Journal of Preventive Medicine and Public Health

Original Articles

Health Behaviors Before and After the Implementation of a Health Community Organization: Gangwon’s Health-Plus Community Program: Joon-Hyeong Kim, Nam-Jun Kim, Soo-Hyeong Kim, Woong-Sub Park; J Prev Med Public Health. 2023;56(6):487-494. Published online August 17, 2023; DOI: https://doi.org/10.3961/jpmph.23.121

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Abstract Summary PDF: Objectives
Community organization is a resident-led movement aimed at creating fundamental social changes in the community by resolving its problems through the organized power of its residents. This study evaluated the effectiveness of health community organization (HCO), Gangwon’s Health-Plus community program, implemented from 2013 to 2019 on residents’ health behaviors.
Methods
This study had a before-and-after design using 2011-2019 Korea Community Health Survey data. To compare the 3-year periods before and after HCO implementation, the study targeted areas where the HCO had been implemented for 4 years or longer. Therefore, a total of 4512 individuals from 11 areas with HCO start years from 2013 to 2016 were included. Complex sample multi-logistic regression analysis adjusting for demographic characteristics (sex, age, residential area, income level, education level, and HCO start year) was conducted.
Results
HCO implementation was associated with decreased current smoking (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.57 to 0.95) and subjective stress recognition (aOR, 0.79; 95% CI, 0.64 to 0.97). Additionally, the HCO was associated with increased walking exercise practice (aOR, 1.39; 95% CI, 1.13 to 1.71), and attempts to control weight (aOR, 1.36; 95% CI, 1.12 to 1.64). No significant negative changes were observed in other health behavior variables.
Conclusions
The HCO seems to have contributed to improving community health indicators. In the future, a follow-up study that analyzes only the effectiveness of the HCO through structured quasi-experimental studies will be needed.; Summary

Korean summary
건강주민운동은 지역사회 건강지표 향상에 기여한 것으로 보여진다. 따라서 주민참여형 건강증진사업이 주민들의 건강을 향상하기 위해서는 주민이 주체가 되어 조직화된 힘으로 지역사회의 근본적인 변화를 만들어가는 주민운동의 관점으로 시행될 필요가 있다.

Key Message
The Health Community Organization (HCO) appears to contribute to the enhancement of community health indicators. Therefore, in order to improve the health of residents through community-based participatory health promotion programs, it is necessary to implement them from the perspective of the HCO in which residents organize themselves as a mobilized force to bring about fundamental changes in the community.

Associations Between Conventional Healthy Behaviors and Social Distancing During the COVID-19 Pandemic: Evidence From the 2020 Community Health Survey in Korea: Rang Hee Kwon, Minsoo Jung; J Prev Med Public Health. 2022;55(6):568-577. Published online October 14, 2022; DOI: https://doi.org/10.3961/jpmph.22.351

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Objectives
Many studies have shown that social distancing, as a non-pharmaceutical intervention (NPI) that is one of the various measures against coronavirus disease 2019 (COVID-19), is an effective preventive measure to suppress the spread of infectious diseases. This study explored the relationships between traditional health-related behaviors in Korea and social distancing practices during the COVID-19 pandemic.
Methods
Data were obtained from the 2020 Community Health Survey conducted by the Korea Disease Control and Prevention Agency (n=98 149). The dependent variable was the degree of social distancing practice to cope with the COVID-19 epidemic. Independent variables included health-risk behaviors and health-promoting behaviors. The moderators were vaccination and unmet medical needs. Predictors affecting the practice of social distancing were identified through hierarchical multiple logistic regression analysis.
Results
Smokers (adjusted odds ratio [aOR], 0.924) and frequent drinkers (aOR, 0.933) were more likely not to practice social distancing. A greater degree of physical activity was associated with a higher likelihood of practicing social distancing (aOR, 1.029). People who were vaccinated against influenza were more likely to practice social distancing than those who were not (aOR, 1.150). However, people with unmet medical needs were less likely to practice social distancing than those who did not experience unmet medical needs (aOR, 0.757).
Conclusions
Social distancing practices were related to traditional health behaviors such as smoking, drinking, and physical activity. Their patterns showed a clustering effect of health inequality. Therefore, when establishing a strategy to strengthen social distancing, a strategy to protect the vulnerable should be considered concomitantly.

Summary

Korean summary
본 연구는 코로나-19 판데믹 기간 동안 한국사회에서 전통적인 건강 행태와 의료이용 행태가 사회적 거리두기 실천과 어떻게 연관되는지 탐구하였다. 연구 결과에 따르면 흡연과 음주 같은 건강위험 행태는 사회적 거리두기의 실천 가능성을 낮추었고 운동과 같은 건강증진 행태는 사회적 거리두기의 실천 가능성을 높였다. 아울러 인플루엔자 백신 접종을 받은 집단은 미접종 집단에 비하여 사회적 거리두기의 실천 가능성이 높았다. 따라서 사회적 거리두기와 같은 방역정책을 수립할 때 인구집단의 건강행태 특성을 고려할 필요가 있다.

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Concordance in the Health Behaviors of Couples by Age: A Cross-sectional Study: Seungmin Jeong, Sung-Il Cho; J Prev Med Public Health. 2018;51(1):6-14. Published online November 27, 2017; DOI: https://doi.org/10.3961/jpmph.17.137

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Abstract PDF Supplementary Material

Objectives
To investigate concordance in the health behaviors of women and their partners according to age and to investigate whether there was a stronger correlation between the health behaviors of housewives and those of their partners than between the health behaviors of non-housewives and those of their partners.
Methods
We used data obtained from women participants in the 2015 Korea Community Health Survey who were living with their partners. The outcome variables were 4 health behaviors: smoking, drinking, eating salty food, and physical activity. The main independent variables were the partners’ corresponding health behaviors. We categorized age into 4 groups (19-29, 30-49, 50-64, and ≥ 65 years) and utilized multivariate logistic regression analysis, stratifying by age group. Another logistic regression analysis was stratified by whether the participant identified as a housewife.
Results
Data from 64 971 women older than 18 years of age were analyzed. Of the 4 health behaviors, the risk of smoking (adjusted odds ratio [aOR], 4.65; 95% confidence interval [CI], 3.93 to 5.49) was highest when the participant’s partner was also a smoker. Similar results were found for an inactive lifestyle (aOR, 2.56; 95% CI, 2.45 to 2.66), eating salty food (aOR, 2.48; 95% CI, 2.36 to 2.62); and excessive drinking (aOR, 1.89; 95% CI, 1.80 to 1.98). In comparison to non-housewives, housewives had higher odds of eating salty food.
Conclusions
The health behaviors of women were positively correlated with those of their partners. The magnitude of the concordance differed by age group.

Summary

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Factors Associated With Subjective Life Expectancy: Comparison With Actuarial Life Expectancy: Jaekyoung Bae, Yeon-Yong Kim, Jin-Seok Lee; J Prev Med Public Health. 2017;50(4):240-250. Published online June 27, 2017; DOI: https://doi.org/10.3961/jpmph.17.036

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Abstract PDF

Objectives
Subjective life expectancy (SLE) has been found to show a significant association with mortality. In this study, we aimed to investigate the major factors affecting SLE. We also examined whether any differences existed between SLE and actuarial life expectancy (LE) in Korea. Methods: A cross-sectional survey of 1000 individuals in Korea aged 20-59 was conducted. Participants were asked about SLE via a self-reported questionnaire. LE from the National Health Insurance database in Korea was used to evaluate differences between SLE and actuarial LE. Age-adjusted least-squares means, correlations, and regression analyses were used to test the relationship of SLE with four categories of predictors: demographic factors, socioeconomic factors, health behaviors, and psychosocial factors. Results: Among the 1000 participants, women (mean SLE, 83.43 years; 95% confidence interval, 82.41 to 84.46 years; 48% of the total sample) had an expected LE 1.59 years longer than that of men. The socioeconomic factors of household income and housing arrangements were related to SLE. Among the health behaviors, smoking status, alcohol status, and physical activity were associated with SLE. Among the psychosocial factors, stress, self-rated health, and social connectedness were related to SLE. SLE had a positive correlation with actuarial estimates (r=0.61, p<0.001). Gender, household income, history of smoking, and distress were related to the presence of a gap between SLE and actuarial LE. Conclusions: Demographic factors, socioeconomic factors, health behaviors, and psychosocial factors showed significant associations with SLE, in the expected directions. Further studies are needed to determine the reasons for these results.

Summary

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Interaction between self-perceived disease control and self-management behaviours among Chinese middle-aged and older hypertensive patients: the role of subjective life expectancy
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The Relationship of Socioeconomic and Behavioral Risk Factors With Trends of Overweight in Korea: Jin Hee Shin, Matthew E. Dupre, Truls Østbye, Gwen Murphy, Mina Silberberg; J Prev Med Public Health. 2015;48(6):310-318. Published online November 17, 2015; DOI: https://doi.org/10.3961/jpmph.15.001

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Abstract PDF

Objectives
Previous studies have shown that overweight (including obesity) has increased significantly in Korea in recent decades. However, it remains unclear whether this change has been uniform among all Koreans and to what extent socioeconomic and behavioral factors have contributed to this increase.
Methods
Changes in overweight were estimated using data from the 1998, 2001, 2005, 2007-2009, and 2010-2012 Korea National Health and Nutrition Examination Survey (n=55 761).
Results
Overweight increased significantly among men but not among women between 1998 and 2012. Changes in socioeconomic and behavioral factors over the time period were not associated with overall trends for both men and women. However, we found significant differences in the prevalence of overweight relative to key risk factors. For men, overweight increased at a significantly greater rate among the non-exercising (predicted probability [PP] from 0.23 to 0.32] and high-calorie (PP from 0.18 to 0.37) groups compared to their active and lower-calorie counterparts, respectively. For women, overweight increased only among the non-exercising (PP from 0.27 to 0.28) and low-income (PP from 0.31 to 0.36) groups during this period.
Conclusions
These findings suggest that programs aimed at reducing overweight should target Korean men and women in specific socioeconomic and behavioral risk groups differentially.

Summary

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Recent Trends in Blood Pressure According to Economic Status: Korean National Health and Nutrition Examination Survey From 2005 to 2015
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Recent trends in the prevalence of underweight, overweight, and obesity in Korean adults: The Korean National Health and Nutrition Examination Survey from 1998 to 2014
Hyun-Young Shin, Hee-Taik Kang
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Influence of Asthma on the Longitudinal Trajectories of Cigarette Use Behaviors From Adolescence to Adulthood Using Latent Growth Curve Models: Jisuk Bae; J Prev Med Public Health. 2015;48(2):111-117. Published online March 24, 2015; DOI: https://doi.org/10.3961/jpmph.14.053

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Abstract PDF

Objectives
While epidemiologic research indicates that the prevalence of risk-taking behaviors including cigarette smoking among young people with asthma is substantial, the longitudinal patterns of cigarette smoking in this vulnerable population have received little attention. The aim of this study was to evaluate differences in the longitudinal trajectories of cigarette use behaviors from adolescence to adulthood between young people with and without asthma.
Methods
Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) during the years 1994 to 1995 (Wave I, adolescence), 2001 to 2002 (Wave III, young adulthood), and 2007 to 2008 (Wave IV, adulthood) were analyzed (n=12 244). Latent growth curve models were used to examine the longitudinal trajectories of cigarette use behaviors during the transition to adulthood according to asthma status.
Results
Regardless of asthma status, the trajectory means of cigarette use behaviors were found to increase, and then slightly decrease from adolescence to adulthood. In total participants, there were no statistically significant differences in initial levels and changes in cigarette use behaviors according to asthma status. However, in select sex and race subgroups (i.e., females and non-whites), former asthmatics showed greater escalation in cigarette use behaviors than did non-asthmatics or current asthmatics.
Conclusions
This study indicated that the changing patterns of cigarette use behaviors during the transition to adulthood among young people with asthma are comparable to or even more drastic than those among young people without asthma.

Summary

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Associations Between Socio-demographic Characteristics and Healthy Lifestyles in Korean Adults: The Result of the 2010 Community Health Survey: So Yeon Ryu, Jong Park, Seong Woo Choi, Mi Ah Han; J Prev Med Public Health. 2014;47(2):113-123. Published online March 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.2.113

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Abstract PDF

Objectives

Several previous studies have found that healthy behaviors substantially reduce non-communicable disease incidence and mortality. The present study was performed to estimate the prevalence of four modifiable healthy behaviors and a healthy lifestyle among Korean adults according to socio-demographic and regional factors.

Methods

We analyzed data from 199 400 Korean adults aged 19 years and older who participated in the 2010 Korean Community Health Survey. We defined a healthy lifestyle as a combination of four modifiable healthy behaviors: non-smoking, moderate alcohol consumption, regular walking, and a healthy weight. We calculated the prevalence rates and odds ratios of each healthy behavior and healthy lifestyle according to socio-demographic and regional characteristics.

Results

The prevalence rates were as follows: non-smoking, 75.0% (53.7% in men, 96.6% in women); moderate alcohol consumption, 88.2% (79.7% in men, 96.9% in women); regular walking, 45.0% (46.2% in men, 43.8% in women); healthy weight, 77.4% (71.3% in men, 73.6% in women); and a healthy lifestyle, 25.5% (16.4% in men, 34.6% in women). The characteristics associated with a low prevalence of healthy lifestyle were male gender, younger age (19 to 44 years of age), low educational attainment, married, living in a rural area, living in the Chungcheong, Youngnam, or Gwangwon-Jeju region, and poorer self-rated health.

Conclusions

Further research should be implemented to explore the explainable factors of disparities for socio-demographic and regional characteristics to engage in the healthy lifestyle among adults.

Summary

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Differences in Cigarette Use Behaviors by Age at the Time of Diagnosis With Diabetes From Young Adulthood to Adulthood: Results From the National Longitudinal Study of Adolescent Health: Jisuk Bae; J Prev Med Public Health. 2013;46(5):249-260. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.249

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Abstract PDF

Objectives

Previous observations propose that risk-taking behaviors such as cigarette smoking are prevailing among young people with chronic conditions including diabetes. The purpose of this study was to examine whether cigarette smoking is more prevalent among diabetics than non-diabetics and whether it differs by age at the time of diagnosis with diabetes from young adulthood (YAH) to adulthood (AH).

Methods

We used US panel data from the National Longitudinal Study of Adolescent Health (Add Health Study) during the years 2001 to 2002 (Wave III, YAH) and 2007 to 2008 (Wave IV, AH). Multivariate logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of cigarette use behaviors according to age at the time of diagnosis with diabetes, after adjusting for demographic and selected behavioral factors.

Results

Of 12 175 study participants, 2.6% reported having been diagnosed with diabetes up to AH. Early-onset diabetics (age at diagnosis <13 years) were more likely than non-diabetics to report frequent cigarette smoking (smoking on ≥20 days during the previous 30 days) in YAH (OR, 3.34; 95% CI, 1.27 to 8.79). On the other hand, late-onset diabetics (age at diagnosis ≥13 years) were more likely than non-diabetics to report heavy cigarette smoking (smoking ≥10 cigarettes per day during the previous 30 days) in AH (OR, 1.54; 95% CI, 1.03 to 2.30).

Conclusions

The current study indicated that diabetics are more likely than non-diabetics to smoke cigarettes frequently and heavily in YAH and AH. Effective smoking prevention and cessation programs uniquely focused on diabetics need to be designed and implemented.

Summary

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English Abstracts

Socioeconomic Inequity in Self-Rated Health Status and Contribution of Health Behavioral Factors in Korea.: Minkyung Kim, Woojin Chung, Seungji Lim, Soojin Yoon, Jakyoung Lee, Eunkyung Kim, Lanju Ko; J Prev Med Public Health. 2010;43(1):50-61.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.50

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Abstract PDF

OBJECTIVES
The study is investigated socioeconomic variations in self-rated health status and contribution of health behavioral factors in Korea. METHODS: A nationally representative sample (2,800 men and 3,230 women aged 20-64 years) from the 2005 Korea National Health and Nutrition Surveys was analyzed using logistic regression. RESULTS: Self-rated health was lower among lower socioeconomic groups compared with higher socioeconomic groups, with gender being irrelevant. This association was attenuated when health behavioral and socio-demographic factors were adjusted. When each health behavioral factor was considered separately, mediators such as smoking in men, and stress or exercise in women explained a large part of the decreased socioeconomic health inequalities. CONCLUSIONS: In Korea, subjective health inequalities arise from different socioeconomic status, but this difference is decreased by health behavioral factors. Therefore, socioeconomic inequity in self-rated health status can be corrected more effectively by promotional health behaviors.

Summary

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Association between the Physical Activity of Korean Adolescents and Socioeconomic Status.: In Hwan Oh, Goeun Lee, Chang Mo Oh, Kyung Sik Choi, Bong Keun Choe, Joong Myung Choi, Tai Young Yoon; J Prev Med Public Health. 2009;42(5):305-314.; DOI: https://doi.org/10.3961/jpmph.2009.42.5.305

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Abstract PDF

OBJECTIVES
The physical activity of Korean adolescents and its distribution based on social characteristics have not yet been fully assessed. This study intends to reveal the distribution of physical activity by its subgroups and offer possible explanatory variables. METHODS: The 3rd Korea Youth Risk Behavior Web-based Survey was analyzed for this study. The appropriateness of physical activity was defined by Korea's Health Plan 2010 and physical inactivity was assessed independently. Family affluence scale, parents' education levels, subjective economic status, grade, and school location were considered explanatory variables. All statistical analysis was conducted using SAS ver. 9.1. RESULTS: The proportion of participants engaging in vigorous physical activity was high in males (41.6%), at a low grade (38.5%), within the high family affluence scale group (35.5%). The distribution of participants engaging in moderate physical activity showed similar patterns, but the overall proportion was lower (9.8%). Low family affluence and students with lower subjective economic status reported a higher prevalence of physical inactivity. In multiple logistic regression analysis for physical activity, significant factors included family affluence scale (p<0.05). For physical inactivity, family affluence scale, parents education levels, and subjective economic status were included as significant factors (p<0.05). CONCLUSIONS: The results suggest that the physical activity and inactivity of adolescents may be affected by socioeconomic variables, such as family affluence scale. This implies the need to take proper measures to address these socio-economic inequalities.

Summary

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Comparative Study

The Comparison of Health Behaviors Between Widowed Women and Married Women in Jeollanamdo Province, Korea.: Seong Woo Choi, Jung Ae Rhee, Jun Ho Shin, Min Ho Shin; J Prev Med Public Health. 2008;41(4):272-278.; DOI: https://doi.org/10.3961/jpmph.2008.41.4.272

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Abstract PDF

OBJECTIVES
To compare the health behaviors of widowed women with those of currently married women. METHODS: We randomly sampled the subjects from the Jeollanamdo Resident Registration Data and we then selected 2,331 widowed women and 4,775 married women. Well-trained examiners measured the height, weight, blood pressure and abdomen circumference, and the women were interviewed with using a questionnaire. Logistic regression analysis was used to estimate the odds ratios(OR) of the two groups. RESULTS: The smoking rate (OR=2.46; 95% confidence interval [CI]1.65, 3.66) was significantly higher for the widowed women. On the contrary, the awareness rate of a smoking cessation campaign (OR=0.80; 95% CI=0.70, 0.92), a quit tobacco telephone line (OR=0.73; 95% CI=0.61, 0.88) and a quit smoking clinic (OR=0.74; 95% CI=0.62, 0.89) were lower for the widowed women. The rate of receiving a health exam (OR=0.80; 95% CI=0.70, 0.91), the rate of undergoing gastric cancer screening (OR=0.77; 95% CI=0.68, 0.88), breast cancer screening (OR=0.79; 95% CI=0.69, 0.89), cervix cancer screening in the last 2 years (OR=0.81; 95% CI=0.71, 0.92), colon cancer screening in the last 5 years (OR=0.74; 95% CI=0.63, 0.87) were significantly lower for the widowed women. CONCLUSIONS: This study revealed that the health behaviors are significantly different between the widowed women and the married women. To improve the health behaviors of the widowed women, further study and research that will investigate the socioeconomic and environmental factors that affect the health behaviors of widowed women will be needed.

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English Abstracts

Factors Influencing the Intention to have Stomach Cancer Screening.: Myung Il Hahm, Kui Son Choi, Su Yeon Kye, Min Son Kwak, Eun Cheol Park; J Prev Med Public Health. 2007;40(3):205-212.; DOI: https://doi.org/10.3961/jpmph.2007.40.3.205

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Abstract PDF

OBJECTIVES
The purpose of this study was to identify the factors influencing the intention to have stomach cancer screening using the theory of planned behavior (TPB) in Korea. METHODS: For this population-based study, 1,535 adult respondents (aged 40 to 70 years) were recruited using multi-stratified random sampling and a face-to-face administered questionnaire. This study was based on Ajzen's theory of planned behavior. Intentions were divided into three scenarios for fee payment in the next two years: (1) free of charge, (2) co-payment, and (3) full charge. Multiple linear regression was used to identify the factors influencing the intention to have stomach cancer screening. RESULTS: Perceived behavioral control and attitude toward stomach cancer screening were significant predictors of the intention to have stomach cancer screening. However, subjective norm only influenced the intention to have stomach cancer screening with full charge in the next two years. CONCLUSIONS: The results suggest that attitude and perceived behavioral control are likely to contribute toward increasing the intention to have stomach cancer screening. Especially, perceived behavioral control is a good predictor. Because the study subjects were nation wide residents, the study results can be generalized.

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The Levels of Psychosocial Stress, Job Stress and Related Factors of Medical Doctors Practicing at Local Clinics.: Moon Kuk Kang, Yune Sik Kang, Jang Rak Kim, Baek Geun Jeong, Ki Soo Park, Sin Kam, Dae Yong Hong; J Prev Med Public Health. 2007;40(2):177-184.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.177

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OBJECTIVES
This study was conducted to investigate the levels of psychosocial stress, job stress and their related factors among medical doctors practicing at local clinics. METHODS: A survey using a self administered questionnaire was administered to 1,456 doctors practicing at private clinics via post for 2 months (2006. 1 - 2006. 3). Psychosocial stress, job stress,demographic factors, job related factors and health related behaviors were investigated. Among the eligible study population, the respondents were 428 doctors (29.4%). RESULTS: The average scores of psychosocial stress and job stress were 2.19 and 3.13, respectively. The levels of psychosocial stress and job stress were statistically lower in older respondents, those who worked shorter or who were more satisfied with their job, and those with higher socioeconomic status. The level of psychosocial stress was related with smoking status, drinking status and exercise. The level of job stress was related with smoking status and exercise. In multiple linear regression analysis using psychosocial stress as a dependent variable, age, working hours per day, job satisfaction and perception on socioeconomic status were significant independent variables. In analysis using job stress as a dependent variable, age, working hours per day and job satisfaction were significant independent variables. CONCLUSIONS: Stress affects the doctor-patient relationship, productivity and overall health level of people. Therefore, it is important to manage and relieve the stress of doctors. It is suggested that more advanced studies on stress level and related factors and ways to improve the stress and health related behaviors of medical doctors should be conducted.

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Original Articles

The Relationship of Social Class and Health Behaviors with Morbidity in Korea.: Mia Son; Korean J Prev Med. 2002;35(1):57-64.

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Abstract PDF: OBJECTIVE
To explore the relationship of social class and health behaviors with self-reported morbidity. METHODS: The 1995 General Household Survey in Korea was used to investigate self-reported morbidity. Logistic regression was used to examine the relationship of social class and health behaviors with self-reported chronic disease and perceived general health. RESULTS: For chronic disease and general perceived health, age adjusted odds ratios were higher for manual workers, lower-educated group as well as those in the lower income group; this held true for both men and women. Health behaviours had little effect on the relationship between social class and morbidity. The relationship between health behaviors and morbidity was very weak. The lower social class expressed higher levels of negative health behaviors, although this relationship appeared to be very weak in Korea. CONCLUSIONS: This study suggests that an understanding of health differentials that addresses the issue of social inequalities in Korea is required.; Summary

Application of the Theory of Planned Behavior and the Theory of Reasoned Action to Predicting Cervix Cancer Screening Behavior.: Kun Sei Lee, Yong Ik Kim, Chang Yup Kim, Young Soo Shin; Korean J Prev Med. 2001;34(4):379-388.

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Abstract PDF: BACKRGROUND: Cervix cancer is the most common form of cancer among Korea women. In spite of proof that cervical cancer screening could reduce death rates substantially, the screening rates reported by previous Korean studies remain stubbornly very low. Behavioral studies to increase the cervix cancer screening rate are essential in order to develop the cancer screening program. OBJECTIVE: To evaluate the factors which are related to the intention and behavior for cervix cancer screening using the Theory of Planned Behavior (TPB) and the Theory of Reasoned Action (TRA). METHODS: The survey was conducted from July 21st to 26th in 1998. Of 3,218 women, 393(12.2%) between 30 and 65 years old, voluntarily participated in the survey in the 3 Myeons in Choongju city. Charge-free cervix cancer screening was provided for the subjects 3 months later. RESULTS: The R-square of both TPB and TRA to the intention (30% and 42%, respectively) was greater than the actual behavior (21% and 13%, respectively. TPB and TRA were found to provide an appropriate framework for the study of cervix cancer screening behavior. However, TRA was more powerful in explaining the intention, not only because the perceived behavioral control component exhibited lower reliability and validity than other components(attitude and subjective norm), but also because there may have been a few limitations in this study design. Consequently, the use of TRA is preferred in attempting to explain intention and actual behavior in this study. CONCLUSIONS: This study suggests that a successful intervention program should focus on changing attitudes and reducing psychologic barriers, rather than on just providing information. Physician recommendations, and the support of family members and friends are also very important factors in cervix cancer program participation. Physicians, friends, family members, and opinion leaders in rural areas, all of whom could affect the individual subjective norm, may all have the potential to play great roles as facilitators.; Summary

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