Associations between substandard housing and depression: insights from the Korea welfare panel study.

BACKGROUND: Housing is an important social determinant of health. Poor housing conditions are associated with a wide range of health conditions, including mental health. The study aimed to investigate the association between substandard housing and depression. METHODS: We used panel data collected by the Korea Welfare Panel Study and a sample drawn from waves 11 (2016) to 13 (2018). Substandard housing was defined via three criteria: the minimum residential area and number of rooms by application, essential facility standards, and environmental standards. Depression was measured with the CESD-11. A generalized estimating equation model was used to investigate associations between substandard housing and CESD-11 scores. RESULTS: Participants living in substandard housing have higher depression scores (male: ß = 0.63, female: ß = 0.40) than participants who do not live in substandard housing. Participants who do not meet environmental standards have higher depression scores (male: ß = 0.85, female: ß = 0.66) than participants who do not live in substandard housing; the findings are seen in both men and women. CONCLUSION: This study identified an association between substandard housing and depression by gender, and the results were significant. We found that among the three criteria, environmental standards are most likely to be associated with depression. In practical terms, we should consider improving environmental factors of housing to mitigate mental health issues related to substandard housing.

Association between successful aging transitions and depressive symptoms among older Korean adults: findings from the Korean longitudinal study of aging (2006-2018).

BACKGROUND: The importance of SA (Successful aging) has been emphasized in recent years, with focus shifting towards attaining healthier aging rather than longevity. However, the influence of SA and its changes on mental health such as depression remains a relatively unexplored area in gerontology. Therefore, we investigated the longitudinal association between changes in SA and depressive symptoms in Korean older adults. METHODS: This study comprised a longitudinal sample of older adults aged ≥ 45 years, drawn from the Korean Longitudinal Study of Aging (2006-2018). Changes in SA status was determined using the Rowe and Kahn model over two consecutive years. Using an adjusted generalized estimating equation model, we examined the association between changes in successful aging status, namely SA and NSA (Non-successful aging), and depressive symptoms. RESULTS: Compared to the SA→SA group, depressive symptom risk in the NSA→NSA and SA→NSA groups were higher in men [(OR, 1.16; 95 % CI, 1.13-1.18), (OR, 1.11; 95 % CI, 1.08-1.13), respectively] and in women [(OR, 1.15; 95 % CI, 1.13-1.18), (OR, 1.11; 95 % CI, 1.09-1.14), respectively]. Subgroup analysis of the dimensions of successful aging revealed that low or worsening criteria of successful aging status in men and women were associated with depressive symptoms. CONCLUSIONS: Korean older adults who continuously failed to attain or maintain successful aging status had the highest risk of depressive symptoms. These results could further assist in establishing policies and interventions that promote successful aging and subsequently protect the mental health of the Korean older adult population.

Association between sedentary time and sleep quality based on the Pittsburgh Sleep Quality Index among South Korean adults.

BACKGROUND: Sleep problems increase the risk of premature illness and death. We evaluated the association between sedentary time and sleep quality among South Korean adults. METHODS: The data of adults (aged ≥ 19 years) from the 2018 Korea Community Health Survey were analyzed. Sedentary time, which included hours spent sitting or lying down daily, was categorized into four standardized groups. Poor sleep quality was defined using the global cutoff point (> 5 points) of the Pittsburg Sleep Quality Index. Multiple logistic regression analyses were performed to identify the association between sedentary time (≤ 3.9, 4.0-5.9, 6.0-7.9, and ≥ 8 hours /day) and sleep quality, by sex. RESULTS: Of the 224,118 participants, 35,784/100,454 men (35.6%) and 58,271/123,664 women (47.1%) had poor sleep quality. Compared with ≤ 3.9 h/day, sedentary times 4.0-5.9, 6.0-7.9, and ≥ 8 h/day were associated with worse sleep quality among men (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.08-1.16; OR: 1.19, 95% CI: 1.14-1.25; OR: 1.30, 95% CI: 1.25-1.34, respectively) and women (OR: 1.06, 95% CI: 1.03-1.10; OR: 1.12, 95% CI: 1.08-1.16; OR: 1.22, 95% CI: 1.18-1.26, respectively). In subgroup analyses of sleep quality, subjective sleep quality, latency, disturbance, use of sleeping medication, and daytime dysfunction showed a strong dose-response relationship with increasing sedentary time in both sexes. CONCLUSIONS: Regardless of sex, the longer the sedentary time, the stronger the association with poor sleep quality. Nationwide efforts are required to recommend standards for sedentary time and develop evidenced-based healthy behavior guidelines.

Association between health behaviours and depression: findings from a national cross-sectional study in South Korea.

BACKGROUND: Depression is a leading cause of disability, and it has been reported that more than 264 million people worldwide have depression. The causes of depression may be numerous, and physical health has also been linked to depression. Therefore, the aim of this study was to determine the effect of health behaviours on depression. METHODS: This study used the data of 224,868 participants from the Community Health Survey, conducted in 2017. We defined health behaviours by combining three variables: no smoking, not belonging to high-risk drinking group, and walking frequently. Depression was measured using the Patient Health Questionnaire-9. Logistic regression was used to examine the association between health behaviours and depression. RESULTS: Both men and women who did not practise health behaviours were more likely to experience depressive symptoms than those who did (men, odds ratio (OR): 1.48, 95% confidence interval (CI): 1.31-1.68; women, OR: 1.42, 95% CI: 1.32-1.53). Not walking frequently had the strongest association with depression in men and the risk of depression was the highest in women who smoked. Participants who did not practise any health behaviours were the most likely to have depressive symptoms (men, OR: 1.69, 95% CI: 1.38-2.07; women, OR: 3.08, 95% CI: 2.27-4.19). CONCLUSION: Our study found that lack of health behaviours is significantly associated with depression. Furthermore, the most influential factor of health behaviours in depression was different for men and women. It is necessary to manage depression through interventional methods customised to gender characteristics. Additionally, national-level policies are needed to encourage steps to improve personal lifestyles, including practising health behaviours.

Association between family financial decline due to COVID-19 and generalized anxiety disorder among Korean adolescents.

BACKGROUND: COVID-19 has had a worldwide economic impact. A decline in family financial level can adversely affect adolescents' mental health. This study examined the association between perceived family financial decline due to COVID-19 and generalized anxiety disorder (GAD) among South Korean adolescents. METHODS: Data from 54,948 middle and high school students from the 2020 Korea Youth Risk Behavior Survey were collected in this cross-sectional study. The effect of the perceived family financial decline due to COVID-19 related to GAD was analyzed using binary and multinomial logistic regression. RESULTS: The relationship between perceived family financial decline due to COVID-19 and GAD was linear with increasing odds ratios and confidence intervals (the possibility of GAD, no financial decline: OR 1.00, mild: OR 1.11, CI 1.05-1.17, moderate: OR 1.30, CI 1.22-1.39, severe: OR 1.48, CI 1.34-1.63). Girls, low-income class, and living with family were vulnerable to GAD. GAD levels of mild, moderate, and severe were most likely to occur in each case of mild, moderate, and severe financial decline, respectively. LIMITATIONS: As this is a cross-sectional study, causality is unknown. Because this study data was self-reported by adolescents, they may have been overestimated or underestimated. CONCLUSION: GAD in adolescents is closely related to perceived decreased family finances due to COVID-19. The dose-response of GAD according to financial decline became gradually severe. Anxious adolescents were afraid of uncertain and adverse outcomes affecting them or their families. Therefore, there is a vital need to care for financially affected adolescents.

Association between parents' country of birth and smoking risks in South Korean adolescents.

This study aimed to determine whether significant associations exist between multicultural families and adolescent smoking risks in South Korea. Data from the Korea Youth Risk Behavior Web-based survey from 2016 to 2020 were analyzed. Participants were classified into four family types (South Korean mother-foreign father, South Korean father-foreign mother, both foreign parents, and both South Korean parents) according to their parents' country of birth and smoking was assessed using a self-reported questionnaire. A logistic regression analysis was used to examine the significance of the associations. Overall, 194,259 participants (boys: 94,793, girls: 99,466) enrolled in this study. Adolescents whose parents were born overseas were more likely to smoke than native South Korean adolescents (boys: odds ratio [OR] = 2.61, confidence interval [CI] = 1.79-3.81, girls: OR 3.94, CI 2.42-6.43). When the mother's country of birth was a developing country, there was an increased likelihood of girls smoking, and there was an increased likelihood of smoking among boys when the mother's country of birth was North Korea. When both parents were born abroad, and the mother's country of birth was a developing country, the likelihood of smoking risks among their multicultural teenage children increased. Policies and interventions need to be established and implemented to lower the smoking rate among multicultural teenagers.

Association between quality and duration of sleep and subjective cognitive decline: a cross-sectional study in South Korea.

Sleep is being emphasized as a factor that improves mental health and quality of life. Here, we aimed to investigate the association between the quality and duration of sleep and subjective cognitive decline in the Korean population. We used the 2018 Korean Community Health Survey data that are nationwide representative data collected by the Korea Centers for Disease Control and Prevention. Sleep quality was measured using the Korean version of Pittsburgh Sleep Quality Index. The study population comprised 206,719 individuals aged 19 years and over. We used multiple logistic regression for the analysis. Individuals of both sexes with poor sleep quality were more likely to experience subjective cognitive decline compared with the reference group (good sleep quality) (men, odds ratio (OR) = 1.97 [95% confidence interval (CI) 1.86-2.09]; women, OR = 1.75 [95% CI 1.67-1.84]). U-shape associations were found between sleep duration and subjective cognitive decline. Additionally, the presence of depressive symptom or stress and health-related behaviors, including smoking, drinking, and not walking, were high-risk factors for subjective cognitive decline. Our results indicate that poor sleep quality might contribute to subjective cognitive decline in the Korean population. We suggest the implementation of intervention measures for poor sleep behaviors to prevent cognitive decline.

Association between healthy lifestyle score changes and quality of life and health-related quality of life: a longitudinal analysis of South Korean panel data.

OBJECTIVES: We aimed to determine the influence of changes in the aggregate score of healthy lifestyle factors on health-related quality of life (HRQOL) and overall quality of life (QOL) in the Korean older adult population. DESIGN: This study used a longitudinal design. SETTING AND PARTICIPANTS: Data on 9474 participants aged 45 years or older were extracted from the Korean Longitudinal Study on Aging for the period 2006-2016. A composite score of four lifestyle factors (smoking, drinking, physical activity and body mass index) was calculated, and biennial changes in aggregate score were computed. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were HRQOL and QOL. RESULTS: Generalised estimating equation analysis results showed that those with healthy lifestyle score changes from 'Low-High' (ß =-0.987, p=0.002; ß =-1.288, p<0.0001), 'High-Low' (ß =-1.281, p<0.0001; ß =-1.952, p<0.0001) and 'Low-Low' (ß =-1.552, p<0.0001; ß =-2.398, p<0.0001) groups were more likely to be have lower HRQOL and QOL estimates than those in 'High-High' group. Female gender, older age and depression had a more negative impact on HRQOL, while male gender and younger age had a more negative impact on QOL, especially in the Low-Low group. The relationship between changes in scores and HRQOL and QOL varied across different elements of healthy lifestyle scores. Changes in physical activity, drinking and smoking status were significantly associated with lower HRQOL and QOL. CONCLUSION: The findings suggest an association between a low healthy lifestyle score and poor quality of life, in both general and health-related aspects. Strategies targeting the Korean ageing demographic to promote a healthier lifestyle should be encouraged.

Association between community deprivation and practising health behaviours among South Korean adults: a survey-based cross-sectional study.

OBJECTIVES: This study aimed to determine the association between community deprivation and poor health behaviours among South Korean adults. DESIGN: This was a survey-based cross-sectional study. SETTING AND PARTICIPANTS: Data of 224 552 participants from 244 communities were collected from the Korea Community Health Survey, conducted in 2015. PRIMARY AND SECONDARY OUTCOME MEASURES: We defined health behaviours by combining three variables: not smoking, not high-risk drinking and walking frequently. Community deprivation was classified into social and economic deprivation. RESULTS: Multilevel logistic analysis was conducted to determine the association of poor health behaviours through a hierarchical model (individual and community) for the 224 552 participants. Among them, 69.9% did not practice healthy behaviours. We found that a higher level of deprivation index was significantly associated with higher odds of not-practising healthy behaviours (Q3, OR: 1.15, 95% CI: 1.00 to 1.31; Q4 (highest), OR: 1.22, 95% CI: 1.06 to 1.39). Economic deprivation had a positive association with not-practising health behaviours while social deprivation had a negative association. CONCLUSION: These findings imply that community deprivation levels may influence individual health behaviours. Accordingly, there is a need for enforcing the role of primary healthcare centres in encouraging a healthy lifestyle among the residents in their communities, developing national health policy guidelines for health equity and providing financial help to people experiencing community deprivation.

Investigation of the Association between Smoking Behavior and Metabolic Syndrome Using Lipid Accumulation Product Index among South Korean Adults.

Electronic cigarette vaping has recently been chosen as a smoking alternative for those who want to quit smoking, but some of the electronic cigarette users use both traditional and electronic cigarettes (dual smoking) without stopping smoking. This study investigated the association between smoking behavior and metabolic syndrome among Korean adults. Data from 14,607 participants (6142 males and 8465 females) were examined. They were divided into four categories: dual smoking (both conventional and e-cigarettes), single smoking (only conventional cigarettes), previously smoking, and non-smoking. Metabolic syndrome risk was calculated as a continuous variable using the lipid accumulation product (LAP) index. Multiple linear regression analyses were performed to examine the association of log-transformed LAP with smoking behavior. Among the total participants, 187 males and 35 females were dual smokers and 1850 males and 372 females were single smokers. LAP was significantly higher in male who practiced dual and single smoking than LAP of non-smokers-dual: ß = 0.27, standard error (SE) = 0.06, p < 0.0001; single: ß = 0.18, SE = 0.03, p < 0.0001. In female, LAP was significantly higher among those who practiced only single smoking than LAP of non-smokers (ß = 0.21, SE = 0.04, p < 0.0001). Dual and single smoking were significantly associated with higher LAP, a strong predictor of metabolic syndrome. Further studies and awareness regarding the adverse effects of dual smoking are required.

Association between parents' smoking status and tobacco exposure in school-age children: assessment using major urine biomarkers.

Children are at risk of exposure to secondhand smoke. We aimed to evaluate the extent of their exposure to it in relation to their parents' smoking status by using biomarkers relevant to smoking. We evaluated 847 school-age children (6-12 years) who lived with their parents, using data from the Korea National Health and Nutrition Examination Survey 2016-2018. Secondhand smoke exposure in children of non-smoking and smoking parents was assessed by measuring urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and cotinine concentrations. Overall, the parents of 482 (55.1%) children smoked and those of 392 (44.9%) children did not smoke. After adjusting for covariates, significantly higher concentrations of NNAL (ß = 0.482, standard error [S.E.] = 0.065, P < 0.001) and cotinine (ß = 0.472, S.E. = 0.06, P < 0.001) were found in children of smoking parents than in children of non-smoking parents. Children of parents who smoked a higher number of cigarettes showed higher NNAL and cotinine concentrations than children of non-smoking parents. Children with both parents who smoked showed the highest NNAL and cotinine concentrations. Children of smoking parents are at a higher risk of exposure to secondhand smoke. A smoke-free environment must be maintained to protect children from the harmful effects of secondhand smoke. Therefore, comprehensive national anti-smoking policies are required.

Effect of Practicing Health Behaviors on Unmet Needs among Patients with Chronic Diseases: A Longitudinal Study.

With the growing prevalence of chronic diseases, the proportion of unmet needs is increasing. In this study, we investigated the effect of practicing health behaviors on unmet needs among patients with chronic diseases, using data from the Korea Health Panel Survey conducted between 2014-2017. Participants (n = 4069) aged 19 or older, with at least one chronic disease (hypertension, diabetes mellitus, dyslipidemia, or arthrosis) and with existing follow up data were selected. Health behaviors combined three variables: not presently smoking, not belonging to high-risk drinking group, and indulging in moderate- or high-intensity exercise. Those who met all three criteria were classified as the practicing health behaviors group. Generalized Estimating Equation analysis was performed to consider correlated data within a subject. Of the participants, 23.9% practiced health behaviors. Participants who did not practice health behaviors were significantly more likely to have unmet needs compared with those who did (OR: 1.24, 95% CI: 1.10-1.39). Further research would be needed to verify the impact of practicing health behavior on unmet needs.

Frailty transitions and cognitive function among South Korean older adults.

Frailty is considered a multidimensional geriatric syndrome, manifested by the accumulation of age-associated deficits. The consequences of frailty transitions are still understudied. This study evaluated the influence of frailty transitions on cognitive function in the older adult population. We used data derived from the Korean Longitudinal Study of Aging (KLoSA) (2008-2018) on older adults aged ≥ 65 years. Frailty was assessed using a validated Korean frailty measure known as the frailty instrument (FI), and cognitive function was measured using the Korean version of the Mini-Mental State Examination (K-MMSE). Transitions in frailty and their relationship with cognitive function were investigated using lagged generalized estimating equations (GEE), t-tests, and ANOVA. Respondents who experienced frailty transitions (those with ameliorating frailty), those who developed frailty, and whose frailty remained constant, were more likely to have a lower cognitive function than those who were consistently non-frail. Older age, activities of daily living (ADL) disability, and instrumental ADL disability were more negatively associated with declining cognitive function, especially in the "frail → frail" group. Changes in all individual components of the frailty instrument were significantly associated with impaired cognitive function. The results suggest an association between frailty transitions and cognitive impairment. Over a 2-year span, the remaining frail individuals had the highest rate of cognitive decline in men, while the change from non-frail to frail state in women was significantly associated with the lowest cognitive function values. We recommend early interventions and prevention strategies in older adults to help ameliorate or slow down both frailty and cognitive function decline.

Association between relative handgrip strength and prediabetes among South Korean adults.

BACKGROUND: Diabetes is a progressive disease, and thus, it is important to prevent diabetes at the prediabetes stage. Although the loss of muscle strength and prediabetes are associated, few studies have examined relative handgrip strength (RHGS), which can be an indicator of both muscle strength and adiposity. Therefore, our study aimed to examine the association between RHGS and prediabetes (HbA1c level >5.7%) stratified by sex due to sex differences in strength. METHODS: We analyzed data from the 2016-2018 Korean National Health and Nutrition Examination Survey. Prediabetes was defined using the HbA1c cut-off level of 5.7-6.4%, identified by the American Diabetes Association. RHGS was calculated as the maximal absolute handgrip strength of both hands divided by body mass index and was divided into sex-specific quartiles. Multiple logistic regression analysis was performed to determine the association between sex-specific RHGS and prediabetes. RESULTS: Among the total participants, 13,384 did not have diabetes. In men, the low and mid-low RHGS groups had increased odds of prediabetes (low group, odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.10-1.82; mid-low group, OR: 1.32, 95% CI: 1.04-1.67). However, no significant differences were observed between the corresponding female groups. Moreover, central obesity and lower RHGS were strongly associated with prediabetes in men (low group, OR: 2.40, 95% CI: 1.52-3.80; mid-low group, OR: 2.00, 95% CI: 1.26-3.17; mid-high group, OR: 1.76, 95% CI: 1.11-2.81), and a trend was observed (p = 0.0026). CONCLUSION: RHGS could be a practical and inexpensive tool for predicting diabetes in men. Programs aimed at preventing diabetes need to include exercise routines for improving muscle strength, and further research through longitudinal studies is required to investigate the causality of RHGS on the risk of prediabetes.

Association Between the Location of Secondhand Smoke Exposure and Depressive Symptoms among South Korean Adolescents.

The incidence of depression among adolescents has gradually increased, leading to adult psychological outcomes and suicide. Although the rate of secondhand smoke exposure (SHSE) has recently decreased, SHSE remains high in children. We aimed to determine the association between depressive symptoms in adolescents and the locations of SHSE using an extensive population survey. Using data from the 14th Korea Youth Risk Behavior Web-based Survey, we assessed self-reported data of depressive symptoms and SHSE among non-smokers. SHSE locations were classified into four groups: only at school, only at home, at both school and home, and other places. Multiple logistic regression analysis was performed to identify the associations between SHSE locations and depressive symptoms. The relationship between SHSE and depressive symptoms was the highest in the "SHSE at home and school" group (boys: odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.44-1.80; girls: OR = 1.72, 95% CI = 1.54-1.91), followed by the "school" (boys: OR = 1.53, 95% CI = 1.39-1.67; girls: OR = 1.36, 95% CI = 1.25-1.48) and "home" groups (boys: OR = 1.23, 95% CI = 1.12-1.35; girls: OR = 1.30, 95% CI = 1.20-1.40). These results emphasize the importance of stricter smoking regulations not only in public places, but also in households. Adolescents and their families should be educated on the dangers of smoking and the effects of SHSE on mental health.

Synergistic Effects and Sex Differences in Anthropometric Measures of Obesity and Elevated High-Sensitivity C-Reactive Protein Levels.

Background: It remains unclear which anthropometric measure best predicts elevated high-sensitivity C-reactive protein (hs-CRP) levels. This study investigated the association and synergistic interaction of two obesity indices with elevated hs-CRP levels in a national sample of Korean adults, stratified by sex. Methods: The present cross-sectional study used data from the 2015-2018 Korea National Health and Nutrition Examination Survey of 18,610 subjects aged ≥20 years after excluding those with missing variables. Multiple logistic regression analyses and chi-squared tests were performed to investigate the association between body mass index (BMI) and waist circumference (WC) with elevated hs-CRP levels. Interaction analysis was used to examine the synergistic effect between BMI and WC on the risk of having elevated hs-CRP levels. Results: Elevated hs-CRP levels exceeding 3 mg/L were present in 9.3% and 7.5% of men and women, respectively. The relationship between each obesity index and elevated hs-CRP levels was significant in women (high WC (odds ratio [OR] = 1.77, 95% confidence interval [CI] = 1.24-2.54), high BMI (OR = 2.08, 95% CI = 1.58-2.74)) but not in men (high WC (OR = 1.19, 95% CI = 0.86-1.64), high BMI (OR = 0.99, 95% CI = 0.77-1.29)). Furthermore, combined measures of the two obesity indices and interaction analysis results revealed a synergistic association in men (OR = 1.57, 95% CI = 1.33-1.85; relative excess risk due to interaction (RERI) = 0.39, 95% CI = -0.09-0.86), and women (OR = 3.70, 95% CI = 3.09-4.43; RERI = 0.85, 95% CI = -0.06-1.75). Conclusion: BMI and WC were significantly associated with a risk of elevated hs-CRP levels in women but not in men. Nevertheless, significant synergistic interactions were seen in combined measures of BMI and WC, regardless of sex. These findings emphasize the need to use both measures of adiposity concurrently in the assessment of obesity and when identifying cardiovascular risk.