Journal of Preventive Medicine and Public Health

Original Articles

Physical Inactivity and Non-communicable Disease Burden in Five ASEAN Countries: A 12-Year Panel Analysis Using Structural Equation Modeling and Machine Learning Projections: Moch Yunus, Mahalul Azam, Endang Sri Wahjuni, Ronal Surya Aditya, Reem Lafi AlMutairi, Supriyadi Supriyadi; J Prev Med Public Health. 2026;59(5):542-554. Published online August 29, 2026; DOI: https://doi.org/10.3961/jpmph.26.543

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Abstract Summary PDF Supplementary Material: 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 the Association of Southeast Asian Nations (ASEAN) 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 to 0.591; p<0.001). A significant attenuating interaction with the universal health coverage (UHC) index was observed (β=−0.183; 95% CI, −0.358 to −0.008; p=0.041). Because the UHC index was rescaled to 10-point units, this indicates that for every 10-point increase in the UHC index, the regression coefficient for physical inactivity decreased by 0.183 units (DALYs per 100 000 population), demonstrating a significant buffering effect of health system coverage on the inactivity–NCD association. 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

Key Message
Physical inactivity significantly drives the non-communicable disease (NCD) burden across five ASEAN countries, but universal health coverage (UHC) acts as a crucial systemic buffer that attenuates this association. Our longitudinal analysis and 2025 projections highlight that expanding UHC and strengthening health system capacity, alongside population-wide physical activity promotion, are essential strategies to mitigate future NCD burden and achieve Sustainable Development Goal 3 in the region.

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.

Association of Sedentary Lifestyle With Skeletal Muscle Strength and Mass in US Adolescents: Results From the National Health and Nutrition Examination Survey (2011-2014): Kun-Hee Oh, Jin-Young Min, Kang Seo, Kyoung-Bok Min; J Prev Med Public Health. 2025;58(3):278-288. Published online January 30, 2025; DOI: https://doi.org/10.3961/jpmph.24.614

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11 Crossref

Abstract Summary PDF Supplementary Material

Objectives
Excessive sedentary behavior in youth is a major global issue, contributing to the rise in childhood obesity and metabolic diseases. International public health authorities have issued guidelines recommending that children and adolescents limit their daily sedentary time, including screen time. However, to date, no studies have explored the relationship between sedentary behavior as an exposure factor and skeletal muscle strength and mass as outcomes in this population. The present study investigated the association of sedentary behavior with handgrip strength (HGS) and appendicular lean mass (ALM) among United States adolescents.
Methods
A total of 1449 adolescent participants from the National Health and Nutrition Examination Survey (2011-2014) were included. Information on sedentary behavior, specifically daily sedentary time, was obtained through a self-reported questionnaire. Muscular parameters, including HGS and ALM, were measured. To adjust for differences in body size, these parameters were divided by body mass index (BMI) and weight. Linear regression analyses were performed to evaluate the associations between daily sedentary time and each muscular parameter, adjusting for age, sex, ethnicity, annual family income, and moderate-to-vigorous physical activity (MVPA).
Results
The linear regression analyses revealed negative associations between daily sedentary time and all muscular parameters, apart from absolute ALM. These included HGS (β, -0.265; standard error [SE], 0.074; p=0.001), HGS/BMI (β, -0.021; SE, 0.004; p<0.001), HGS/weight (β, -0.008; SE, 0.002; p<0.001), ALM/BMI (β, -0.008; SE, 0.003; p=0.010), and ALM/weight (β, -0.003; SE, 0.001; p=0.005).
Conclusions
After adjusting for MVPA, daily sedentary time was inversely associated with HGS, HGS/BMI, HGS/weight, ALM/BMI, and ALM/weight in United States adolescents.

Summary

Korean summary
소아청소년기의 과도한 좌식 습관은 소아 비만 등의 건강문제를 초래하여 전세계적인 공중보건학적 이슈가 되었고, 이에 따라 다수의 공중보건 관련 가이드라인에서 소아청소년의 일일 좌식 시간을 제한할 것을 권고하고 있다. 미국 국민건강영양조사(NHANES) 자료를 이용하여 15-19세 청소년을 대상으로 일일 좌식 시간과 각 근육 관련 변수(악력, 상대적 악력, 사지골격근량, 상대적 사지골격근량)의 상관관계를 선형 회귀분석을 통해 분석하였으며, 나이, 성별, 인종, 연간 가구 소득, 중-고강도 신체활동을 공변량으로 보정하였다. 미국 청소년에서 중-고강도 신체활동을 보정한 뒤에도, 일일 좌식 시간과 악력, 악력/BMI, 악력/체중, 사지골격근량/BMI, 사지골격근량/체중은 각각 음의 상관관계를 나타내었다.

Key Message
Since excessive sedentary behavior in youth is a global issue, contributing to the childhood obesity, international public health authorities issued guidelines recommending that adolescents limit their daily sedentary time. For eligible study population of U.S. adolescents aged 15-19 year-old of NHANES, linear regression analyses were performed to evaluate the associations between daily sedentary time and each muscular parameter (HGS, relative HGS, ALM, and relative ALM), adjusting for age, sex, ethnicity, annual family income, and moderate-to-vigorous physical activity (MVPA). After adjusting for MVPA, daily sedentary time was inversely associated with HGS, HGS/BMI, HGS/weight, ALM/BMI, and ALM/weight in U.S. adolescents.

Citations

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Associations of Sex and Household Area With Physical Activity and Sedentary Behavior During Total and Partial COVID-19 Lockdowns in Chile: A Study in Adults Aged 18-44 Years: Jairo Vanegas-López, Rodrigo Guzmán-Venegas, Gabriel Marzuca-Nassr, Claudio Muñoz-Poblete, Gonzalo Quiroz-Sandoval, Juan Silva-Urra, Andres Orellana-Uribe, Sebastián Dubó, Ignacio Sepúlveda, José Luis Márquez; J Prev Med Public Health. 2025;58(2):177-187. Published online December 5, 2024; DOI: https://doi.org/10.3961/jpmph.24.461

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Abstract Summary PDF

Objectives
The coronavirus disease 2019 pandemic led to various intensities of lockdowns, affecting lifestyles globally. This study investigates the impact of partial lockdown versus total lockdown on adult physical activity (PA) and sedentary behavior.
Methods
A cross-sectional online survey was conducted from April 2020 to October 2020, with 493 participants included in the analysis.
Results
The analysis revealed no significant differences in total PA or total sitting time between partial lockdown and total lockdown scenarios. However, moderate physical activity (MPA) significantly decreased during total lockdowns, with more pronounced reductions among females than males. Notably, a positive correlation was found between household area and MPA, suggesting that larger living spaces may encourage more PA. A negative correlation was observed between sitting time and MPA during both types of lockdown.
Conclusions
Total lockdown conditions were associated with a significant decrease in MPA, highlighting sex disparities in PA responses. Living space size emerged as a crucial factor in maintaining PA levels during restricted conditions. This study emphasizes the need to consider environmental and demographic factors in public health strategies during prolonged periods of restricted movement.

Summary

Key Message
This study assessed the impact of partial and total COVID-19 lockdowns on physical activity and sedentary behavior in Chilean adults aged 18–44 years. Although total physical activity and sitting time did not significantly differ between lockdown types, moderate physical activity was significantly lower during total lockdowns, particularly among females. A positive association between household area and moderate activity suggests that public health strategies should consider gender and living conditions to mitigate the negative effects of prolonged restricted movement.

Citations

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Behavioral configurations of movement, screen exposure, and diet in school-aged children: a cross-sectional study
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The Influence of Family Adversities on Longitudinal Changes in Physical Inactivity Among Korean Adolescents During the COVID-19 Pandemic: Tae Kyoung Lee, Jing Zhu, Young Mi Kim, Ze-Kai Jiang, Meilin Zhang, Won Ha Choi, Tae-Young Pak, Hana Song; J Prev Med Public Health. 2024;57(5):443-450. Published online August 4, 2024; DOI: https://doi.org/10.3961/jpmph.24.236

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Abstract Summary PDF Supplementary Material: Objectives
Lack of physical activity has a critical effect on the physical and mental health of adolescents. This study examined the influence of family adversities on the longitudinal changes in physical inactivity among adolescents during the coronavirus disease 2019 (COVID-19) pandemic.
Methods
The study used multi-wave data from the Korean Children and Youth Panel Survey, including 2590 Korean adolescents aged 12-14 years. The longitudinal trajectory of physical inactivity among adolescents and the effects of related factors were estimated using a latent growth modeling method.
Results
Our results revealed a significant increase in physical inactivity among adolescents over time. At the onset of the pandemic, approximately one-seventh of Korean middle schoolers reported a lack of physical activity. However, 3 years later, during the quarantine, nearly one-fifth of these adolescents reported a significant increase in their physical inactivity. Initially, low level parental education was predictive of adolescents’ physical inactivity, but this effect diminished over time, becoming statistically insignificant by the end of the 3-year period. Moreover, the increase in physical inactivity over the 3 years was significantly influenced by parental rejection.
Conclusions
These findings suggest that adolescents who experience parental rejection are more likely to report an increase in sedentary behaviors in contexts such as the COVID-19 pandemic.; Summary

Korean summary
본 연구는 팬데믹 기간 동안 청소년의 신체 활동 변화와 신체 활동 부족에 대한 부정적 가정 환경의 영향을 조사했다. 한국 청소년 2,590명을 대상으로 한 3년간의 종단 패널 데이터를 잠재 성장 모형으로 분석하여 신체 활동 부족의 변화를 추적하였다. 그 결과, 팬데믹 기간 동안 청소년들의 신체 활동 부족이 현저히 증가했으며, 부모의 거부가 이러한 증가에 유의한 영향을 미친 것으로 나타났다.

Key Message
This study examined the impact of family adversities on the longitudinal changes in physical inactivity among 2,590 Korean adolescents during the COVID-19 pandemic. Over the 3-year period, physical inactivity increased significantly, with parental rejection playing a key role in this rise. While low parental education initially predicted higher levels of inactivity, its influence diminished over time.

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