Impacts of Smoking Ban Policies on Billiard Hall Sales in South Korea Using Objective Sales Information of a Credit Card Company: Quasi-Experimental Study.

BACKGROUND: Smoking ban policies (SBPs) are potent health interventions and offer the potential to influence antismoking behavior. The Korean government completely prohibited smoking in indoor sports facilities, including billiard halls, since the government revised the National Health Promotion Act in December 2017. OBJECTIVE: This study aimed to examine the impact of the SBP on the economic outcomes of indoor sports facilities, particularly billiard halls. METHODS: This study used credit card sales data from the largest card company in South Korea. Data are from January 2017 to December 2018. Monthly sales data were examined across 23 administrative neighborhoods in Seoul, the capital city of South Korea. We conducted the interrupted time series model using the fixed effects model and the linear regression with panel-corrected standard errors (PCSE). RESULTS: The sales and transactions of billiard halls were not significantly changed after the introduction of the SBP in the full PCSE models. The R2 of the full PCSE model was 0.967 for sales and 0.981 for transactions. CONCLUSIONS: The introduction of the SBP did not result in substantial economic gains or losses in the sales of billiard halls. In addition to existing price-based policies, the enhanced SBP in public-use facilities, such as billiard halls, can have a positive synergistic effect on reducing smoking prevalence and preventing secondhand smoke. Health policy makers can actively expand the application of SBPs and make an effort to enhance social awareness regarding the necessity and benefits of public SBPs for both smokers and the owners of hospitality facilities.

Current status and needs in the primary healthcare system in Yangon, Myanmar: a mixed-method evaluation.

BACKGROUND: Many low- and middle-income countries and international organisations have invested resources to strengthen primary health care (PHC). This study aimed to identify the challenges and unmet needs in the current PHC by assessing the experiences and perceptions of healthcare workers in three townships (Htan Ta Pin, Hmawbi, and Taikkyi) in Yangon, Myanmar. METHODS: The study was conducted among healthcare professionals and community leaders in three townships. Adopting a mixed-method approach, a cross-sectional health needs assessment survey was conducted for quantitative data (n = 66), and focus group discussions (FGDs) were conducted online for qualitative data. FINDINGS: Enhancing the management and leadership capacity had the lowest average score on the current achievement (2.81 out of 5 ratings) while strengthening infectious disease control service and accessibility was perceived as the highest mean on the priority of intervention (4.28) and the impact of the intervention (4.7). The FGDs revealed that while specific infrastructures and equipment were reported insufficient and necessary, the need for financial support has been the recurrent theme throughout the discussions. INTERPRETATION: Utilising the World Health Organisation's six building block frameworks, our findings suggest that a long-term targeted financial investment in the PHC system is critical in Myanmar through increasing healthcare expenditure per capita.

Challenges of COVID-19 prevention during protracted conflicts: differential adherence to preventive measures in "contact line" regions in eastern Ukraine.

Objectives: Despite the epidemiological importance of social vulnerabilities in compliance with preventive measures, little is known about the disproportional nature of preventive behaviors in crisis-affected populations. We examined adherence to COVID-19 preventive behaviors, focusing on social distancing measures in the conflict-affected regions in eastern Ukraine. Methods: From a multisectoral needs assessment conducted in 2020 using a household interview of a stratified simple random sample, we included 1,617 rural and urban households located in the government-controlled area. We performed multivariable binary logistic regression analysis with latent class analysis (LCA) to identify unmeasured patterns of classification of preventive measures using data from a cross-sectional survey. Results: The conflict-affected populations showed difficulty in complying with COVID-19 preventive measures due to losses of housing, partners, and access to food resources due to conflicts. Among the various preventive measures, wearing a face mask (88.1%) and washing hands more regularly (71.4%) were the most frequently reported. Compliance with social distancing was significantly lower in those who experienced the direct impacts of conflicts indicated by damaged accommodation or being widowed. Three different groups who showed distinctive patterns of employing COVID-19 preventive measures were identified via the LCA model, which were "highly complying group", "moderately complying group", and "face masks only group". The group membership was associated with a respondent's poverty status. Conclusion: The findings show the difficulty in compliance with COVID-19 preventive measures among conflict-affected populations indicating secondary impacts of the conflicts on preventive health behaviors. To mitigate the health impacts of conflicts, immediate attention is needed to address barriers to COVID-19 preventive measures among conflict-affected populations in Ukraine. This study suggests the need for public health strategies to improve preventive health behaviors in conflict-affected populations under pandemics or large-scale outbreaks.

Association Between Changes in Oral Health-Related Quality of Life and Depressive Symptoms in the Korean Elderly Population.

Objectives: The aim of this study was to examine the association between changes in oral health related quality of life (OHRQoL) and depressive symptoms in the elderly South Koreans. Methods: We used the 2018 and 2020 Korean Longitudinal Study of Ageing data. Our study population was a total of 3,604 participants aged over 65 in 2018. The independent variable of interest was the changes in the Geriatric Oral Health Assessment Index as OHRQoL between 2018 and 2020. The dependent variable was depressive symptoms in 2020. Multivariable logistic regression analyzed the associations between changes in OHRQoL and depressive symptoms. Results: Participants with improvement in OHRQoL over 2-year period were likely to have fewer depressive symptoms in 2020. Especially, changes in the oral pain and discomfort dimension score was associated with depressive symptoms. A decline in oral physical function, such as difficulty in chewing and speaking, was also associated with depressive symptoms. Conclusion: Negative change in OHRQoL is a risk factor for depression in elderly. This results suggest the importance of maintaining good oral health in later life, as a protective factor against depression.

Influence of COVID-19-Related Interventions on the Number of Inpatients with Acute Viral Respiratory Infections: Using Interrupted Time Series Analysis.

After the first COVID-19 patient was diagnosed, non-pharmaceutical interventions such as social distancing and behavior change campaigns were implemented in South Korea. The social distancing policy restricted unnecessary gatherings and activities to prevent local transmission. This study aims to evaluate the effect of social distancing, a strategy for COVID-19 prevention, on the number of acute respiratory infection inpatients. This study used the number of hospitalized patients with acute respiratory infection from the Infectious Disease Portal of the Korea Centers for Disease Control and Prevention (KCDC) between the first week of January 2018, to the last week of January 2021. Intervention 1t represents the first patient occurrence of COVID-19, Intervention 2t represents the relaxing of the social distancing policy. We used acute respiratory infection statistics from Korea and segmented regression analysis was used. The analysis showed that the trend of the number of acute respiratory infection inpatients decreased after the implementation of the first patient incidence of COVID-19 due to prevention activities. After the relaxing of the social distancing policy, the number of inpatients with acute respiratory infections significantly increased. This study verified the effect of social distancing on the reduction in hospital admissions for acute respiratory viral infections.

Thoracic spinal angiomyolipoma: case report from an Ethiopian neurosurgical teaching hospital. Illustrative case.

BACKGROUND: Angiomyolipoma (AML) of the spine is a rare benign neoplasm (accounting for 0.14%-1.2% of all spine tumors) that is often described along with angiolipoma because of their similarities. They occur almost exclusively in the extradural space, with the thoracic spine being the commonest level. OBSERVATIONS: The authors present the clinical presentation, diagnosis, and treatment of an extremely rare case of thoracic spine AML in a 47-year-old male patient. The patient underwent laminectomy and gross total resection of the tumor and had an excellent immediate postoperative neurological recovery and long-term functional neurological outcome. LESSONS: It is always wise to consider rare benign spinal epidural neoplasms such as spinal AMLs in the differential diagnosis of spinal epidural mass, despite metastasis being the commonest epidural tumor with variable modes of treatment, because the management of benign spinal epidural masses such as spine AML is always surgical and associated with an excellent long-term outcome.

Factors influencing injury or death due to traumatic events in Afghanistan's crisis-affected populations: a cross-sectional nationwide study.

OBJECTIVE: Afghanistan, with one of the world's largest refugee populations, suffers an enormous burden of injury resulting in loss of life. This study aims to identify the epidemiology of injuries or death in the crisis-affected populations across Afghanistan and to investigate factors associated with injuries or deaths due to traumatic events. DESIGN: Cross-sectional study. SETTING: This study analysed Whole Afghanistan Assessment 2019 data. This survey geographically covered all 34 accessible provinces in Afghanistan. PARTICIPANTS: 31 343 displaced and shock-affected households in Afghanistan. PRIMARY AND SECONDARY OUTCOME MEASURES: Injury or death of household members due to traumatic events. RESULTS: 2561 (8.2%) reported at least one household member had been injured or deceased because of a significant conflict or natural disaster in the past year. Households experienced significant events such as active conflict or violence (prevalence ratio, PR=5.575, p<0.001), earthquake (PR=3.118, p=0.004), flood (PR=1.534, p=0.008) and avalanche or heavy snowfall (PR=3.450, p<0.001) were significantly associated with injury or death. The likelihood of injury or death was significantly higher for long-distance households than for households living within a 5 km radius of the nearest healthcare facilities (6-10 km: PR=1.402, p=0.030; >10 km: PR=1.560, p=0.020). CONCLUSION: The study provides an epidemiological profile of injuries or death in crisis-affected populations across Afghanistan. Results also suggest that certain factors place the crisis-affected populations in Afghanistan at high risk for injuries or death, which can inform the development of surveillance and prevention programmes, the monitoring of patterns over time and the formulation of healthcare policies.

Effect of COVID-19-Related Interventions on the Incidence of Infectious Eye Diseases: Analysis of Nationwide Infectious Disease Incidence Monitoring Data.

Objective: Social distancing has been confirmed to reduce the incidence of not only the COVID-19, but also the incidence of other diseases. Therefore, this study aimed to investigate the effect of social distancing policies on the incidence of infectious eye diseases by monitoring their nationwide incidence data in all age groups. Methods: In this study, to analyse the impact of COVID-19 policy on IEDSC, the time periods were divided into two interventions. The first intervention was the first COVID-19 patient report in Korea on 19 January 2020. The second intervention was relaxation of the social distancing policy on 6 May 2020. Segmented regression analysis of the interrupted time series was used to assess COVID-19 policies on the IEDSC. Results: After the first incidence of a COVID-19 patient, IEDSCs decreased significantly in all age groups, while the relaxation of the social distancing policy increased IEDSCs significantly, mostly in all groups. Conclusion: In the post-COVID-19 era, we hope that national-level interventions such as reducing air pollution and employing precautionary measures will significantly reduce the financial burden of developing infectious ophthalmic diseases.

Factors Related to Oversleeping in Korean Young Adults, with a Focus on Sociodemographic Factors.

Young adults the year after high school experience changes in lifestyle and circumstances and tend to experience more oversleeping. However, there are few studies on oversleeping in young adults. This study aims to identify the sociodemographic factors related to oversleeping among young adults in Korea using nationally representative data. This study analyzed self-reported and cross-sectional data in 2016 from a sample of 1876 participants from the Korean Children and Youth Panel Survey, which included respondents one year after high school graduation. Oversleeping was defined as sleeping 9 or more hours a day on average. Logistic regression models were analyzed to test a multivariate association between independent sociodemographic variables and oversleeping. Over one-tenth of young adults reported oversleeping. Oversleeping was associated with household income (OR = 0.99, p = 0.011) and smoking (OR = 1.52, p = 0.041). In addition, when compared to non-working college students, college students who were working (OR = 2.58, p = 0.021), non-students who were working (OR = 1.68, p = 0.048), and non-students who were not working (OR = 3.07, p < 0.001) were more likely to report oversleeping. Oversleeping among young adults was associated with major sociodemographic factors including household income (-), smoking (+), and academic and working status (+). These findings suggest the significant role of sociodemographic factors as predictors of oversleeping and emphasize the importance of examining various factors to achieve a better understanding of oversleeping in young adults.

Association between the Human Development Index and Confirmed COVID-19 Cases by Country.

It is important to understand the ultimate control of COVID-19 in all countries around the world in relation to the characteristics of developed countries, LDCs, and the variety of transmission characteristics of COVID-19. Therefore, this study aimed to identify factors associated with confirmed cases of COVID-19 with a focus on the Human Development Index (HDI). The units of analysis used for the current study were countries, and dataset were aggregated from multiple sources. This study used COVID-19 data from Our World in Data, the Global Health Security Index, and the WORLD BANK. A total of 171 countries were included in the analysis. A multi-variable linear regression with a hierarchical framework was employed to investigate whether the HDI is associated with confirmed COVID-19 cases after controlling for the demographic and healthcare system characteristics of the study countries. For Model 2, which controlled for demographic and healthcare system characteristics, HDI (ß = 0.46, p < 0.001, 95% CI = 2.64−10.87) and the number of physicians per 1000 people (ß = 0.34, p < 0.01, 95% CI = 0.21−0.75) had significant associations with the total number of confirmed COVID-19 cases per million people. Countries with a high HDI level are able to conduct higher per capita testing, resulting in higher numbers of confirmed cases than in countries with lower HDI levels. This study has shown evidence that could be used by governments and international organizations to identify national characteristics and provide the international cooperation necessary to develop effective prevention and intervention methods to deal with the global pandemic.

Contributing Factors in Whether Displaced Households Want to Receive Humanitarian Information from Humanitarian Actors: Iraq Multi-Cluster Needs Assessment.

Due to political conflict, insurgency, and the COVID-19, the number of displaced households in need of humanitarian support in Iraq has increased. This study investigated factors related to desire of displaced households to receive humanitarian information. Data from the eighth round of the Iraq Multi-Cluster Needs Assessment was used. We classified the household displacement status, identifying levels and types of humanitarian information that the households sought, together with whether the households were impacted by COVID-19. We identified safety and security, housing, water and electricity services, education, health care, and levels of humanitarian assistance resulted in significant differences between internally displaced person (IDP) and returnee households in terms of interest in receiving humanitarian information. The desire to receive humanitarian information was related to whether household members were unemployed due to COVID-19, displacement status, and walking time to reach the nearest health care facility and marketplace. Returnees and IDPs in Iraq are facing a new crisis. Their individual, structural, and environmental vulnerabilities are increasing commensurately. New strategies such as strategies using online or mobile communication that provide humanitarian information are needed to provide humanitarian information to vulnerable groups such as those who have lost jobs due to COVID-19, female heads of households, and those with health problems. In addition to traditional cash and voucher support, the use of the latest technologies such as smartphones and mobile clinics in humanitarian settings would be new strategies.

How public and private health insurance coverage mitigates catastrophic health expenditures in Republic of Korea.

BACKGROUND: The private health insurance (PHI) market in Republic of Korea has instituted indemnity insurance plans that provide partial reimbursements for some medical services or costs that are not covered by the National Health Insurance (NHI). To date, no study has estimated the extent to which PHI coverage lowers the economic burden of households' access to health care. The current study aims to evaluate the design of Korea's PHI system in terms of coverage using a catastrophic health expenditure (CHE) indicator and compare it with NHI. METHODS: This study determined the difference between the number of households that were subscribed to PHI and those that received reimbursements from PHI. Additionally, it compared the effects of reduced CHE by NHI benefits with PHI reimbursements. Furthermore, it compared PHI reimbursements based on income class. Finally, it analyzed the contribution of NHI and PHI to CHE reduction through a two-part model with hierarchical regression. RESULTS: The results indicated that of the 5644 households examined, 3769 subscribed to PHI, but only 246 households received reimbursements. Notably, NHI reduced CHE incidence by 15.17%, whereas PHI only reduced CHE by 1.22%. The NHI scheme indicated reduced inequality as it provided more benefits to the low-income class for their used medical services, whereas PHI paid more reimbursements to the high-income class. Accordingly, NHI coverage has protected households from CHE and improved equality to some extent; however, PHI coverage has had a relatively low effect on relieving CHE and has increased inequality. CONCLUSIONS: The indemnity health insurance plans of PHI companies in Korea only cover partial medical costs or services, and so, most patients do not receive reimbursements. Thus, Korea's PHI system needs to improve to provide benefits to patients more generously and alleviate their financial burden.

Financial burden of catastrophic health expenditure on households with chronic diseases: financial ratio analysis.

BACKGROUND: The financial status of households is vulnerable to chronic diseases which entail high medical expenses and income loss. Financial strain can be assessed by four indicators: a household surplus indicator, the liquid asset/debt ratio, a solvency indicator, and a liquidity indicator. We investigated the association between catastrophic health expenditure (CHE) and financial ratio indicators in households with chronic diseases in South Korea. METHODS: This study applied thresholds to the financial ratios to determine the financial strain. We conducted multiple logistic regression analyses to determine whether CHE is associated with financial strain. Furthermore, we analyzed the relationship between CHE and basic financial indicators, absolute finance size, using multiple linear regression. RESULTS: When CHE occurred, all financial ratio indicators deteriorated. However, this was not due to decreases in the absolute size of wealth and income, but rather the relative balance between finances. In particular, the loss of liquid assets was a major factor in the deterioration. In addition, all types of labor-related income deteriorated; only private transfer income increased. CONCLUSIONS: This study revealed that CHE in households with chronic diseases negatively impacts household finances. It was found that financial coping strategies are only resource consuming.

Association between smokeless tobacco use and cigarette smoking amount by age.

BACKGROUND: The use of smokeless tobacco has increased worldwide among young people. This study aimed to investigate the association between smokeless tobacco use and cigarette smoking amount in adult smoker groups stratified by age. METHOD: 2013-2015 National Health Interview Survey was used. A total of 19,635 subjects were included in our analysis. Propensity score matching was used to adjust for selection and any other bias. Generalized estimating equation was used to analyze the association between smokeless tobacco use and cigarette smoking amount by age. RESULTS: All 580 smokeless tobacco users were matched to 2,900 non-smokeless tobacco users. Among those who were aged under 30, smokeless tobacco use was positively associated with the number of cigarettes used per day. Smokeless tobacco users who were aged under 30 and tried quitting smoking used more cigarettes than those who did non-smokeless tobacco users. CONCLUSIONS: The present study revealed that among those who were aged under 30, smokeless tobacco use was positively associated with the number of cigarettes used per day. This study could contribute to understand the behaviors and tendencies of smoking in young adulthood and to establish effective smoking cessation methods for their age.

The Impact of Weekday-to-Weekend Sleep Differences on Health Outcomes among Adolescent Students.

The sleep difference between weekdays and weekends can lead to negative physical and mental health outcomes in adolescents. Thus, this study has attempted to analyze the impact of sleep time differences on various health outcomes, using nationally representative panel data. Data from the junior high school student panel of the Korean Children and Youth Panel Survey were analyzed. The sleep difference was defined as the difference between the average sleep duration on weekdays and that on weekends in minutes. A series of mixed effect linear regression models for continuous variables or mixed effect logit regression for binary variables was utilized. Korean adolescent students reported from 96.8 min to 133.2 min of sleep duration difference between weekdays and weekends. After controlling for gender, parent work status, and type of housing, the weekday-to-weekend sleep differences were associated with various health-related outcomes including concentration difficulty, aggression, somatic symptoms, and withdrawal. Additionally, adolescent student life satisfaction was associated with sleep difference. The sleep differences among adolescent students were more associated with mental health-related outcomes and emotional symptoms than with physical health-related outcomes. The appropriate intervention to reduce the sleep difference gap is an important key to improve health in the adolescence period.

Factors affecting weekday-to-weekend sleep differences among Korean adolescent students: Focus on extracurricular tutoring time.

OBJECTIVES: Discrepancy in weekday-weekend sleep induces negative effects on physical health, obesity, psychological disorders, and academic performance; this particularly affects adolescent students through extracurricular tutoring, including evening self-study, private tutoring, and home studies. The present research aimed to clarify sociodemographic and economic factors, including extracurricular tutoring time, associated with weekday-to-weekend sleep differences using longitudinal data. STUDY DESIGN: Data from the Korean Children and Youth Panel Survey (KCYPS) data were analyzed. Weekday-to-weekend sleep differences and extracurricular tutoring, as well as other covariates, were measured using adolescent's self-report questionnaires. Multilevel regression and structural equation modeling (SEM) of repeated measures were used to test the hypothesized relationship between variables. RESULTS: The time spent in weekly extracurricular tutoring was negatively associated with weekday-to-weekend sleep differences. However, increased tutoring time was positively associated with bedtime, and bedtime was in turn positively associated with differences in Korean adolescents' weekday-to-weekend sleep patterns. The SEM analysis result showed a significant indirect effect of tutoring time on sleep differences via bedtime. CONCLUSIONS: Limiting weekly extracurricular tutoring time is important to early bedtime and reducing weekday-to-weekend sleep pattern differences. Policymakers should develop alternatives to private tutoring to improve the sleep duration and reduce weekday-to-weekend sleep differences among adolescents.

Digital and Economic Determinants of Healthcare in the Crisis-Affected Population in Afghanistan: Access to Mobile Phone and Socioeconomic Barriers.

Despite recent progress in Afghanistan's health system from the support of international donors and NGOs, protracted conflicts combined with a series of natural disasters have continued to present substantial health risks. Extreme poverty has still aggravated social determinants of health and financial barriers to healthcare. Little is known about the context-specific factors influencing access to healthcare in the crisis-affected population. Using a subset of data from 'Whole of Afghanistan Assessment (WoAA) 2019', this study analyzed 31,343 households' data, which was collected between 17 July and 19 September 2019 throughout all 34 provinces in Afghanistan. The outcome measured was access to care in the healthcare facility, and multivariable binary logistic regression models were used to identify the specific factors associated with access to healthcare. Of 31,343 households exposed to complex emergencies in Afghanistan, 10,057 (32.1%) could not access healthcare facilities when one was needed in last three months. The access to healthcare was significantly associated with displacement status, economic factors such as employment status or total monthly income, and the distance to healthcare facilities. Significant increase in healthcare access was associated with factors related to communication and access to information, such as awareness of humanitarian assistance availability and mobile phone with a SIM card, while disability in cognitive function, such as memory or concentration, was associated with poorer healthcare access. Our findings indicate that the crisis-affected population remains vulnerable in access to healthcare, despite the recent improvements in health sectors. Digital determinants, such as access to mobile phone, need to be addressed along with the healthcare barriers related to poverty and household vulnerabilities. The innovative humanitarian financing system using mobile communication and cash transfer programs would be considerable for the conflict-affected but digitally connected population in Afghanistan.

The Correlation amongst Salty Taste Preference and Overactive Bladder Symptoms in Female Individuals.

Sodium intake could have an indirect effect on storage symptoms as it is an established fact that it has a correlation to hypertension (HTN). However, clinical support for the correlation of sodium intake to STORAGE symptom remains scarce. Therefore, the present work sought to determine how sodium intake and OAB symptom seriousness were correlated in female individuals based on a cross-sectional research design. Data from 115,578 respondents chosen from 228,921 individuals enrolled in the Korean Community Health Survey (KCHS) were subjected to cross-sectional analysis. The correlation amongst sodium intake and STORAGE symptom was assessed on the basis of estimates of the incidence rate ratio (IRR) with 95% confidence interval (CI). Furthermore, joint correspondence analysis (JCA) was conducted to investigate how a predilection for salty taste was associated with several factors, including STORAGE symptom, socio-economic factors, comorbidities, and dietary habits. By comparison to respondents indicating a neutral predilection for salty taste, those who indicated a predilection for bland and salty taste were 7.1% (IRR = 1.071, p < 0.001, 95% CI = 1.045-1.097) and 20.5% (IRR = 1.205, p < 0.001, 95% CI = 1.177-1.234) more probable to experience severe STORAGE symptom, within an adjusted model with multiple variables. JCA confirmed the existence of a correlation between predilection for salty taste and STORAGE symptom. A close correlation was established to exist between predilection for salty taste and lower urinary tract symptoms (LUTS), such as voiding and storage symptoms and nocturia. Moreover, sodium intake was found to be a risk factor for LUTS seriousness in both excessive and deficient amount.

Relationships between Extra-School Tutoring Time, Somatic Symptoms, and Sleep Duration of Adolescent Students: A Panel Analysis Using Data from the Korean Children and Youth Panel Survey.

As private tutoring has expanded worldwide, it has been noted that private tutoring and associated emotional distress can affect sleep duration and the health of adolescent students. However, the relationships between extra-school tutoring time, somatic symptoms, defined as physical symptoms of emotional distress, and sleep duration in adolescents has rarely been determined. The aim of this study was to identify these relationships in adolescent students. Data from the Korean Children and Youth Panel Survey were analyzed to address the research questions. Weekday sleep duration, extra-school tutoring time, and somatic symptoms were measured using adolescents' self-report questionnaires. A multilevel, structural equation model was utilized to test the relationships between these variables and was deemed appropriate considering the repeated measure of the panel data. After controlling for respondent sex, parent working status and education level, and family structure, adolescents' extra-school tutoring time and level of somatic symptoms were associated with sleep duration during weekdays. Furthermore, the association between extra-school tutoring time and sleep duration was partially mediated by somatic symptoms. Korean adolescent students slept less than the recommended duration. Intervention programs that increase parental interest and attention in adolescent students' lives, not only focused on academic achievement but also emotional distress is needed. Researchers and policymakers should understand recommended age-appropriate sleep duration and the educational culture and provide balanced strategies between the consideration of the effect of private education on academic achievement and the need to guarantee physical and mental health in adolescent students.