Psychological Stress, Smoking, and Hazardous Drinking Behaviors among South Korean Adults: Findings from the Korean National Health and Nutrition Examination Survey.

INTRODUCTION: There is growing attention to mental health as a contributor to behavioral health in South Korea. We investigated the prevalence of psychological stress and its associations with cigarette smoking and drinking behaviors among a nationally representative sample of South Korean adults. METHODS: Using data from 14,855 adults aged ≥19 years who participated in the 2013 to 2016 Korea National Health and Nutrition Examination Survey (KNHANES), we performed weighted logistic regression to examine the associations between stress and three binary outcome variables: cigarette smoking, heavy episodic drinking and frequent drinking. RESULTS: 27.2% of participants reported high stress. Controlling for sociodemographic covariates, high stress was associated with 1.54 times the odds (p<0.001) of being a smoker, 1.25 times the odds (p<0.001) of being a heavy episodic drinker, and 1.23 times the odds (p<0.001) of being a frequent drinker. There was evidence of effect modification by gender and occupation, such that the effects of stress on these behaviors were particularly stronger among women and pink-collar (service industry) workers (compared to men and white-collar workers). CONCLUSIONS: Future policies that aim to address smoking and drinking behaviors in South Korea should consider stress reduction and coping strategies, especially among women and pink-collar workers.

Cumulative Social Risk and Cardiovascular Disease Among Adults in South Korea: A Cross-Sectional Analysis of a Nationally Representative Sample.

INTRODUCTION: The Framingham risk score (FRS) is widely used to predict cardiovascular disease (CVD), but it neglects to account for social risk factors. Our study examined whether use of a cumulative social risk score in addition to the FRS improves prediction of CVD among South Korean adults. METHODS: We used nationally representative data on 19,147 adults aged 19 or older from the Korea National Health and Nutrition Examination Survey 2013-2016. We computed a cumulative social risk score (range, 0-3) based on 3 social risk factors: low household income, low level of education, and single-living status. CVD outcomes were stroke, myocardial infarction, and angina. Weighted logistic regression examined the associations between cumulative social risk, FRS, and CVD. McFadden pseudo-R2 and area under receiver operating characteristic curve (AUC) assessed model performance. We conducted mediation analyses to quantify the association between cumulative social risk score and CVD outcomes that is not mediated by the FRS. RESULTS: A unit increase in social risk was associated with 89.4% higher risk of stroke diagnosis, controlling for the FRS (P < .001). The FRS explained 8.0% of stroke diagnosis (R2) with fair discrimination (AUC = 0.728), and adding the cumulative social risk score enhanced R2 and AUC by 2.4% and 0.039. In the association between cumulative social risk and stroke, the proportion not mediated by the FRS was 65% (P < .001). We observed similar trends in myocardial infarction and angina, such that an increase in social risk was associated with increased relative risk of disease and improved disease diagnosis, and a large proportion of the association was not mediated by the FRS. CONCLUSION: Controlling for the FRS, cumulative social risks predicted stroke, myocardial infarction, and angina among adults in South Korea. Future research is needed to examine non-FRS mediators between cumulative social risk and CVD.

The Internet Addiction Test in a Young Adult U.S. Population.

Internet use has increased rapidly over the past 20 years, accompanied by a growing number of individuals whose Internet use has adverse effects on their lives. Yet no study to date has administered the Young's Internet Addiction Test (IAT) in the United States, nor has the reliability been assessed in a U.S. population. Thus, we aimed to: (a) assess the reliability of the instrument and (b) examine sociodemographic characteristics associated with the Internet addiction score. Participants included young adults 21-28 years of age, the third generation of a 50-year longitudinal cohort, the New England Family Study. The mean weighted kappa across all 20 items of the instrument was 0.45 and the median was 0.46. To examine correlates of the addiction score, we examined age, gender, race/ethnicity, education, partnership status, employment, social support, and depression diagnosis. In the fully adjusted model, those with social support had -3.96 (95% CI: -6.52 to -1.41) lower Internet addiction scores on average compared to those without social support. Also, those with a depression diagnosis had 3.28 (95% confidence interval [CI]: 1.03-5.84) higher Internet addiction scores on average compared to those without a depression diagnosis. Study findings suggest that Young's IAT had good reliability in a U.S. young adult population. Therefore, this measure can be a useful tool to measure Internet addiction in young adult populations in the United States. Future studies should examine the potential benefits of social support and depression treatment in Internet addiction among young adults in the United States.