Middle-aged Korean Research Articles

Arthritis status changes and depressive symptoms among middle-aged and older Koreans: Analysis of data from the Korean Longitudinal Study of Aging survey

ObjectiveArthritis can negatively affect physical and mental health, especially among middle-aged and older people. This study investigated the longitudinal association between changes in arthritis status and depressive symptoms among Korean adults aged ≥45 years. MethodsWe analyzed data from the Korean Longitudinal Study of Aging 2008–2018, using a generalized estimating equation model to investigate associations between arthritis status change and depressive symptoms, which were assessed using five categories according to measurements based on the Center for Epidemiological Studies Depression Scale (CES-D-10). ResultsBoth men and women whose arthritis status changed to “worse” or remained “same” scored higher for depressive symptoms than those who reported “no symptoms of arthritis” (men, worse = β: 1.07, P ≤ .001, same = β: 0.25 P = .031; women, worse = β: 0.99, P ≤ .001, same = β: 0.13, P = .049). Conversely, men with a “better” arthritis status (β: -0.71, P ≤ .001) and women with a “recovered” arthritis status (β: -0.56, P = .031) scored lower for depressive symptoms than those who reported “no symptoms of arthritis.” ConclusionsArthritis status changes are associated with depressive symptoms in middle-aged and older Koreans. Therefore, mental health evaluation and management interventions are recommended for patients with arthritis and changes in disease status.

Dietary Acid Load Is Positively Associated with the Incidence of Hyperuricemia in Middle-Aged and Older Korean Adults: Findings from the Korean Genome and Epidemiology Study.

Hyperuricemia has been associated with a number of chronic diseases, such as type 2 diabetes mellitus, hypertension, and cardiovascular diseases. Dietary acid load plays a key role in regulating uric acid levels. We hypothesized that potential renal acid load (PRAL) and net endogenous acid production (NEAP) score would be positively associated with the incidence of hyperuricemia. Data from the Health Examinees study, a part of the Korean Genome and Epidemiology Study were used. The PRAL and NEAP scores were calculated to evaluate the dietary acid load. Hyperuricemia was defined as follows: >7.0 mg/dL and >6.0 mg/dL of serum uric acid levels in men and women, respectively. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of hyperuricemia. We identified 2500 new cases of hyperuricemia during a mean follow-up of 5.0 years (223,552 person years). The participants in the highest quartiles of the PRAL and NEAP score had 21% (HR: 1.21, 95% CI: 1.07–1.35, p for trend <0.0001) and 17% (HR: 1.17, 95% CI: 1.04–1.31, p for trend <0.0001) higher risks for hyperuricemia, respectively, than those in the lowest quartiles, after adjusting for covariates. In this prospective cohort study, a higher dietary acid load was positively associated with a higher incidence of hyperuricemia in Korean adults. This suggests that an alkaline diet may be an effective strategy to reduce the future risk of elevated uric acid levels.

Association between subjective cognitive decline and falls in middle-aged adults

Falling experiences and the fear of falling in relation to subjective cognitive decline (SCD) was examined in middle-aged Koreans. A nationwide cross-sectional study was conducted using data from the 2019 Korea Community Health Survey. The final analysis included 92,323 individuals aged 40–64 years who had available data on SCD and falls. A multivariate regression model was applied to examine the independent effect of SCD on falls. Approximately 10.7% of participants had experienced a fall in the previous 12 months. Stepwise multivariate regression analysis showed that SCD was independently associated with a falling experience (adjusted odds ratio [95% confidence interval], 1.16 [1.53–1.70]); individuals with SCD were more likely to experience falling (13.9% vs. 9.14%, p < 0.001) and had more fear of falling (2.33% vs. 1.74%, p < 0.001). In conclusion, SCD is independently associated with falls in the middle-aged, which highlight the clinical need to investigate cognitive deficits among this population.

Cigarette Smoking and Risk of Infection-Related Mortality: A Cohort Study.

Cigarette smoking is a leading cause of death worldwide and is associated with various diseases. However, studies addressing its impact on infection-related deaths are limited. This study examined the relationship between smoking and infection-related mortality. A cohort of 583 034 South Korean adults who underwent annual or biennial health examinations were followed up for infection-related deaths using national records. Cox proportional hazards regression assessed hazard ratios (HRs) and 95% confidence intervals (CIs) for infection-related mortality. The median follow-up was 9.1 years (maximum 18 years), and 335 infection-related deaths were identified. Current smoking, but not former smoking, was positively associated with an increased risk of infection-related mortality. After adjusting for possible confounders, the multivariable-adjusted HRs (95% CIs) for infection-related mortality comparing former and current smokers with never smokers were 0.94 (0.68-1.30) and 1.45 (1.05-2.02), respectively; and those for infection-related mortality by number of pack-years comparing 10-19.9 and ≥20 pack-years to <10 pack-years were 1.26 (0.81-1.96) and 1.47 (1.03-2.09), respectively, while those comparing 10-19 and ≥20 cigarettes/day to <10 cigarettes/day were 1.35 (0.86-2.11) and 1.54 (1.13-2.11), respectively (p for trend <.05). Individuals with ≥20 pack-years had a 2.06 times greater risk of infection-related mortality when changes in smoking status and confounders during follow-up were updated in the analysis as time-varying covariates. Current smoking status, intensity, and pack-years were associated with an increased risk of infection-related death, with the highest risk of infection-related mortality found consistently in individuals with ≥20 pack-years. In this large-scale cohort study of relatively young and middle-aged South Korean adults, current smoking, smoking intensity, and pack-years were associated with an increased risk of death due to infections; in particular, a significantly increased risk of infection-related mortality was consistently found in individuals with ≥20 pack-years. When appropriate, infection-related mortality should be included in smoking-attributable mortality burdens, and effective smoking control measures should be considered to improve infection-related mortality.

Usefulness of Relative Handgrip Strength as a Simple Indicator of Cardiovascular Risk in Middle-Aged Koreans

BackgroundReduced muscular strength, measured by handgrip strength, has been associated with increased risk for cardiovascular disease (CVD) and mortality. However, the prognostic significance of handgrip strength has been less well-studied in the middle-aged Korean population. This study determined whether handgrip strength predicted 10-year CVD risk in this population and whether there is a sex-specific difference. MethodsThe data were derived from the 2015 Korean National Health and Nutrition Examination Survey that included total of 2776 participants aged 40–69 years without prior history of CVD (men: 1184; women: 1592). Isometric relative handgrip strength was calculated by dividing absolute handgrip strength by body mass index. Participants were classified into three groups by their 10-year Framingham cardiovascular risk score: low (<10%), intermediate (10–19%), and high (≥20%). ResultsIn men, relative handgrip strength was higher in the absence of hypertension, dyslipidemia, and diabetes compared with in the presence of these CVD risk factors. In women, a higher relative handgrip strength was observed in the absence of hypertension and dyslipidemia but not in the absence of diabetes compared with their counterparts. Advanced age was inversely associated with relative handgrip strength for both sexes. Multivariate logistic regression analysis demonstrated that an increased relative handgrip strength was a significant and independent predictor of low 10-year CVD risk among middle-aged women (odds ratio range 0.09–0.49, p < 0.001), but not among men. ConclusionsHandgrip strength is a simple and effective screening tool for risk stratification for CVD in middle-aged Korean women.

Feasibility and Effectiveness of Assessing Subhealth Using a Mobile Health Management App (MibyeongBogam) in Early Middle-Aged Koreans: Randomized Controlled Trial.

BackgroundMobile health (mHealth) is a major source of health management systems. Moreover, the demand for mHealth, which is in need of change due to the COVID-19 pandemic, is increasing worldwide. Accordingly, interest in health care in everyday life and the importance of mHealth are growing.ObjectiveWe developed the MibyeongBogam (MBBG) app that evaluates the user’s subhealth status via a smartphone and provides a health management method based on that user’s subhealth status for use in everyday life. Subhealth is defined as a state in which the capacity to recover to a healthy state is diminished, but without the presence of clinical disease. The objective of this study was to compare the awareness and status of subhealth after the use of the MBBG app between intervention and control groups, and to evaluate the app’s practicality.MethodsThis study was a prospective, open-label, parallel group, randomized controlled trial. The study was conducted at two hospitals in Korea with 150 healthy people in their 30s and 40s, at a 1:1 allocation ratio. Participants visited the hospital three times as follows: preintervention, intermediate visit 6 weeks after the intervention, and final visit 12 weeks after the intervention. Key endpoints were measured at the first visit before the intervention and at 12 weeks after the intervention. The primary outcome was the awareness of subhealth, and the secondary outcomes were subhealth status, health-promoting behaviors, and motivation to engage in healthy behaviors.ResultsThe primary outcome, subhealth awareness, tended to slightly increase for both groups after the uncompensated intervention, but there was no significant difference in the score between the two groups (intervention group: mean 23.69, SD 0.25 vs control group: mean 23.1, SD 0.25; P=.09). In the case of secondary outcomes, only some variables of the subhealth status showed significant differences between the two groups after the intervention, and the intervention group showed an improvement in the total scores of subhealth (P=.03), sleep disturbance (P=.02), depression (P=.003), anger (P=.01), and anxiety symptoms (P=.009) compared with the control group.ConclusionsIn this study, the MBBG app showed potential for improving the health, especially with regard to sleep disturbance and depression, of individuals without particular health problems. However, the effects of the app on subhealth awareness and health-promoting behaviors were not clearly evaluated. Therefore, further studies to assess improvements in health after the use of personalized health management programs provided by the MBBG app are needed. The MBBG app may be useful for members of the general public, who are not diagnosed with a disease but are unable to lead an optimal daily life due to discomfort, to seek strategies that can improve their health.Trial RegistrationClinical Research Information Service KCT0003488; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=14379

Age-Related Difference in Weight Change and All-Cause Mortality in Middle-Aged and Older Korean Populations: Korean Longitudinal Study of Aging.

BackgroundObesity is associated with increased mortality as a significant risk factor for chronic diseases, including cardiovascular diseases and cancer. Several people believe that weight gain is harmful, and weight loss helps maintain health. However, some studies have shown that weight loss, particularly among older adults, is more likely to increase the risk of mortality than weight gain.MethodsWe used data for the cohort of the Korean Longitudinal Study of Aging, which is a nationwide stratified multi-stage sample of adults aged 45 years. The all-cause mortality risk was assessed using the survival status and the number of months of survival calculated from 2006 (baseline year) to 2016. Cox proportional hazard regression were used to study the causal link between weight change and all-cause mortality risk.ResultsThe results showed interactive associations between weight loss and mortality among middle-aged and older adults. The hazard ratio was 1.62 (95% confidence interval [CI], 1.10–2.40) for the participants aged 45–65 years with weight losses greater than 5 kg and 1.56 (95% CI, 1.29–1.89) for those older than 65 years with weight losses greater than 5 kg. The results for the group with weight gain above 5 kg were not significant. Middle-aged and older men showed an increase in all-cause mortality associated with weight loss of more than 5 kg, but only the older women showed significant results.ConclusionThis large-scale cohort study in Korea showed a relationship between weight loss and all-cause mortality in middle-aged and older individuals.

A Study to develop Lifelong education model for middle and elderly adult’s life redesign

The purpose of this study is to develop a model of lifelong education to support life redesign for middle-aged and elderly adults in Korea. The contents of this study are firstly to analyze how middle-aged and elderly Koreans want to spend their second life; second to analyze the contents of support that must be publicly provided for life redesign support for middle-aged and elderly Koreans; and third purpose of this study was to analyze the contents of life redesign support services, support organizations and related experts currently provided for middle-aged and elderly people in Korea. Finally, based on the results of this analysis we tried to present a Lifelong Education Model to support life redesign for middle-aged and elderly Koreans. The method of this study was used the Delphi survey. The Delphi panelists consisted of 30 and conducted the Delphi survey three times. The Delphi survey used a questionnaire developed by the researcher. The research results are as follows. First, middle-aged and elderly adults in Korea hope to live their second life with various orientations such as economic activity, health care, volunteer activity, social participation activity, leisure, hobbies and travel. Second, in Korea, there are institutions, actors and experts who provide various services such as life redesign support and counseling, employment startup education and employment startup support, volunteer education and volunteer support for middle-aged and elderly people. Third, the contents of support from the state and local government for life redesign of middle-aged and elderly in Korea according to the types of life types lifelong education programs, organizations operating lifelong education programs, organizations supporting employment and start-ups and national policies to be implemented were derived. Based on the above results, a lifelong education model to support lifelong redesign for middle-aged and elderly adults was derived. In the future, support for lifelong redesign and lifelong education for middle-aged and elderly people at the national level establishment of a dedicated institution, training and deployment of expert, provision of customized lifelong education programs to meet the diverse needs of middle-aged and elderly people and related services are integrated will have to be provided.

Determinants of Intention Toward Dementia-Preventive Behaviors Among Middle-Aged Korean Adults.

This study aims to determine the influence of the constructs of the health belief model and fear of dementia on the behavioral intention to prevent middle-aged Korean adults' dementia. Applying a descriptive design, 163 middle-aged adults were recruited. Structured questionnaires were used to collect data regarding fear of dementia, behavioral intention to prevent dementia, the expanded health belief model's variables (i.e., perceived susceptibility, perceived severity, perceived benefit, perceived barrier, cues to action, general health motivation, and self-efficacy), and other general characteristics between August and September 2019. The determinants of the behavioral intention for dementia prevention were identified through hierarchical regression analysis. The significant factors influencing the behavioral intention for dementia prevention were general health motivation and self-efficacy, accounting for 34.2% of the variance. The results revealed key factors that should be considered in future interventions to enhance adherence concerning dementia-preventive behaviors.

Obesogenic Environments in the Middle-Aged Korean Men: Based on 2020 KDRIs

ObjectivesAccording to 2019 KNHANES, the obesity prevalence of Korean adults was 33.8% and it has been increased by 2.5% in the past decade. With the highest prevalence of men aged 30–40 years old as 45–46.4%, we aimed to find what environmental variables affect the obesity prevalence in the middle-aged man. MethodsUsing the 7th KNHANES (2016–2018), obesogenic environments, such as nutrients intakes, dietary habits, lifestyle habits/disease, and exercise were collected/analyzed to elucidate the causality of obesity in 907 middle-aged men. Using the nutrient levels of 2015 and 2020 Korean Dietary Reference Intake (KDRIs) recommendation, we figured out what the variables, such as nutrients over/under intakes, lifestyle changes, dietary habits, were involved in obesogenic environments in 30–40 aged men. ResultsIn men aged 30–40 years old, protein (146.2%) and sodium (198%) intakes were increased, however, dietary intakes of Vit A (75%) decreased, although their DRI values were elevated in 2020 KDRIs compared to 2015. Calcium (74.9%) and Vit C (72.5%), phosphate (190.7%), iron (149.7%), thiamine (141.6%), riboflavin (134.0%), and niacin (111.5%) should be fit for middle-aged men as much as each value of 2020 KDRIs recommendation. The rate of breakfast skipping was 48.1% in the thirties and 37.9% in forties, and eating out frequency was highest in 30–40 as 50%. Moreover, the drinking rate was 80.8% in the thirties as 1st, 74.9% in forties as 2nd, and the rate of muscle exercise practice in men aged 30–40 years was lower than fifties, the rate of stress cognition was highest in thirties (38.8%) in the whole lifestyle. ConclusionsIt is easy to neglect health and nutrition management in middle-aged men between 30 and 40 because that age is the most active on economics during life. Based on our results, we recommend the nutritional management or education in the workplace of middle-aged men and personalized diets to prevent chronic diseases in the coming elderly stage. Funding SourcesThis work was supported by the Rural Development Administration of Korea (RDA) grant funded by the Korea government.

The Effects of Lifestyle Interventions on the Health-Promoting Behavior, Type D Personality, Cognitive Function and Body Composition of Low-Income Middle-Aged Korean Women

Low-income middle-aged women (LMW) who are vulnerable have various physical and psychosocial problems. They need lifestyle interventions to actively cope with these risk factors. This study used a randomized control group pretest-posttest design. LMW aged from 40 to 60 years were recruited and randomly assigned to an experimental group (n = 31) and a control group (n = 32). The lifestyle interventions for this study, which were implemented for eight weeks, included nutritional management, physical activity, stress management and cognitive function improvement based on King’s goal attainment theory. The measured outcomes were health-promoting behaviors, Type D personality, cognitive function and body composition. The experimental group scored significantly higher than the control group for health-promoting behaviors (effect size (ES) = 0.68~1.27, p < 0.001~0.014) and cognitive function (ES = 0.79~1.31, p < 0.001~0.005). The negative affectivity (ES = 0.70, p = 0.012) and the prevalence of a Type D personality (x2 = 4.39, p = 0.047) and the systolic blood pressure (ES = 0.65, p = 0.019) decreased significantly in the experimental group compared with the control group. Lifestyle interventions for LMW were effective in improving health-promoting behavior, Type D personality traits and cognitive function.

The association between psychological resilience and cognitive function in longitudinal data: Results from the community follow-up survey

Background: The present study aimed to investigate the association between resilience and cognitive function of middle-aged Koreans in a longitudinal setting. Methods: We utilized the baseline and 5-year follow-up data from the Cardiovascular and Metabolic Diseases Etiology Research Center study. The final number of participants included in the analysis was 397 (108 men, 289 women, mean age 55.4 years) who had valid measurements of both baseline resilience and Mini-Mental State Estimation at follow-up. The resilient people at baseline were operationally defined as the people who had at least one negative experience in the Life Experience Survey without depression, which was defined as a Beck Depressive Inventory-Ⅱ score of 20 or above. Cognitive function was evaluated by the Korean version of the Mini-Mental State Examination in both surveys. A generalized linear model was applied after adjusting for confounders. The association between resilience and cognitive function was further analyzed using stratification by median age and education level. Results: At follow-up, only in men, the resilience group showed a higher MMSE level compared to the reference group (β = 1.3, p = 0.002). Stratified by median age, both the younger group (β = 1.2, SE = 0.5, p = 0.031) and the older group among men (β = 2.1, SE = 0.7, p = 0.0069) showed a positive association between resilience and cognitive functions. However, when stratified by education level, only the low-education group presented the association (β = 1.7, SE = 0.5, p = 0.002). In women, no significant results were found. Limitation: This study had limited number of participants. Conclusion: Resilience at baseline was associated with more well-preserved cognitive function at follow-up in men.

Mediating Effects of Family Stress on the Relationship between Self-Efficacy and Midlife Crisis in Middle-Aged Men

Middle-aged men bridge younger and older generations and are burdened with social roles and responsibilities that increase their risk of poor health. The aim of this study was to investigate whether family stress had a mediating effect on the relationship between self-efficacy and midlife crisis in a sample of 198 middle-aged South Korean men. Mediation analysis was performed according to the Baron and Kenny method and using the Sobel test. This study confirmed that midlife crisis decreased with increased self-efficacy and increased with family stress level. Family stress was also a significant partial mediator of the relationship between self-efficacy and midlife crisis. As family stress influences all members of the family, interventions are required that engage all family members to alleviate stress. Strategies to boost self-efficacy should be utilized, and family support constitutes the best means of coping.

Successful Aging Perception in Middle-Aged Korean Men: A Q Methodology Approach.

The purpose of this study is to identify the types of perception of successful aging in middle-aged men and to analyze and describe the characteristics of each type of successful aging perception of middle-aged men in South Korea. This study uses an exploratory study design, applying the Q methodology, which is a subjective research method. The participants were 25 middle-aged men (40 to 60 years old) living in C, Y, and B cities, which were P-samples that were judged to best reveal the successful aging of middle-aged men. In this study, principal component analysis of the PQ method program was used. The five perception types of successful aging among middle-aged men are Type 1 for the “leisure type”, Type 2 for the “mature type”, Type 3 for the “health-oriented type”, Type 4 for the “patriarchal type”, and Type 5 for the “family-centered type”. The mature type had the highest variance among the five types, and the leisure type was the type that showed the second-highest variance. In nursing practice, nurses need to pay attention to the successful aging perceptions of middle-aged Korean men for their successful aging in the future.

Optimal cutoff values for anthropometric indices of obesity as discriminators of metabolic abnormalities in Korea: results from a Health Examinees study

BackgroundObesity is well known as a risk factor for cardiovascular disease. We aimed to determine the performance of and the optimal cutoff values for obesity indices to discriminate the presence of metabolic abnormalities as a primary risk factor for cardiovascular diseases in a Health Examinees study (HEXA).MethodsThe current study analyzed 134,195 participants with complete anthropometric and laboratory information in a Health Examinees study, consisting of the Korean population aged 40 to 69 years. The presence of metabolic abnormality was defined as having at least one of the following: hypertension, hyperglycemia, or dyslipidemia. The area under the receiver operating characteristic curve (AUC) and 95% confidence intervals (CIs) were calculated for body mass index, waist to hip ratio, waist to height ratio, waist circumference, and conicity index.ResultsThe AUC of metabolic abnormalities was the highest for waist-to-height ratio (AUC [95% CIs], 0.677 [0.672–0.683] among men; 0.691 [0.687–0.694] among women), and the lowest for the C index (0.616 [0.611–0.622] among men; 0.645 [0.641–0.649] among women) among both men and women. The optimal cutoff values were 24.3 kg/m2 for the body mass index, 0.887 for the waist-to-hip ratio, 0.499 for the waist-to-height ratio, 84.4 cm for waist circumference and 1.20 m3/2/kg1/2 for the conicity index among men, and 23.4 kg/m2 for the body mass index, 0.832 for the waist-to-hip ratio, 0.496 for the waist-to-height ratio, 77.0 cm for the waist circumference and 1.18 m3/2/kg1/2 for the conicity index among women.ConclusionThe waist-to-height ratio is the best index to discriminate metabolic abnormalities among middle-aged Koreans. The optimal cutoff of obesity indices is lower than the international guidelines for obesity. It would be appropriate to use the indices for abdominal obesity rather than general obesity and to consider a lower level of body mass index and waist circumference than the current guidelines to determine obesity-related health problems in Koreans.

Relationship between Active Aging and Quality of Life in Middle-Aged and Older Koreans: Analysis of the 2013-2018 KNHANES.

With the increase in the aging population worldwide, social interest in having a vibrant and valuable old age has been increasing with changes in the perspectives on old age. This study aimed to determine the relationship between active aging and health-related quality of life (HRQOL) in middle-aged and older Korean using national data. The subjects were 14,117 adults aged ≥55 years. HRQOL was evaluated using the EuroQol–5 Dimension (EQ-5D) questionnaire, and active aging was defined based on the health factors, participation factors, and security factors. The average EQ-5D score was 91.04 ± 0.143. Hierarchical multiple regression analysis sequentially inputting the health, participation, and security factors showed that health factors had the strongest influence on HRQOL (F = 216.656, p < 0.001). In the final model, which included all variables, activity limit (B = −10.477, p < 0.001) and subjective health status (B = −7.282, p < 0.001) were closely related to the HRQOL. In addition, economic activity, income level, home ownership, private health insurance, and unmet healthcare needs were associated with HRQOL. The R2 of the model was 38.2%. To improve the HRQOL of middle-aged and older people, it is necessary to consider active aging factors. Furthermore, follow-up studies using various indicators reflecting active aging should be conducted.

Objectively Measured Built Environments and Cardiovascular Diseases in Middle-Aged and Older Korean Adults.

This study assesses the association between the objectively measured built environment and cardiovascular diseases (CVDs) in 50,741 adults from the Korean Community Health Survey. The CVD outcomes of hypertension, diabetes, dyslipidemia, stroke, and myocardial infarction (MI) or angina were derived from self-reported histories of physician diagnoses. Using ArcGIS software and Korean government databases, this study measured the built environment variables for the 546 administrative areas of Gyeonggi province. A Bayesian spatial multilevel model was performed independently in two age groups (i.e., 40–59 years or ≥60 years). After adjusting for statistical significant individual- and community-level factors with the spatial associations, living far from public transit was associated with an increase in the odds of MI or angina in middle-aged adults, while living in neighborhoods in which fast-food restaurants were concentrated was associated with a decrease in the odds of hypertension and stroke. For adults 60 or older, living farther from public physical-activity (PA) facilities was associated with a 15% increased odds for dyslipidemia, compared with living in neighborhoods nearer to PA facilities. These findings suggest that creating a built environment that provides more opportunities to engage in PA in everyday life should be considered a strategy to reduce the prevalence of CVD.

Pathways among Frailty, Health Literacy, Acculturation, and Social Support of Middle-Aged and Older Korean Immigrants in the USA.

Culturally and linguistically different immigrants in the U.S. are considered populations with low health literacy in general, thereby having a high risk of negative health outcomes such as frailty. The purpose of this study is to identify the effects of social support and acculturation on the relationship between health literacy and frailty of Korean immigrants in existing models of health literacy. A total of 244 Korean immigrants aged 50 years and older residing in Southern United States (Alabama and Georgia) were recruited. Path analysis was used to examine the pathways among variables, and the indirect effects of health literacy were analyzed. The results revealed that health literacy and social support directly influenced frailty; social support and acculturation were identified to influence health literacy. Health literacy had a partial mediating effect in the relationship between social support and frailty and a complete mediating effect in the relationship between acculturation and frailty. Therefore, to prevent frailty, it is necessary to consider enhancing immigrants’ health literacy by elevating acculturation and social supports.

Risk of Incident Hypertension According to Physical Activity and Temporal Changes in Weight.

Physical activity (PA) and maintenance of a normal weight contribute to the prevention of hypertension but not always concurrently. Our aim was to investigate whether maintaining PA, regardless of weight change, is associated with a reduced risk of developing hypertension. We conducted a cohort study of 195,045 Koreans (mean age, 37.7 years; standard deviation, 7.1 years) who participated in an occupational health screening program from January 2011 to December 2016. PA levels were measured using the validated Korean version of the International Physical Activity Questionnaire Short Form, and participants were classified into 3 categories as inactive, active, and health-enhancing physically active (HEPA). Weight was tracked, and participants were divided into 2 categories: those whose weight change >0 and those whose weight change ≤0. During 616,326.5 person-years, 12,206 participants developed hypertension (19.8 per 1,000 person-years). A higher PA level and greater reduction in body mass index were associated with lower risk for incident hypertension. Hazard ratio (HR) for incident hypertension was lower (0.83; 95% confidence interval, 0.79-0.88) in subjects with active/HEPA at baseline and decreased weight than in those in the inactive and increased weight groups after adjustment for confounding factors. Even in the increased weight group, HR for incident hypertension was 0.85 (0.81-0.90) in subjects whose PA was consistently maintained at active or HEPA levels during follow-up. In this large cohort of young and middle-aged Koreans, maintaining active or HEPA PA levels was associated with reduced risk of developing hypertension regardless of weight change.

The Impacts of the Neighborhood Built Environment on Social Capital for Middle-Aged and Elderly Koreans

The purpose of this study was to investigate the relationship between the neighborhood built environment (NBE) aspects of age-friendly cities and communities (AFCCs) and social capital in the Korean context. We described and compared age differences when analyzing misfits of AFCC NBE and impacts on social capital. We collected the data (N = 1246) from two Korean communities; our multiple and binary logistic regression outcomes show that AFCC NBE aspects such as outdoor spaces, transportation, and housing are significant predictors of different subcategories of social capital. For the older group, the outdoor spaces misfit was significant for all three subcategories of social capital, but transportation and housing misfits were significant for the social trust and reciprocity index scores. For the middle-aged group, the outdoor spaces misfit was significant for social networking and participation, and a transportation misfit was significant for participation and social trust and reciprocity. Fewer misfits or better fits of outdoor spaces and transportation encouraged more networking, participation, social trust, and reciprocity. Dwelling type was important to predict social capital, especially for the older group. The present study confirmed the importance of AFCC NBE in predicting social capital and unique factors in the Korean context.