Complex Samples General Linear Model Research Articles

Evaluation of beverage consumption patterns and oral health in Korean adolescents and young adults

Objectives: This study aimed to investigate the beverage consumption patterns and analyze the relationship between the frequency of beverage consumption and oral health in Korean adolescents and young adults who consumed large amounts of sugar from beverages. Methods: Data from the 8th Korea National Health and Nutrition Examination Survey (2019–2021) were analyzed, and 2,787 individuals aged 12-29 years were selected as the study subjects. A complex sample general linear model was used to assess the associations of subject general characteristics and oral health with the frequency of beverage consumption. Results: Both adolescents and young adults frequently consumed carbonated beverages 2.04 and 2.12 times per week, respectively. The most commonly consumed volume per drink was 200 cc. In both groups, the lower the average number of times teeth were brushed daily, the higher was the frequency of fizzy drink consumption. When teeth were brushed less than once daily, the frequency of carbonated drink consumption was 2.63 in adolescents and 2.22 in young adults. Conclusions: This study highlights the need for oral health education of adolescents and young adults on diet and beverage intake. Additionally, information should be provided on oral diseases associated with beverage consumption, such as dental caries and erosion.

Factors influencing health-related quality of life of children with overweight and obesity in Kuala Lumpur, Malaysia

ABSTRACT Introduction: Overweight and obesity among children may have psychological consequences, with potentially lasting effects on health-related quality of life (HRQOL). The aims of this study were to compare HRQOL across weight status among children and to determine the factors influencing HRQOL among children with overweight and obesity. Methods: This cross-sectional study involved school children aged 9–16 years that were recruited from eight randomly selected primary and secondary schools in Kuala Lumpur. The validated Malay version of Pediatric Quality of Life Inventory (PedsQL) was used to measure HRQOL. Complex sample general linear model was used to determine the significant factors associated with HRQOL among children with overweight and obesity. Results: From 928 students, 41.2% (n = 375) of them had either overweight or obesity. Children with obesity reported lower overall HRQOL, physical functioning, social functioning, and psychosocial health summary, compared to normal weight children. In the final model, children with obesity had significantly lower HRQOL and physical functioning compared to children who were overweight, while those who lived with a single parent reported poorer HRQOL compared to children who lived with both parents. Children with history of being bullied had lower HRQOL and psychosocial health. Whereas those with lower self-esteem reported significantly lower scores in all three domains. Conclusion: Overweight and obesity have negative impacts on HRQOL of children. Among children with overweight and obesity, factors such as degree of obesity, family structure, history of being bullied, and self-esteem were found to be significantly associated with HRQOL. Therefore, assessing and managing HRQOL should be included as a part of the obesity prevention programme.

A nationwide analysis of the spatial patterns and correlates of heart disease and sleep deficiency in the United States

In the United States, heart disease stands as the primary cause of mortality across genders and various racial and ethnic groups. A health-related behavioral factor that could potentially contribute to the regional differences in heart disease is the lack of adequate sleep. We employed hierarchical regression and a complex sample general linear model (CSGLM) statistics to enhance our understanding of the factors influencing heart disease, with a particular emphasis on exploring these factors from a spatial viewpoint. Utilizing the Getis-Ord G* hot-spot analysis, we identified a clustering of contiguous hotspots in the southeast regions for both the death rate associated with heart disease and the prevalence of sleep deficiency, as observed in their geographic distribution. Furthermore, within the hierarchical regression model, a substantial correlation between heart disease and deficient sleep persisted, even after adjusting for confounding factors and addressing multicollinearity. This implies that the mortality risk associated with heart disease tends to rise with an increasing prevalence of deficient sleep (R 2 = 0.548). Within the CSGLM framework, an R 2 value of 0.627 underscored the robust indication that mortality due to heart disease was notably linked to sleep deficiency. This association persisted even after considering complex sample designs and incorporating adjustments for weighting. This geographic relationship has not been previously documented in existing literature. These discoveries suggest a requirement for additional exploration into regional variations in heart disease and sleep deficiency, offering new insights into our comprehension of the origins of heart disease.

Biopsychosocial factors of quality of life among middle-aged adults living alone in South Korea: a secondary data analysis using the 2017 Korea Community Health Survey

BackgroundThis study aimed to investigate quality of life (QoL) in middle-aged adults living alone and identify comprehensive biological, psychological, interpersonal, and contextual factors related to QoL using the dynamic biopsychosocial model. As a secondary analysis, this study used data from the 2017 Korea Community Health Survey conducted by the Korea Disease Control and Prevention Agency.MethodsAmong the total 228,381 respondents, 10,639 middle-aged individuals aged 40–64 years from single-person households (5,036 men and 5,603 women) were included in the analysis. QoL was measured using the EuroQoL-5 Dimension (EQ-5D). The EQ-5D descriptive statistics were provided according to biological, psychological, interpersonal, and contextual factors. Considering the data structure of the multistage stratified cluster sampling method, a complex samples general linear model statistic was used to identify the predictors of QoL.ResultsQoL was lower in those who had undesirable psychological status (e.g., more depressive symptoms, poor subjective health, and higher perceived stress), less engagement in social networking (less frequent contact with friends and less frequent participation in social activities such as religious activities, friendship gathering, and leisure), and lower physical, behavioral, and socioeconomic factors.ConclusionsThis study’s findings indicate that psychological and interpersonal factors should be addressed and prioritized to improve the QoL of middle-aged adults living alone. By providing many opportunities for easily accessible social activities that meet the needs and interests of this demographic, their QoL can be improved through strengthening social support.

Association of mixed polycyclic aromatic hydrocarbons exposure with oxidative stress in Korean adults

Polycyclic aromatic hydrocarbons (PAHs) are widespread pollutants associated with several adverse health effects and PAH-induced oxidative stress has been proposed as a potential mechanism. This study evaluated the associations of single and multiple PAHs exposure with oxidative stress within the Korean adult population, using serum gamma glutamyltransferase (GGT) as an oxidative stress marker. Data from the Second Korean National Environmental Health Survey (2012–2014) were analyzed. For analysis, 5225 individuals were included. PAH exposure was assessed with four urinary PAH metabolites: 1-hydroxyphenanthrene, 1-hydroxypyrene, 2-hydroxyfluorene, and 2-naphthol. After adjusting for age, sex, body mass index, drinking, passive smoking, and current smoking (model 1), as well as the presence of diabetes and hepatobiliary diseases (model 2), complex samples general linear model regression analyses for each metabolite revealed a significant positive association between Ln(1-hydroxyphenanthrene) and Ln(GGT) (model 1: β = 0.040, p < 0.01 and model 2: β = 0.044, p < 0.05). For the complete dataset (n = 4378), a significant positive association was observed between mixture of four urinary PAH metabolites and serum GGT in both the quantile g-computation and the Bayesian kernel machine regression analysis. Our study provides evidence for the association between mixed PAH exposure and oxidative stress.

Determinants of Oral Health-Related Quality of Life in Older People with Diabetes Mellitus: A Secondary Analysis of the 8th Korean Longitudinal Study of Aging (KLoSA) Dataset

Purpose : This study aimed to comprehensively evaluate the factors that influence the oral health-related quality of life (OHRQoL) of older adults with diabetes mellitus (DM) using the 8th Korean Longitudinal Study of Aging (KLoSA) dataset. Methods : This secondary analysis utilized the 8th KLoSA dataset from 2020, with a study sample of 1,144 older adults with DM. Dependent variable: OHRQoL; independent variables categorized into socio-demographic, oral health-related, and health-related characteristics. Complex Samples General Linear Model and Bonferroni correction in IBM SPSS/Win 26.0 were employed for assessing factors influencing OHRQoL. Results : The average OHRQoL was 33.96±0.28 points out of 60. Factors influencing OHRQoL included subjective health status (good: t＝3.00, p＝.003; moderate: t＝4.38, p＜.001), wearing dentures (yes) (t＝ -2.89, p＝.004), having heart disease (t＝-2.50, p＝.013), having arthritis (t＝-2.19, p＝.028), and experiencing depression (t＝-4.28, p＜.001). These factors explained approximately 20% of OHRQoL in older adults with DM. Conclusion : To enhance OHRQoL in older adults with DM, it is crucial to consider psychological factors such as depression in the development of continuous oral health management programs. Additional factors to consider include effective denture management and chronic disease conditions.

Lifestyle and Health Behaviors Associated with Metabolic Syndrome and Cardiovascular Disease.

Background: As the prevalence of cardiovascular disease increases, the socioeconomic burden is expected to increase further. This study aimed to investigate lifestyle and health behaviors related to metabolic syndrome (MetS), myocardial infarction (MI), and stroke prevalence in men and women 50-79 years of age to assess clustering of risk factors. Methods: This study used raw data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES) in 2021. Collected data were analyzed using SPSS 29.0 program. Complex Samples General Linear Model procedure and Complex Samples Logistic Regression procedure were performed. Results: Body mass index of more than 25.0 kg/m2, being a woman, having a middle school education or less, reporting a lower middle economic status, and performing exercise for less than 150 min a week were associated with MetS prevalence. Stress was associated with MI prevalence in men and women. Depression was associated with stroke prevalence in men. Conclusions: This study found that an education on obesity control in men and women is needed to reduce the prevalence of MetS. To reduce the prevalence of MI, stress management is required for men and women. To decrease stroke prevalence, depression management is needed for men.

Relationships of neck circumference and abdominal obesity with insulin resistance considering relative handgrip strength in middle-aged and older individuals

PurposeThis cross-sectional study evaluated how neck circumference (NC) influences the association between abdominal obesity (AO) and insulin resistance (IR) while considering relative handgrip strength (RHGS) in middle-aged and older people. MethodsUsing data from the 2019 Korea National Health and Nutrition Examination Survey for 3804 Korean adults aged 40–80 years, AO (waist circumference [WC] ≥90 cm for men, ≥85 cm for women), large NC (sex-specific highest 5th quintile), weak RHGS (sex-specific 1st quintile of HGS/body mass index), and IR (homeostasis model assessment of IR [HOMA-IR] ≥2.5) were defined. A complex sample general linear model and logistic regression analyses were performed after adjusting for confounding factors. ResultsAs NC increased, the relationship between WC and HOMA-IR increased (p for interaction <0.001). In the group with AO, large NC, or both, the adjusted odds ratio (AOR) for IR increased in the group with weak RHGS than in the group with normal RHGS. In the group with normal NC, the AOR for IR in those with AO (vs. those without AO) was 3.3 (95% confidence interval, 2.6–4.3) even after controlling for RHGS; however, the AOR was 5.3 (95% confidence interval, 2.7–10.4) in the group with large NC. These relationships of WC, NC, and RHGS with IR were comparable across sex and age groups. ConclusionsLarge NC increased the association between AO and IR independent of RHGS and the relationships between large NC and AO and insulin resistance varied according to RHGS.

Association between the Urine Cotinine Level and Blood Pressure in Korean Adults with Secondhand Smoke Exposure: Korea National Health and Nutritional Examination Survey 2016-2018.

Similar to smoking, exposure to secondhand smoke is a risk factor for developing hypertension and cardiovascular diseases; however, there is no standardized method for measuring smoke exposure. Measuring urine cotinine levels is one possible means for determining the degree of exposure to secondhand smoke. This study investigated the association between urinary cotinine levels and blood pressure in Korean adults exposed to secondhand smoke. Data from the Korea National Health and Nutrition Examination Survey conducted between 2016 and 2018 were used. A total of 9,273 participants aged ≥19 years self-reported as current non-smokers, which was cotinine- verified. A complex sample general linear model regression analysis was performed to analyze the association between urine cotinine and blood pressure. A P-value of <0.05 was considered statistically significant. Corrected urine cotinine levels were positively associated with systolic and diastolic blood pressure in female participants (P<0.001 and P=0.040, respectively). Furthermore, a 10-fold increase in the corrected urine cotinine level of those in contact with secondhand smoke was independently associated with 2.085 mm Hg and 0.575 mm Hg increases in systolic and diastolic blood pressure, respectively. However, there was no association between systolic and diastolic blood pressure in male participants (P=0.226 and P=0.256, respectively). Urinary cotinine levels were positively associated with increased blood pressure in females exposed to secondhand smoke. Therefore, urinary cotinine may be used as an indicator to quantify and monitor the effects of blood pressure elevation in females exposed to secondhand smoke.

Spatial variations in the associations of mental distress with sleep insufficiency in the United States: a county-level spatial analysis

ABSTRACT In this research, we conducted hierarchical multiple regression and complex sample general linear model (CSGLM) to expand knowledge on factors contributing to mental distress, particularly from a geographic perspective. Based on the Getis-Ord G* hot-spot analysis, geographic distribution of both FMD and insufficient sleep showed several contiguous hotspots in southeast regions. Moreover, in the hierarchical regression, even after accounting for potential covariates and multicollinearity, a significant association between FMD and insufficient sleep was found, explaining that mental distress increases with increasing insufficient sleep (R 2 = 0.835). In the CSGLM, a R 2 value of 0.782 indicated that the CSGLM procedure provided concrete evidence that FMD was significantly related to sleep insufficiency even after taking complex sample designs and weighting adjustments in the BRFSS into account. This geographic association between FMD and insufficient sleep based on cross-county study has not been reported before in the literature. These findings suggest a need for further investigation on geographic disparity on mental distress and insufficient sleep and have novel implications in our understanding of the etiology of mental distress.

Relationships between Interpersonal Goals and Loneliness in Older Adults: A Cross-Sectional Study.

Loneliness is linked to many physiological and psychological issues and disproportionately affects older adults. Interpersonal goals (compassion and self-image) are essential to interpersonal relationships; however, how they relate to loneliness in older adults is unknown. We investigated the impact of interpersonal goals on loneliness using the Ecosystem-Egosystem Theory of Social Motivation. This study, adopting a descriptive cross-sectional correlational design, used data from the 2016 Health and Retirement Study. Participants (n = 3212) included people aged >65 years (mean age: 75; female: 60.1%). We performed exploratory factor analysis with principal axis factoring and varimax rotation to examine the suitability of compassionate and self-image goals as separate factors. The complex samples general linear model was used to assess the relationship between loneliness and interpersonal goals. Interpersonal goals were significantly negatively associated with loneliness. Respondents with higher compassion and self-image goals reported lower loneliness levels. Our results contribute to understanding how interpersonal goals relate to loneliness in older adults. These initial findings warrant further investigation.

Adolescents' Self-Perceived Weight and Metabolic Syndrome.

Background and Objective: The aim of this study was to assess the relationships of self-perceived weight with having more metabolic syndrome (MetS) components and the MetS score regardless of body mass index (BMI)-based weight category. Methods: Utilizing data from the Korea National Health and Nutrition Examination Survey 2014 to 2019, weight categories according to BMI and self-perception (underweight, normal weight, or overweight), MetS components defined by the International Diabetes Federation for adolescents, the MetS score, and confounding factors were evaluated in 1441 female adolescents and 1646 male adolescents aged 10 to 18 years. A complex samples general linear model and ordinal regression were used to analyze those relationships. Results: The odds of having more MetS components were 1.67 (95% confidence interval, CI: 1.38-2.03) in adolescents who self-perceived as overweight than in those who self-perceived as normal weight after controlling for sociodemographic and health-related factors and BMI-based weight categories. Compared with adolescents who accurately self-perceived as normal weight (reference group), the odds were 1.48 (95% CI: 1.19-1.84) in those with normal weight, but self-perceived as overweight; 2.90 (95% CI: 1.69-4.98) in those who were overweight, but self-perceived as normal weight; and 9.38 (95% CI: 7.52-11.71) in those who accurately self-perceived as overweight. In relation to the MetS score, similar findings were observed. The combined weight categories had significant interactions with sex and age groups (10-12 years vs. 13-18 years) in those relationships. Conclusions: Regardless of actual weight status, adolescents' self-perceived weight may be a crucial consideration when determining whether or not MetS components may be present.

Association between clinical oral health status and perceived oral health in different age groups.

ObjectiveThe perceived oral health refers to the very own perception of a person’s oral health (OH). This study aims to explore the association of perceived oral health status (PSR-OHS) with clinically determined OHS in three age groups: young adults, adults and older adults. This study also aims to identify demographic, socio-economic and/or clinical factors that influence PSR-OHS.MethodsA cross-sectional study was conducted in ten different dental hospitals of Pakistan. The one-way ANOVA test was used to analyze patient’s demographic distribution with PSR-OHS and oral functions. The complex sample general linear model was used to determine association between clinical OH and PSR-OHS. Analyses of each age group were conducted separately.ResultsA total of 1,804 outdoor patients participated in the study, out of which 660 were young adults, 685 adults and 459 were older adults. Overall self-perception of all age groups about their oral health was ‘good’ (mean = 3.71). Female gender and education status were a significant factor in young adults and adults. Family income affected PSR-OHS of only the adult age group. Frequent visit to dental clinic and preventive reason of dental attendance were associated with good PSR-OHS. DMFT score, prosthesis score and periodontal score also affected the PSR-OHS of individuals. Association between PSR-OHS and clinical examination was confirmed by complex general linear model.ConclusionThere are differences in the perceived oral health status of young adults, adults and older adults. The variables, age, education, family income, DMFT score, prosthesis score and periodontal score directly influence the self-perception of individuals.

Factors influencing the health-related quality of life of postmenopausal women with diabetes and osteoporosis: a secondary analysis of the Seventh Korea National Health and Nutrition Examination Survey (2016-2018)

The prevalence of osteoporosis in postmenopausal women is increasing, and diabetes patients have decreased bone density. Their health-related quality of life (HRQoL) is diminished by the resultant physical dysfunction and depression. The purpose of this study was to identify factors influencing HRQoL in postmenopausal women with diabetes and osteoporosis. This was a secondary data analysis of the Seventh Korea Health and Nutrition Examination Survey (2016-2018), which utilized a complex, multistage probability sample design. The participants in the study were 237 women with diabetes and osteoporosis. To evaluate the factors that influenced HRQoL, a complex-samples general linear model was constructed, and the Bonferroni correction was performed. In this sample of women aged 45 to 80 years (mean±standard deviation, 71.12±7.21 years), the average HRQoL score was 0.83±0.18 out of 1.0. Factors influencing HRQoL were age (70s: t=-3.74, p<.001; 80s: t=-3.42, p=.001), walking for exercise more than 5 days a week (t=-2.83, p=.005), cerebrovascular disease (t=-8.33, p<.001), osteoarthritis (t=-2.04, p=.014), hypertension (t=2.03, p=.044), higher perceived stress (t=-2.17, p=.032), poor glycemic control (t=3.40, p=.001), waist circumference (t=-2.76, p=.007), sitting time per day (t=-2.10, p=.038), and a longer postmenopausal period (t=3.09, p=.002). In order to improve the HRQoL of postmenopausal women with osteoporosis and diabetes, it is necessary to implement intervention strategies that enable the effective management of chronic diseases, while preventing the complications of diabetes and minimizing stress through physical activity.

Effects of Different Types of Physical Activity on Health-Related Quality-of-Life in Korean Women with Depressive Disorder.

Depressive disorder is a frequent psychological illness and causes community health problems for many women. It was found that the health-related quality of life (HRQoL) score of many women was altered due to mental and physical problems. Physical activity (PA) might effectively improve the responses of the HRQoL of women with depressive disorder. Therefore, the study aimed to identify the effects of different types of PA (e.g., walking, strength exercise, flexibility exercise) on the responses of the HRQoL of Korean women with depressive disorder. A sample of 1315 Korean women aged 19 or older with a depressive disorder was accumulated. The Korea National Health and Nutrition Examination Survey (KNHANES) and Euro Quality of Life-5 Dimensions (EQ-5D index score) were used. The characteristics of the participants were analyzed by the complex sample in frequency analysis. Furthermore, the complex sample general linear model was used to determine the effects of different types of PA on the HRQoL of Korean women with depressive disorder. In the results, there was a statistically significant difference between the groups who participated for one to two days, who participated for three to four days, and who did not participate in walking at all. In the flexibility exercise, there was a statistically significant difference in the group who participated for three to four days from the group who did not participate at all. However, there was no statistically significant difference in the strength exercise. In conclusion, the walking and flexibility exercises were effective physical activities (PAs) to improve the responses to the HRQoL of Korean women with depressive disorder.

Relationship between Dietary Patterns and Cardiovascular Disease Risk in Korean Older Adults

Objectives: The purpose of this study was to assess the relationship between dietary patterns and the 10-year risk of cardiovascular disease (CVD) in the elderly population in Korea. Methods: Cluster analysis was conducted on the data of 1687 elderly participants (797 men and 890 women) aged ≥65 years from the 2014–2016 Korea National Health and Nutrition Examination Survey (KNHANES), using a 24-h dietary recall survey to assess dietary patterns. Dietary patterns were classified into clusters 1 (typical Korean diet), 2 (high carbohydrate diet), and 3 (healthy diet). The 10-year risk of CVD was calculated based on age, total and HDL-cholesterol levels, systolic blood pressure level, antihypertensive medication use, smoking status, and presence of diabetes. A complex sample general linear model was applied to determine the association between dietary patterns and the 10-year risk of CVD. Results: In total, 275 (33.7%), 141 (17.9%), and 381 (48.3%) men, and 207 (22.6%), 276 (30.9%), and 407(46.6%) women were included in clusters 1, 2, and 3, respectively. The 10-year risk of CVD was lower in men in cluster 3 (healthy diet) than in those in cluster 1 (typical Korean diet) (t = 2.092, p = 0.037). Additionally, the 10-year risk of CVD was lower in men who performed strength training than in those who did not (t = 3.575, p < 0.001). There were no significant differences in women. Conclusions: After adjusting for sociodemographic variables, men who consumed a healthy diet had a lower 10-year risk of CVD than those who consumed a typical Korean diet. When organizing nutrition education programs to improve dietary habits in the elderly, content on diets that consist of various food groups to prevent CVD is required. In particular, it is necessary to develop content that emphasizes the importance of healthy eating habits in men.

Changes in oral health indicators due to implementation of the National Health Insurance Services coverage for first molar dental sealant for children and adolescents in South Korea

BackgroundIn South Korea, dental sealant was included in the National Health Insurance Services (NHIS) coverage for the first molar for ages 6–14 in December 2009. The second molar was included in 2012, and the age of insurance coverage was extended to under 18 in 2013. This study aimed to verify the effectiveness of an NHIS dental sealant coverage policy for children and adolescents by comparing the changes in first molar oral health indicators before and after policy implementation.MethodsThe Korea National Health and Nutrition Examination Survey data were analyzed; the fourth period (2007–2009) provided data for before and the sixth period (2013–2015) provided data for after policy implementation. The proportion of individuals with first-molar sealant, decay-missing-filled first molar permanent teeth, and single crowns in the group aged 11–20 years were calculated. Data were analyzed using chi-square for complex samples and the complex samples general linear model. In addition, complex-sample logistic regression analysis was performed to confirm the association between factors.Results: Compared with non-beneficiaries, among policy beneficiaries, sealant ownership increased by 7.7% (from 27.8 to 35.5, P < 0.001), and the number of permanent teeth with sealant per capita increased by approximately 0.4 to 0.8 (P < 0.001). The proportion of individuals with decay-missing-filled permanent teeth decreased by 9.1% (from 68.4 to 59.3, P < 0.001), and the average decay-missing-filled permanent teeth index per person decreased by approximately 2.0 to 1.5 (P < 0.001). The rate of single-crown holders decreased by 2.7% (from 8.7 to 6.0, P > 0.05), and the average single-crown index decreased by approximately 0.11 to 0.08 per person(P > 0.05). The number of sealants increased with age and household income (P < 0.001). The mother’s education level affected sealant experience (P < 0.05). The caries rate was higher in females and older respondents (P < 0.001).ConclusionsThe sealant covered by NHIS contributed to decreasing dental caries in Korea. However, policies that can reduce oral health inequality should also be considered, and a follow-up study is required for long-term sealant maintenance in Korea.

Dietary Patterns and Associated Factors Among Adolescents in Malaysia: Findings from Adolescent Nutrition Survey 2017.

Balanced diet in the early stages of life plays a role in optimum growth and maintains good health status of adolescents. Dietary habits that are established during adolescence will sustain till adulthood. Therefore, this present study aims to identify the dietary patterns and to determine factors associated with dietary patterns in terms of socio-demographic characteristics, locality of schools, ethnicity, eating habits, self-perceived weight status, and food label reading habit among adolescents in Malaysia. Data from the Adolescent Nutrition Survey (ANS) 2017 was used for the present study. ANS is a population representative school-based cross-sectional study among school-going adolescents from primary four to secondary five from schools in 13 states and three federal territories registered under the Ministry of Education Malaysia. A self-administrated questionnaire was used to collect information on socio-demographic characteristics, locality of schools, ethnicity, eating habits, self-perceived weight status, and food label reading habit. A pre-tested face-to-face food frequency questionnaire (FFQ) was used to collect information on food group intake frequency. Dietary patterns were identified by using exploratory factor analysis and associated factors, using complex sample general linear model (GLM) analysis. All statistical analyses were carried out at 95% confidence interval or p-value < 0.05. The dietary patterns identified are healthy, unhealthy, and alternative proteins. The healthy dietary pattern was significantly associated with the types of school and ethnicity. The unhealthy dietary pattern was significantly associated with the locality of schools, ethnicity, frequency of snacks intake per week, frequency of eating out per week, self-perceived weight status, and food label reading habit. Significant associations were found between alternative proteins dietary pattern and locality of schools, ethnicity, and types of school. This study found that there is a disparity of dietary patterns between different ethnicity, locality of schools, and types of school. We recommend strategies of specifying ethnicity and geographical area to improve dietary patterns of adolescents in Malaysia.

The association of family structure with health behavior, mental health, and perceived academic achievement among adolescents: a 2018 Korean nationally representative survey

BackgroundAdolescence is a period during which physical, social, and mental abilities are rapidly developed, and during this time the family environment plays an important role. Differences in health behaviors, mental health, and academic achievement by family structure may affect future families, income, and employment. The purpose of the study was to investigate the association of family structure with health behaviors, mental health, and academic achievement in Korean adolescents.MethodData from the 2018 Korean Youth Risk Behavior Web-based Survey were analyzed. The study sample was comprised of 59,096 adolescents. Logistic regression, t-tests, and a variance analysis of a complex sample general linear model were used to examine the association of family structure with health behaviors, mental health, and academic achievement. The significance level was set at P < 0.05.ResultsNon-intact families (single-mother families, single-father families, and restructured families) had significantly higher odds of smoking a cigarette, drinking a sip of alcohol, internet use, physical activity, and sexual experience, and mental health issues such as depression, suicidal ideation, perceived stress, and poor perceived health status than intact families (two-parent families). Also, non-intact families were significantly related to low perceived academic achievement compared to intact ones.ConclusionThis study showed that family structure is a significant factor in adolescent health behavior, mental health, and perceived academic achievement. Adolescents who experience a transition in their family structure may be more vulnerable to health risks and exhibit lower academic achievement than those in an intact family.

Mediating effect of sleep satisfaction on the relationship between stress and self-rated health among Korean adolescents: A nationwide cross-sectional study

This study examined the mediating effects of sleep satisfaction on the relationship between stress and self-rated health among adolescents in Korea. This study performed a secondary analysis of cross-sectional data from the 14th Korea Youth Risk Behavior Survey (2018). The participants were 60,040 middle and high school students from 800 schools in Korea aged 12–18, who completed an anonymously self-administered online survey collecting data on stress, sleep satisfaction, and self-rated health, as well as socio-demographic, health-related, and disease-related characteristics. Data were analyzed using complex samples descriptive statistics and general linear model. Mediating effects were analyzed using Baron and Kenny's procedures and the Sobel test with the complex sample general linear model. Associations between stress, sleep satisfaction, and self-rated health were found (p < 0.001). Sleep satisfaction had a significant mediating effect on the relationship between stress and self-rated health (p < 0.001). This was the first study to identify the mediating effect of sleep satisfaction between stress and self-rated health among Korean adolescents. In order to enhance the self-rated health of Korean adolescents, it is necessary to develop a strategy to improve sleep satisfaction.