Journal of Preventive Medicine and Public Health

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.

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Delivering online communication skills training for radiation therapists
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Original Article

Impact of Physical Activity on the Association Between Unhealthy Adolescent Behaviors and Anxiety Among Korean Adolescents: A Cross-sectional Study: Hyo-jung Lee, Jeong Pil Choi, Kunhee Oh, Jin-Young Min, Kyoung-Bok Min; J Prev Med Public Health. 2023;56(6):552-562. Published online November 15, 2023; DOI: https://doi.org/10.3961/jpmph.23.313

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Abstract Summary PDF

Objectives
Adolescents who engage in unhealthy behaviors are particularly vulnerable to anxiety. We hypothesized that participation in physical activity could influence the relationship between anxiety and unhealthy behaviors in adolescents. These behaviors include smoking, alcohol consumption, and unsafe sexual activity.
Methods
This study included 50 301 students from the first year of middle school to the third year of high school, all from Korea. The unhealthy adolescent behaviors examined included current alcohol consumption, current smoking, and unsafe sexual behavior. Anxiety levels were assessed using the Generalized Anxiety Disorder-7 questionnaire (GAD-7).
Results
The participants had a mean age of 15.19 years and an average GAD-7 score of 4.23. No significant differences were observed in GAD-7 score among exercising participants when categorized by smoking status (p=0.835) or unsafe sexual behavior (p=0.489). In contrast, participants in the non-exercise group who engaged in these behaviors demonstrated significantly higher GAD-7 scores (p<0.001 and 0.016, respectively). The only significant interaction was found between unsafe sexual behavior and exercise (p=0.009). Based on logistic regression analysis, within the non-exercise group, significant positive associations were observed between current smoking and anxiety (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.18 to 1.57), as well as between unsafe sexual behavior and anxiety (OR, 1.33; 95% CI, 1.02 to 1.73). However, within the exercise group, no significant association was found between anxiety and either smoking or unsafe sexual behavior. Furthermore, no significant interaction was observed between unhealthy behaviors and exercise.
Conclusions
These findings are insufficient to conclude that physical activity influences the relationship between unhealthy behaviors and anxiety.

Summary

Korean summary
이 연구는 신체활동이 한국 청소년들사이에서 불안과 불건강행태간의 관계에 어떠한 영향을 미치는지 조사하였다. 이 연구에서 신체활동을 하지 않는 청소년에서만 흡연 및 불안전한 성행위와 같은 불건강행태와 불안 간의 유의미한 연관성을 보였음에도 불구하고, 이러한 불건강행태와 운동 간에는 같은 방향의 유의미한 상호작용이 관찰되지 않았다. 따라서 이 연구는 신체 활동이 청소년들의 불건강행태와 불안간의 관계에 직접 미치는 영향에 대해 명확하게 결론을 내릴 수 없었다.

Key Message
Among Korean adolescents, this study found that significant associations between unhealthy behaviors such as smoking and unsafe sex, and anxiety were only observed in adolescents who did not engage in physical activity. Despite this, no significant interaction was observed between these unhealthy behaviors and exercise. Contrary to popular belief, this study concludes that the evidence is insufficient to definitively say that physical activity influences the relationship between adolescent unhealthy behaviors and anxiety.

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Special Article

Examining the Role of Psychosocial Stressors in Hypertension: Komal Marwaha; J Prev Med Public Health. 2022;55(6):499-505. Published online November 30, 2022; DOI: https://doi.org/10.3961/jpmph.21.266

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Abstract PDF

Despite advances in medicine and preventive strategies, fewer than 1 in 5 people with hypertension have the problem under control. This could partly be due to gaps in fully elucidating the etiology of hypertension. Genetics and conventional lifestyle risk factors, such as the lack of exercise, unhealthy diet, excess salt intake, and alcohol consumption, do not fully explain the pathogenesis of hypertension. Thus, it is necessary to revisit other suggested risk factors that have not been paid due attention. One such factor is psychosocial stress. This paper explores the evidence for the association of psychosocial stressors with hypertension and shows that robust evidence supports the role of a chronic stressful environment at work or in marriage, low socioeconomic status, lack of social support, depression, anxiety, post-traumatic stress, childhood psychological trauma, and racial discrimination in the development or progression of hypertension. Furthermore, the potential pathophysiological mechanisms that link psychosocial stress to hypertension are explained to address the ambiguity in this area and set the stage for further research.

Summary

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Original Article

Association Between Sleep Quality and Anxiety in Korean Adolescents: Hyunkyu Kim, Seung Hoon Kim, Sung-In Jang, Eun-Cheol Park; J Prev Med Public Health. 2022;55(2):173-181. Published online February 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.498

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381 Download
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Abstract Summary PDF

Objectives
Anxiety disorder is among the most prevalent mental illnesses among adolescents. Early detection and proper treatment are important for preventing sequelae such as suicide and substance use disorder. Studies have suggested that sleep duration is associated with anxiety disorder in adolescents. In the present study, we investigated the association between sleep quality and anxiety in a nationally representative sample of Korean adolescents.
Methods
This cross-sectional study was conducted using data from the 2020 Korea Youth Risk Behavior Web-based Survey. The Generalized Anxiety Disorder-7 questionnaire was used to evaluate anxiety. The chi-square test was used to investigate and compare the general characteristics of the study population, and multiple logistic regression analysis was used to analyze the relationship between sleep quality and anxiety.
Results
In both sexes, anxiety was highly prevalent in participants with poor sleep quality (adjusted odds ratio [aOR], 1.56; 95% confidence interval [CI], 1.43 to 1.71 in boys; aOR, 1.30; 95% CI, 1.19 to 1.42 in girls). Regardless of sleep duration, participants with poor sleep quality showed a high aOR for anxiety.
Conclusions
This study identified a consistent relationship between sleep quality and anxiety in Korean adolescents regardless of sleep duration.

Summary

Korean summary
청소년건강행태조사를 이용하여 청소년들의 수면의 질과 불안과의 연관성을 분석하였다. 좋지 않은 수면의 질은 불안감과 연관성이 있었으며 이 연관성은 대상자들의 수면시간과 상관없이 나타났다.

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Research Support, Non-U.S. Gov't

Relationship Between Depression Anxiety Stress Scale (DASS) and Urinary Hydroxyproline and Proline Concentrations in Hospital Workers.: Keou Won Lee, Soo Jeong Kim, Jae Beom Park, Kyung Jong Lee; J Prev Med Public Health. 2011;44(1):9-13.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.9

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Abstract PDF

OBJECTIVES
Although increased reactive oxygen species (ROS) is caused by stress accelerates collagen degradation, there was no data on the relationship between stress and urinary hydroxyproline (Hyp) and proline (Pro), a good marker of collagen degradation. The purpose of this study was to evaluate the relationship between depression, anxiety, and stress (DAS) and concentrations of urinary Hyp and Pro. METHODS: 97 hospital employees aged 20 to 58 were asked to fill out comprehensive self-administrated questionnaires containing information about their medical history, lifestyle, length of the work year, shit-work and DAS. Depression Anxiety Stress Scale (DASS) was applied to evaluate chronic mental disorders. Urine samples were analyzed using High Performance Liquid Chromatography (HPLC) with double derivatization for the assay of hydroxyproline and proline. RESULTS: The mean value of Hyp and Pro concenturation in all subjects was 194.1+/-113.4 micromol/g and 568.2+/-310.7 micromol/g. DASS values and urinary Pro concentrations were differentiated by sex (female > male, p < 0.05) and type of job (nurse > others, p < 0.05). In the stepwise multiple linear regressions, urinary Hyp and Pro concentrations were influenced by stress (Adjusted r2 = 0.051) and anxiety and job (Adjusted r2 = 0.199), respectively. CONCLUSIONS: We found that stress and anxiety were correlated with urinary Hyp and Pro concentrations. To identifying a definite correlation, further study in large populations will be needed.

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Original Articles

Health Promoting Lifestyle, Anxiety and Self-Esteem : Korean Immigrants in New York.: Hyo Jeong Song, Hee Chong Baek, Myung Ja Kim; Korean J Prev Med. 2002;35(2):116-122.

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Abstract PDF: OBJECTIVES
To examine the relationships among health promoting lifestyle, anxiety, and self-esteem for korean immigrants in New York. METHODS: The study included 425 adults aged 18 and over, who were chosen from Korean church and social organizations located in New York. The data were collected from April to July, 1996 using self-administered questionnaires. Data analyses were conducted using stepwise multiple regression, Pearson s correlation coefficients, t-test, and ANOVA. RESULTS: Health promoting lifestyle was significantly different by age, religion, occupation, and the length of residence. Those insured and those with no current medial diagnosis revealed significantly higher score in health promoting lifestyle than their counterparts. As for the level of anxiety, significant differences were found by educational level, marital status, occupation, income, and the length of residence. Self-esteem varied significantly by education, marital status, occupation, income, and the length of residence. Those with no current medical diagnosis and those insured experienced significantly higher level of self-esteem than their counterparts. Negative correlations were observed between health promoting lifestyle and anxiety. Perceived health status at present was positively correlated to perceived health status in the future. Health promoting lifestyle was significantly predicted by anxiety, age, and insurance. CONCLUSIONS: The above findings suggested that it is necessary to develop programs improving the perceived health status and lowering the level of anxiety. In this context, further researches on the relation between health promoting lifestyle and anxiety is required.; Summary

Relationship of Serum Cholesterol and Anxiety in Rural Residents.: Yp Seop Park, Kyeong Soo Park, Baeg Ju Na, Hae Sung Nam, Jun Ho Shin, Seok Joon Sohn, Jin Su Choi, Byong Woo Kim; Korean J Prev Med. 1997;30(3):489-496.

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Abstract PDF: In other to study relationship of anxiety and serum cholesterol in general population, we performed the interview survey and screening test for the Ju-am cohort and residents in controlling area at 1995. Among them, 622 people are selected for this analysis. The results were summarized as follows. 1. Anxiety and total serum cholesterol related each other in the group of anxiety. Correlation coefficient was 0.39(p<0.01). 2. According to the result of multiple regression that the total serum cholesterol regarded as the dependent variable, anxiety and total serum cholesterol were related each other positively in the group of anxiety(p<0.05). 3. As the symptoms of anxiety was dichotomized affective and somatic symptom. There was no relationship of 2 symptoms and total serum cholesterol in all subjects, but there was more relationship on the affective symptom than on the somatic symptom in the group of anxiety(p<0.05). The above results show that anxiety and total serum cholesterol related each other significantly in the anxiety group. And the relationship of psychological factors and serum cholesterol could be applied significantly in general population as well as in the special group.; Summary

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