Impact of digital interventions and online health communities in patient activation: Systematic review and meta-analysis.

OBJECTIVE: Study the efficacy of digital health interventions in enhancing patient activation and identify the distinct features of these interventions using the WHO classification system. METHODS: Asystematic reviewand meta-analysis were carried out according to the PRISMA guidelines. A search was conducted in Scopus, PubMed, and ProQuest. Randomized controlled trials (RCT), quasi-randomized controlled trials, and before-and-after studies enrolling patients ≥ 18 years of age with the Patient Activation Measure (PAM) score measurement and contain digital intervention with any aspects of health education or health-related behavior were included. The Downs and Black quality assessment tool was used to assess the quality of the articles. RESULTS: In the three different types of meta-analyses, implementing the intervention led to a PAM score increase (Mean Difference (M.D.)), ranging from a minimum of (MD = 0.2014, 95 % CI = 0.0871-0.3158) and a highly significant p-value 0.0006 to a maximum of (MD = 2.7882, 95 % CI = 1.5558-4.0206) and a p-value < .0001. While the M.D. score of 0.2014 may seem relatively low, it is enough to elevate the patient from one activation level to a higher one out of the four activation levels. CONCLUSION AND PRACTICE IMPLICATIONS: The results suggest the effectiveness of digital health interventions on patient activation across diverse settings and contexts, implying potential generalizability. Using WHO classification, all examined digital interventions addressed the challenges of information, utilization, and efficiency in the health system, but not equity-related challenges. The study recognized online health communities (OHCs) as a subset of digital interventions that enhance patient activation through social support.

COVID-19 vaccine intercountry distribution inequality and its underlying factors: a combined concentration index analysis and multiple linear regression analysis.

Introduction: Inequitable access to COVID-19 vaccines among countries is a pressing global health issue. Factors such as economic power, political power, political stability, and health system strength contribute to disparities in vaccine distribution. This study aims to assess the inequality in vaccine distribution among countries based on these factors and identify their relationship with COVID-19 vaccine distribution. Methods: A Concentration Index (CI) analysis was conducted to evaluate inequalities in the distribution of COVID-19 vaccines among countries based on four separate variables: GDP per capita, political stability (PS), World Power Index (WPI), and Universal Health Coverage (UHC). Additionally, Multiple Linear Regression (MLR) analysis was employed to explore the relationship between vaccine distribution and these independent variables. Two vaccine distribution variables were utilized for result reliability. Results: The analysis revealed significant inequalities in COVID-19 vaccine distribution according to the countries' GDP/capita, PS, WPI, and UHC. However, the multiple linear regression analysis showed that there is no significant relationship between COVID-19 vaccine distribution and the countries' GDP/capita and that UHC is the most influential factor impacting COVID-19 vaccine distribution and accessibility. Discussion: The findings underscore the complex interplay between economic, political, and health system factors in shaping vaccine distribution patterns. To improve the accessibility to vaccines in future pandemics, Global Health Governance (GHG) and countries should consider working on three areas; enhance political stabilities in countries, separate the political power from decision-making at the global level and most importantly support countries to achieve UHC.

Changing roles in global health governance following COVID-19.

Background: The Global Health Governance (GHG) response to the COVID-19 pandemic has been criticized, particularly regarding vaccine management, and changes in the roles of GHG actors have been recommended. Aim: To investigate the perception of experts regarding changes in the roles of different GHG actors following the COVID-19 pandemic. Methods: This study used a 3-round Delphi survey to collect data from 30 global health experts between May and December 2022. The GHG roles investigated were stewardship, production of guidelines and policies, promotion of solidarity and collaboration, and management of global health challenges. Social network analysis was performed and collected data was converted into a 1-mode network. Degree centrality and Eigenvector centrality were calculated using the UCINET 6.757 modelling programme. Results: There were variations between the current and future roles in degree centrality and eigenvector centrality for the 19 GHG actors in each of the 4 functions investigated. For stewardship, WHO, governments and the World Bank had the highest degree centrality and eigenvector centrality during both the current and future periods. In terms of production of guidelines and policies, WHO maintained the highest current and future eigenvector centralities, while research agencies, UNICEF and Gavi upheld their current eigenvector centrality measure. For the promotion of solidarity and collaboration, WHO had the highest centrality measures, followed by UNICEF, governments and Gavi. Regarding the function "management of global health challenges", WHO lost its position to UNICEF as the most central, while UNDP, FHI 360 and research agencies were predicted to have a more central role in the future. Conclusion: The findings position WHO as the current and future top actor in stewardship, production of guidelines and policies, and promoting solidarity and collaboration, and UNICEF as the upcoming most central actor in managing global health challenges. Governments were major actors in all GHG functions except for managing global health challenges. Funding actors were central in all GHG functions, indicating finance as an important factor in obtaining a central role in GHG. Research organizations received a high centrality rating, indicating their importance in GHG.

Cross-cultural adaptation and validation of a self-reporting tool to assess health-related quality of life for Egyptians with extremity bone sarcomas in childhood or adolescence.

BACKGROUND: Validated self-reporting tools are required to evaluate the functional outcome and health-related quality of life (HRQOL) for those who had extremity bone sarcomas in their childhood or adolescence. Our study pursued cross-cultural adaptation and validation of the pediatric Toronto Extremity Salvage Score (pTESS) and Toronto Extremity Salvage Score (TESS) to assess the functional outcome for Egyptian children and adult survivors following surgeries of extremity bone sarcomas. In the modified versions of pTESS and TESS, mental domains were added to allow the evaluation of HRQOL using a specific instrument for childhood bone cancer. METHODS: The internal consistency and test-retest reliability of the studied forms were assessed with Cronbach's alpha and Intra-class coefficients (ICC), respectively. For convergent validity, correlations between scores of the generic Pediatric Quality of Life Inventory (PedsQL 4.0) and pTESS /TESS scores were reported. Factor Analysis was feasible for pTESS-leg; due to the insufficient samples, only the average inter-item correlation coefficients were reported for the remaining versions. RESULTS: Out of 233 participants, 134 responded to pTESS-leg, 53 to TESS-leg, 36 to pTESS-arm, and only 10 to TESS-arm. All versions showed excellent internal consistency (Cronbach's alpha >0.9), good test-retest reliability (ICC >0.8), moderate to strong correlations with PedsQL, and acceptable average inter-item correlation coefficients (≥0.3). Three factors were extracted for the pTESS-leg, in which all mental items were loaded on one separate factor with factor loadings exceeding 0.4. Active chemotherapy, less than one year from primary surgery, or tibial tumors were associated with significantly inferior pTESS/TESS scores in the lower extremity group. CONCLUSION: The Egyptian pTESS and TESS are valid and reliable self-reporting tools for assessing the functional outcome following surgeries for extremity bone sarcomas. The modified pTESS and TESS versions, which include additional mental domains, enabled the assessment of the overall health status of our population. Future studies should include a larger sample size and evaluate the ability of pTESS/TESS to track progress over time.

Global health governance performance during Covid-19, what needs to be changed? a delphi survey study.

BACKGROUND: Covid-19 is not the first pandemic to challenge GHG. Preceding outbreaks and epidemics were sources of continuous debate on GHG leadership and structure resulting in its current structure. However, Covid-19 proved the presence of many deficits in the current GHG. The response to the Covid-19 pandemic is a cumulative result of all policies and actions of different governments and agencies active in global health. Assessing how Covid-19 is being handled globally provides lessons for ensuring better performance in facing upcoming outbreaks. This study has three main objectives: first, to evaluate the performance of GHG during Covid-19 in general and in relation to Covid-19 vaccine equity in particular. Second, to identify the reasons behind this performance; and third, to propose prospective changes in GHG for better performance. METHODS: A cross-sectional research design using the Delphi method was applied. A panel of experts participated in the three-round Delphi surveys. Their scores were used to perform consensus, performance and correlation analysis. RESULTS: GHG performance limited the achievement of Covid-19 vaccines' global equity. GHG performance is a product of the existing GHG system, its actors and legal framework. It is a collective result of individual GHG actors' performance. The most influential actors in decision-making regarding Covid-19 vaccine are the vaccine manufacturers and governments. While the most invoked power to influence decision are economic and political powers. Covid-19 decisions underlying value, although had human right to health at the base, overlooked the concept of health as a global public good and was skewed towards market-oriented values. GHG mal-performance along with its underlying factors calls for four main changes in GHG structure: assigning a clear steward for GHG, enhanced accountability, centralized authority, more equitable representation of actors, and better legal framework. CONCLUSION: GHG structure, actors' representation, accountability system, and underlying priorities and value require future modification for GHG to achieve better future performance and higher health equity levels.

COVID-19 vaccine hesitancy among parents in Low- and Middle-Income Countries: A meta-analysis.

Background: Vaccination is the most effective method to prevent the spread of infectious diseases. Nevertheless, vaccine hesitancy has been an issue. Parental hesitancy toward vaccines is a major part of the problem. COVID-19 vaccine acceptance is no different, it poses another challenge in facing the pandemic. In Low- and Middle-Income Countries (L&MICs) several studies measured parents' acceptance to vaccinate their children against COVID-19 and resulted in different acceptance proportions. Aims: The paper aims at obtaining a precise estimate of the overall proportion of L&MICs' parents accepting to vaccinate their children against COVID-19 and identifying the main determinant of their decisions. Methods: This meta-analysis follows the PRISMA 2020 statement on updated guidelines and the checklist for reporting systematic reviews. Studies published between December till February 2022 were assessed for inclusion. The final effect size (i.e., the proportion of parents in L&MICs accepting to vaccinate their children against COVID-19) was measured using the Arcsine proportions method. Analysis was done using R program. Results: The proportion of parents in L&MICs accepting to vaccinate their children against COVID-19 is 49%. The major reason for their acceptance is their belief that COVID-19 vaccine is fundamental to the fight against the pandemic while the most common factor for parents' hesitancy to vaccinate their children against COVID-19 is their concerns about vaccine efficacy, safety, and possible side effects. Conclusion: The proportion of parents in L&MICs accepting to vaccinate their children against COVID-19 is lower than the global level. To increase parental acceptance, responsible authorities should concentrate on increasing their population's trust in the government and in vaccine manufacturers. As well as concentrating on increasing acceptance of the vaccine idea in general.

Global Health Governance and Health Equity in the Context of COVID-19: A Scoping Review.

BACKGROUND: Health equity is an important aspect of responsible governance. COVID-19 exposed existing shortfalls of Global Health Governance (GHG). A considerable amount of related literature is produced. This scoping review aims at mapping the present knowledge and at identifying research gaps. METHODS: This scoping review is based on the Joanna Briggs Institute's guideline for standardized methods and PRISMA-ScR guidelines for reporting. Documents published from December 2019 to October 2021 were searched using PubMed, Scopus, Google Scholar, World cat, and WHO-Global Index Medicus. Two reviewers screened and reviewed eligible studies in three stages: duplicates identification and elimination, title and abstract screening, and full-text assessment. Data was charted and results were classified into conceptual categories. Analysis was done in three stages: open descriptive coding, focused thematic analysis, and frequency, commonality and significance analysis. RESULTS: forty-nine studies met the inclusion criteria. Areas of research were grouped into seven themes: "human rights and inequities", "solidarity, collaboration and partnership", "GHG structure change", "political and economic power and finance", "approaches to address inequity", "law and regulations", and "private investment and public-private partnerships (PPPs) in GHG". The highest number of papers were in the first theme, "human rights and inequities". However, the themes are interrelated. Authors who contributed to research were mostly affiliated to developed countries indicating a gap in knowledge and expertise in developing countries. CONCLUSION: Through this scoping review we found that the seven themes are interconnected. Disciplinary collaboration in research relating GHG to health inequities is solicited. Collaboration in research, information sharing, and research capacity development are in needed in developing countries.

Effects of COVID-19 Lockdown on Physical Activity and Dietary Behaviors in Kuwait: A Cross-Sectional Study.

The Coronavirus disease (COVID-19) pandemic has brought about drastic measures that have significantly altered the norms of daily living. These measures have affected human behaviors in disparate ways. This study seeks to understand the impact of the pandemic on physical activity and dietary behavior among adults living in Kuwait. A cross-sectional survey was conducted between 18 June and 15 July 2020, using a questionnaire disseminated through social media, including WhatsApp and Facebook. The target population was individuals aged 21 years or older living in the State of Kuwait. The study included 679 respondents; 57.9% were females, and 67.7% were Kuwaiti nationals. Both genders reported an increased consumption of vegetables, fruits, and carbohydrates, and a decreased consumption of fish and sugary drinks. Compared to males, females reported eating more during the outbreak than their pre-pandemic eating behaviors (32.3% vs. 35.9%, p < 0.05). Approximately one-third of respondents (33.1%) reported performing less than 30 min of physical activity or exercise in a week, and 36.4% of respondents rated their quality of sleep as 'poor' or 'very poor'. The rate of smoking cigarettes among males was significantly higher than in females (40.6% vs. 5.3%, p < 0.001). Physical activity was positively correlated with vegetable consumption and quality of sleep. Quality of sleep was negatively correlated with the consumption of sweets and snacks, just as the consumption of vegetables was negatively correlated with the consumption of sugary drinks. The overall negative impact of the COVID-19 pandemic in Kuwait necessitates the development of health promotion interventions to support positive physical activity and dietary behaviors using alternative coping strategies among the residents of Kuwait.

Enhancing Research and Development in the Health Sciences as a Strategy to Establish a Knowledge-Based Economy in the State of Kuwait: A Call for Action.

Kuwait Vision 2035 is an initiative that was launched in 2017 by His Highness the Emir of the State of Kuwait Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah. This initiative includes the implementation of a detailed development plan aimed at transforming the state of Kuwait into a regional leader in science, technology, and innovation. Health research will arguably prove to be one of the most impactful research arenas when it comes to accomplishing the goals set forth by the Kuwait Vision 2035 Development Plan. The high impact of health research is derived from its capacity to aid in the establishment of a knowledge-based health industry. The state of Kuwait lacks a system for promoting and managing national R&D efforts. At present, the research and development (R&D) expenditure in the state of Kuwait is far below the international standards that have been shown to lead to innovation and the subsequent development of a knowledge-based economy. Improvement of the weak and unstructured existing R&D apparatus in the State of Kuwait is among the most urgent challenges facing the nation as it strives toward innovation and development of a knowledge-based economy. Developing health research capacities in the State of Kuwait can significantly contribute toward improving public health, health promotion, disease prevention and treatment, and overall human welfare. Importantly, the positive impacts of such extensive benefits will not be restricted to the state of Kuwait and its citizens, but may in fact reap benefits for the global society as a whole. This article first analyzes the current status of healthcare services and health science research in the State of Kuwait, and then summarizes some essential R&D design principles that Kuwait needs to implement in order to achieve the milestones set forth in the Kuwait Vision 2035 Development Plan.

Health Promotion Programs to Reduce Noncommunicable Diseases: A Call for Action in Kuwait.

Most public health issues in Kuwait are related to unhealthy behaviours. Research shows that behaviours are the result not only exclusively of personal choices but also of myriads of other social and environmental factors. Kuwait is one of the leading countries in obesity and tobacco use in the world. Cardiovascular diseases stemming from complications related to these and other risk factors are important health issues based on their morbidity and mortality implications. These risks are spread across society and affect the old as well as young boys. The serious gaps between Kuwait's health-related needs and the existing policies to reduce public health risks in Kuwait create a significant obstacle to healthy behaviour change. Kuwait requires adequate laws, policies, regulations, activities, and programs to promote people's health. The Socio-Ecological Model (SEM) has been used successfully in health promotion in various behavioural settings, including obesity, physical inactivity, and smoking. We propose the use of SEM as a planning framework in building sustainable health promotion programs in Kuwait while paying attention to other concepts such as systems thinking, authentic community participation, community capacity, policy development, public health infrastructure enhancement, health coaching, and equity.

The Associations between Mental Well-Being and Adherence to Physical Activity Guidelines in Patients with Cardiovascular Disease: Results from the Scottish Health Survey.

The association between physical activity (PA) and mental well-being in individuals with a cardiovascular disease (CVD) is poorly studied. The objective of this study was to assess the association between mental well-being and adherence to the recommended guidelines for PA in a Scottish adult population with CVD. The study used data from 3128 adults who had CVD conditions (1547 men and 1581 women; mean age 63.29 years) who participated in the Scottish Health Survey between 2014 and 2017. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was used as a surrogate measure of mental health. PA was classified as "met" or "unmet" on the basis of the recommended PA guidelines (150 min of moderate activity or 75 min of vigorous activity per week). The relationship between PA guidelines being met and the WEMWBS score was explored using hierarchical linear regression accounting for a set of health and sociodemographic characteristics. Of the participants, ~41.8% met the recommended PA levels. Among those with CVD, the mean (SD) WEMWBS scores of individuals who did not have a long-standing illness (51.14 ± 7.65 vs 47.07 ± 9.54; p < 0.05), diabetes (48.44 ± 9.05 vs 46.04 ± 10.25; p < 0.05), or high blood pressure (48.63 ± 9.08 vs 47.52 ± 9.47; p < 0.05) were significantly higher than those of individuals with such conditions. Meeting PA recommendations was significantly associated with a higher mean WEMWBS score (50.64 ± 7.97 vs 46.06 ± 9.75; p < 0.05). Multiple regression analysis of health-related behaviors improved the prediction of mental well-being over and above meeting the recommended PA levels. Mental well-being was strongly correlated with PA adherence in CVD patients. It seems that for patients with CVD, PA should be tailored to meet patients' health conditions in order to promote mental well-being and improve overall health.

Prevalence and Perception of Obesity Among Sub-Saharan Africans in Korea.

There is a dearth of obesity study among sub-Saharan African immigrants in Seoul, Korea. We investigated the prevalence and perception of obesity among this population. A cross-sectional study involving 211 immigrants aged 20 years and above from sub-Saharan Africa was carried out, using a structured questionnaire. Obesity (BMI ≥ 30.0 kg/m²) was calculated as the primary outcome variable. The overall prevalence of obesity was 27.0% (men 22.6% and women 36.8%). In a logistic regression analysis adjusting for age, obesity was significantly associated with increased duration of residence. Participants were 4.03 (95% CI 1.63-9.94) more likely to disagree than agree that obesity is a sign of wealth and that it gives respect. There is an urgent need to assess the possible factors predisposing sub-Saharan Africans to obesity and interventions should be designed targeting their lifestyle modification for healthy weight.

The International Alcohol Control Study: Methodology and implementation.

INTRODUCTION AND AIMS: The International Alcohol Control (IAC) Study is a multi-country collaborative project to assess patterns of alcohol consumption and the impact of alcohol control policy. The aim of this paper is to report the methods and implementation of the IAC. DESIGN AND METHODS: The IAC has been implemented among drinkers 16-65 years in high- and middle-income countries: Australia, England, Scotland, New Zealand, St Kitts and Nevis, Thailand, South Africa, Peru, Mongolia and Vietnam (the latter four samples were sub-national). Two research instruments were used: the IAC survey of drinkers and the Alcohol Environmental Protocol (a protocol for policy analysis). The survey was administered via computer-assisted interview and the Alcohol Environmental Protocol data were collected via document review, administrative or commercial data and key informant interviews. RESULTS: The IAC instruments were readily adapted for cross-country use. The IAC methodology has provided cross-country survey data on key measures of alcohol consumption (quantity, frequency and volume), aspects of policy relevant behaviour and policy implementation: availability, price, purchasing, marketing and drink driving. The median response rate for all countries was 60% (range 16% to 99%). Where data on alcohol available for consumption were available the validity of survey consumption measures were assessed by calculating survey coverage found to be 86% or above. Differential response bias was handled, to the extent it could be, using post-stratification weights. DISCUSSION AND CONCLUSIONS: The IAC study will allow for cross-country analysis of drinking patterns, the relationship between alcohol use and policy relevant behaviour in different countries.

Relationship between Alcohol Purchasing Time and Alcohol Use Disorder in South Korea.

OBJECTIVES: Currently, time of alcohol purchase is not part of the policies to regulate alcohol consumption in South Korea. This study was conducted to determine the relationship between alcohol purchasing time and alcohol use disorder. METHODS: The survey for this study was conducted in geographically diverse regions of South Korea in 2012. Respondents' purchasing behaviors for both on-licensed (i.e., allows for consumption within the premises) and off-licensed (i.e., where alcohol is consumed off the premises) outlets and time of alcohol consumption were collected. Alcohol consumption patterns were examined using the Rapid Alcohol Problem Screen 4 (RAPS4). Data were also analyzed by age, gender and purchasing time. RESULTS: Results showed that among the off-licensed premises, supermarkets appear to be the most popular venue while for on-licensed premises; alcohol was generally consumed inside hotels/pubs regardless of age and gender of the purchaser. Purchasing of alcohol was highest during the day and early evening period (9:00 a.m. to 9:59 p.m.). Females are most likely to abuse alcohol than males during the early morning period and is that period after 12:00 midnight. CONCLUSION: Analysis suggests that the survey instrument used in the International Alcohol Control Study is being used to collect data on alcohol purchasing time consumption; therefore, the potential is there to provide accurate results to contribute appropriate policy responses to reduce alcohol related-harm.

Association between alcohol consumption and Korean young women's bone health: a cross sectional study from the 2008 to 2011 Korea National Health and Nutrition Examination Survey.

OBJECTIVES: To assess the association between alcohol consumption and healthy Korean young women bone by Alcohol Use Disorders Identification Test (AUDIT) scores and drinking consumption; frequency and amount. DESIGN: Cross-sectional study composed of three parts: health interview, health examination, nutrition survey. SETTING: 2008-2011 Korea National Health and Nutrition Examination Survey. PARTICIPANTS: Of the 21,303 participants whose bone mineral density (BMD) was assessed, 1176 healthy women aged 19-30 years were selected. PRIMARY AND SECONDARY OUTCOME MEASURES: Mean BMD T-scores of the total femur (TF), femur neck (FN) and lumbar spine (LB) by drinking consumption and AUDIT scores, and the odds of having a low BMD (T-score <-1) at the sites by AUDIT scores. RESULTS: After adjustment, lower BMD was found at three sites in those who drank more and had higher AUDIT scores. These associations were significant by AUDIT scores at TF (p=0.002) and FN (p=0.004) and by drinking frequency and amount at FN (p=0.029 and 0.039, respectively). The adjusted OR of having low BMD increased significantly, particularly at FN, in those who had higher AUDIT scores such as 16-17 harmful drinking (OR 4.31; 95% CI 1.16 to 16.06) and 20-40 alcohol dependence (OR 5.99; 95% CI 1.69 to 21.21), compared with young women who scored 0-7 low-risk drinking or abstinence. No beneficial effect of moderate drinking was observed at any of the sites and the association between alcohol consumption and bone health was most evident at FN. CONCLUSIONS: It is crucial to promote the awareness of alcohol harm on Korean young women's bone health. At the same time, since alcohol's effect on the bone is complex with cumulative effects of various factors over the years and there is an absence of studies with young women in their twenties, more studies, in particular for FN, are needed with more precise and appropriate design to confirm our findings.

Comparative study of the impact of intoxication on injuries in china and Korea.

OBJECTIVES: Alcohol misuse has been widely studied as a substantial contributor to injured patients' visits to emergency departments. The current research studied differences in alcohol-related injury variables in China and Korea. METHODS: Data were collected from a sample of 4,509 patients (2,862 males and 1,667 females) reporting at emergency departments in China and Korea using the World Health Organization collaborative study on alcohol and injuries protocol. RESULTS: More injuries were reported by men, young people aged 25-34 years, employed individuals, and persons who had at least a high-school education. The proportion of injury cases among intoxicated patients was 14% for Chinese and 20% for Koreans. The odds of intentional injuries to intoxicated patients increased significantly when the perpetrator had been drinking, especially for severely intoxicated victims in both countries. The odds of injuries for intoxicated persons in both countries were high during sports and leisure activities; odds ratio (OR) = 3.93, 95% confidence interval (CI) = 2.76-5.59 for Chinese and OR = 10.97, 95% CI = 6.06-19.85 for Koreans. CONCLUSION: These findings are a contribution to research in the two Asian countries about the effect of intoxication on injuries especially when both victim and perpetrator are intoxicated.

Korean public opinion on alcohol control policy: a cross-sectional International Alcohol Control study.

OBJECTIVE: To examine Korean public opinions toward alcohol control measures on availability, advertisement, drink-driving and pricing policy, and how the views on alcohol control policy vary by demographics, drinking patterns and attitude to drinking environments. METHODS: The study used national-based, cross-sectional data collected in 2012 as part of the International Alcohol Control study. 2510 people (M: 1163, F: 1261) aged 15-65 and living in geographically diverse regions of Korea completed the questionnaire asking the support of 12 alcohol control measures. RESULTS: Generally, targeted measures (purchase age of 20 and drink-driving) were more popular than universal (availability, advertisement and price) among Koreans. Gender, age, marital status, drinking patterns and attitude to drinking environments related to alcohol use of young and heavy drinkers were strong predictors of the opinions on most of the alcohol control measures. It was daily/weekly drinkers who opposed most restrictions on alcohol availability and price and the support from individuals who are more aware of problems with drinking in public place was outstanding in every control measure. CONCLUSION: These findings should be taken into account by Korean policy-makers as they formulate an alcohol policy for the country.

A study of high-risk drinking patterns among generations based on the 2009 Korea national health and nutrition examination survey.

OBJECTIVES: The aim of this study was to identify how the drinking patterns of a generation on the paternal side affect those of the next generations by estimating the number of high-risk drinkers by generation according to the Alcohol Use Disorder Identification Test. METHODS: Data were selected from the 2009 Korea National Health and Nutrition Examination Survey conducted by the Korea Centers for Disease Control and Prevention and were analyzed using SPSS 18.0. RESULTS: Later generations started drinking earlier (62.4%, 71.8% and 91.1%, respectively). The majority of the second generation consumed more than 2-4 drinks a month (83.7%), but only a small proportion experienced difficulty in everyday life (9.6%), felt repentance (9.6%), or experienced memory loss (17.9%) after drinking. Unmarried third-generation adults with high-risk-drinking fathers reported more frequent alcohol consumption [odds ratio (OR) 1.441), greater amounts on one occasion (>7 cups for men, OR 1.661; > 5 cups for women, OR 2.078), temperance failure (OR 2.377), and repentance after drinking (OR 1.577). Unmarried third-generation adults with high-risk-drinking grandfathers consumed greater amounts of alcohol on one occasion (OR 3.642), and unmarried third-generation women more frequently consumed large amounts of alcohol (>5 cups, OR 4.091). Unmarried third-generation adults with high-risk-drinking fathers were more likely to exhibit high-risk drinking patterns (OR 1.608). Second-generation individuals from a high-risk-drinking first generation were more likely to engage in high-risk drinking (OR 3.705). CONCLUSION: High-risk drinking by a generation significantly affects the high-risk drinking patterns of subsequent generations.

A Comparison of two Case-crossover Methods for Studying the Dose-Response Relationship Between Alcohol and Injury.

BACKGROUND: This study compares dose-response injury risk estimates for two control periods defined as the same 6-hour period the week prior and the set of all non-sleeping 6-hour periods over the past year. METHOD: Dose-response injury risk estimates for the multiple match controls are generated via the application of a maximum-likelihood approach. RESULTS: Injury risk associated with any (i.e., 1 drink or more) drinking 6 hours prior to injury was similar for the two control choices (last week and usual frequency). For 1-4 drinks, risk estimates were similar across control period definitions; for 5+ drinks, risk using the week prior as the control was nearly double that using the past 12 months as the control. CONCLUSIONS: Although studies with smaller ns may benefit from the increase in precision from the use of the multiple control periods, results indicate that heavy drinking injury risk estimates should be used with caution.

Social supply of alcohol to Korean high school students: a cross-sectional International Alcohol Control Study.

PURPOSE: Underage drinking is strictly prohibited by law, nevertheless, adolescents report having access through social supply from family, friends and other members of the society. The aim of this study was to determine the primary suppliers of alcohol to Korean teenagers. DESIGN: Cross-sectional study. SETTING: Data were collected from 21 high schools in geographically diverse regions in South Korea from June to July 2012 as part of the International Alcohol Control Study. PARTICIPANTS: Data were analysed from 247 high schoolers aged 16-18 years old as part of the International Alcohol Control Study. PRIMARY AND SECONDARY OUTCOME MEASURES: Social supply to high school students. RESULTS: More than 56% of high schoolers who participated in the International Alcohol Control Survey had been supplied alcohol at least once. Of this number, approximately 59% were males. Parents (especially fathers) and friends were the main suppliers, with friends contributing greater volumes (205 g) of alcohol. Of the number of students provided by mothers, 52% of them were females while 73% of respondents provided by friends were males. The most significant place for alcohol supply was at special events. Males were at higher odds for risky drinking. CONCLUSIONS: These results support previous findings about the role of parents and friends in underage drinking in South Korean high school drinkers.