Epidemiology and Health

COVID-19: Special Article

Changes in mental health of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior Survey: Bomi Park, Jihee Kim, Jieun Yang, Sunhye Choi, Kyungwon Oh; Epidemiol Health. 2023;45:e2023019. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023019

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Abstract PDF: Abstract
OBJECTIVES
We aimed to study the effects of the coronavirus disease 2019 (COVID-19) pandemic on adolescents’ mental health in Korea.
METHODS
We used data from the Korea Youth Risk Behavior Survey 2018-2021 with 227,139 students aged 12-18 years. We estimated the differences in depressive symptoms, suicidal ideation, and stress perception before (2018-2019) and during (2020-2021) the pandemic, as well as before (2019), the first year (2020) of, and the second year (2021) of the pandemic. We also examined whether COVID-19 is statistically associated with mental health.
RESULTS
In both male and female adolescents, the prevalence of depressive symptoms, suicidal ideation, and stress perception was higher in the “not living with family,” “low household economic status,” and “self-rated unhealthy status” subgroups. The prevalence of depressive symptoms and stress perception was higher in middle school students. Adolescents were less likely to experience depressive symptoms (adjusted odds ratio [aOR], 0.86; 95% confidence interval [CI], 0.83 to 0.89), suicidal ideation (aOR, 0.80; 95% CI, 0.76 to 0.83), and stress perception (aOR, 0.76; 95% CI, 0.74 to 0.79) in 2020 than in 2019. However, there were more depressive symptoms (aOR, 1.06; 95% CI, 1.02 to 1.09), suicidal ideation (aOR, 1.15; 95% CI, 1.10 to 1.21), and stress perception (aOR, 1.19; 95% CI, 1.16 to 1.23) in 2021 than in 2020.
CONCLUSIONS
The COVID-19 pandemic had positive impacts on mental health of adolescents in its early stages but has had negative impacts as the pandemic continues. Attention should be paid to adolescents who are particularly vulnerable to the mental health effects of the pandemic.; Summary

Korean summary

Key Message

COVID-19: Special Article

Changes in health behaviors and obesity of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior Survey: Chang-Mo Oh, Yangha Kim, Jieun Yang, Sunhye Choi, Kyungwon Oh; Epidemiol Health. 2023;45:e2023018. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023018

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to investigate changes in health behaviors, including cigarette smoking, alcohol drinking, physical activity, dietary behaviors, and obesity, before and during the coronavirus disease 2019 (COVID-19) pandemic using the Korea Youth Risk Behavior Survey (KYRBS) database.
METHODS
KYRBS data from 2015 to 2021 were used in this study. Differences in health behaviors between before (pre-pandemic period: 2018-2019) and during (pandemic period: 2020-2021) the pandemic were examined. Differences were compared using linear regression and the chi-square test considering the complex survey design after adjusting for grade level.
RESULTS
The prevalence of current cigarette smoking and current alcohol drinking significantly decreased in both male and female students during the pandemic compared to the pre-pandemic period. However, the prevalence of obesity significantly increased in both male and female students during the same period. When examining physical activity and dietary behaviors closely related to obesity, fast food consumption increased and fruit consumption decreased during the pandemic in both male and female students, whereas no significant changes in physical activity were observed in either male or female students.
CONCLUSIONS
The deterioration of adolescent dietary behaviors and an increase in the prevalence of obesity can increase the future disease burden, and concerted efforts at the individual and national levels are needed to reduce obesity and promote healthy dietary behaviors.; Summary

Korean summary
이 연구는 한국 청소년건강행태조사자료(KYRBS)를 사용하여 코로나19 유행 전후의 우리나라 청소년들의 흡연, 음주, 신체활동, 식습관, 비만 등의 건강행태의 변화에 대하여 살펴보고자 하였다. 이 연구에서는 2015년부터 2021년까지의 청소년건강행태조사자료를 사용하여, 코로나19 유행 이전 (2018-2019년)과 코로나 유행 이후 (2020-2021년) 기간의 건강행태의 변화에 대하여 조사하였다. 학년레벨을 보정한 후, 복합표본설계를 고려하여 로지스틱 회귀분석과 카이제곱검정을 이용하여 코로나19 유행 이전 (2018-2019년)과 비교하여, 코로나 유행 이후 (2020-2021년) 기간의 건강행태의 변화가 있었는지에 대하여 확인하였다. 그 결과, 코로나19 유행 이전 (2018-2019년)과 비교하여, 코로나19 유행 기간(2020-2021년) 동안에 현재흡연율과 현재음주율이 유의하게 감소하였다. 그러나 동일한 기간 동안에 남학생과 여학생 모두에서 비만율이 유의하게 증가하였는데, 비만율과 관련된 신체활동 및 식습관에 대하여 살펴보았을 때, 신체활동에서는 유의한 변화가 없었던 반면, 남학생과 여학생 모두에서 패스트푸드 섭취는 증가하고 과일섭취가 감소한 것으로 나타났다. 따라서 코로나19 유행기간 동안 흡연율 및 음주율 등의 청소년 건강에 유익한 변화도 있었으나, 비만율도 같이 증가한 것을 확인할 수 있었다. 청소년기의 식습관의 악화 및 비만율의 증가는 미래 우리나라의 질병부담을 증가시킬 수 있기 때문에, 청소년의 비만율을 낮추고 건강한 식습관을 증진시키기 위한 개인 및 사회 차원의 노력이 필요하다.

Key Message
-The current cigarette smoking and current alcohol drinking rates significantly decreased among Korean adolescents during the pandemic period compared to the pre-pandemic period. -On the other hand, the obesity rate increased significantly especially among Korean male adolescents, which is accompanied by changes in dietary habits such as an increase in fast food intake and a decrease in fruit intake.

COVID-19: Original Article

Cause-specific mortality in Korea during the first year of the COVID-19 pandemic: Jinwook Bahk, Kyunghee Jung-Choi; Epidemiol Health. 2022;44:e2022110. Published online November 23, 2022; DOI: https://doi.org/10.4178/epih.e2022110

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to examine the trends in total mortality between 1998 and 2020 and to compare the changes in a wide range of detailed causes of death between 2020 (i.e., during the coronavirus disease 2019 [COVID-19] pandemic) and the previous year in Korea.
METHODS
We used registered population and mortality data for the years 1998-2020 obtained from Statistics Korea. The age-standardized all-cause mortality rate and the annual percent change between 1998 and 2020 were determined. The rate ratio and rate difference of the age-standardized mortality rate between 2019 and 2020 were calculated.
RESULTS
The age-standardized all-cause mortality rate in Korea has been on a downward trend since 1998, and the decline continued in 2020. In 2020, 950 people died from COVID-19, accounting for 0.3% of all deaths. Mortality decreased for most causes of death; however, the number of deaths attributed to sepsis and aspiration pneumonia increased between 2019 and 2020 for both men and women. Age-specific mortality rates decreased or remained stable between 2019 and 2020 for all age groups, except women aged 25-29. This increase was mainly attributed to a higher number of suicide deaths.
CONCLUSIONS
This study shed light on the issues of sepsis and aspiration pneumonia despite the successful response to COVID-19 in Korea in 2020. Cases of death from sepsis and aspiration pneumonia should be identified and monitored. In addition, it is necessary to develop a proactive policy to address suicide among young people, especially young women.; Summary

Korean summary
1998년 이래 한국의 연령표준화 총사망률은 지속적으로 감소하였고, 이러한 경향은 코로나19 대유행 첫해인 2020년에도 관찰되었다. 대부분 사망원인별 사망률이 코로나19 대유행이후에도 감소하였으나, 패혈증 및 흡인성 폐렴으로 인한 사망자가 남성과 여성 모두에서 증가했다. 연령별 사망률에서는 25-29세 여성을 제외한 모든 연령대에서 2019년에 비해 2020년 사망률이 감소하거나 유지되었고, 25-29세 여성의 사망률 증가는 주로 자살 사망의 증가에 기인했다.

Key Message
During 1988-2020, the age-standardized all-cause mortality rate in Korea has been on a downward trend and the decline continued in 2020. In 2020, mortality decreased for most causes of death, however, the number of deaths attributed to sepsis and aspiration pneumonia increased between 2019 and 2020. Age-specific mortality rates decreased or remained stable between 2019 and 2020 for all age groups, except women aged 25-29. This was mainly attributed to increased suicide deaths.

COVID-19: Original Article

Changes in eating behaviors according to household income in adolescents during the COVID-19 pandemic: findings from the Korea National Health and Nutrition Examination Survey: Hye Ah Lee, Ho Jung Lee, Bomi Park, Yoonhee Shin, Hyunjin Park, Hyesook Park; Epidemiol Health. 2022;44:e2022102. Published online November 9, 2022; DOI: https://doi.org/10.4178/epih.e2022102

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Abstract Summary PDF: Abstract
OBJECTIVES
To assess social inequalities in changes in dietary behaviors among adolescents during the coronavirus disease 2019 (COVID-19) pandemic, we compared changes in dietary behavior indicators by household income.
METHODS
Using cross-sectional data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, the prevalence of dietary behaviors in adolescents (12-18 years old) was estimated and changes in dietary behaviors during the COVID-19 pandemic were evaluated. We assessed changes in dietary behaviors with a household income (as a measure of socioeconomic status, SES) disparity.
RESULTS
During the COVID-19 pandemic, the average consumption of vegetables decreased and food insecurity worsened. Adolescents were more likely to skip breakfast than before COVID-19 (33.1 and 37.4%). Soft drink consumption also increased in 2020 from 2019 (7.6 and 14.8%), especially among boys. Average sugar intake and sodium intake showed a tendency to decrease only in girls, but there was no significant difference according to SES level. Skipping breakfast was particularly evident in the low-SES group, and the difference according to household income level (high vs. low) was greater during COVID-19 than before. The prevalence of soft drink consumption increased significantly in the low-SES group, but the rate of increase did not differ by SES level.
CONCLUSIONS
We found that the social disparity in skipping breakfast was further aggravated during the COVID-19 pandemic. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.; Summary

Korean summary
국민건강영양조사 자료를 활용하여, COVID-19 팬데믹 전후 청소년의 식생활 변화 및 가구소득 수준에 따른 차이를 평가하였다. 대체로, 평균 채소 섭취량은 감소하고 탄산음료 소비는 증가한 것으로 나타났으며, 아침식사 결식율도 약간 증가한 것으로 나타났다. 게다가, 가구소득 수준에 따라 평가하였을 때, 아침식사 결식율 증가는 가구소득이 높은 군에 비해 가구소득 수준이 낮은 군에서 두드러진 것으로 나타났다. COVID-19 팬데믹이 장기화됨에 따라, 청소년의 식생활 변화에 대해서는 지속적인 모니터링이 필요하다.

Key Message
Using data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, changes in dietary behaviors of adolescents (12-18 years old) during the COVID-19 pandemic were evaluated. During the COVID-19 pandemic, average consumption of vegetables decreased and consumption of soft drinks increased in 2020 from 2019 (7.6% and 14.8%). In addition, the social disparity in skipping breakfast among adolescents was further aggravated. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

COVID-19: Original Article

No evidence of delay in colorectal cancer diagnosis during the COVID-19 pandemic in Gwangju and Jeonnam, Korea: Hye-Yeon Kim, Min-Gyeong Kim, Mi-Ran Kang, Jeong-Ho Yang, Min-Ho Shin, Sun-Seog Kweon; Epidemiol Health. 2022;44:e2022092. Published online October 17, 2022; DOI: https://doi.org/10.4178/epih.e2022092

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Abstract Summary PDF: Abstract
OBJECTIVES
We evaluated whether the coronavirus disease 2019 (COVID-19) pandemic caused delays in the diagnosis and treatment of colorectal cancer (CRC) in Korea, where there have been no regional or hospital lockdowns during the pandemic period.
METHODS
Data on CRC patients (n=1,445) diagnosed in Gwangju Metropolitan City and Jeonnam Province between January 2019 and December 2021 were assessed. The stage at the time of CRC diagnosis, route to diagnosis, time to initial cancer treatment, and length of hospital admission were compared before and during the COVID-19 pandemic. Logistic regression was also performed to identify factors associated with the risk for diagnosis in an advanced stage.
RESULTS
No negative effects indicating a higher CRC stage at diagnosis or delayed treatment during the pandemic were observed. Instead, the risk for an advanced stage at diagnosis (TNM stage III/IV) decreased in CRC patients diagnosed during the pandemic (odds ratio, 0.768; 95% confidence interval, 0.647 to 0.911). No significant differences in the interval from diagnosis to operation or chemotherapy were observed.
CONCLUSIONS
No negative effects on CRC diagnosis and treatment were found until the end of 2021, which may be related to the small magnitude of the COVID-19 epidemic, the absence of a lockdown policy in Korea, and the rebound in the number of diagnostic colonoscopy procedures in 2021.; Summary

Korean summary
COVID-19 판데믹 시기에 진단된 대장암환자에서 진단병기의 지연과 치료의 지연이 발생한 증거는 찾을 수 없었다. 이것은 2021년까지 한국에서는 유행규모가 크지 않았고, 의료기관 또는 지역단위의 봉쇄정책이 거의 없었기 때문일 것으로 추정된다.

Key Message
No evidence of delayed diagnosis and treatment of colorectal cancer was found during the COVID-19 pandemic period (2020-2021) in Gwangju-Jeonnam, Korea. It may be related to the small magnitude of the COVID-19 epidemic, the absence of a lockdown policy in Korea.

COVID-19: Original Article

The association between tobacco or nicotine product use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic: a cross-sectional study in Korea: Da-eun Lee, Heewon Kang, Sung-il Cho; Epidemiol Health. 2022;44:e2022087. Published online October 7, 2022; DOI: https://doi.org/10.4178/epih.e2022087

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
It is necessary to investigate tobacco or nicotine product (TNP) use which acts as a risk factor for coronavirus disease 2019 (COVID-19) infection. Especially, wearing a mask is difficult to practice while using TNP. Therefore, this study aimed to examine the association between TNP use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic.
METHODS
The samples of 208,618 Korean adults from 2020 Community Health Survey in Korea were used. As an independent variable, TNP use behaviors such as TNP use status, changes in TNP use after the COVID-19 outbreak, TNP types, and attempt to quit were analyzed. Logistic regression was performed on gender-stratified participants.
RESULTS
Among men, the odds ratio (OR) of current and former TNP users were 2.00 (95% confidence interval [CI], 1.66 to 2.40) and 1.32 (95% CI, 1.09 to 1.60), respectively, compared to never users. In women, OR was 1.50 (95% CI, 1.00 to 2.26) for former users. Cigarette use was more associated with not wearing a mask than non-cigarette tobacco or nicotine product (NCTNP) use (OR, 1.53; 95% CI, 1.12 to 2.08). Men whose TNP use decreased had lower non-compliance (OR, 0.52; 95% CI, 0.36 to 0.74); while women whose TNP use increased had lower non-compliance (OR, 0.13; 95% CI, 0.07 to 0.26).
CONCLUSIONS
Current and former users were less likely to wear masks. Cigarette use was more associated with not wearing a mask than NCTNP use. Changes in TNP use showed association for men and women; however, in the opposite direction. Therefore, more attention should be paid to TNP use prevention and cessation support during the epidemic of respiratory infectious diseases. Moreover, it is necessary to identify risk factors of cigarette users in compliance with mask-wearing.; Summary

Korean summary
담배 또는 니코틴 제품 (Tobacco or Nicotine Products, TNPs) 현재사용자와 과거사용자는 비사용자 대비 마스크 미착용 연관성이 높고, 비궐련 담배 또는 니코틴 제품 (Non-Cigarette Tobacco or Nicotine Products, NCTNPs) 사용자보다는 일반담배 사용자의 마스크 미착용 연관성이 높다. 남성에서는 코로나19 유행 이전 대비 TNPs 사용이 감소했을 때, 여성에서는 증가했을 때 마스크 미착용 연관성이 낮았다. 따라서 호흡기 감염병 유행 시기에는 더욱 TNPs 사용 예방과 금연 지원에 관심을 가질 것을 제안한다.

Key Message
During the epidemic of respiratory infectious diseases, more attention should be paid to tobacco or nicotine products (TNPs) use prevention and cessation support.

COVID-19: Original Article

Seroprevalence of SARS-CoV-2 antibodies during the third wave of COVID-19 in the Seoul metropolitan area of Korea: Kyuhyun Yoon, Jayeun Kim, Kyong Ran Peck, Hyun Soo Kim, Hyukmin Lee, Yoo-Sung Hwang, Soon Young Lee, Sung-il Cho, Hun Jae Lee, Yeong-gyeong Kim, Byoungguk Kim, June-Woo Lee, Ah-Ra Kim, Hyeon Nam Do, Dong-Hyun Kim; Epidemiol Health. 2022;44:e2022085. Published online September 30, 2022; DOI: https://doi.org/10.4178/epih.e2022085

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Abstract Summary PDF: Abstract
OBJECTIVES
After the third wave of coronavirus disease 2019 (COVID-19), by mid-February 2021, approximately 0.16% of the Korean population was confirmed positive, which appeared to be among the lowest rates worldwide at that time. However, asymptomatic transmission is challenging for COVID-19 surveillance. Therefore, a community-based serosurvey of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted to understand the effectiveness of Korea’s strong containment strategy.
METHODS
We collected 5,002 residual sera samples from January 30 to March 3, 2021, from 265 medical facilities in Seoul, 346 in Gyeonggi Province, and 57 in Incheon. Sixty samples from tertiary institutions were excluded. We defined the sub-regions according to the addresses of the medical facilities where the specimens were collected. Elecsys Anti-SARS-CoV-2 was used for screening, and positivity was confirmed using the SARS-CoV-2 sVNT Kit. Prevalence was estimated using sampling weights and the Wilson score interval for a binomial proportion with a 95% confidence interval.
RESULTS
Among the 4,942 specimens, 32 and 25 tested positive for COVID-19 in the screening and confirmatory tests, respectively. The overall crude prevalence of SARS-CoV-2 antibodies was 0.51%. The population-adjusted overall prevalence was 0.55% in women and 0.38% in men. The region-specific estimation was 0.67% and 0.30% in Gyeonggi Province and Seoul, respectively. No positive cases were detected in Incheon.
CONCLUSIONS
The proportion of undetected cases in Korea remained low as of early 2021. Therefore, an infection control strategy with exhaustive tracing and widespread pre-emptive testing appears to be effective in containing community spread of COVID-19.; Summary

Korean summary
코로나19바이러스 감염병(COVID-19)의 한국 내 3차 대유행기인 2020년 말 이후, 2021년 1월 우리나라 인구의 약 0.16%가 누적 확진되었으며, 이는 세계에서 매우 낮은 비율을 보이는 국가 중 하나였습니다. 그러나 COVID-19의 무증상 전파는 감염 확산방지와 감시체계에 문제점들을 초래할 수 있어 지역사회 기반 혈청 조사를 통해 그 현황을 파악했습니다. 2021년 1월 30일부터 3월 3일까지 서울, 경기, 인천 등 수도권 소재 1, 2차 의료기관에서 수집된 혈액검체의 잔여혈청표본 4942개에 대해 Roche사의 Elecsys Anti-SARS-CoV-2를 이용한 1차 항체검사와, GenScript의 SARS-CoV-2 sVNT Kit를 이용하여 2차 중화항체유무를 확인하였다. 4942명의 검체 중 1차 검사와 2차 중화항체검사에서 각각 32명과 25명이 항체 양성이었다. SARS-CoV-2 항체의 전체 수도권 조유병률은 0.51%였습니다. 인구의 연령보정 전체 유병률은 0.47%였으며, 성별로는 여성에서 0.55%, 남성에서 0.38%였습니다. 지역별 추정치는 경기도와 서울이 각각 0.67%와 0.30%였고, 인천에서는 양성사례가 발견되지 않았습니다. 한국의 미발견 사례 비율은 누적 확진율의 3배에 달하지만, 여전히 1% 미만으로 낮습니다. 철저한 추적과 광범위한 선제적 검사를 통한 감염 관리 전략이 지역사회에서 바이러스 확산을 억제하는 데 효과적이었던 것으로 보입니다.

Key Message
Around February 2021, the SARS-CoV-2 antibody test was conducted on the residual serum of adults (≥19 years) collected from primary and secondary medical institutions in the metropolitan area in South Korea. The estimated overall prevalence was 0.60% in the electrochemiluminescence immunoassay (ECLIA) detecting IgG against the nucleocapsid protein and 0.47% for the neutralization antibody. The positivity of the confirmed test using surrogate neutralizing antibodies was only 78% of the ECLIA’s results. For prevention and control measures against the spread of SARS-CoV-2 infections and new variants emerge, serosurvey targeting community-dwelling people is needed to understand the changing status in the community.

COVID-19: Original Article

Inequitable distribution of excess mortality during the COVID-19 pandemic in Korea, 2020: Jin-Hwan Kim, Saerom Kim, Eunhye Park, Chang-yup Kim; Epidemiol Health. 2022;44:e2022081. Published online September 26, 2022; DOI: https://doi.org/10.4178/epih.e2022081

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
This study analyzed inequities in excess mortality according to region and socioeconomic position to explain the distribution of excess mortality in Korea in 2020.
METHODS
We acquired weekly all-cause mortality data from January 2015 to December 2020 from (1) the National Health Insurance Database and (2) Vital Statistics. Excess mortality for 2020 was calculated by comparing the weekly observed and expected deaths from the same period (2015-2019) using quasi-Poisson regression.
RESULTS
An inequitable distribution of excess mortality was identified. The estimated excess mortality in Korea was -29,112 (95% confidence interval, -29,832 to -28,391), corresponding to -55 per 100,000, and the ratio of observed deaths to expected deaths was 0.91. Negative excess mortality was observed except for females in the 0-14 age group. Male Medical Aid beneficiaries showed positive excess mortality, while non-disabled and disabled groups showed similar negative values. When the standardized mortality ratio was calculated for the top 10 causes of death, deaths from Alzheimer’s disease and septicemia increased, whereas those from diabetes mellitus and cerebrovascular disease decreased. The decrease in mortality was primarily concentrated in older adults, while the mortality of young females increased due to increased intentional self-harm.
CONCLUSIONS
This study adds essential evidence regarding the overall performance of Korea. The observed inequalities according to various socioeconomic variables indicate that the results of strict measures to control coronavirus disease 2019 were not distributed equitably. Efforts should be made to properly evaluate the current and future problems related to the pandemic.; Summary

Korean summary

Key Message

COVID-19: Original Article

Awareness of and practice toward cancer prevention recommendations: results of the Korean National Cancer Prevention Awareness and Practice Survey in 2021: Jin-Kyoung Oh, Eunjung Park, Byungmi Kim, Yoon-Jung Choi, E Hwa Yun, Min Kyung Lim, Jeong-Soo Im, Eun Young Park; Epidemiol Health. 2022;44:e2022068. Published online August 26, 2022; DOI: https://doi.org/10.4178/epih.e2022068

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study reports data regarding the awareness and practice of cancer prevention among Koreans in 2021 and behavioral changes during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS
We collected Cancer Prevention Awareness and Practice Survey data through face-to-face interview surveys using a structured questionnaire completed by 4,000 randomly selected men and women aged between 20 years and 74 years in 17 provinces. We examined the awareness and practice of 10 cancer prevention recommendations and evaluated their associations with potential risk factors through multiple logistic regression analysis adjusted for age, gender, residence, marital status, education, and income.
RESULTS
Eighty percent of participants knew that cancer is preventable, while 45% practiced cancer prevention. Cancer prevention practice tended to be more common among older participants (adjusted odds ratio [aOR], 1.39 per 10-year increment; 95% confidence interval [CI], 1.29 to 1.49) and less common among rural inhabitants (aOR, 0.66; 95% CI, 0.51 to 0.86) than among urban residents and among single people (aOR, 0.55; 95% CI, 0.45 to 0.66) than among married people. Practices were the highest for avoiding burned or charred foods (87.6%) and lowest for vaccination against human papillomavirus (14.5%). Refusal to follow recommendations was most common for avoiding alcohol consumption (7.9%). The most difficult recommendations to follow were (1) regular exercise (57.7%); (2) maintaining a healthy body weight (46.1%); and (3) avoiding alcohol (40.1%). The most significant COVID-19-related changes were less exercise (32.5%) and increased body weight (25.6%).
CONCLUSIONS
The awareness of cancer prevention was high, but the practice was low. Recommendations targeting awareness and practice need to be further promoted.; Summary

Korean summary
2021년 국민 암예방 인식 및 실천행태 조사에 따르면, 국민의 80%는 암이 예방 가능하다는 사실을 알고 있으나, 45%만이 암예방을 위한 건강생활을 실천하고 있음. 암예방수칙 중 가장 지키기 어려운 항목으로는 ‘운동하기’(57.7%)를 꼽았고, 그 다음으로 ‘건강체중 유지하기’(46.1%)와 ‘소량음주도 피하기’(40.1%)순으로 나타났음. 코로나19 유행으로 인한 가장 흔한 변화는 운동 감소(32.5%)와 체중 증가(25.6%)로 나타났음.

Key Message
According to the data collected from the Cancer Prevention Awareness and Practice Survey in 2021, 80% of participants knew that cancer is preventable, while 45% practiced cancer prevention. The most difficult recommendations to follow were (1) regular exercise (57.7%); (2) maintaining a healthy body weight (46.1%); and (3) avoiding alcohol (40.1%). The most significant COVID-19-related changes were less exercise (32.5%) and increased body weight (25.6%).

COVID-19: Epidemiologic Investigation

Analysis of the on-ship transmission of the COVID-19 mass outbreak on the Republic of Korea Navy amphibious warfare ship: Soo Hyeon Cho, Young-Man Kim, Gyeongyong Seong, Sunkyun Park, Seoncheol Park, Sang-Eun Lee, Young Joon Park; Epidemiol Health. 2022;44:e2022065. Published online August 11, 2022; DOI: https://doi.org/10.4178/epih.e2022065

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This investigation was conducted to determine the size and pattern, source, and transmission route of the coronavirus disease 2019 (COVID-19) outbreak on the Republic of Korea Navy (ROKN) amphibious warfare ship.
METHODS
We investigated the characteristics of all crew members and tracked the medical records of the confirmed cases. Fourteen essential ship operation personnel were interviewed. The study design was a retrospective cohort study, and the incidence rate ratio was through a statistical program.
RESULTS
The COVID-19 incidence on the ROKN amphibious warfare ship was 44.7% (38/85). It was estimated that the main propagation route started from the 1st floor worker, which spread to the same floor, and then to other floors. In the case of the working area, the incidence rate of crew members below the 1st floor without ventilation was higher than those on the 2nd or higher floors with natural ventilation.
CONCLUSIONS
This case is the first case of a COVID-19 outbreak on the ROKN amphibious warfare ship, and it is estimated that the incidence rate is high because of the closed and dense environment. To prevent the spread of various respiratory diseases including COVID-19, unified mitigation such as vaccination, observing personal quarantine rules, periodic ventilation, preemptive testing, and blocking transmission through prompt contact management is necessary.; Summary

Korean summary
본 조사는 국내 첫 해군 상륙함 내 코로나19 집단발생의 규모 및 양상, 감염원과 전파경로를 규명하기 위해 수행되었다. 해군 상륙함에서의 발생률은 44.7%였으며 자연 환기가 가능한 2층 이상 근무자에 비해 환기가 불가능한 1층 이하 근무자의 발생률이 높았고 이는 통계적으로 유의했다. 밀폐된 환경에서 밀접한 생활을 하는 해군 상륙함의 특성을 고려하여 개인방역수칙 준수, 주기적 환기, 선제적 검사, 신속한 접촉자 관리 등을 통한 전파 차단이 필요할 것으로 판단된다.

Key Message
This investigation was conducted to determine the size and pattern of the outbreak of the COVID-19 infection, the source of infection and the transmission route on the ROK Navy Amphibious Warfare ship. The incidence on ROKN Amphibious Warfare ship was 44.7% (38/85) and the incidence rate of crew members below the first floor without ventilation was higher than those on the second floor or higher with natural ventilation. To prevent various respiratory diseases including COVID-19, unified mitigation such as vaccination, observing personal quarantine rules, periodic ventilation, preemptive testing, and blocking transmission through prompt contact management is necessary.

COVID-19: Original Article

Physical and mental health characteristics related to trust in and intention to receive COVID-19 vaccination: results from a Korean community-based longitudinal study: Ye Jin Jeon, Youngrong Lee, Ji Su Yang, Young Su Park, Sun Jae Jung; Epidemiol Health. 2022;44:e2022064. Published online August 3, 2022; DOI: https://doi.org/10.4178/epih.e2022064

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The aim of this study was to explore factors affecting attitudes toward coronavirus disease 2019 (COVID-19) vaccination, including socio-demographic characteristics and mental health status during the pandemic.
METHODS
This study analyzed responses from 1,768 participants who were originally included in a community cohort study and responded to 3 online surveys related to COVID-19 (March 2020 to March 2021). The k-means method was used to cluster trust in and intention to receive COVID-19 vaccination. Baseline (2013-2018) socio-demographic characteristics, physical health status, and depressive symptoms were analyzed as exposure variables, and current mental health status was included in the analyses.
RESULTS
Almost half of all participants were classified into the moderate trust and high intention cluster (n=838, 47.4%); those with high trust and high intention accounted only for 16.9%. They tended to be older, had high-income levels, and engaged in regular physical activity at baseline (p<0.05), and their sleep quality and psychological resilience were relatively high compared to other groups.
CONCLUSIONS
Our results suggest that more efforts are required to enhance the perceived need for and trust in COVID-19 vaccination.; Summary

Korean summary
•본 연구는 코로나19 관련 온라인, 모바일 설문조사에 응답한 1,768명을 대상으로 코로나19 유행 동안의 정신건강 상태와 백신 접종에 대한 태도 (백신에 대한 믿음, 백신에 대한 접종 의사) 사이의 관련성을 파악하고자 하였다. •연구결과 우울, 불안, 외로움, 회복탄력성 등과 같은 정신건강 상태가 나쁜 사람은 백신에 대한 접종 의사가 높을 오즈가 그렇지 않은 사람에 비해 높았으며, 이는 통계적으로 유의하였다.

Key Message
In this community-based study including 1,768 participants who responded online survey related to COVID-19, we investigate the relationship between mental health during the pandemic and attitude toward COVID-19 vaccine (trust and intention). Each of the mental symptoms, including depression, anxiety, and loneliness, was significantly associated with higher intention to COVID-19 vaccine. Our results suggest that more efforts are required to enhance the perceived need for and trust in COVID-19 vaccination.

COVID-19: Original Article

Predictors of COVID-19 booster vaccine hesitancy among fully vaccinated adults in Korea: a nationwide cross-sectional survey: Yunha Noh, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Sang-Won Lee, Ju-Young Shin; Epidemiol Health. 2022;44:e2022061. Published online July 22, 2022; DOI: https://doi.org/10.4178/epih.e2022061

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored predictors of coronavirus disease 2019 (COVID-19) booster hesitancy among fully vaccinated young adults and parental COVID-19 vaccine hesitancy for their children.

METHODS

This cross-sectional study administered an online survey from December 2 to December 20, 2021. We enrolled participants aged 18-49 years, for whom ≥2 weeks had passed after their initial COVID-19 vaccination. We estimated odds ratios (ORs) with 95% confidence intervals (CIs) using multivariate logistic regression to evaluate factors associated with booster/vaccine hesitancy.

RESULTS

Among the 2,993 participants, 48.8% showed hesitancy (wait and see: 40.2%; definitely not: 8.7%). Booster hesitancy was more common among women (OR, 1.25; 95% CI, 1.05 to 1.50), younger people (OR, 1.44; 95% CI, 1.17 to 1.77), those with a lower education level (OR, 2.05; 95% CI, 1.10 to 3.82), those who received the mRNA-1273 vaccine type (OR, 2.01; 95% CI, 1.65 to 2.45), and those who experienced serious adverse events following previous COVID-19 vaccination (OR, 2.03; 95% CI, 1.47 to 2.80). The main reasons for booster hesitancy were concerns about safety (54.1%) and doubts about efficacy (29.8%). Among the 1,020 respondents with children aged <18 years, 65.8% were hesitant to vaccinate their children against COVID-19; hesitancy was associated with younger parental age, education level, the type of vaccine the parent received, and a history of COVID-19 infection.

CONCLUSIONS

Concerns about the efficacy and safety of COVID-19 vaccines were the major barrier to booster acceptance. The initial COVID-19 vaccine type (mRNA-1273), young age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.

Summary

Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 3차접종 의향과 그들의 18세 미만 자녀에 대한 코로나19 기초접종 의향을 조사하고, 코로나19 백신접종 기피와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 코로나19 3차접종 기피율은 약 48.8%로 나타났으며, 접종 기피 관련 영향요인으로는 젊은 연령층, 여성, 낮은 교육수준, 기초접종 백신 종류, 기초접종 후 중증 이상반응 경험이 포함되었으며, 18세 미만 자녀에 대한 코로나19 기초접종 기피율은 65.8%로, 관련 영향요인으로는 젊은 부모 연령, 교육수준, 부모의 기초접종 백신 종류, 코로나19 감염 과거력이 포함되었다.

Key Message
Concerns about the safety and efficacy of COVID-19 vaccines were the major barrier to booster acceptance; the initial COVID-19 vaccine type (mRNA-1273), younger age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.

Citations

Citations to this article as recorded by

Why Some People Are Hesitant to Receive COVID-19 Boosters: A Systematic Review
Yam B. Limbu, Bruce A. Huhmann
Tropical Medicine and Infectious Disease.2023; 8(3): 159. CrossRef
COVID-19 Vaccine Booster Hesitancy in Malaysia: A Web-Based Cross-Sectional Study
Kai Wei Lee, Sook Fan Yap, Hooi Tin Ong, Myo Oo, Kye Mon Min Swe
Vaccines.2023; 11(3): 638. CrossRef

COVID-19: Original Article

Maternal vaccine hesitancy towards COVID-19 immunisation of children in Qatar: a population-based cross-sectional study: Shuja Reagu, Suruchi Mohan, Johnny Awwad, Majid Alabdulla; Epidemiol Health. 2022;44:e2022056. Published online July 6, 2022; DOI: https://doi.org/10.4178/epih.e2022056

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Abstract PDF: Abstract
OBJECTIVES
This study was conducted in Qatar to explore beliefs and attitudes among mothers towards coronavirus disease 2019 (COVID-19) vaccination for their children and to understand major factors influencing vaccine hesitancy among these mothers.
METHODS
A population-based, online cross-sectional survey was conducted between 15 October and 15 November 2020. A composite questionnaire incorporating a validated vaccine hesitancy tool was developed and administered in both English and Arabic. Approval was obtained from the local ethics committee. Participation was voluntary and offered to all adult residents of Qatar through an online link available on social media platforms and local news portals. Only adult respondents who self-identified as mothers were included in the present study. No personal identifying data were collected.
RESULTS
Of the mothers surveyed, 29.4% exhibited COVID-19 vaccine hesitancy regarding their children. This exceeded these mothers’ rate of personal vaccine hesitancy (27.5%). Hesitancy rates varied significantly with ethnicity, with the highest among Qatari mothers (51.3%). Intention to vaccinate children did not differ significantly between mothers who accepted the vaccine for themselves and those who did not. Overall, the main reported concerns related to long-term vaccine safety. To a significant extent, mothers relied most on self-directed research on vaccine safety for decision-making.
CONCLUSIONS
The rate of maternal COVID-19 vaccine hesitancy exceeded both those mothers’ rate of personal vaccine hesitancy and the hesitancy rate in the general population. The intention to vaccinate children was independent of maternal vaccination history. Factors influencing maternal vaccine hesitancy differ from those influencing personal hesitancy and require an informed public health response.; Summary

Korean summary

Key Message

COVID-19: Original Article

The impact of COVID-19 on screening for colorectal, gastric, breast, and cervical cancer in Korea: Hyeree Park, Seung Hee Seo, Jong Heon Park, Shin Hye Yoo, Bhumsuk Keam, Aesun Shin; Epidemiol Health. 2022;44:e2022053. Published online June 21, 2022; DOI: https://doi.org/10.4178/epih.e2022053

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The coronavirus disease 2019 (COVID-19) pandemic has affected the utilization of healthcare services, including participation in cancer screening programs. We compared cancer screening participation rates for colorectal, gastric, breast, and cervical cancers among participants in the National Cancer Screening Program (NCSP) in 2019 and 2020 to address the potential distraction effect of COVID-19 on cancer screening.

METHODS

Data from the NCSP for 4 cancer types (stomach, colorectal, breast, and cervical) in 2019 and 2020 were used to calculate cancer screening participation rates by calendar month, gender, age group, and geographical region. Monthly participation rates were analyzed per 1,000 eligible individuals.

RESULTS

The screening participation rate decreased in 2020 compared to 2019 for all 4 cancers: colorectal (40.5 vs. 35.3%), gastric (61.9 vs. 54.6%), breast (63.8 vs. 55.8%), and cervical (57.8 vs. 52.2%) cancers. Following 2 major COVID-19 waves in March and December 2020, the participation rates in the 4 types of cancer screening dropped compared with those in 2019. The highest decline was observed in the elderly population aged 80 years and older (percentage change: -21% for colorectal cancer; -20% for gastric cancer; -26% for breast cancer; -20% for cervical cancer).

CONCLUSIONS

After the 2 major COVID-19 waves, the screening participation rate for 4 types of cancer declined compared with 2019. Further studies are needed to identify the indirect effects of the COVID-19 pandemic on cancer patients, such as delayed diagnoses of cancer or excess cancer deaths.

Summary

Korean summary
본 연구는 코로나 대유행 기간 전과 후 대장암, 위암, 유방암, 자궁경부암 검진 수검률 차이를 비교하고자 하였다. 첫 코로나 확진자가 발생한 2020년을 코로나 대유행 기간, 전년도 기간인 2019년을 코로나 대유행 전 기간으로 설정하며 국민건강보험공단에서 집계된 전수자료를 이용하여 암 검진 대상자 수와 수검자 수를 비교 분석하였다. 4개 암종 모두에서 2019년도와 비교하여 2020년도에 전국적으로 수검률이 감소하는 경향이 있었으며, 1차 대유행이 있었던 3월과 3차 대유행 시기인 12월에 2019년도 동기간과 비교하여 수검률이 크게 감소하였고, 80대 이상 노인 인구에서 감소폭이 다른 연령대와 비교하여 크게 나타났다.

Key Message
We found decline of the colorectal, gastric, breast and cervical cancer screening participation rates in 2020 following the two major COVID-19 waves, compared with those of 2019, and the highest decline was observed in the elderly population aged 80 years and older.

Citations

Citations to this article as recorded by

Analysis of the current situation and related influencing factors of cervical precancer screening under the COVID-19
Xiaohong Song, Yongbin Yang
Biotechnology and Genetic Engineering Reviews.2023; : 1. CrossRef
Willingness to Undergo Gastroscopy for Early Gastric Cancer Screening and Its Associated Factors During the COVID-19 Pandemic – A Nationwide Cross-Sectional Study in China
Kejia Ma, Xuejie Chen, Xin Xiang, Xueyi Mao, Ningxin Zhu, Tianyu Wang, Shuyu Ye, Xiaoyan Wang, Minzi Deng
Patient Preference and Adherence.2023; Volume 17: 505. CrossRef
Impact of the COVID-19 Pandemic on Gastric Cancer Screening in South Korea: Results From the Korean National Cancer Screening Survey (2017–2021)
Kyeongmin Lee, Mina Suh, Jae Kwan Jun, Kui Son Choi
Journal of Gastric Cancer.2022; 22(4): 297. CrossRef
Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis
Xiaoyan Wang, Yimeng Sun, Pei Wang, Yu Jie, Guodong Liu, Dandan Gong, Yu Fan
Frontiers in Oncology.2022;[Epub] CrossRef

COVID-19: Original Article

Changes in cancer screening before and during COVID‐19: findings from the Korean National Cancer Screening Survey 2019 and 2020: Thao Thi Kim Trinh, Yun Yeong Lee, Mina Suh, Jae Kwan Jun, Kui Son Choi; Epidemiol Health. 2022;44:e2022051. Published online May 30, 2022; DOI: https://doi.org/10.4178/epih.e2022051

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The coronavirus disease 2019 (COVID-19) pandemic has negatively affected every aspect of medical care. However, information regarding the impact of the pandemic on cancer screening is lacking. This study aimed to explore cancer screening changes by geographic region before and during the pandemic in Korea.
METHODS
Korean National Cancer Screening Survey data for 2019 and 2020 were used. Changes in the screening rate before and during the COVID-19 pandemic were calculated by subtracting the rate in 2020 from the rate in 2019. Multivariate logistic regression analyses examined the differences in screening rates at the national and 16 provincial levels before and after the COVID-19 outbreak.
RESULTS
The 1-year screening rates for the four types of cancer decreased during the pandemic (stomach cancer: -5.1, colorectal cancer: -3.8, breast cancer: -2.5, cervical cancer: -1.5%p). In metropolitan areas, the odds of undergoing screening tests during the pandemic were significantly lower than before the pandemic for stomach (adjusted odds ratio [aOR], 0.66; 95% confidence interval [CI], 0.56 to 0.76), colorectal (aOR, 0.63; 95% CI, 0.50 to 0.79), and breast cancers (aOR, 0.75; 95% CI, 0.60 to 0.94). Furthermore, the likelihood of undergoing stomach cancer screening during the pandemic was significantly lower than before the pandemic in non-metropolitan urban areas (aOR, 0.81; 95% CI, 0.70 to 0.94), while it was higher in rural areas (aOR, 1.54; 95% CI, 1.10 to 2.16).
CONCLUSIONS
Since the COVID-19 pandemic, the cancer screening rate has decreased significantly, especially in large cities. Public health efforts are required to improve cancer screening rates.; Summary

Korean summary
• 코로나 대유행 이전과 이후의 최근 1년간 암검진 수검률을 비교한 결과, 위암 (5% 포인트), 대장암 (3.8% 포인트), 유방암 (2.5% 포인트), 자궁경부암 (1.5% 포인트) 수검률이 통계적으로 유의하게 감소하였음 • 특히 위암, 대장암, 유방암의 경우 대도시 지역에서의 수검률이 현저하게 감소하였음

Key Message
The 1-year screening rates for stomach, colorectal, breast, and cervical cancer decreased significantly during the pandemic in Korea, especially in large cities.

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