorbidity was substantial from 1990 to 2021 and may continue to increase to 2050. Public health interventions targeting COPD-HF comorbidity may help reduce this burden.; Summary

Interactive Effects of Parental Age on Adverse Birth Outcomes in Japan: An Investigation of Nationwide Birth Data: Tasuku Okui; Received January 14, 2026 Accepted May 22, 2026 Published online July 14, 2026; DOI: https://doi.org/10.3961/jpmph.26.044 [Accepted]

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Abstract PDF: Objectives
We investigated the interactive effects of parents’ ages, as well as the overall effects of paternal age, on adverse birth outcomes using nationwide data from Japan.
Methods
Live birth data from the Vital Statistics Surveys in Japan from 2010 to 2023 were analyzed. Preterm birth, low birth weight, macrosomia, small-for-gestational-age (SGA) status, and large-for-gestational-age status were defined as adverse birth outcomes. Log-binomial regression models were used to examine associations between maternal and paternal ages and adverse birth outcomes. In addition to regression analyses using maternal and paternal age groups separately, we conducted regression analyses using combined parental age groups to assess interactive effects.
Results
Data from 12,279,842 live births were analyzed. Overall, the risk ratio (RR) increased significantly with an increase in the paternal age categories for all adverse birth outcomes. In contrast, among mothers aged ≥30 years, the RRs for preterm birth, low birth weight, and SGA status were higher for infants of fathers aged <25 years than for those of fathers aged ≥35 years. In particular, the RRs for these outcomes, as well as macrosomia, were highest for the combination of the youngest paternal age group (<25 years) and the oldest maternal age group (≥40 years).
Conclusions
Analysis of nationwide birth data indicated that the effects of paternal age on adverse birth outcomes varied according to maternal age, underscoring the importance of assessing pregnancy risk according to combined parental age.; Summary

Social Capital in Digitally Mediated Communities: Conditional Associations with Depressive Mood: Kyungmin Baek; Received April 2, 2026 Accepted June 5, 2026 Published online July 13, 2026; DOI: https://doi.org/10.3961/jpmph.26.305 [Accepted]

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Abstract PDF: Objectives
This study examined whether engagement with different online community environments moderates the association between social capital and depressive mood.
Methods
Using the 2023 Korea Social Integration Survey (n=8,221), a nationally representative survey conducted by the Korea Institute of Public Administration, social capital was measured as an index of participation in 9 types of voluntary and community organizations, and depressive mood was assessed using a single-item measure of day-to-day emotional distress. Ordinary least squares regression models with interaction terms were used to determine whether the association between social capital and depressive mood varied across 3 types of online community environments: messenger services, social networking services (SNS), and membership-based online communities.
Results
Higher levels of social capital were associated with higher levels of depressive mood (b=0.327), contrary to the conventional assumption that social participation is uniformly beneficial. Interaction analyses indicated that this association varied across online community environments. Frequent messenger service use was associated with a weaker positive association between social capital and depressive mood (b=−0.084), whereas SNS use showed a smaller and more conditional moderating effect (b=−0.042). Use of membership-based online communities was not a statistically significant moderator.
Conclusions
The mental health implications of social participation depend on how social engagement is organized across offline and online contexts. Relationally oriented digital environments, particularly messenger services, may attenuate the emotional burden associated with extensive social participation. These findings underscore the need to consider digitally mediated community environments in public mental health research and interventions.; Summary

Association Between Prolonged Sedentary Time and Elevated High-sensitivity C-reactive Protein Among Korean Adults Aged 65 Years or Older: KNHANES 2022: Roma Seol, Chaemin Chun, Sang Ok Cho; J Prev Med Public Health. 2026;59(4):373-380. Published online July 13, 2026; DOI: https://doi.org/10.3961/jpmph.26.091

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Abstract Summary PDF: Objectives
Sedentary behavior has emerged as a health risk factor distinct from insufficient physical activity. This study examined the association between sedentary time and high-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, among Korean older adults.
Methods
Data were obtained from the 2022 Korea National Health and Nutrition Examination Survey. Among 1667 participants aged 65 years or older with available hs-CRP measurements, 496 with leukocyte counts ≥10 000 cells/mm3 or hs-CRP levels ≥10.0 mg/L were excluded, yielding a final sample of 1171 participants. hs-CRP levels ≥1.0 mg/L were classified as abnormal. Differences in the prevalence of abnormal hs-CRP were assessed using the chi-square test, and multivariable logistic regression analysis was performed to evaluate the association between sedentary time and abnormal hs-CRP after adjustment for covariates.
Results
The prevalence of abnormal hs-CRP was higher among participants who did not engage in regular walking (prevalence ratio [PR], 1.24; 95% confidence interval [CI], 1.05 to 1.46) and those with adverse cardiometabolic profiles, including elevated blood pressure, dyslipidemia, and abdominal obesity. It was also higher among participants with sedentary time ≥10 hr/day (PR, 1.20; 95% CI, 1.02 to 1.41). In multivariable logistic regression analysis, prolonged sedentary time remained associated with abnormal hs-CRP levels after adjustment for covariates (odds ratio, 1.31; 95% CI, 1.01 to 1.71).
Conclusions
Prolonged sedentary time was independently associated with elevated hs-CRP levels among Korean adults aged 65 years or older. Accordingly, sedentary behavior reduction may be a useful target for chronic disease prevention strategies in older populations.; Summary

Korean summary
2022년 국민건강영양조사 자료를 분석한 결과, 65세 이상 한국 노인에서 하루 10시간 이상의 장시간 좌식행동은 높은 hs-CRP 수준과 독립적으로 관련되었다. 본 연구는 노인의 만성질환 예방과 건강한 노화를 위해 신체활동 증진뿐만 아니라 장시간 좌식행동을 줄이는 전략도 중요할 수 있음을 시사한다.

Key Message
Among Korean adults aged 65 years or older, sedentary time of ≥10 hr/day was independently associated with elevated high-sensitivity C-reactive protein (hs-CRP) levels. These findings suggest that reducing prolonged sedentary time, alongside promoting physical activity, may be an important behavioral target for chronic disease prevention and healthy aging.

Brief Report

Primary Healthcare Utilization of Undocumented Migrants in Busan, South Korea: A Retrospective Chart Review of a Free Clinic From 2020 to 2024: Yujin Lee, Hyunjin Moon, Saerom Kim; J Prev Med Public Health. 2026;59(4):421-427. Published online July 9, 2026; DOI: https://doi.org/10.3961/jpmph.26.037

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Abstract Summary PDF Supplementary Material: Objectives
This study examined healthcare utilization patterns and health needs among undocumented migrants attending a free clinic in Busan, South Korea.
Methods
We retrospectively analyzed clinical records from 750 undocumented migrants who made 2111 clinic visits between 2020 and 2024. The primary outcome was the number of clinic visits. Diagnoses were classified using the International Classification of Primary Care, Second Edition. Mixed-effects negative binomial regression, with nationality specified as a random intercept, was used to model visit counts and to assess interaction effects between gender and other variables.
Results
Cardiovascular and endocrine diseases were the most prevalent conditions, with chronic diseases accounting for a substantial proportion of clinic visits. In multivariable analysis accounting for gender-based effect modification (model 2), older age was significantly associated with increased visit frequency (β=0.030; 95% confidence interval [CI], 0.014 to 0.045, p<0.001). The association between chronic disease and visit frequency differed significantly by gender (gender×chronic disease interaction, β=0.488; 95% CI, 0.053 to 0.924, p=0.028). Linear combination testing indicated that men with chronic diseases visited the clinic 1.9 times as frequently as men without chronic disease, whereas chronic disease status showed little association with visit frequency among women.
Conclusions
Undocumented migrants attending the free clinic experienced a substantial burden of chronic disease, and healthcare utilization patterns differed by gender. These findings highlight the need for inclusive healthcare policies and targeted interventions for this population.; Summary

Korean summary
본 연구는 2020?2024년 부산 소재 무료진료소를 방문한 미등록 이주민 750명의 진료기록 2111건을 후향적으로 분석하여 일차의료 이용 양상을 파악했다. 고혈압·당뇨병·이상지질혈증 등 만성질환이 전체 방문 사유의 45.5%를 차지했으며, 혼합효과 음이항 회귀분석 결과 연령이 높을수록 방문 빈도가 증가했고 성별과 만성질환 간 상호작용이 유의했다. 공적 의료보장에서 배제된 미등록 이주민의 의료필요를 파악하는 데에 단일 진료소의 의료이용 분석은 제한적인 정보를 제공할 뿐이며, 한국에서 함께 살아가는 이주민들의 건강과 의료접근성 개선을 위한 학술적 노력이 지속되어야 할 것으로 보인다.

Key Message
This retrospective study analyzed 2111 visits by 750 undocumented migrants attending a free clinic in Busan, South Korea (2020–2024). Chronic diseases—hypertension, diabetes, and lipid disorder—accounted for 45.5% of visit reasons, and mixed-effects negative binomial regression showed that visit frequency increased with age, with a significant interaction between gender and chronic disease. Although analysis of healthcare utilization at a single clinic provides only limited information on the healthcare needs of undocumented migrants excluded from public healthcare coverage, continued scholarly efforts appear warranted to improve the health and healthcare access of migrants living as part of Korean society.

Perspective

Fine Particulate Matter (PM_2.5), the Exposome, and Cumulative Health Risk: A Life-course Perspective: Sarawut Sangkham, Piyanuch Lonan, Narongsuk Munkong, Arthid Thim-Uam, Worradorn Phairuang; J Prev Med Public Health. 2026;59(4):432-436. Published online July 1, 2026; DOI: https://doi.org/10.3961/jpmph.26.219

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Abstract Summary PDF: Fine particulate matter (PM_2.5; aerodynamic diameter ≤2.5 μm) is a leading contributor to the global burden of disease and is associated with substantial morbidity and mortality. However, its health effects are often evaluated within single-exposure frameworks, limiting causal inference and reducing the translational relevance of evidence for policy development. In this study, we reconceptualise PM_2.5 within the exposome framework by integrating external exposures, internal biological responses, and structural determinants of health across the life course. PM_2.5 comprises a complex and dynamic mixture of pollutants from ambient and household sources, including biomass combustion, traffic emissions, and industrial activities. After inhalation, PM_2.5 particles can penetrate the respiratory tract, and finer fractions may enter the systemic circulation, where they induce oxidative stress, inflammation, epigenetic dysregulation, and endocrine disruption. These mechanisms contribute to a broad spectrum of adverse health outcomes, including cardiovascular, respiratory, metabolic, and neurodegenerative diseases as well as cancers. The multi-level and temporally accumulated nature of these effects highlights the limitations of reductionist exposure assessment and underscores the need for integrative, systems-based approaches. Integrating cumulative impact assessment with exposome-wide approaches that leverage satellite, clinical, land-use, urban planning, and socioeconomic data can improve the characterization of context-specific cumulative health effects. Positioning PM_2.5 as a sentinel indicator of cumulative environmental risk provides a unifying framework for exposome-informed science and supports the development of more precise, equitable, and policy-relevant interventions.; Summary

Key Message
This perspective considers PM 2.5 as a sentinel marker of cumulative environmental risk within the context of the exposome. The integration of external exposures, biological responses, and social determinants across the life course can help us understand chronic disease development. Moreover, this approach may facilitate more comprehensive, equitable, and policy-relevant environmental health strategies.

Original Article

Occupational Noise Exposure and Cardiovascular Function and Lipid Profile in the Garment Industry in Egypt: A Comparative Cross-sectional Study: Reham Bassem Ibraheem, Ayman Ekram Fahim, Samar Mosaad Gaafar, Fathy Ahmed Nada, Adel M. Mishriky; J Prev Med Public Health. 2026;59(4):392-402. Published online June 27, 2026; DOI: https://doi.org/10.3961/jpmph.26.077

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Abstract Summary PDF Supplementary Material: Objectives
Occupational noise exposure is a widespread hazard across multiple industries. However, the association between occupational noise exposure and cardiovascular health outcomes remains inconclusive. This study aimed to compare cardiovascular function between workers exposed and unexposed to occupational noise and to compare lipid profiles between these groups.
Methods
A Comparative cross-sectional study was conducted in a denim garment manufacturing facility in Ismailia, Egypt. Two equal groups of workers exposed to occupational noise (≥85 A-weighted decibels; dB[A] for ≥3 years, n=213) and unexposed workers (<85 dB[A], n=213) were recruited using systematic sampling, but three unexposed workers dropped out. Data collection included structured interviews, clinical examinations, 12-lead electrocardiography (ECG), blood pressure measurements, and laboratory lipid profile analyses. Noise exposure was assessed using both environmental and personal integrated sound level meters. Multiple logistic regression analysis was performed to identify potential predictors of ECG abnormalities.
Results
The mean ages of the noise-exposed and unexposed groups were 34.5±9.8 years and 33.3±7.7 years, respectively, and females accounted for 67.6% and 66.2% of the groups, respectively. Noise-exposed workers had significantly higher pulse pressure, systolic blood pressure, low-density lipoprotein cholesterol, total cholesterol, triglyceride levels, and prevalence of dyslipidemia (59.2 vs. 48.6%, p<0.05). ECG abnormalities were more prevalent in the noise-exposed group than in the unexposed group (30.0 vs. 8.1%, p<0.001), with P mitrale and right bundle branch block being the most frequent findings. Duration of noise exposure, personal noise level, age, and systolic blood pressure were independent predictors of ECG abnormalities. Body mass index and duration of noise exposure were significant predictors of dyslipidemia.
Conclusions
Chronic occupational noise exposure was associated with elevated blood pressure, dyslipidemia, and ECG abnormalities. Longer duration and higher intensity of noise exposure were also associated with increased cardiovascular risk indicators. These findings support workplace noise-control measures, periodic cardiovascular screening, and improved use of personal protective equipment in similar garment manufacturing settings.; Summary

Key Message
Occupational noise exposure among garment workers was associated with adverse cardiovascular and lipid outcomes, suggesting potential implications for workers’ long-term cardiovascular health. Compared with unexposed workers, noise-exposed workers had higher systolic blood pressure and a greater prevalence of hypertension, electrocardiographic abnormalities, and dyslipidemia, while longer duration and higher levels of noise exposure were also associated with several adverse outcomes. These findings emphasize the importance of effective workplace noise-control measures, consistent use of hearing protection, regular exposure monitoring, and periodic cardiovascular and lipid surveillance as integral components of occupational health programs for workers exposed to hazardous noise in garment factories.

Review

Reassessing Early COVID-19 Strategies in East Asia: Insights From Japan and Korea: Duk-Hee Lee, Hideki Kakeya; J Prev Med Public Health. 2026;59(4):343-351. Published online June 24, 2026; DOI: https://doi.org/10.3961/jpmph.26.274

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Abstract Summary PDF Supplementary Material: East Asian countries had remarkably low coronavirus disease 2019 (COVID-19) mortality in 2020, a pattern widely cited as evidence of effective public health interventions. However, Japan and Korea—often classified as having followed similar early intervention strategies—adopted substantially different approaches. These differences are largely obscured by commonly used stringency indices and policy score analyses. While neither country implemented a lockdown, Korea pursued an aggressive, government-mandated strategy based on extensive testing, isolation, quarantine, and compulsory data collection. In contrast, Japan relied on a voluntary model with limited mass testing, a policy that drew strong criticism during the early phase of the pandemic. Because asymptomatic COVID-19 infection was highly prevalent, these divergent testing policies were particularly important in shaping patterns of community transmission. Using excess mortality as a comprehensive outcome metric, Japan’s outcomes were as favorable as Korea’s through the pre-Omicron period, despite Japan’s limited testing. In 2020, excess mortality was negligible in both countries (−1.7% in Japan vs. +0.3 to +2.1% in Korea). In 2021, excess mortality increased modestly (+2.2% vs. +4.0 to +5.6%). However, in 2022, despite approximately 80% vaccination coverage in both countries, excess mortality reached +7.6% in Japan and about +20% in Korea—three times the Japanese level despite Korea’s much higher booster rate. These patterns of excess mortality in 2 countries with contrasting testing strategies challenge the view that East Asia’s early success stemmed primarily from stringent virus suppression measures. They highlight the need to consider alternative explanations, including the possibility that pre-existing immunity differed substantially across geographical regions.; Summary

Korean summary
- 2020년 동아시아는 서구 국가들에 비해 훨씬 낮은 코로나19 사망률을 기록하며 성공적인 팬데믹 대응의 모범 사례로 평가받았으나 한국과 일본은 상당히 다른 방역 정책을 가진 국가이다. - 본 연구는 다양한 강제적 전파억제 조치와 대규모 진단검사를 시행한 한국과, 제한적인 진단검사와 자율적 방역 정책을 채택한 일본의 팬데믹 성과를 비교하였다. - 2020년 양국 모두 초과사망은 미미하였으나, 2022년에는 높은 백신 접종률에도 불구하고 초과사망이 급증했으며 특히 한국은 일본보다 약 3배 높은 초과사망을 보였다. 이러한 결과는 2020년 동아시아의 낮은 코로나19 사망률이 역정책보다 지역 간 교차면역 수준의 차이에 의해 더 잘 설명될 수 있음을 시사한다.

Key Message
- In 2020, East Asia recorded far lower COVID-19 mortality than Western countries and was regarded as a model of successful pandemic control. However, Korea and Japan adopted markedly different strategies. - This study compared pandemic outcomes between Korea with mandatory transmission- suppression measures and mass testing, and Japan with limited testing and voluntary mitigation. - Excess mortality was minimal in both countries in 2020 but rose sharply in 2022 despite high vaccination coverage, with Korea’s excess mortality three times that of Japan. These findings suggest that cross-immunity may better explain East Asia’s low pandemic impact than public health measures.

Original Articles

Behavioral Segmentation of Integrative Care Use Among Older Adults With Knee Osteoarthritis in a Rural District in Northern Thailand: Kitrawee Jiraratsatit, Wijittra Ubolkam, Kaysorn Sumpowthong; J Prev Med Public Health. 2026;59(4):411-420. Published online June 23, 2026; DOI: https://doi.org/10.3961/jpmph.26.263

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Abstract Summary PDF: Objectives
To identify behavioral segments of integrative care use among older adults with knee osteoarthritis in a rural district in Northern Thailand and to compare these segments according to PRECEDE-related factors and baseline characteristics.
Methods
This analytical cross-sectional study included 302 community-dwelling older adults with primary knee osteoarthritis in Thoen District, Lampang Province, Northern Thailand. Data were collected through face-to-face interviews using a structured questionnaire that assessed demographic and health characteristics, PRECEDE-related factors, and behaviors across 3 care domains: professional medical care, traditional medicine, and community-based medicine. Standardized behavioral domain scores were analyzed using hierarchical cluster analysis, followed by k-means clustering. Differences among segments were examined using chi-square tests, one-way analysis of variance, or Kruskal-Wallis tests, as appropriate.
Results
Three behavioral segments were identified: high engagement (20.9%), intermediate engagement (48.0%), and low engagement (31.1%). The 3 behavioral domains differed significantly across segments (all p<0.001; η²=0.400–0.535). Baseline demographic and health characteristics did not differ significantly among segments. In contrast, significant differences among segments were observed for the total enabling score, access, decision-making, total reinforcing score, social support, and attitude, whereas perceived information showed no significant difference.
Conclusions
Older adults with knee osteoarthritis were not behaviorally homogeneous in their use of professional, traditional, and community-based care. Segment differences were more pronounced for enabling and reinforcing conditions than for perceived information alone. These findings support segment-informed health promotion strategies in primary care and community settings.; Summary

Key Message
This study found three distinct patterns of care use among older adults with knee osteoarthritis in rural Northern Thailand: high, intermediate, and low engagement in professional, traditional, and community-based care. Differences between the groups were more apparent in access, decision-making, and social support than in perceived information. These findings highlight the potential value of tailoring primary care and community-based support to the needs of each group.

Social Networking Service Usage Behaviors and Loneliness Among Adults in Seoul, Korea: A Population-based Cross-sectional Study: Kang Seo, Kun-Hee Oh, Baek-Yong Choi, Jin-Young Min, Kyoung-Bok Min, Seung-Woo Ryoo, Seok-Yoon Son, Ji-Hyeon Lee, Taehoon Kim; J Prev Med Public Health. 2026;59(4):381-391. Published online June 23, 2026; DOI: https://doi.org/10.3961/jpmph.26.024

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Abstract Summary PDF: Objectives
Although social network services (SNS) are prevalent globally, the relationship between SNS use and loneliness remains complex, particularly regarding qualitative behavioral patterns. This study examined associations between specific SNS behaviors and loneliness among Seoul adults and explored differences by age and digital literacy.
Methods
Data from the 2024 Seoul Survey were analyzed (n=34 142; mean age, 52.3 years). Loneliness was assessed with 2 items measuring isolation in family and non-family relationships. Five SNS behavioral domains were examined: active use, information-seeking use, communication priority, social comparison, and exclusionary feeling. Digital literacy was dichotomized using an 8-item scale, with scores ≥6 considered high. Multivariable logistic regression estimated adjusted associations.
Results
Overall SNS use was associated with lower odds of loneliness than non-use (adjusted odds ratio [aOR], 0.90; 95% confidence interval [CI], 0.83 to 0.98). However, higher odds were observed for specific SNS behaviors compared with non-use: active use (aOR, 1.24), communication priority (aOR, 1.26), social comparison (aOR, 1.50), and exclusionary feeling (aOR, 1.66); information-seeking use was not significant (aOR, 1.11). A dose–response pattern peaked at 3 problematic behaviors (aOR, 3.21; 95% CI, 2.82 to 3.65). Associations between SNS behaviors and loneliness were stronger among adults aged ≥60 years and participants with high digital literacy.
Conclusions
Although overall SNS use was associated with modestly lower odds of loneliness, qualitative SNS engagement—particularly problematic behaviors—was strongly associated with higher odds. Older adults and participants with high digital literacy appeared particularly vulnerable when performing problematic SNS behaviors, underscoring the need for behavior-focused, population-tailored education and interventions.; Summary

Korean summary
기존 연구는 SNS 이용량에 주로 주목해, 어떤 이용 방식이 외로움과 관련되는지는 분명하지 않았다. 서울 성인 34,142명에서 SNS 이용자는 비이용자보다 외로움 오즈가 다소 낮았으나, 일상 공유·온라인 소통 우선·사회적 비교·소외감을 보이는 이용자는 오히려 높았고 세 가지가 겹칠 때 가장 높았다. 이 경향은 60세 이상과 기능적 디지털 문해력이 높은 집단에서 더 뚜렷했으므로, 외로움 예방은 SNS 이용 여부가 아니라 이용 방식과 자기조절 역량을 다루어야 한다.

Key Message
Most population evidence treats social network service (SNS) use as a matter of quantity, leaving unclear which qualitative patterns of engagement matter for loneliness. In 34 142 Seoul adults, any SNS use was associated with slightly lower odds of loneliness, whereas self-presentation, prioritizing online contact, social comparison, and feeling excluded were each associated with higher odds - peaking when three such behaviors co-occurred, and strongest in adults aged 60 years or older and in those with high functional digital literacy. Loneliness prevention should therefore address how people use SNS, and digital education should cultivate self-regulation rather than technical skill alone.

Stage-specific Healthcare Burden of Fall-related Injuries Among Older Adults in Korea: Minseok Kim, Taekwon Kim, Kyungsub Song, Sang-hun Lee, Jonghoon Yoo; J Prev Med Public Health. 2026;59(4):403-410. Published online June 22, 2026; DOI: https://doi.org/10.3961/jpmph.26.053

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Abstract Summary PDF Supplementary Material: Objectives
This study aimed to describe the distribution of fall-related injury burden across healthcare stages and age groups in Korea, with particular emphasis on differences between young-old adults (aged 65–74 years) and old-old adults (aged ≥75 years).
Methods
Using the 14th Korea National Injury Statistics Report (2022), we analyzed data on fall-related injuries from 5 national sources: the 119 Emergency Medical Services Registry, the National Emergency Department Information System (NEDIS), the Korea National Hospital Discharge In-depth Injury Survey, the Severe Trauma Survey, and cause-of-death statistics. Five age groups (0–6, 7–18, 19–64, 65–74, and ≥75 years) were defined according to the original classifications used in the data sources. Age-specific crude rates were calculated using mid-year population denominators from Statistics Korea.
Results
Emergency department (ED) visit rates were highest among children aged 0–6 years (2312/100 000) and adults aged ≥75 years (2121/100 000). Despite comparable ED visit rates, the within-NEDIS ED admission rate increased from 2.6% among children aged 0–6 years to 42.9% among adults aged ≥75 years. The hospitalization rate among adults aged ≥75 years (4852/100 000) was 2.6 times higher than that among adults aged 65–74 years (1832/100 000). Among adults aged ≥75 years, the mortality rate was 32.5/100 000, and this age group accounted for 45.4% of all fall-related deaths.
Conclusions
Fall-related injury burden among adults aged ≥75 years was disproportionately concentrated at the hospitalization and mortality stages. These findings suggest that fall prevention strategies for aging populations should consider the downstream burden beyond ED visits.; Summary

Korean summary
본 연구는 2022년 국가손상종합통계를 활용하여 한국 노인의 낙상 관련 손상 부담을 응급실 방문·입원·사망 등 의료단계별로 분석하였다. 75세 이상 초고령 노인에서 부담이 입원과 사망 단계에 불균형적으로 집중되었으며, 응급실 방문률이 유사한 연령대라도 입원 전환율과 사망률은 크게 높았다. 따라서 노인 낙상 예방 전략은 응급실 방문을 넘어 입원·사망 등 후속 단계의 부담까지 함께 고려할 필요가 있다.

Key Message
Using 5 national data sources for 2022, this study shows that the burden of fall-related injuries in older Korean adults is concentrated at the hospitalization and mortality stages rather than at the emergency department (ED) visit stage. Although adults aged ≥75 years and young children had comparable ED visit rates, the oldest adults had far higher admission, hospitalization, and mortality rates, with a steep increase after age 75. Fall-prevention strategies for aging populations should therefore look beyond ED visits and address the downstream inpatient and mortality burden.

National Trends in Healthcare Quality in Korea: A Multidimensional Assessment Using OECD Health Care Quality Indicators (2008–2023): Hyejin Lee, Soo-Hee Hwang, Sang-A Cho, Hyemin Jung, Youngs Chang, Jieun Yun, Sanghyun Cho, Un-Na Kim, Hye Yeon Koo, Eun Byul Cho, Do Hee Kim, Jin Yong Lee; J Prev Med Public Health. 2026;59(3):225-238. Published online May 20, 2026; DOI: https://doi.org/10.3961/jpmph.26.233

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Abstract Summary PDF Supplementary Material: Objectives
Assessing healthcare quality at the national level is essential for evaluating health system performance and identifying areas requiring improvement. This study examined long-term trends in healthcare quality in Korea from 2008 to 2023 using internationally comparable indicators.
Methods
We conducted a trend analysis of healthcare quality in Korea using the Organization for Economic Cooperation and Development (OECD) Health Care Quality and Outcomes framework and quality indicators. Indicators across multiple domains, including acute care, primary care, prescribing in primary care, mental healthcare, and patient experiences, were analyzed and compared with OECD averages.
Results
Healthcare quality in Korea improved across several domains. Thirty-day mortality for acute myocardial infarction decreased from 14.2% in 2008 to 10.2% in 2023, while mortality for ischemic stroke declined from 8.7% to 5.5%. Avoidable hospitalizations decreased substantially, with hospitalizations for chronic obstructive pulmonary disease declining by 59.7%. The proportion of patients with diabetes receiving cholesterol-lowering treatment increased from 44.1% to 82.5%. However, the proportion of broad-spectrum antibiotic prescriptions remained substantially higher than the OECD average (40.3 vs. 15.5%). In mental healthcare, excess mortality ratios increased from 4.3 in 2010 to 4.9 in 2023 for schizophrenia and from 3.5 to 4.3 for bipolar disorder, while post-discharge suicide rates showed little improvement. Patient experience indicators related to patient-physician communication improved and approached OECD averages.
Conclusions
Healthcare quality in Korea improved substantially between 2008 and 2023, particularly in acute care outcomes and chronic disease management. However, persistent challenges remain in areas such as antibiotic use, polypharmacy, and mental healthcare. These findings provide internationally comparable evidence to inform future health policy and healthcare quality improvement efforts.; Summary

Korean summary
이 연구는 OECD Health Care Quality Indicators(HCQI)를 활용하여 2008년부터 2023년까지 한국 의료의 질 변화를 주요 OECD 국가와 비교·분석하였다. 분석 결과, 한국의 급성기 치료 성과(급성심근경색과 허혈성·출혈성 뇌졸중의 30일 사망률)와 만성질환 관리 수준(천식·만성폐쇄성폐질환·심부전·당뇨병의 입원율 감소와 당뇨병 환자의 적절한 약물치료 증가)은 전반적으로 향상된 것으로 나타났다. 그러나 광범위 항생제 사용, 고령층 다약제 처방, 중증 정신질환자의 초과사망 및 퇴원 후 자살률 등은 여전히 OECD 평균 대비 취약한 영역으로 나타나, 지속적인 질 관리와 정책 개선이 필요하다.

Key Message
This study analyzed changes in healthcare quality in Korea from 2008 to 2023 compared with major OECD countries using the OECD Health Care Quality Indicators (HCQI). Acute care outcomes and chronic disease management improved overall, including reduced 30-day mortality for acute myocardial infarction and stroke and lower hospitalization rates for major chronic diseases. However, broad-spectrum antibiotic use, polypharmacy among older adults, excess mortality among patients with severe mental illness, and post-discharge suicide rates remained worse than the OECD average, highlighting the need for continuous quality improvement and policy reform.

Effectiveness of an Innovative Leg Support Ring for Lower Limb Muscle Rehabilitation Among Older Adults in Eastern Thailand: A Randomized Controlled Trial: Kaittisak Wataksorn, Phannathat Tanthanapanyakorn, Pitchapa Sankasem, Nattaya Rorakklang, Atitaya Samaikun, Chanthima Khumthong, Nonlapan Khantikulanon, Chaninan Praserttai, Sootthikarn Mungkhunthod; J Prev Med Public Health. 2026;59(4):352-363. Published online May 20, 2026; DOI: https://doi.org/10.3961/jpmph.26.109

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Abstract Summary PDF Supplementary Material: Objectives
Thailand is rapidly transitioning to an aged society. Lower limb muscle weakness among older adults is associated with increased fall risk, loss of independence, and reduced quality of life (QoL). Although exercise can improve strength and mobility, many community-dwelling older adults face barriers to participation. We evaluated the effectiveness of an innovative leg support ring for lower limb muscle rehabilitation among older adults in Eastern Thailand.
Methods
This randomized controlled trial, repeated-measures study included 64 adults aged 60 years or older with lower limb muscle weakness and activities of daily living (ADL) scores of 9–11. The intervention group (n=32) used the leg support ring for 12 weeks (3–5 day/wk), while the control group (n=32) received standard care and continued usual physical exercise. Leg motor power, range of motion (ROM), ADL, and QoL were assessed at baseline, immediately post-intervention, and at the 3-month follow-up. Data were analyzed using repeated-measures analysis of variance.
Results
Compared with control participants, the intervention group showed significantly greater improvements in motor power of the quadriceps, hamstrings, hip flexors, ankle dorsiflexors, and ankle plantar flexors (p<0.001) and ROM for hip flexion, hip extension, knee flexion, and ankle plantar flexion (p<0.05). ADL and QoL also demonstrated significantly greater improvements (p<0.001). These improvements were sustained or further increased at the 3-month follow-up.
Conclusions
The leg support ring program was associated with improvements in lower limb strength, mobility, functional independence, and QoL among older adults. Its simplicity and accessibility may support integration into community-based health promotion programs for active aging.; Summary

Key Message
This randomized controlled trial evaluated an innovative leg support ring for lower limb rehabilitation among 64 community-dwelling older adults in Eastern Thailand. Over 12 weeks, the intervention group showed significantly greater improvements in motor power, range of motion, activities of daily living, and quality of life compared with the control group, with benefits sustained at 3-month follow-up. Findings support the leg support ring as a simple, low-cost, community-based rehabilitation tool for active aging.

Spatio-temporal Distribution and Relative Risk of Dengue Fever in Peninsular Malaysia: Mohamad Afiq Amsyar Hamedin, Kamarul Imran Musa, Mohd Rahim Sulong; J Prev Med Public Health. 2026;59(4):364-372. Published online May 17, 2026; DOI: https://doi.org/10.3961/jpmph.26.035

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Abstract Summary PDF Supplementary Material: Objectives
Dengue fever remains a major public health concern in Malaysia, with marked spatial heterogeneity and evolving temporal dynamics. Although the incidence of dengue has increased substantially in recent years, district-level risk patterns and their changes over time remain insufficiently characterized. This study aimed to assess the spatio-temporal distribution of dengue risk in Peninsular Malaysia.
Methods
A retrospective analysis of dengue surveillance data was conducted using district-level monthly case counts from 2022 to 2024. Dengue risk was modeled with Bayesian spatio-temporal models incorporating spatial effects, temporal effects, and space–time interaction terms. Spatial variation was modeled using the Besag–York–Mollié 2 specification, while temporal trends were modeled using a first-order random walk. Competing models were compared using the deviance information criterion (DIC) and Watanabe–Akaike information criterion (WAIC). Relative risk (RR) and exceedance probability maps were generated from the best-fitting model.
Results
Dengue incidence increased markedly after 2022, with incidence rates nearly doubling in 2023 and remaining high in 2024. Incidence maps showed pronounced spatial heterogeneity, with persistent high-incidence districts concentrated in urban and peri-urban regions. Spatio-temporal models incorporating space–time interaction substantially outperformed the additive model, with lower DIC and WAIC values. The best-fitting model identified the highest RRs in districts within Selangor, while several districts in Penang, and Johor had high posterior probabilities of elevated risk [P(RR>1)>0.8].
Conclusions
This study demonstrates substantial spatial heterogeneity and evolving temporal dynamics in dengue risk across Peninsular Malaysia. Bayesian spatio-temporal disease mapping provides robust, localized, time-specific estimates of dengue risk and may support targeted surveillance and intervention in endemic settings.; Summary

Key Message
This study mapped district-level dengue risk across Peninsular Malaysia from 2022 to 2024 using Bayesian spatio-temporal models. Dengue incidence nearly doubled in 2023 and remained high in 2024, with the greatest relative risks concentrated in districts within Selangor and additional districts in Penang and Johor showing high probabilities of elevated risk. These findings demonstrate how relative risk and exceedance probability mapping can support more targeted dengue surveillance, vector control, and resource allocation.

Contribution of Medication Expenditures to Catastrophic Health Expenditures in Iran: An Inequality Analysis: Abdoreza Mousav, Rajabali Daroudi, Ali Akbari Sari, Masoomeh Gholami, Saeed Mohammadpour, Ali Akbar Fazaeli; J Prev Med Public Health. 2026;59(3):298-307. Published online May 14, 2026; DOI: https://doi.org/10.3961/jpmph.26.025

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Abstract Summary PDF Supplementary Material: Objectives
Catastrophic health expenditures (CHE) is a well-established indicator of financial risk protection. This study aimed to examine the contribution of medication expenditure to CHE and the associated socioeconomic inequalities.
Methods
Data were drawn from 6 nationally representative income and expenditure surveys covering the period 2019–2024. Using the budget share method, CHE was defined as out-of-pocket (OOP) health payments exceeding 25% of a household’s total consumption expenditure. The contribution of medication expenditures to CHE was then calculated as the difference in the proportion of households experiencing CHE with and without medication payments. Socioeconomic inequalities were quantified using the Concentration Index (CI), and decomposition analysis was conducted to identify the primary drivers of overall socioeconomic inequality in the contribution of medication expenditures to CHE.
Results
During the study period, medications represented a substantial share of household health expenditures and contributed to CHE. In 2024, OOP spending on medications accounted for 31.2% of total health expenditures, while the contribution of medication expenditures to CHE was 1.28%. The CI indicated that the contribution of medication expenditures to CHE was concentrated among poorer households. Decomposition analysis further identified medium-sized households, male-headed households, households with employed heads, insured households, and urban households as the main contributors to this socioeconomic inequality.
Conclusions
In Iran, OOP payments for medications constitute a substantial share of household healthcare expenditures and contribute to CHE. Because the roots of inequality extend beyond the healthcare system, addressing this issue requires a comprehensive, cross-sectoral strategy that integrates broader social and economic policies.; Summary

Key Message
• Medications are a major component of out-of-pocket health expenditures in Iran. In 2024, they accounted for 31.2% of total health spending and contributed 1.28% to catastrophic health expenditures. • This burden is disproportionately concentrated among poorer households. • Addressing this issue requires policy actions beyond the health sector and stronger cross-sectoral strategies to improve financial risk protection.

Risk and Protective Factors for Child Sexual Abuse in Indonesia: Cross-sectional Findings From the 2024 National Survey on Child and Adolescent Life Experiences (SNPHAR 2024): Kinanthi Estu Linadi, Dian Ayubi; J Prev Med Public Health. 2026;59(3):278-288. Published online May 13, 2026; DOI: https://doi.org/10.3961/jpmph.25.777

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1 Crossref

Abstract Summary PDF

Objectives
Child sexual abuse is the most frequently reported form of violence against children in Indonesia, with reported cases increasing over the past 5 years. This study aimed to identify risk and protective factors associated with sexual abuse among adolescents aged 13–17 years in Indonesia.
Methods
The analysis used data from the 2024 National Survey of Children’s and Adolescents’ Life Experiences (SNPHAR), including 6811 respondents. Bivariate analyses were conducted using chi-square tests to identify variables associated with sexual abuse. Variables with p-values less than 0.25 in binary logistic regression were included in multivariable logistic regression. Odds ratios, adjusted odds ratios (aORs), and 95% confidence intervals (CIs) were calculated to identify risk and protective factors associated with the experience of sexual abuse.
Results
Overall, 8.7% of respondents reported experiencing sexual abuse. Protective factors included never having worked (aOR, 0.77; 95% CI, 0.61 to 0.99; p<0.05), never having witnessed violence (aOR, 0.20; 95% CI, 0.17 to 0.24; p<0.001), and no history of sexual intercourse (aOR, 0.08; 95% CI, 0.04 to 0.15; p<0.001). Conversely, positive gender attitudes (aOR, 1.56; 95% CI, 1.29 to 1.87; p<0.001) and knowledge of child protection services (aOR, 3.85; 95% CI, 3.15 to 4.72; p<0.001) were unexpectedly associated with elevated risk.
Conclusions
Violence-free environments and limited exposure to early sexual experiences appear to represent critical protective factors. Counterintuitive associations suggest potential influences of cultural norms, patriarchy, and limited access to services.

Summary

Key Message
This study found that 7% of Indonesian adolescents aged 13–17 years reported experiencing child sexual abuse, based on the 2024 SNPHAR data. Protective factors included never having worked, never witnessing violence, and no prior sexual intercourse, while positive gender attitudes and awareness of child protection services were associated with higher reported odds of abuse. These findings highlight the need for safe environments, early prevention of violence and sexual exposure, and culturally sensitive, accessible child protection services for adolescents.

Citations

Citations to this article as recorded by

Policy Discourse on Child Protection from Cyberbullying and Online Sexual Violence: A Thematic Analysis in Indonesia
Zahra Ahmadi, Rahmat Nur
International Journal of Education Reports.2026; 1(1): 59. CrossRef

Exploring Factors Influencing Decisions to Withdraw Treatment in Iranian Patients With Metastatic Cancer: A Qualitative Content Analysis Study: Faezeh Abadi, Mostafa Bijani, Esmat Nouhi, Camelia Rohani; J Prev Med Public Health. 2026;59(3):267-277. Published online April 30, 2026; DOI: https://doi.org/10.3961/jpmph.25.872

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Abstract Summary PDF: Objectives
The decision to withdraw treatment in patients with metastatic cancer is a complex and emotionally charged process influenced by multiple interrelated factors. Despite its significant clinical and ethical implications, this phenomenon remains insufficiently explored through qualitative inquiry. This study aimed to explore the factors influencing decisions to withdraw treatment among patients with metastatic cancer.
Methods
A qualitative study using conventional content analysis was conducted. Fourteen patients with metastatic cancer were purposively selected. Data were collected through in-depth, semi-structured interviews and analyzed using the qualitative content analysis approach proposed by Graneheim and Lundman. Data organization was facilitated using MAXQDA software.
Results
The analysis yielded 1 main theme (“Finding the meaning of life, and freedom from cycles of suffering”), 4 categories, and 15 subcategories. The overarching theme suggests that understanding life’s meaning enables patients to situate their illness within a broader existential purpose, thereby affirming life’s intrinsic value beyond mere physical survival. The 4 categories were social and family influences, physical health factors, psychological determinants, and divine and spiritual beliefs.
Conclusions
This study outlines a multilevel approach to improving end-of-life care. At the clinical level, holistic nursing assessments are needed to guide transitions to palliative care. At the institutional level, implementing structured protocols with multidisciplinary support and financial counselling is essential. At the national level, policies should ensure universal health coverage and promote cultural acceptance of dignified treatment withdrawal. These findings provide actionable insights for healthcare administrators and policymakers and offer a foundation for strategies aimed at reducing barriers and improving access to supportive care services.; Summary

Key Message
This qualitative study with the conventional content analysis method explored the factors influencing treatment withdrawal decisions in 14 Iranian patients with metastatic cancer. The results revealed one overarching theme: “Finding the meaning of life and freedom from the cycles of suffering,” along with 15 subcategories and four main categories: “social and family influences,” “physical health factors,” “psychological determinants,” and “divine and spiritual beliefs.” These findings provide practical insights for healthcare administrators and policymakers to develop strategies for mitigating barriers and enhancing access to supportive care services for this vulnerable population.

Perspective

Protecting Informational Self-determination in AI-driven Precision Oncology: Privacy, Ethics, and Governance Challenges: Minsoo Jung; J Prev Med Public Health. 2026;59(4):428-431. Published online April 27, 2026; DOI: https://doi.org/10.3961/jpmph.26.094

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Abstract Summary PDF: Artificial intelligence (AI) is rapidly transforming cancer care, from diagnosis and risk prediction to treatment planning and drug development. These advances depend on the large-scale integration of genomic, imaging, and clinical data, intensifying privacy and ethical concerns. This study examines emerging challenges in AI-driven precision oncology and explores strategies for protecting patients’ informational self-determination through a narrative ethical and policy analysis informed by recent empirical and technical research. Even data considered de-identified, including molecular and imaging profiles, may enable inference of sensitive attributes through machine-learning analytics. Although many patients support the clinical promise of AI, they express concerns about secondary data use without meaningful consent, commercialization, and security breaches. Privacy violations threaten autonomy, confidentiality, and trust and may exacerbate existing inequities. Current regulatory frameworks, including the General Data Protection Regulation and the Health Insurance Portability and Accountability Act, focus primarily on identifiability and the removal of explicit identifiers. However, AI systems generate risks not only through re-identification but also through inferential analytics that derive new privacy-relevant information, such as disease susceptibility or familial risk, from ostensibly anonymized data. Addressing these gaps requires multilayered governance that combines privacy-preserving technologies, dynamic consent, data minimization, transparency, and strengthened legal safeguards to sustain public trust.; Summary

Korean summary
인공지능 기반 정밀종양학은 암 진단과 치료의 정확성을 향상시키는 동시에, 유전체·영상·임상정보의 대규모 활용으로 인해 개인정보 자기결정권(informational self-determination)에 새로운 윤리적·법적 도전을 제기하고 있다. 본 논문은 기존의 동의 중심 개인정보 보호체계의 한계를 분석하고, 개인정보보호 기술, 동적 동의, 데이터 최소화, 투명성, 법적 보호를 통합한 다층적 거버넌스가 환자의 자율성과 신뢰를 지속적으로 보장하기 위한 핵심 전략임을 제시한다.

Key Message
AI-driven precision oncology challenges conventional privacy frameworks because machine-learning systems can generate sensitive inferences from ostensibly de-identified genomic and clinical data. Protecting informational self-determination therefore requires moving beyond one-time informed consent toward multilayered governance integrating privacy-preserving technologies, dynamic consent, transparency, legal safeguards, and equitable oversight. Such a governance framework is essential for preserving patient autonomy, sustaining public trust, and ensuring that advances in precision oncology are achieved without compromising privacy or exacerbating health inequities.

Original Articles

Modeling Fatigue and Work Stress in Aircraft Maintenance Personnel at Sultan Hasanuddin Airport, Makassar, Indonesia: A PLS-SEM Study on Quality of Life: Lalu Muhammad Saleh, Syamsiar Siang Russeng, Mahfuddin Yusbud, Tae-Gu Kim, Nurul Mawaddah Syafitri, Fatimah Azzahrah Zainuddin, Andi Alifah Kultsum Umniyah Tenri; J Prev Med Public Health. 2026;59(3):308-317. Published online April 6, 2026; DOI: https://doi.org/10.3961/jpmph.25.726

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Abstract Summary PDF: Objectives
This study aimed to develop and test a comprehensive model analyzing direct and indirect relationships among workload, demographic factors, fatigue, work stress, and quality of life among aircraft maintenance personnel (AMP).
Methods
This cross-sectional study was conducted at the maintenance, repair, and overhaul facility at Sultan Hasanuddin Airport, Makassar. Data collection combined structured interviews, standardized questionnaires (the NASA Task Load Index, Work Fatigue Feeling Measurement Questionnaire, Depression Anxiety Stress Scale-21, and World Health Organization Quality of Life-BREF), and objective measures (a Cocoro Meter for stress and an oximeter for physical workload). The model was examined using partial least squares structural equation modeling (PLS-SEM), which is well-suited to complex models with latent variables and non-normally distributed data.
Results
In the PLS-SEM analysis, physical workload (β=0.229, p=0.018) and work experience (β=0.277, p=0.007) were significantly and directly associated with fatigue. Age significantly predicted work stress (β=0.371, p=0.001). Crucially, fatigue (β=−0.344, p=0.002) and work stress (β=−0.385, p<0.001) had significant negative direct effects on quality of life and were central mediators. No direct effects of exogenous variables on quality of life were observed. Cross-tabulation supported these findings; subgroups with higher physical demands, longer tenure, and older age reported greater fatigue, higher stress, and lower quality of life.
Conclusions
Fatigue and work stress are pivotal mediators that are significantly associated with reduced quality of life among AMP. Interventions to reduce physical workload and provide targeted support for more experienced and older workers may improve well-being and safety in the aviation maintenance industry.; Summary

Key Message
Fatigue and work stress are serious occupational health concerns that can threaten aviation safety. This study showed that greater physical workload, longer work experience, and older age were associated with higher fatigue and work stress, which in turn were significantly associated with lower quality of life among AMP. Strategic interventions, such as improved ergonomic design, structured breaks, and targeted support for more experienced and older workers, may help address these risks. By investing in the well-being of AMP, aviation organizations may strengthen both worker health and the reliability and safety of flight operations.

Associations of Body Mass Index and Waist Circumference With Falls Among Community-dwelling Older Adults in Korea: Seonho Kim, Jeong-Soo Im, Beomman Ha; J Prev Med Public Health. 2026;59(3):328-336. Published online March 31, 2026; DOI: https://doi.org/10.3961/jpmph.26.092

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Abstract Summary PDF: Objectives
This study aimed to investigate the association between obesity and falls among community-dwelling older adults in Korea and to assess whether body mass index (BMI) or waist circumference (WC) more accurately predicts fall risk.
Methods
This study included 4378 community-dwelling older adults aged ≥65 years from the seventh Korea National Health and Nutrition Examination Survey (2016–2018). Complex-sample logistic regression analyses were conducted to examine the associations between general and central obesity and falls, stratified by sex and age group. Predictive accuracy was evaluated using Harrell’s C-index, and differences between WC and BMI were assessed using the ΔC-index and the DeLong test.
Results
BMI-defined general obesity was not significantly associated with falls. In contrast, WC-defined central obesity was significantly associated with falls among older adults overall (adjusted odds ratio, 1.82; 95% confidence interval, 1.20 to 2.76). In sex-stratified analyses, central obesity remained significantly associated with falls in both males and females. Age-stratified analyses showed a significant association between central obesity and falls among adults aged 65–74 years, but not among those aged ≥75 years. WC demonstrated a modest but statistically significant improvement in predictive ability compared with BMI (ΔC-index=0.047, p=0.044), although subgroup differences were not statistically significant.
Conclusions
Central obesity, but not general obesity defined by BMI, was significantly associated with falls among community-dwelling older Korean adults. WC showed slightly better predictive performance than BMI. These findings suggest that WC may be a more appropriate indicator than BMI for identifying older adults at increased risk of falls.; Summary

Korean summary
본 연구는 지역사회 거주 노인을 대상으로 비만과 낙상 간의 관련성을 분석하고, 체질량지수(BMI)와 허리둘레(WC)의 낙상 예측력을 비교하였다. 분석 결과, BMI 기반 일반 비만은 낙상과 유의한 관련이 없었으나, WC 기반 복부비만은 낙상 위험 증가와 유의하게 관련되었으며, 허리둘레가 BMI보다 낙상 예측에 더 우수한 지표로 나타났다. 따라서 노인 낙상 위험 선별 시 BMI보다 허리둘레를 우선적으로 고려할 필요가 있다.

Key Message
Central obesity defined by waist circumference was significantly associated with falls among community-dwelling older adults in Korea, whereas BMI-defined general obesity was not. Waist circumference also demonstrated slightly better predictive performance for falls than BMI. These findings suggest that waist circumference may be a more appropriate anthropometric indicator for identifying older adults at increased risk of falls.

Editorial

Our Valuable Contributors: Reviewers of 2025: Sue K. Park; J Prev Med Public Health. 2026;59(2):109-109. Published online March 30, 2026; DOI: https://doi.org/10.3961/jpmph.26.232

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PDF: Summary

Original Articles

Cross-cultural Adaptation and Psychometric Validation of 3 Health Literacy Instruments (SAHL-E, AAHLS, and HLS-EU-Q47) in Hindi Among Rural Adults in North India: Dheeraj Sharma; J Prev Med Public Health. 2026;59(2):194-203. Published online March 30, 2026; DOI: https://doi.org/10.3961/jpmph.25.893

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Abstract Summary PDF Supplementary Material: Objectives
Health literacy (HL) is a key determinant of health behaviors and health outcomes. However, the lack of validated Hindi-language instruments limits its assessment in India. This study aimed to translate, culturally adapt, and psychometrically validate 3 internationally recognized tools—the Short Assessment of Health Literacy in English (SAHL-E), the All Aspects of Health Literacy Scale (AAHLS), and the European Health Literacy Survey Questionnaire (HLS-EU-Q47)—for Hindi-speaking adults in rural North India.
Methods
A community-based cross-sectional study enrolled 250 adults from 5 villages in Uttar Pradesh. Translation followed forward–backward procedures with expert review and pretesting. Psychometric evaluation included internal consistency (Cronbach α), test–retest reliability (intraclass correlation coefficients, ICC), construct validity (exploratory factor analysis), convergent and known-groups validity, and feasibility indicators (completion rates and interview duration).
Results
All instruments demonstrated strong psychometric performance. Cronbach α values were 0.84 (SAHL-E), 0.87 (AAHLS), and 0.93 (HLS-EU-Q47), and ICCs ranged from 0.86 to 0.94. Factor structures aligned with theoretical expectations. Convergent correlations ranged from 0.42 to 0.61 (p<0.001), and known-groups validity analyses showed significant differences according to education and occupation. Completion rates exceeded 98%, and the mean interview duration was approximately 32 minutes.
Conclusions
The Hindi-adapted SAHL-E, AAHLS, and HLS-EU-Q47 demonstrated strong reliability, validity, and feasibility for assessing HL among rural adults in India.; Summary

Key Message
The Hindi versions of SAHL-E, AAHLS, and HLS-EU-Q47 showed acceptable reliability and construct validity among rural adults in North India. The instruments retained their expected factor structures and demonstrated moderate correlations with each other, indicating related but distinct dimensions of health literacy. These findings support their use for assessing health literacy in Hindi-speaking rural populations.

Repeated Health Screening Measures and Incident Ischemic Stroke: Evidence From a Korean Population Study: Inhyeok Yim, Heui Sug Jo, Seongheon Kim, Su Kyoung Kim, Gyoung-Min Lee, Yu Seong Hwang; J Prev Med Public Health. 2026;59(3):318-327. Published online March 30, 2026; DOI: https://doi.org/10.3961/jpmph.25.810

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Abstract Summary PDF Supplementary Material: Objectives
Ischemic stroke is influenced by long-term metabolic and renal deterioration; however, many risk prediction frameworks rely on single time-point measurements. We examined whether multi-period patterns in national health screening indicators are associated with incident ischemic stroke in Korea.
Methods
Using customized National Health Insurance Service data with 3 biennial screenings (P1: 2013–2014; P2: 2015–2016; P3: 2017–2018), we identified incident ischemic stroke during 2019–2023 (Korean Standard Classification of Diseases-7 I63). After applying eligibility criteria and excluding individuals with missing screening values, we performed 1:1 propensity score matching on sex, 1-year age strata, and insurance type (97 454 matched pairs; n=194 908). Multi-period indicators included waist circumference increase ≥10%, sustained blood pressure ≥130/80 mmHg, sustained fasting glucose ≥126 mg/dL, proteinuria progression, and creatinine elevation in ≥2 periods (sex-specific thresholds). Associations were evaluated using conditional logistic regression; a comparator model used P3-only indicators.
Results
In the multi-period model, stroke was associated with waist circumference increase ≥10% (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01 to 1.08), sustained blood pressure ≥130/80 mmHg (OR, 1.34; 95% CI, 1.31 to 1.37), sustained fasting glucose ≥126 mg/dL (OR, 1.66; 95% CI, 1.60 to 1.73), creatinine elevation in ≥2 periods (OR, 1.08; 95% CI, 1.06 to 1.10), and proteinuria progression (OR, 1.36; 95% CI, 1.32 to 1.39). In the P3-only model, all single-time-point indicators were associated with incident stroke (ORs, 1.08 to 1.47).
Conclusions
Multi-year patterns in metabolic screening indicators were associated with incident ischemic stroke. Repeated health screening measurements may complement single time-point assessments and support continuous risk-factor monitoring and patient-centered prevention.; Summary

Korean summary
- 본 연구는 국민건강보험공단 맞춤형 자료를 활용하여 3회 연속 국가건강검진 지표의 다년간 변화 양상과 이후 허혈성 뇌졸중 발생 간의 관련성을 분석하였다. - 분석 결과, 허리둘레 증가, 지속적 혈압 상승, 지속적 공복혈당 상승, 반복적인 크레아티닌 상승, 단백뇨 진행 등 대사 및 신장 관련 검진지표의 장기적 변화가 허혈성 뇌졸중 발생과 유의하게 관련되었다. - 이러한 결과는 반복 측정된 건강검진 자료가 단일 시점 평가를 보완하고, 뇌졸중 고위험군의 조기 식별과 지속적인 위험요인 모니터링 및 환자중심 예방전략 수립에 활용될 수 있음을 시사한다.

Key Message
- Multi-year patterns in waist circumference, blood pressure, fasting glucose, repeated creatinine elevation, and proteinuria progression were associated with incident ischemic stroke. - Repeated health screening measurements may provide clinically meaningful longitudinal information beyond single-time-point assessments. - Monitoring persistent or worsening metabolic and renal indicators may support earlier risk identification and patient-centered stroke prevention.

Review

Temporal Trends of the Obesity Epidemic in the United States: Zhen Zhang, Lei Zhang, Marinelle Payton; J Prev Med Public Health. 2026;59(3):219-224. Published online March 27, 2026; DOI: https://doi.org/10.3961/jpmph.25.973

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Abstract Summary PDF: Objectives
Obesity has emerged as a major public health concern in the United States, with prevalence increasing steadily over the past 4 decades. This mini-review summarizes recent trends and subgroup disparities using data from the National Health and Nutrition Examination Survey (NHANES) and related publications.
Methods
Data from NHANES cycles conducted between 1988 and 2023 were reviewed to examine temporal trends in adult obesity prevalence, with particular attention to differences by age, sex, race, and interactions between sex and age as well as sex and race.
Results
The prevalence of adult obesity increased from approximately 15% in the late 1970s to 42.4% in 2017–2018. For the first time in nearly 3 decades, consecutive declines were observed, with prevalence falling to 40.3% in 2021–2023. Disparities persist: middle-aged adults and non-Hispanic Black females continue to experience the highest prevalence of obesity, whereas non-Hispanic Asian populations consistently exhibit the lowest rates.
Conclusions
Recent declines may indicate progress in obesity control; however, targeted and equity-focused interventions remain essential to sustain improvements and reduce persistent disparities.; Summary

Key Message
• Recent NHANES data suggest that U.S. adult obesity prevalence may be entering a period of stabilization or modest decline after decades of continuous increase. • Significant disparities persist, particularly among middle-aged women and non-Hispanic Black women, who continue to bear the highest obesity burden. • Tailored prevention and intervention strategies are needed to sustain recent progress and reduce obesity-related health inequities.

Original Articles

Under-reporting of Childhood Tuberculosis Cases in Indonesia and Associated Factors: Kristina L Tobing, Dina Bisara Lolong, Doni Lasut, Mirna Widiyanti, Felly Philipus Senewe, Rachmalina Soerachman, Oster Suriani, Yusniar , Rita Aryati, M N Farid; J Prev Med Public Health. 2026;59(3):289-297. Published online March 25, 2026; DOI: https://doi.org/10.3961/jpmph.25.894

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Abstract Summary PDF: Objectives
Indonesia has the second-highest number of tuberculosis (TB) cases globally, after India. The estimated TB incidence in Indonesia is 1 090 000 cases (387 cases per 100 000 population), with an associated mortality of 131 000 deaths (47 deaths per 100 000 population). The 2023–2024 TB Inventory Study in Indonesia aimed to quantify the extent of under-reporting by identifying TB cases that were diagnosed and/or treated but not reported to the National TB Surveillance System (Sistem Informasi Tuberkulosis [SITB]). This study specifically assessed the magnitude of under-reporting of TB cases among children younger than 15 years in Indonesia.
Methods
This study used a cross-sectional design and analyzed data from the 2023–2024 TB Inventory Study (SIV-TB) in Indonesia. The sample included all TB cases in children younger than 15 years identified from eligible health facilities. Under-reported cases were defined as those that were diagnosed and/or treated but not reported to the SITB. Descriptive statistics were used to characterize under-reporting. A record-linkage process was performed to compare SIV-TB data with SITB data after deduplication.
Results
A total of 12 293 TB cases in children younger than 15 years were identified across health facilities in 31 districts and cities. The overall under-reporting rate for childhood TB was 23.5%. The highest under-reporting rate was observed in Eastern Indonesia (28.0%).
Conclusions
Under-reporting of childhood TB was significantly associated with both age group and type of health facility; Summary

Key Message
- In Indonesia, a substantial number of childhood TB cases remain unreported, especially in private health facilities and in children aged 5–9 years. - The 2023–2024 TB Inventory Study highlights regional gaps, with Eastern Indonesia most affected. - Enhancing TB reporting, engaging private-sector providers, and scaling active case finding are critical steps to detect cases early and accelerate TB elimination efforts.

Socioeconomic and Regional Disparities in Under-five Mortality in Indonesia: Insights From Indonesia’s 2020 Census: Asep Hermawan; J Prev Med Public Health. 2026;59(3):258-266. Published online March 20, 2026; DOI: https://doi.org/10.3961/jpmph.25.763

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Abstract Summary PDF Supplementary Material: Objectives
This study examined district-level and municipality-level socioeconomic determinants of the under-five mortality rate (U5MR) to inform equitable policies aimed at achieving Sustainable Development Goal (SDG) 3.2.
Methods
An ecological cross-sectional study was conducted using data from 514 districts and municipalities in Indonesia. U5MR estimates were obtained from Statistics Indonesia and calculated using the indirect Trussell method based on the 2020 Population Census Long Form. Poverty rate, mean years of schooling, gross regional domestic product per capita, and total fertility rate (TFR) were analyzed using bivariate and multivariable ordinary least squares regression with robust standard errors. To account for spatial dependence, a spatial autoregressive (SAR) model was additionally applied. Spatial mapping was used to illustrate geographic variation.
Results
U5MR ranged from 10.7 to 75.8 deaths per 1000 live births across districts and municipalities. Higher TFR (β=13.21, p<0.001) and higher poverty rates (β=0.61, p<0.001) were associated with higher U5MR, whereas higher educational attainment was associated with lower U5MR (β=−0.79, p=0.001). The association between poverty and mortality was stronger in rural districts than in municipalities (interaction β=−0.30, p=0.06). The SAR model identified significant spatial dependence and demonstrated improved model fit. Spatial clustering revealed an east-west divide, with the highest mortality observed in Papua and East Nusa Tenggara.
Conclusions
Fertility, poverty, and educational attainment are key predictors of child survival in Indonesia, with districts in eastern regions bearing disproportionate burdens. Policy efforts should prioritize family planning, maternal education, and targeted support for socioeconomically disadvantaged districts to accelerate progress toward achieving SDG 3.2 by 2030.; Summary

Key Message
Socioeconomic inequalities remain important determinants of under-five mortality in Indonesia at the district and municipality levels. Higher poverty and fertility rates were associated with increased mortality, whereas higher educational attainment was associated with lower mortality. Equity-oriented and geographically targeted interventions, particularly in disadvantaged eastern districts, are essential to accelerate progress toward Sustainable Development Goal 3.2.

Modeling the Impact of Behavior Changes on Mortality Attributable to Non-communicable Diseases in Canada: Laurence Tanguay, Pierre Faivre, Saïd Mekari, Pierre Philippe Wilson Registe, Emily Richard, Jennifer Russell, Mathieu Belanger; J Prev Med Public Health. 2026;59(2):152-161. Published online March 17, 2026; DOI: https://doi.org/10.3961/jpmph.25.663

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Abstract Summary PDF Supplementary Material: Objectives
In Canada, non-communicable diseases account for 88% of all deaths, most of which could be prevented through a healthier diet, regular physical activity (PA), smoking cessation, and reduced alcohol consumption. This study aims to estimate the number of deaths that could be prevented or delayed if (1) the average behaviors of Canadians aligned with recommendations for healthy behaviors, or if (2) the average behaviors of Canadians equaled those of residents in the provinces with the healthiest behaviors.
Methods
We used the Preventable Risk Integrated Model macrosimulation model to estimate the number of deaths that could be prevented through population-level behavioral changes. Information on Canadians’ health behaviors was obtained from the most recent edition of the Canadian Community Health Survey (2015), which reported diet (from 20 487 participants) as well as PA, alcohol consumption, smoking, and sedentary time (from 110 095 participants). Age-specific and gender-specific mortality data for 2015 were obtained from Canadian Vital Statistics, and 95% uncertainty intervals (UI) were calculated through Monte Carlo analyses.
Results
Following behavioral recommendations could have prevented 30 756 deaths (95% UI, 25 867 to 34 965) in 2015. Improving Canadians’ lifestyles to match the behaviors of the healthiest provinces could have prevented 6758 deaths (95% UI, 5062 to 8382). Improvements in fruit and vegetable intake alone could have prevented most of these deaths. Most preventable deaths were attributed to cardiovascular diseases.
Conclusions
These findings show that even modest, realistic lifestyle improvements at the population level could substantially reduce the burden of chronic disease in Canada.; Summary

Key Message
Small and realistic improvements in population-level fruits and vegetable consumption, physical activity level, avoidance of tobacco use, and reduction in salt ingestion could amount to nearly 7,000 lives saved per year in Canada. Given most of these lives saved could result from only a few behavioral improvements, the findings suggest that public health should prioritize interventions focused on increasing fruit and vegetable intake as well as promoting physical activity and smoking cessation.

Income-related Inequalities in Cancer Screening Among Korean Adults Aged 40 and Above: A Cross-sectional Analysis of the Age-varying Mediation of Health Literacy: Hyejin Hong, Hyun-Jin Goo, Hyebin Choi, Sin Kam, Jong-Yeon Kim; J Prev Med Public Health. 2026;59(2):184-193. Published online March 12, 2026; DOI: https://doi.org/10.3961/jpmph.25.866

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Abstract Summary PDF Supplementary Material: Objectives
This study investigated how the mediating effect of health literacy (HL) on the association between income and cancer screening participation varies by age among Korean adults aged 40 years and older, with the aim of identifying the optimal timing for HL interventions.
Methods
Data from 4171 adults aged ≥40 years in the 2023 Korea National Health and Nutrition Examination Survey were analyzed using moderated mediation analysis implemented with the lavaan.survey package, accounting for the complex sampling design. The Johnson–Neyman technique was used to identify age thresholds at which the mediation effect became statistically significant, and the number needed to benefit (NNB) was calculated to estimate the potential efficiency of interventions targeting this pathway.
Results
Each 1-quintile increase in income was associated with a 16.0% higher likelihood of undergoing cancer screening (odds ratio=1.16, p<0.001). The mediating effect of HL increased significantly with age (index of moderated mediation=0.000438, p=0.048). Mediation became statistically significant from age 54.2 years (Johnson–Neyman threshold), with the proportion of the total effect mediated rising from 0.1% among adults aged 40–49 years to 8.1% among those aged ≥70 years. The NNB for this pathway indicated substantial intervention efficiency in older adults (NNB=372 for ages ≥70), whereas the mediation effect was not statistically significant in the 50–59 age group.
Conclusions
HL significantly mediated the relationship between income and cancer screening participation from the mid-50s onward, with progressively greater contributions at older ages. These findings support age-differentiated strategies, including structural accessibility improvements for adults in their 40s and early 50s and integrated income–HL interventions for individuals aged ≥55 years. Experimental studies are warranted to confirm these associations.; Summary

Korean summary
40세 이상 한국 성인에서 소득과 암검진 참여 간 건강문해력의 매개효과는 54.2세부터 유의해지기 시작하여 연령 증가에 따라 점진적으로 강화되었다. 70세 이상에서 매개 비율은 8.1%, 중재효율(NNB=372)이 가장 높았다. 이는 55세 이상에서 소득 지원과 건강문해력 향상을 결합한 연령별 맞춤형 중재가 필요함을 시사한다.

Key Message
Health literacy mediation of the income–cancer screening relationship became statistically significant from age 54.2 years and strengthened progressively with age among Korean adults aged ≥40 years. Among adults aged ≥70 years, health literacy accounted for 8.1% of the total income effect, with the highest intervention efficiency (NNB=372). These findings suggest that integrated income support and health literacy interventions are warranted for adults aged ≥55 years.

Brief Report

Missing Occupation, Missing Risk: Insights From COVID-19 Case Investigation Data in Busan, South Korea: Jin-Hwan Kim, Daseul Moon, Changhoon Kim; J Prev Med Public Health. 2026;59(2):204-210. Published online March 12, 2026; DOI: https://doi.org/10.3961/jpmph.25.718

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Abstract Summary PDF Supplementary Material: Objectives
This study evaluated the quality and analytic utility of occupational data in coronavirus disease 2019 (COVID-19) case investigation records from Busan, South Korea, during the period of comprehensive surveillance in 2020–2021, when occupation was inconsistently integrated into routine case reporting despite its importance for infection-risk assessment.
Methods
We analyzed 25 283 confirmed COVID-19 cases reported between February 21, 2020, and December 31, 2021. Occupational information was extracted from investigation forms, epidemiological reports, and electronic medical records. We assessed completeness, internal inconsistencies, and codability to the Korean Standard Classification of Occupations (KSCO), and examined temporal trends across pandemic phases. Descriptive statistics and manual reviews of free-text entries were conducted.
Results
Occupational information was recorded for nearly all investigated cases in 2020–2021 (>99%), but entries were often vague (“unemployed,” “other”) or institutional (“school,” “hospital”), which limited their utility. A minority of entries could be standardized to KSCO 1–3-digit categories because of ambiguous wording or contradictions between occupation and workplace. Although data collection virtually ceased in 2022 and 2023 after individual-level investigations were discontinued, patterns in the 2020–2021 dataset already showed that design flaws in the occupation field reduced analytic value.
Conclusions
Busan’s early COVID-19 surveillance system recorded occupation for nearly all cases but produced limited analyzable information. The disconnect between data entry and analytic usefulness highlights the need for structured, dual occupation–industry coding, searchable picklists, and real-time quality checks so that occupational risk can be systematically identified and incorporated into future pandemic preparedness and response.; Summary

Korean summary
본 연구는 코로나바이러스감염증-19에 대한 전수감시가 이루어지던 2020-2021년 시기에 부산광역시 확진자 역학조사에 포함된 직업 정보의 질과 그 활용 가능성을 평가했다. 약 2년 동안 약 99% 이상의 확진자에서 직업 정보가 기입되어 있었으나 “무직”, “기타” 등의 모호한 기재나 “학교”, “병원”과 같은 기관 수준의 기재가 빈번해 활용 가능성은 제한적이었다. 자료 입력과 분석적 유용성 간의 괴리는 향후 감염병 대비 및 대응에서 직업적 위험을 체계적으로 파악하고 반영하기 위해, 구조화된 직업-산업 이중 입력 체계, 검색 기반 폐쇄형 입력 기능, 실시간 자료 질 점검 체계 도입이 필요함을 시사한다.

Key Message
- Occupation is critical for infection-risk assessment, yet occupation was not systematically collected during the COVID-19 pandemic. - In Busan, although occupational information was recorded for most confirmed COVID-19 cases reported between February 2020 and December 2021, many entries contained workplace names or industry categories instead of specific occupations, limiting standardization and analytic utility. - To improve the quality of occupational data in future pandemic preparedness, dual occupation–industry coding, searchable picklists, and real-time quality checks are needed.

Original Article

Associations Between Tobacco Use Behaviors and Metabolic Syndrome in Korean Adults: Analysis of the 2020–2022 KNHANES: Jinsun Kim, Seungju Kim; J Prev Med Public Health. 2026;59(2):174-183. Published online March 5, 2026; DOI: https://doi.org/10.3961/jpmph.25.684

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Abstract Summary PDF: Objectives
This study examined the association between various tobacco product use behaviors and metabolic syndrome (MetS) among Korean adults.
Methods
Data from 15 359 adults aged ≥19 years who participated in the 2020–2022 Korea National Health and Nutrition Examination Survey were analyzed. Participants were classified as dual users, e-cigarettes (EC; nicotine-containing liquid-type)/ heated tobacco products (HTP) users, cigarette-only users, ex-smokers, or non-smokers. MetS was defined according to the NCEP ATP III criteria. Subgroup analyses were conducted by survey year and age group. Complex-sample cross-tabulation and logistic regression analyses were performed.
Results
All types of tobacco product use were associated with an increased likelihood of MetS compared with non-smokers. This association was particularly evident among dual users (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.12 to 1.94) and cigarette-only users (OR, 1.19; 95% CI, 1.01 to 1.41). The highest risk was observed among adults aged 19–39 years and among dual users in 2020.
Conclusions
Dual use and cigarette smoking were associated with a higher likelihood of MetS, particularly among younger adults. Efforts are needed to reduce the misconception that EC/HTP products are less harmful alternatives and to strengthen education and prevention in order to prevent changes in tobacco use behavior from leading to new health risks.; Summary

Korean summary
이 연구는 2020–2022년 국민건강영양조사 자료를 이용하여 국내 성인의 담배 사용 형태와 대사증후군 간의 연관성을 분석하였다. 총 15,359명을 대상으로 분석한 결과, 모든 담배 사용 형태는 비흡연자에 비해 대사증후군 위험 증가와 관련되었으며, 특히 이중사용자와 궐련 단독 사용자에서 유의한 연관성이 나타났다. 이러한 연관성은 19–39세 젊은 성인에서 더욱 두드러졌다. 본 연구는 전자담배 및 가열담배의 안전성에 대한 인식을 재고하고, 변화하는 담배 사용 행태에 대응한 예방 전략의 필요성을 시사한다.

Key Message
Using data from 15,359 Korean adults in the 2020–2022 KNHANES, this study analyzed associations between tobacco use behaviors and metabolic syndrome (MetS). All tobacco use types increased MetS risk, with significant associations observed among dual users (OR 1.48) and cigarette-only users (OR 1.19). This risk was most pronounced in young adults aged 19–39. These findings suggest a need to address misconceptions about EC/HTP products and to improve education and prevention strategies in the context of evolving tobacco use patterns.

Brief Report

Long Working Hours and Risk of Ischemic Heart Disease Among Japanese Workers: The Jichi Medical School Cohort Study: Mayumi Saiki, Akizumi Tsutsumi, Jian Li; J Prev Med Public Health. 2026;59(2):211-218. Published online February 5, 2026; DOI: https://doi.org/10.3961/jpmph.25.577

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Abstract Summary PDF Supplementary Material: Objectives
Karoshi, or “death from overwork,” has been recognized for decades; however, epidemiological findings regarding long working hours (LWH) and ischemic heart disease (IHD) remain inconsistent. This study aimed to provide new evidence on the association between LWH and IHD, while accounting for job strain among Japanese workers, both male and female.
Methods
This study utilized data from 6670 workers participating in the Jichi Medical School Cohort Study. Baseline working hours were categorized as <5.0, 5.0 to 6.9, 7.0 to 8.9 (reference), 9.0 to 10.9, and ≥11.0 hr/day. Fatal and non-fatal incident IHD cases were determined during follow-up using International Classification of Diseases, 10th revision codes. Multivariable Cox proportional hazards models were used to examine associations, adjusting for socio-demographic factors, lifestyle behaviors, cardiometabolic characteristics, and job strain.
Results
During a mean follow-up of 12 years, 58 incident IHD cases (42 male and 16 female) were documented. Long working hours (≥11.0 hr/day) were significantly associated with an increased risk of IHD in the total sample (hazard ratio, 2.92; 95% confidence interval, 1.15 to 7.39), and the overall pattern of associations was similar in sex-stratified analyses.
Conclusions
These findings suggest that LWH independently increases the risk of IHD among Japanese workers, even after adjustment for job strain, underscoring the importance of managing working hours to reduce karoshi in both male and female workers.; Summary

Key Message
Our study provides new evidence on the association between long working hours (LWH) and ischemic heart disease (IHD), while accounting for job strain among Japanese workers, both male and female, utilizing data from the Jichi Medical School Cohort Study. Our study revealed that LWH (≥11.0 hr/day) were significantly associated with an increased risk of IHD in the total sample (hazard ratio, 2.92; 95% confidence interval, 1.15 to 7.39). These findings suggest that LWH increase the risk of IHD among Japanese workers, underscoring the importance of managing working hours to reduce karoshi in both male and female workers.

Original Article

Measuring Trends in Disability-adjusted Life Years and Life Expectancy in Korea: 2008 to 2021: Chung-Nyun Kim, Dawit Urgi Gurmu, Young-Eun Kim, Yoon-Sun Jung, Yongseok Choi, Minsu Ock, Seok-Jun Yoon; J Prev Med Public Health. 2026;59(1):25-34. Published online January 29, 2026; DOI: https://doi.org/10.3961/jpmph.25.604

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Abstract Summary PDF Supplementary Material: Objectives
This study, part of the ongoing Korean National Burden of Disease (KNBD) updates, assesses disability-adjusted life years (DALYs) and disability-adjusted life expectancy (DALE) in Korea, taking into account the effects of coronavirus disease 2019 and emphasizing the importance of analyzing these metrics jointly.
Methods
Data were obtained from Statistics Korea, the National Health Insurance Service, and the Korea Disease Control and Prevention Agency. DALYs and DALE were calculated using an incidence-based approach, following disease classification, disability weights, and estimation procedures consistent with prior KNBD research.
Results
Compared with earlier estimates, DALYs showed a slight decline in 2020 followed by an increase in 2021, with this pattern observed across all income quintiles. For DALE, both men and women experienced modest gains relative to earlier studies; however, a decrease occurred across all income levels in 2021 compared with 2020. Regional disparities in DALE also narrowed beginning in 2020, with a more marked reduction among women.
Conclusions
Unlike previous studies, this research presents DALYs and DALE concurrently, offering a more comprehensive perspective on summary measures of population health. The post-2020 rise in DALYs underscores the growing need for effective chronic disease management. Additionally, widening income-based disparities in DALE highlight the urgency of addressing health inequities. Continued monitoring and updates of DALYs and DALE are necessary to understand and respond to these evolving trends.; Summary

Korean summary
한국인의 질병부담과 건강수명을 2021년까지 추가적으로 측정하였다. 그 결과 2021년은 2020년에 비해 질병부담은 증가하였고 건강수명은 감소하였다.

Key Message
The burden of disease and disability-adjusted life expectancy of Korea was measured through 2021. The results showed that the burden of disease increased and disability-adjusted life expectancy decreased, compared to 2020.

Systematic Review

Association of Particulate Matter (PM_2.5) With COVID-19 Infection and Mortality in Low-and Middle-income Asian Countries: A Systematic Review and Meta-analysis: Frisca Rahmadina, Riris Andono Ahmad, Aditya Lia Ramadona; J Prev Med Public Health. 2026;59(1):12-24. Published online January 17, 2026; DOI: https://doi.org/10.3961/jpmph.25.499

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Abstract Summary PDF Supplementary Material: Objectives
Low-income and middle-income countries in Asia bear a disproportionate burden of particulate matter with an aerodynamic diameter of 2.5 micrometers or less (PM_2.5) pollution, yet data remain scarce. This systematic review and meta-analysis aimed to quantify the association between PM_2.5 exposure and the risks of coronavirus disease 2019 (COVID-19) infection and mortality in this vulnerable region.
Methods
A systematic search was conducted in PubMed, Scopus, and other major databases for studies published up to December 31, 2024. We included observational studies reporting associations between PM_2.5 and COVID-19 outcomes in low-income and middle-income Asian countries. Pooled effect sizes and 95% confidence intervals (CIs) were calculated using a random-effects model. The study was registered with PROSPERO (CRD42022316008).
Results
Fourteen studies met the inclusion criteria. Separate analyses demonstrated statistically significant positive associations between PM_2.5 exposure and COVID-19 infection for both short-term exposure (pooled risk ratio [RR], 1.12; 95% CI, 1.07 to 1.18) and long-term exposure (pooled RR, 1.41; 95% CI, 1.28 to 1.56). For mortality, the analysis identified a statistically non-significant positive association with short-term exposure (pooled RR, 1.37; 95% CI, 0.80 to 2.33). Substantial heterogeneity was observed across all analyses (I²>75%); however, sensitivity analyses confirmed that the findings for infection were robust.
Conclusions
Our findings provide robust evidence that PM_2.5 exposure is a significant risk factor for COVID-19 infection in low-income and middle-income Asian countries. The available evidence was insufficient to establish a clear association with mortality. These results underscore the urgent need for strengthened air quality control policies as a critical component of public health strategies to mitigate the burden of respiratory pandemics.; Summary

Key Message
This systematic review and meta-analysis confirms that both short-term and long-term PM 2.5 exposure significantly increase COVID-19 infection risks in Asian LMICs, with long-term exposure showing a substantially higher risk ratio. These findings highlight a critical intersection between air quality and infectious disease vulnerability. Consequently, integrating air quality management into public health strategies is essential for strengthening preparedness against future respiratory pandemics.

Scoping Review

Reporting Quality for Comorbidity Adjustment in Studies Using Korean Health Insurance Claim Data: A Scoping Review: Kyoung-Hoon Kim; J Prev Med Public Health. 2026;59(2):123-131. Published online January 6, 2026; DOI: https://doi.org/10.3961/jpmph.25.839

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Abstract Summary PDF

Objectives
Adjustment for comorbidity is essential in observational studies using administrative data to ensure the reproducibility and transparency of research findings. However, the reporting quality of comorbidity adjustment in studies using the National Health Insurance Claim Data (NHICD) has not yet been evaluated. This study aimed to assess the reporting quality of comorbidity adjustment in health outcome studies that used the NHICD.
Methods
We conducted a PubMed search in April 2025 using the terms “(Korea OR Korean) AND (‘health insurance claim*’ OR claims data OR NHIS OR HIRA) AND (2024).” Of the 239 retrieved studies, 82 outcome studies that exclusively used the NHICD and adjusted for comorbidities as confounding variables were included. Reporting quality was evaluated across 3 domains: (1) scope of data, (2) range of diagnostic codes, and (3) length of the look-back period.
Results
Among the 82 studies, 33 (40.2%) used ad hoc selection, 33 (40.2%) used the Charlson comorbidity index, and 13 (15.9%) applied both methods. The Elixhauser comorbidity measure was rarely used, appearing in only 3 studies. Only 3 studies explicitly described the scope of data used, and 6 reported the diagnostic code range. The look-back period was specified in 26 studies (31.7%), with 1 year being the most commonly reported duration.
Conclusions
The reporting quality of comorbidity adjustment in studies using the NHICD remains suboptimal. Transparent and standardized reporting of data scope, diagnostic code range, and look-back period is essential to improve the reproducibility and comparability of research findings.

Summary

Korean summary
건강보험 청구자료를 활용한 관찰연구에서 동반질환 보정은 연구 결과의 타당성을 확보하는 데 중요한 요소이나, 그 보고 수준은 충분히 평가되지 않았다. 본 연구는 2024년에 발표된 건강보험 청구자료 기반 연구를 대상으로 문헌검색을 수행하고, 데이터 범위, 진단코드 범위, 관찰기간 측면에서 동반질환 보정의 보고 수준을 평가하였다. 그 결과, 대부분의 연구에서 이러한 핵심 방법론적 정보가 충분히 보고되지 않았으며, 보고 방식에도 상당한 변이가 존재하였다. 이러한 결과는 연구의 재현성과 비교 가능성을 제한할 수 있음을 의미하며, 향후 행정자료 기반 연구의 신뢰성과 방법론적 정확성을 높이기 위해 표준화되고 투명한 보고가 필요함을 시사한다.

Key Message
The reporting quality of comorbidity adjustment in studies using Korean health insurance claims data remains suboptimal. Key methodological elements, including the scope of data, diagnostic code range, and look-back period, are frequently omitted or insufficiently described, limiting the reproducibility and comparability of findings. Transparent and standardized reporting of these components is essential to improve methodological rigor and support more reliable evidence generation in administrative data research.

Citations

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Psoriasis and Risk of Colorectal Cancer: A Nationwide Population-Based Cohort Study in Korea
Kyeong Min Han, Dae Myoung Yoo, Ho Suk Kang, Hyo Geun Choi, Joo-Hee Kim, Nan Young Kim, Kyueng-Whan Min, Mi Jung Kwon
Diseases.2026; 14(6): 200. CrossRef

Original Articles

Obstetric Outcomes of Jehovah’s Witness Women Under Patient Blood Management: A Single-center, Propensity Score–Matched Cohort Study in Korea: Jeong-Won Oh, Seug Yun Yoon, Jeong Jae Lee, Kyu Yeon Choi, Seong Soon Kwon; J Prev Med Public Health. 2026;59(2):143-151. Published online January 6, 2026; DOI: https://doi.org/10.3961/jpmph.25.596

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Abstract Summary PDF Supplementary Material: Objectives
Patient blood management (PBM) is increasingly recognized as an essential strategy in obstetric care for reducing transfusion-related risks and improving maternal safety. Jehovah’s Witness (JW) women, who categorically refuse blood transfusion, represent a unique clinical population in which to evaluate the effectiveness of PBM. This study aimed to assess obstetric outcomes of JW women compared with non-JW women at a PBM-based center in Korea.
Methods
We retrospectively reviewed delivery outcomes and PBM practices among JW women (n=205) with singleton pregnancies and non-JW women (n=601) who were matched at a 1:3 ratio using propensity scores at Soonchunhyang University Seoul Hospital between 2018 and 2023. The primary outcomes included obstetric morbidities, with particular attention to complications related to postpartum hemorrhage and the interventions used for its management.
Results
JW women were more likely to receive intravenous iron administration (7.3 vs. 2.8%, p=0.008) and had higher hemoglobin (Hb) levels during the first trimester (12.6±1.1 vs. 11.8±3.4 g/dL, p=0.012) than non-JW women. Blood loss during cesarean section and the incidence of severe postpartum anemia (Hb <7 g/dL) were lower among JW women; however, these differences did not reach statistical significance. In the hemorrhage-related high-risk subgroup, JW women were managed according to PBM protocols without transfusion, and their obstetric outcomes were comparable to those observed in non-JW women.
Conclusions
This study identified no significant differences in hemorrhage-related obstetric outcomes between JW and non-JW women at a PBM-based center. The systematic application of PBM enables safe delivery in transfusion-restricted settings and may reduce reliance on blood transfusion while maintaining maternal safety.; Summary

Korean summary
수혈을 거부하는 여호와의 증인 산모에게 환자혈액관리(PBM) 프로토콜을 적용한 결과, 일반 산모와 비교하여 산후출혈 및 중증 빈혈 등 주요 산과적 합병증에서 유의한 차이는 관찰되지 않았으며, 이는 선제적인 철분 관리의 기여로 해석된다. 비록 대량 출혈 시에는 적용에 한계가 있으나, 이는 PBM이 종교적 특수 상황을 넘어 향후 혈액 수급 위기에 대응할 수 있는 보편적이고 안전한 산과적 대안이 될 수 있음을 시사한다.

Key Message
Implementation of patient blood management (PBM) in Jehovah’s Witness women who refuse transfusion resulted in obstetric outcomes comparable to those of non-JW women, with no significant differences in postpartum hemorrhage or severe anemia. These outcomes were associated with proactive anemia management, including intravenous iron therapy. Although its applicability may be limited in cases of massive hemorrhage, PBM represents a safe and potentially generalizable obstetric strategy to mitigate future blood supply constraints.

Development of Machine Learning Models to Predict Health Insurance Claim Costs Among Older Indonesians: A Retrospective Predictive Modeling Study: Yeni Mahwati, Dhihram Tenrisau, Syarif Rahman Hasibuan, Bhirau Wilaksono, Yeni Indriyani, Andi Afdal Abdullah, Halik Malik, Andi Alfian Zainuddin; J Prev Med Public Health. 2026;59(2):132-142. Published online January 6, 2026; DOI: https://doi.org/10.3961/jpmph.25.350

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Abstract Summary PDF Supplementary Material: Objectives
The objective of this study was to develop machine learning models to predict health insurance claim costs among older adults in Indonesia.
Methods
This study utilized secondary data from the Indonesian National Health Insurance program (Jaminan Kesehatan Nasional [JKN]) spanning 2017 to 2023. Three modeling techniques—linear regression, random forest, and XGBoost—were employed to predict individual claim costs. Model performance was assessed using the root mean square error (RMSE), coefficient of determination (R²), and mean absolute error (MAE). Additionally, variable importance analysis was conducted to identify key predictors.
Results
XGBoost with 500 boosting rounds yielded the best performance, with an RMSE of 11 360 283, an R² of 0.81, and an MAE of 4 485 917, outperforming both linear regression (RMSE, 13 710 035; R²=0.72) and random forest (RMSE, 12 434 238; R²=0.78). Notably, outpatient care was identified as the most consistent predictor across all models. Other significant predictors included length of stay (LOS), diagnosis type (International Classification of Diseases, 10th revision chapter), facility type, facility classification, and severity of illness, particularly for moderate cases. Although LOS and diagnosis type were important predictors, these findings should be interpreted in the context of Indonesia’s fixed Indonesian Case-Based Groups payment system.
Conclusions
XGBoost provides reliable predictions of claim costs among older adults, capturing clinical, utilization, and structural drivers. These findings can inform targeted interventions, improve chronic disease management, optimize the referral system, and support integration of predictive tools into JKN to enhance responsiveness and promote sustainable, equitable financing.; Summary

Key Message
Machine learning models, particularly XGBoost, demonstrated superior performance in predicting healthcare costs among older adults in Indonesia. Nonlinear relationships between outpatient visits, severity, and diagnoses highlight the limitations of conventional linear approaches. These findings support the integration of advanced predictive models into national health insurance systems to improve cost management and resource allocation.

Systematic Review

Patient Education to Reduce Anxiety Among Cancer Patients Undergoing Radiotherapy Procedure: A Systematic Review of Interventional Studies: Fathiya Juwita Hanum, Rizanda Machmud, Soehartati Gondhowiardjo, Daan Khambri, Wirsma Arif Harahap, Aisyah Elliyanti, Firdawati Firdawati, Rima Semiarty; J Prev Med Public Health. 2026;59(2):110-122. Published online December 21, 2025; DOI: https://doi.org/10.3961/jpmph.25.318

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Abstract Summary PDF Supplementary Material: Objectives
Nearly 1 in 3 cancer patients undergoing radiotherapy experience anxiety, which can negatively affect both quality of life and prognosis. This systematic review aimed to synthesize evidence on patient education and its impact on anxiety levels among cancer patients undergoing radiotherapy.
Methods
We conducted a systematic review of the current literature using 3 scientific databases—PubMed, EBSCOhost, and Web of Science—to identify intervention studies. Data were analyzed using a narrative synthesis approach, integrating findings across studies to draw comprehensive conclusions.
Results
Fifteen studies involving 1988 participants were included. Baseline anxiety levels, measured using various instruments, ranged from 2.9% to 88.2% before radiotherapy and declined thereafter in both intervention and control groups. Most studies reported no significant difference in anxiety reduction between intervention groups receiving educational programs and control groups receiving standard education. However, interventions that were more intensive and delivered by professional staff were more likely to produce statistically significant reductions in anxiety.
Conclusions
This review suggests that patient education remains relevant for reducing anxiety among cancer patients undergoing radiotherapy. Routine screening for anxiety prior to radiotherapy is recommended, along with the development of more intensive and tailored educational interventions rather than passive or minimal approaches.; Summary

Key Message
Patient education plays a meaningful yet nuanced role in alleviating anxiety among cancer patients undergoing radiotherapy. While standard educational approaches show limited additional benefit over routine care, more intensive, structured, and professionally delivered interventions demonstrate greater potential for significant anxiety reduction. These findings underscore the importance of early anxiety screening and the development of tailored, high-quality educational strategies to optimize patient outcomes.

Perspective

Firefighters as a Key Alliance Group to Advocate for Tobacco Control Policies in Korea: Heewon Kang, Susan Park, Sung-il Cho; J Prev Med Public Health. 2026;59(1):105-108. Published online December 14, 2025; DOI: https://doi.org/10.3961/jpmph.25.528

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Abstract Summary PDF: Tobacco control is a public health priority. However, Korea has recently experienced a reversal in its long-term decline in smoking prevalence. To address this trend, it is essential to broaden advocacy networks by engaging new stakeholders. We propose that firefighters represent a strategic yet under-represented partner in tobacco control because their professional interests closely align with tobacco-related policy goals. First, cigarette butts have consistently been the leading cause of fire incidents, and tobacco use directly undermines firefighters’ core mission to protect life and public safety. Moreover, firefighters face elevated health risks due to occupational exposure to harmful substances, and tobacco use and exposure to tobacco smoke can further compound these risks. Additionally, a portion of tobacco tax revenue is allocated to fire service funding, creating a direct fiscal linkage between tobacco control and firefighting resources. A logical next step is to promote collaboration through intergovernmental partnerships between public health authorities and national fire services. This collaboration includes targeted health promotion initiatives that assess tobacco use among firefighters and provide cessation support. Broader strategies, such as mass media campaigns and coordinated advocacy for increases in tobacco taxes, should also be jointly implemented. Such an alliance could improve firefighters’ well-being, reduce fire-related risks, and strengthen the overall tobacco control response.; Summary

Korean summary
담배 사용이 화재 위험과 소방관의 건강에 미치는 영향을 바탕로, 소방관을 담배규제 정책 옹호를 위한 핵심 협력 집단으로 제안한다. 담배꽁초로 인한 화재, 소방관의 직업적 건강 위험, 그리고 담뱃세의 소방 재정 기여라는 구조적 연계를 통해 공중보건과 소방 안전 간의 공동 이익을 실현할 수 있다. 공중보건과 소방 조직 간의 협력은 담배 사용 감소와 화재 예방을 동시에 달성할 수 있는 전략적 기회가 될 수 있을 것이다.

Key Message
This perspective argues that firefighters represent a strategic yet underutilized alliance group for advancing tobacco control in Korea. Tobacco use directly contributes to fire incidents, exacerbates firefighters’ occupational health risks, and is fiscally linked to fire services through earmarked tobacco taxes. Strengthening collaboration between public health authorities and fire services could reduce smoking prevalence, improve firefighter well-being, and enhance fire safety, creating mutually reinforcing public health and safety gains.

Original Articles

The Effect of an Educational Program Based on Orem’s Self-care Model on Treatment Adherence, Self-care Behaviors, and Quality of Life in Hemodialysis Patients in Iran: A Randomized Controlled Clinical Trial: Samira Rezaei, Mostafa Bijani, Azizallah Dehghan, Zhila Fereidouni; J Prev Med Public Health. 2026;59(3):249-257. Published online December 12, 2025; DOI: https://doi.org/10.3961/jpmph.25.727

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Abstract Summary PDF: Objectives
Patients undergoing hemodialysis encounter a wide range of complex challenges, underscoring the essential role of self-care in disease management. The present study aimed to examine the effectiveness of an educational intervention grounded in Orem’s self-care model for enhancing treatment adherence, self-care behaviors, and quality of life among hemodialysis patients in southern Iran.
Methods
This single-blind randomized controlled trial included 120 hemodialysis patients who met the predetermined eligibility criteria. Data were collected between April 2023 and August 2023 at 2 university-affiliated teaching hospitals located in southern Iran. After providing informed consent, participants were randomly allocated to either the intervention group (n=60) or the control group (n=60) through a simple randomization procedure. Three psychometrically robust instruments were used to collect data: the End-Stage Renal Disease Adherence Questionnaire, the Kidney Disease Quality of Life Short Form, and the Self-Management Behavior Scale. Statistical analyses were performed using SPSS version 23, and p-values<0.05 were considered statistically significant.
Results
At baseline, no statistically significant differences were observed between the intervention and control groups in the mean scores of the measured variables. However, immediately following the intervention and at the 3-month follow-up, the intervention group demonstrated statistically significant improvements across all 3 variables.
Conclusions
The findings underscore the effectiveness of an educational program based on Orem’s self-care model in significantly improving self-care behaviors, treatment adherence, and quality of life among hemodialysis patients.; Summary

Key Message
Patients undergoing hemodialysis encounter a wide range of complex challenges, underscoring the essential role of self-care in disease management. The findings underscore the effectiveness of an educational program based on Orem’s self-care model in significantly improving self-care behaviors, treatment adherence, and quality of life among hemodialysis patients. The results of this trial carry implications for clinical practice and health policy. It is recommended that contemporary educational methodologies—particularly those grounded in well-established nursing theories such as Orem’s model—be systematically integrated into nursing curricula. Additionally, structured training workshops emphasizing the clinical utility and outcomes of Orem-based self-care education should be incorporated into hospital-based educational programs.

Determinants of Smoking Relapse Among Indonesian Children: A National Cross-sectional Analysis Using Global Youth Tobacco Surveillance Data: Risky Kusuma Hartono, Muhammad Abdul Rohman, Renny Nurhasana, Aryana Satrya, Salsabila Nadya, Ni Made Shellasih, Fadhilah Rizky Ningtyas, Astri Hanna Waruwu; J Prev Med Public Health. 2026;59(2):162-173. Published online December 12, 2025; DOI: https://doi.org/10.3961/jpmph.25.703

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Abstract Summary PDF: Objectives
This study aimed to identify the determinants associated with 4 smoking trajectories (never smoking, current smoking, consistently quitting smoking, and smoking relapse) among Indonesian children using pooled national data.
Methods
This study analyzed children’s smoking trajectories using pooled data from the Indonesian Global Youth Tobacco Survey (2006, 2009, 2014, and 2019). Multinomial logistic regression was applied to examine 4 categories of smoking behavior, and propensity score matching (PSM) was used to address potential selection bias related to advertising exposure.
Results
Higher prices (>IDR31 000/USD1.87) (relative risk ratio [RRR], 0.527) were protective against relapse. This policy effect was systematically undermined by single-stick purchasing, which increased relapse risk by 57.41 times (p<0.01). Peer smoking (RRR, 3.696) and exposure to advertisements in sports events (RRR, 1.477) were also significant risk factors for relapse. Free cigarette distribution demonstrated the strongest association, corresponding to a 23.1 percentage-point increase in relapse probability.
Conclusions
The findings indicate that children’s smoking relapse in Indonesia is shaped by distinct behavioral trajectories. Relapse was influenced by the widespread availability of single-stick cigarettes, pervasive marketing, peer dynamics, and relatively affordable prices. These results underscore the urgent need for a comprehensive strategy that includes substantially increasing excise taxes, eliminating single-stick sales, and fully banning tobacco advertising. Simultaneous implementation of these measures is crucial to prevent relapse and interrupt the progression toward lifelong nicotine addiction.; Summary

Key Message
- To examine factors associated with smoking relapse among Indonesian children, including price, affordability, and advertising exposure. - Pooled Global Youth Tobacco Survey data (2006–2019) were analyzed using multinomial logistic regression and propensity score matching. - Higher cigarette prices (>IDR31,000) reduced relapse risk (RRR 0.527), while single-stick purchases (>57-fold), peer smoking (RRR 3.696), sports advertising exposure (RRR 1.477), and receiving free cigarettes (+23.1 percentage points) significantly increased relapse. - Relapse is driven by accessibility, social influence, and marketing, requiring comprehensive tobacco control policies.

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