CREDIBILITY OF ANTI-SMOKING MESSAGES ON THE EFFECTIVENESS OF HEALTH WARNING MESSAGES: THE MEDIATING ROLES OF PERCEIVED HEALTH AND SOCIAL RISKS

Murat Aktan,Paul Chao 글로벌지식마케팅경영학회 2018 Global Marketing Conference Vol.2018 No.07

Introduction There is ample evidence in the medical research literature to show that the harmful effects of smoking are real. As a result, most governmental agencies around the world attempt to discourage smoking among smokers and nonsmokers alike by requiring cigarette companies to print health-warning messages on their product packages as a means to deter smoking. Little, however, is known about the credibility of these cigarette-warning messages perceived by both smokers and non-smokers alike on the effectiveness of these messages. Other studies have also examined socio-psychological factors other than health warning messages such as peer pressure, bad breadth, et al., (Pechmann, et al, 2003) which can also influence consumer desires whether or not to smoke. No study to our knowledge has incorporated this factor other than just health warning messages in the same model to study this phenomenon. Furthermore, most research on this topic has focused on consumers in western industrialized countries, even though the issues related to smoking can be just as severe in developing countries and warrants more research attention. In this research, we propose to study the credibility of cigarette warning messages on the effectiveness of these messages on deterring smoking behavior and the mediating effects of the perceived health and social risks in an integrated structural equation model (SEM) framework in an emerging country- Turkey. The study should provide insights into how these factors may influence smokers and nonsmokers differently and enable public policy makers to institute programs or strategies targeting the two different segments of consumers. Literature Background and Hypotheses Copious research has reported on the efficacy of Health Warning Message (HWM) in the Health Communications and Marketing literature (for reviews see Hammond, 2011; Noar, et al, 2015; 2016). In the USA, current rules only require health warnings be printed with tiny fonts on cigarette packages. The effectiveness of this format to deter smoking has come into serious questions. Other countries including countries in the EU have long required pictorial depiction of health hazards resulting from smoking be printed on cigarette packages that must occupy a substantial portion (50% or more) of the surface area on the cigarette package. The assumption is that “a picture is worth a thousand words”. However, the results are equivocal at best (Sabbane, et al., 2009). The real impact of HWM continues to be a point for debate as there are other tobacco consumption reduction methods such as increased taxes and smoking bans (Ruiter & Kok, 2005) various governments can and have imposed. Previous research has shown that when consumers believe that smoking behavior leads to unhealthy consequences and is unwise and unattractive, they generally would refrain from engaging in this behavior (Azjen & Fishbein, 1980). However, consumers who think that they are invincible and that these health hazards will never affect them but only other people, may have engaged in the process of rationalization and may actually discount the credibility of these claims. If so, the HWM may become less effective (Kees, et al., 2006). We therefore formulate the following hypothesis: H1: Perceived credibility of HWMs increases the effectiveness of HWMs. On the other hand, the extent to which consumers may perceive that cigarette HWMs to be credible can better persuade them about the health and social risks such as yellow teeth, bad breath, bad smell, et al., leading to social rejection associated with smoking (Pechmann, et al., 2003). Hammond’s review article (2011) provided some evidence that size and the presentation format can enhance the believability of HWMs. We should expect then that a greater perceived credibility will lead to better persuasion. Similarly, Kowitt, et al. (2016) also show in their study that the believability of HWMs vary among the adolescents regarding cigar smoking. Again, the assumption is that if they perceive the messages to be more credible, they will be more effective in persuading them about the harmful effects of smoking. We thus formulate the following two hypotheses: H2: Perceived credibility of HWMs increases negative social risk perception of smoking H3: Perceived credibility of HWMs increase negative health risk perception of smoking Past research has revealed that knowledge about the negative consequences of a behavior can lead to behavior change even though this may be contingent upon how difficult it is to quit a behavior such as smoking (Nourjah, et al., 1994). Consumer behavior literature has confirmed that due to various factors, attitude may not correlate with behavior even in the context of smoking (Ruiter &Kok, 2005; Solomon, 2018). Extant literature suggests that HWMs may be more successful in influencing attitude (Cameron & Williams, 2015). This research focuses on the health risk perception’s potential impact on intention to quit smoking rather than the act of actually quitting smoking. Furthermore, as mentioned earlier, other factors such as smoking ban and price increases, et al. may cause smoking behavior change. Hence we present the following hypothesis: H4: Perceived health risks associated with smoking influence the effectiveness of HWMs. Smoking has become less socially acceptable in western industrialized countries in recent years. Many nations and states have now banned smoking in public places such as colleges, restaurants and airports including second hand smokes. This creates a social stigma for many smokers. Smokers, as a result, has to bear greater social risks these days. This may also cause them to develop a negative attitude toward smoking as well as reducing their intention to smoke (Chuang & Huang, 2012). As Turkey is a country whose citizens care more about social acceptance, we postulate the following hypothesis: H5: Perceived social risks of smoking affect the effectiveness of HWMs. As mentioned earlier, the effectiveness of HWMs may vary according to subjects’ responses to such messages. They may discount the message veracity by a process of rationalization or even by the extent to which they may have been addicted to the habit. This is so particularly for smokers who may have engaged in such behavior for a long time. Hence, one should expect these messages to be more persuasive and thus more effective in dissuading non-smokers from starting the habit. Smokers, on the other hand, are likely to remain unconvinced and view these messages as exaggerations and therefore less affected by these messages (Hammond, 2009; Hahn & Renner, 1998; Pechmann & Knight, 2002). Based on this discussion, we postulate that the impacts of HWMs’ credibility on perceived health and social risks, as well as the messages’ effectiveness will vary depending on the smoking status of the subjects. We expect greater impacts for non-smokers. Therefore, we tested the SEM for smokers and the same model for nonsmokers in this study. The model is shown in Figure 1 in the Appendix. MethodologyWe designed a four parts questionnaire to measure the constructs in the model we used in this study. In the first part of the questionnaire, we first presented the 14 HWMs currently required by law in Turkey to be displayed on cigarette packages. Furthermore, each of these messages is to be rotated on the packages. We then used the semantic differential scale items comprising of five bipolar adjectives derived from previous literature (Beltramini, 1988; Renee & Cameron, 2015) to measure the perceived credibility of HWMs: (1) believable- unbelievable, (2) convincing- unconvincing, (3) reasonable- unreasonable, (4) easy to understand- hard to understand, (5) informativeuninformative. In the second part of the questionnaire, we operationalized the effectiveness construct by asking the respondents to indicate the extent to which they perceived these HWMs as effective on a 1 item semantic differential scale: “HWMs motivate me to quit or not quit smoking” for smokers and “HWMs reduce my curiosity and desire to try smoking” for nonsmokers. In the third part of the questionnaire, we measured health and social risks perceptions by using 4 statements. Respondents were asked to indicate their agreement/disagreement with each of the 5- point Likert scales culled from Kim (2006): Smoking makes me “contract various diseases and become addicted (health risks); Smoking makes me look “stupid, filthy (social risks). The last part of the questionnaire asked respondents about their smoking status and demographics including age, gender and the level of education. We collected the data by posting a copy of the questionnaire online on a website dedicated to discussing higher education issues in Turkey (www.akademikpersonel.org). We obtained an effective sample size of 432 after removing those with incomplete answers. Male and female respondents constituted 50 % of the sample each. The largest percentage of respondents was in the age group of 17 to 22 (35 %). Respondents (249) who have achieved the level of a college undergraduate degree or equivalent on education constituted 58 % of the sample. We conducted Chi-sqaure analyses to test significance of demographic differences between the two groups of smokers and nonsmokers. The results revealed no significant differences on age (χ2/3df=4.83; p=0.185), gender (χ2/1df=2.70; p=0.123) and the level of education (χ2/2df= 0.873; p= 0.646) between the smoking and nonsmoking subsamples. ResultsWe used WarpPLS 5.0 to conduct the structural model analyses as this analysis tool does not require the data set to be normally distributed (Kock & Lynn, 2012). We first tested the measurement scales with respect to their convergent and discriminant validities through standardized factor loadings. We conducted an Exploratory Factor Analysis (EFA). We eliminated two items on the credibility scale, which did not reach at least 0.5 on factor loadings for both subsamples. The two remaining items are “believable” and “convincing”. We then evaluated reliabilities of the scales for both subsamples, results for both subsamples showed that both credibility and health risk scales achieved Cronbach’s α scores higher than 0.7. Even though the Cronbach α score for the two items scale to measure social risk only reached a value of 0.6 for each of the subsample, this is considered adequate due to the smaller number of items used (Field, 2013). We assessed the assumptions of PLS-SEM. Variance inflation factors (VIFs) are well below the recommended 3.30. Hence, both vertical and lateral collinearity assumptions were met, thus deemed to be free from the common method bias (Kock & Lynn, 2012). We then evaluated convergent and discriminant validities of the latent construct. Discriminant validity was achieved as the square roots of AVE (average variance extracted) scores were higher than and correlation of the factor with another measure (Fornell & Larcker, 1981). For each subsample, composite reliabilities of all factors were higher than 0.8 and indicators’ loadings higher than 0.5 on the latent constructs. Thus, all scales used in the model achieved convergent validities for each subsample. We then proceeded to test the structural model for each of the subsamples. The results showed that for nonsmokers, the model explained 12% of total variance in the effectiveness of HWMs and for smokers 33%. All path coefficients were significant for nonsmokers except the health risks → HWMs effectiveness (β= 0.05, p= 0.23). Other path coefficients all showed significance as follows: perceived credibility of HWMs → perceived health risks (β= 0.154, p= 0.01), perceived credibility → perceived social risks (β= 0.148, p= 0.014), perceived credibility of HWMs → perceived effectiveness (β= 0.285, p < 0.01) and perceived social risk → perceived effectiveness (β= 0.148, p < 0.014). For the smokers’ subsample, the path coefficient between the perceived health risks and effectiveness was also shown to be non-significant (β= 0.06, p= 0.19). All other path coefficients all showed significance as follows: perceived credibility of HWMs → perceived health risks (β= 0.197, p < 0.01), perceived credibility → perceived social risks (β= 0.247, p< 0.001), perceived credibility of HWMs → perceived effectiveness (β= 0.503, p < 0.001) and perceived social risk → perceived effectiveness (β= 0.213, p < 0.001). These results confirmed H1, H2, H3 and H5 but not H4 for both smokers and nonsmokers. Discussion and Conclusion This study reveals some useful insights about how HWMs on cigarette packages may influence smokers and nonsmokers differently in an emerging country- Turkey, which can be used by public policy makers to formulate effective anti-smoking campaigns to target the two groups. The effect sizes appeared to be greater for smokers than nonsmokers. This suggests that if these HWMs can be crafted to be perceived as more credible, the smokers can be more persuaded to quit smoking than for nonsmokers to start smoking. These results appear to be consistent across the board whether we are considering the direct effect or indirect effects through the mediating variables. This is perhaps somewhat consistent with what we would expect based on our earlier discussions. Smokers may be more resistant to HWMs due to the fact they are already engaged in such behavior and therefore more likely to discount the messages as well as the associated health and social risk perceptions. For nonsmokers, on the other hand, it may not take as much to convince them about the harmful effects of smoking and therefore greater perceived credibility of HWMs may be less critical in persuading them not to start smoking. It is important then when designing such HWMs to consider carefully whether these messages are perceived to be credible. Some of the US cigarette warning messages printed in tiny scripts are ambiguous such as smoking can be harmful to your health clearly can not be expected to be highly credible. Research has also shown that pictorial messages can be more persuasive. However, research has also shown that the results are far from being conclusive (Sabbane, et al., 2009). More research is warranted, especially in emerging countries. It is also interesting to note that social risks perceptions are more persuasive than health risks perceptions. Future communications strategies should place a greater emphasis on this factor and not just on health risks. Limitations and Suggestions for Further Research Although our study is able to provide some useful insights into how perceived credibility of HWMs can influence the effectiveness in deterring smoking among nonsmokers and smokers alike either directly or indirectly through perceived health and social risks, we would like to point out several limitations of this study. First, we collected our data online using a web portal in Turkey that focuses on discussing higher education issues in general and therefore the respondents’ level of education is higher than the general population as well as the age group being younger. Future study should collect data from other age groups and education levels to produce results that are more generalizable. We conducted our study in one emerging country- Turkey. In future studies, more countries should be included. As the results revealed the prominence of social risks over health risks in influencing the effectiveness of anti-smoking campaigns, the issue about how to promote the social wellbeing of not smoking (promotional) versus the health risks aspects of the campaign warrants further research.

미충족의료와 소득의 상호작용이 주관적 건강수준에 미치는 효과: 한국의료패널 2009-2014년도 자료의 분석

박유경,김창엽,황승식 한국보건사회학회 2018 보건과 사회과학 Vol.0 No.47

Unmet healthcare needs index is widely used as an indicator to measure the performance of health care system and inequality of healthcare. It needs to be paid more attention since recent studies report that unmet healthcare needs have a negative effect on health outcome. There are little knowledge and research on how unmet healthcare needs affect health although it is essential for the policy effectiveness. This study explored the relationship between unmet healthcare needs and subjective health status by analyzing the interaction effect of income level, which is an important factor both for healthcare utilization and health. We estimated the modification effect of the income level to the health effects of unmet healthcare needs. The generalized estimation equation (GEE) was applied include 1-year time-lagged effect. A 6-year(from 2009 to 2014) data of Korea Health Panel was analyzed. It has confirmed that unhealthy influence of unmet healthcare needs is more effective in the low-income group than the high-income group. The additive interaction effect size of EQ-VAS was 2.29, and 0.48 in self-rated health. Interaction effects were prominent in the unmet needs experiences due to user's resource shortage. The trend of unhealthy effects of both income and unmet healthcare needs was increasing, but the slope which means the additive interaction effect was gradually decreasing. The presence of additional interactions means that there are other complex influence factors thatare not accounted for by income alone. To address unmet healthcare needs aimed at improving health, other factors besides financial issues for healthcare use should be considered, and efforts should be made to identify pathways and mechanisms between experiencing unmet healthcare needs and health. 미충족의료는 보건의료제도의 성과와 의료이용 불평등을 측정하기 위한 지표로 널리 쓰인다. 특히건강 수준에도 좋지 않은 영향을 미친다는 연구가 발표되면서 더욱 주목해야 할 문제가 되었다. 미충족의료 경험과 건강 수준은 상호관련성이 있음에도 그 기전이 명확하게 밝혀지지 않았고 연구도 부족하다. 이 연구는 의료이용의 미충족과 건강수준에 모두 중요한 요인인 소득의 상호작용 효과를 분석함으로써 미충족의료가 건강에 미치는 복잡한 과정의 일부를 설명하고자 하였다. 2009년도부터2014년도까지 6개년도의 의료패널 자료에 일반화추정방정식(GEE)을 적용한 상호작용 분석으로 미충족의료 경험의 건강 영향에서 소득수준으로 인한 조절 효과의 크기를 추정했다. 연구 결과, 저소득군에서 미충족의료 경험을 할 때 소득과 미충족의료 경험으로 인한 개별 건강 영향의 합보다 더 크게건강이 악화되는 상호작용 효과를 확인했다(EQ-VAS의 덧셈 상호작용 효과: 2.29, 주관적 불건강 응답률의 덧셈 상호작용 효과: 0.48). 상호작용 효과는 이용자의 자원 문제로 발생하는 미충족 경험에서 두드러졌고 연도에 따라 소득과 미충족 경험의 건강 영향은 점차 커지고 있으나 그 증가폭은 조금씩 줄어들었다. 덧셈 상호작용이 있다는 것은 소득이 의료이용과 건강 영향에서 중요한 요인이기는하나 소득만으로는 설명되지 않는 다른 복잡한 영향요인들이 존재함을 의미한다. 건강 향상을 목표로미충족의료 정책을 펴려면 단지 의료이용을 위한 재정적 문제 외에 다른 요인도 고려해야 하며, 미충족의료 경험이 건강에 영향을 주는 경로와 기제를 파악하기 위해 힘써야 할 것이다.

녹지환경 만족도가 노인의 인지기능에 미치는 영향: 신체적 건강과 정신적 건강의 다중매개효과 검증

이성은 한국비즈니스학회 2023 비즈니스융복합연구 Vol.8 No.5

본 연구의 목적은 녹지환경 만족도와 노인의 인지기능의 관계에서 신체적 건강과 정신적 건강의 다중매개 효과를 검증하는 것이다. 통계청의 사회조사(2022년) 자료를 사용하였으며 만 65세 이상 총 9,120명의 노인을 대상으로 분석을 하였다. 분석을 위해 SPSS Process Macro를 활용하여 다중매개분석을 실시하고 부트스트랩 방식으로 매개효과의 유의성을 검증하였다. 분석결과 첫째, 녹지환경에 대한 만족도는 인지기능에 직접적인 정적 영향을 미치는 것으로 나타났다. 즉 녹지환경에 대한 만족도가 높을수록 노인의 인지기능 수준이 높아지는 것으로 나타났다. 둘째, 녹지환경에 대한 만족도는 신체적 건강과 정신적 건강에 유의미한 정적 영향을 미치는 것으로 나타났다. 즉 녹지환경에 대한 만족도가 높을수록 노인의 신체적 건강 수준이 높아지는 것으로 나타났으며, 녹지환경에 대한 만족도가 높을수록 노인의 정신적 건강 수준이 높아지는 것으로 나타났다. 셋째, 신체적 건강과 정신적 건강은 노인의 인지기능에 유의미한 정적 영향을 미치는 것으로 나타났다. 즉 신체적 건강 수준이 높을수록, 그리고 정신적 건강 수준이 높을수록 노인의 인지기능 수준이 높아지는 것으로 나타났다. 넷째, 녹지환경 만족도는 신체적 건강과 정신적 건강을 매개로 인지기능에 유의미한 영향을 미치는 것으로 나타났다. 본 연구의 결과는 노인의 인지기능 건강을 위해서 녹지환경이 적극적으로 활용될 필요가 있으며 녹지환경 조성에 있어 신체적, 정신적 건강을 증진시킬 수 있는 요소들이 고려될 필요가 있음을 보여준다. The purpose of this study is to examine multi-mediation effects of physical health and mental health in the relationship between satisfaction with green space and cognitive function of the elderly. Social survey(year 2022) data of Statistics Korea were used and a total of 9,120 elderly aged over 65 years was analyzed. For the analyses, using SPSS Process Macro, multi-mediation analyses were performed and the significance of mediation effects were examined by use of a bootstrapping method. Results of the analyses show that first, satisfaction with green space had a direct positive effect on cognitive function. That is, the elderly with a higher level of satisfaction with green space showed a higher level of cognitive function. Second, satisfaction with green space had a significant positive effect on physical health and mental health. That is, the elderly with a higher level of satisfaction with green space showed a higher level of physical health and the elderly with a higher level of satisfaction with green space showed a higher level of mental health. Third, physical health and mental health had significant positive effects on cognitive function. That is, the elderly with a higher level of physical health and the elderly with a higher level of mental health showed a higher level of cognitive function. Fourth, satisfaction with green space had a significant effect on cognitive function mediated by physical health and mental health. Results of this study show that green environment need to be used actively for healthy cognitive function of the elderly and factors that can improve physical and mental health should be considered in making green environment.

대도시의 주거환경이 주민건강에 미치는 영향분석 -서울시를 중심으로-

전경구 한국집합건물법학회 2019 집합건물법학 Vol.29 No.-

It has long been recognized that health is directly associated with personal household factors. However, since 1930’s there has been an ongoing debate regarding whether there are contextual effects or neighborhood effects on the health of adults in large metropolitan area. It has been suggested that the effects are prominent in the metropolitan areas in the United States. In Korea too there has been a limited number of research on the issue but the analysis results regarding whether there are the contextual effects or not indicate inconclusive. In this regard, this study attempted to examine the presence of contextual effects of the residential environment on self-rated health, stress, and depressive symptoms of adults in Seoul Metropolitan City with the hierarchical linear model. In the analysis this study used the data of ‘community health survey’ by Korea Centers for Disease Control & Prevention(KCDC) for the health diagnosis and the personal and household characteristics. To test the contextual effects the neighborhoods were defined by Gu districts and data of the 25 districts from a variety of secondary sources provided by Seoul City and Korean Statistical Information Service (KOSIS) were employed. The analysis results indicated that the contextual effects of residental environment on the self-rated health, stress and depression symptoms were minimal compared to personal and household characteristics. In particular ICCs of the unconditional models indicated less than 1%. Even if ICCs were low, among the three health diagnosis depressive symptoms appeared to be the most influenced by neighborhood characteristics. The analysis results of the hierarchical linear model showed that even of the contextual effects of the residential environment were low, some variables such as housing price, socioeconomic characteristics, safety, and collective heath resources of the neighbors were significant for the psycho-mental health. Also, the variables of personal and household characteristics in the 1st level that were significant differed by health diagnosis. In the case of depression symptoms the variables such as gender, number of household member, social security, experience of serious illness, educational attainment and spouse were significant. Based on the analysis this study suggested reasons why the contextual effects were so low in the large metropolitan areas such as Seoul city. Also, this study discusses policy implications for the analysis. In particular the social mix policy, improvement of housing conditions of the disadvantaged neighborhoods and security from crime were suggested to be important policy instruments for the health of adults in the neighborhood context. 본 연구는 서울을 대상으로 대도시의 주거환경이 주민들의 심리적·정신적 건강에 미치는 영향을 분석하였다. 질병관리본부가 조사한 지역사회건강조사 자료를 이용하여 지역특성이 주민들의 자기건강평가, 스트레스, 우울감에 미치는 맥락효과를 분석한 연구결과는 다음과 같다. 첫째, 지역사회건강조사를 토대로 주관적 건강평가, 스트레스, 우울감의 세 가지 종속변수의 변동에 영향을 미치는 독립변수를 분석한 결과, 건강의 유형에 따라 차이는 있지만 개인적 특성 차이가 대부분을 차지하고 있는 반면 지역 간 특성차이는 크지 않았다. 이는 우리나라 대도시에 있어서는 지역환경에 따른 개인건강의 차이가 크지 않다는 것을 의미하고 이는 지역환경의 영향이 적다는 것을 의미한다고 볼 수 있다. 둘째, 비록 지역특성의 차이가 건강에 미치는 영향이 적을지라도 몇 가지 유의미한 변수가 있었다. 본 연구 결과 스트레스의 경우 문화시설과 지역안전성, 그리고 의료시설이 유의미한 변수이고, 우울감의 경우 주택가격과 영세가구의 비율 그리고 안전성이 유의미한 변수인 것으로 나타났다. 따라서 심리적ㆍ정신적 건강에 중요한 지역특성은 주택특성, 사회경제적 특성, 안전성, 그리고 건강집합자원이 중요한 요인인 것으로 나타났다. 한편 개인 및 가구특성과 관련하여 심리ㆍ정신건강에 영향을 미치는 요인은 질병별로 차이가 있는 바 우울감의 경우 성별, 가구원수, 기초생활수급여부, 질병여부, 교육수준, 그리고 배우자 유무 등인 것으로 나타났다. 본 논문은 이와 같은 분석결과를 바탕으로 우리나라 대도시의 지역사회 건강정책과 관련한 시사점을 제시하였다. 먼저 사회적 혼합정책을 통하여 슬럼발생을 원천적으로 방지할 필요가 있다. 그동안 우리나라 대도시에서는 일부 지역에 저소득 영세민이 집단적으로 거주하는 취약지역이 자연적으로 발생하거나 저소득계층을 위한 장기임대주택을 집단적으로 형성하는 정책을 추진해 왔는데 이는 사회적 배제와 소외감을 야기하고 나아가 우울감과 같은 정신건강에도 영향을 미치므로 근린의 사회적 포용정책을 통하여 열악한 취약근린이 형성되는 것을 방지할 필요가 있다. 그리고 취약지역의 주거환경을 개선하는 것이 필요하다. 주택가격은 건강에 영향을 미치는 중요한 요인의 하나로 나타났다는데 주택가격이 높다는 것은 주거환경이 좋다는 것을 의미한다. 따라서 주택의 사회적, 물리적 환경을 개선하는 작업이 필요하다. 그리고 마지막으로 지역의 범죄발생 위협을 감소시킴으로써 안전성을 확보할 필요가 있다. 외국의 사례에서 많이 볼 수 있는 것처럼 범죄에 취약한 지역의 주민들은 심리와 정신건강 측면에서 많은 고통을 안게 된다. 우리나라의 지역사회 안전이 외국과 같은 수준으로 나쁜 정도는 아니지만 점점 악화되어 가는 경향이 있고 이는 주민들의 건강에도 영향을 미칠 수 있으므로 보다 적극적인 대책을 마련할 필요가 있다.

빅데이터를 이용한 대기오염의 건강영향 평가 및 피해비용 추정

안소은,배현주,곽소윤,임연희,김명희,김진산 한국환경정책평가연구원 2015 사업보고서 Vol.2015 No.-

대기오염은 환경부문 질병부담의 가장 큰 요인이다. 본 연구는 최근 활용 가능하게된 국민건강보험공단의 표본코호트DB를 기반으로 대기오염으로 인한 건강영향의 정량적평가, 특히 만성 건강영향 평가체계를 개선하고 질병비용(COI) 및 통계적생명가치(VSL)로의 연계를 통한 사회적 비용추정을 일차적 목표로 하고 있다. 본 연구는 3년 과제로 기획되었으며 연구내용은 크게 표본코호트DB를 활용한 대기오염의 건강영향 평가, 건강영향의 사회적 비용추정, 건강영향·경제성 통합분석 및 정책평가분석 틀 구축으로 구분된다. 연구진행은 각 부문 간의 순차적 접근보다는 병렬적 접근을 취하여 부문 간 피드백을 도모하는 방향으로 추진하였다. 이러한 맥락에서 1차년도(2015)는 대기오염으로 인한 호흡기계 만성 건강영향 평가와 호흡기계 질병비용 산정을 위한 표본코호트DB 자료가공 및 분석을 병행하여 진행하였다. 먼저 건강영향은 대기오염으로 인한 호흡기계 질환 신규입원과 반복입원위험을 중심으로 평가하였다. 질병비용(COI)은 동일한 질병군에 대하여 의료비용, 교통비용, 간병비용, 생산성 손실비용 등을 산출하였다. 또한 건강영향 평가와 질병비용(COI) 산출의 분석단위를 동일한 무진료기간을 적용한 에피소드로 묶어줌으로써 향후 건강영향 평가와 질병비용(COI)의 연계가 가능하도록 설계하였다. 대기오염의 호흡기계 신규입원 발생위험을 생존분석한 결과, 미세먼지(PM10), 이산화황(SO₂), 오존(O₃)의 경우, 대기오염의 장기노출 농도 증가는 호흡기계 신규입원위험을 유의하게 높였다. 이산화질소(NO₂)와 오존(O₃)으로 인한 호흡기계 신규입원위험은 전국에 비해 서울지역에서 높았으며, 65세 이상 연령집단의 경우 미세먼지(PM10)의 영향을 전체 연령에 비해 더 많이 받는 것으로 나타났다. 시계열 패널자료를 구축하여 대기오염으로 인한 재입원위험을 반복측정분석한 평가결과, 65세 이상 연령집단에서 미세먼지(PM10), 일산화탄소(CO), 오존(O₃), 이산화황(SO₂)이 증가할수록 입원증가와 유의한 연관성을 보였다. 한편 질병비용(COI) 항목별 산출결과(약제비용 제외)를 요약하면, 2002년도 기준, 호흡기계 질환 입원 에피소드당 질병비용 합계는 총 178만 원으로 이 중 의료비용이 47%,생산성 손실비용이 36%를 차지하는 것으로 나타났다. 2013년 기준, 입원 에피소드당질병비용 합계는 총 377만 원으로 이 중 의료비용이 51%, 생산성 손실비용이 33%를 차지하는 것으로 나타났다. 본 연구는 표본코호트DB를 활용하여 대기오염의 만성 건강영향과 질병비용을 다각적으로 분석할 수 있는 기반을 구축하였다. 특히 건강영향 평가 부문에서는 입원 에피소드가공 또는 시계열 패널자료 구축 등을 통하여 데이터를 분석목적에 적합하도록 가공하여 사용하였다. 또한 대기오염으로 인한 호흡기계 질환 신규입원위험과 호흡기계 질환 재입원위험을 추정함으로써, 기존에 미흡했던 만성 건강영향 평가결과를 제시했다는 점에 의의를 찾을 수 있다. 향후 지속적으로 모형을 개선하는 노력이 필요할 것이다. 질병비용(COI)추정은 건강영향 평가와의 연계를 위하여 호흡기계 질환 에피소드별로 항목별 비용을 추정하였다는 점이 기존 연구와 차별화된다. 향후 약제비용이 추가되어야 하고 생산성손실을 포함한 시간 기회비용 추정을 위해 사용된 원자료 등에 대한 추가 검토가 필요하며 이러한 이슈들은 2차년도에 지속적으로 개선해 나갈 예정이다. This study aims to assess the long-term effects of air-pollution on human health using cohort DB provided by the National Health Insurance Service and to estimate its economic costs in Korea. The ultimate goal is to construct an policy-evaluation framework based on the results from the assessment of health effects and economic costs. An integrated policy assessment framework is composed of 4 steps as illustrated in Figure 1. Step 1 is scoping stage where the policy scenarios are developed, which includes determining the end-points of health effects and population to be affected. Step 2 is health risk assessment. Our focus is the long-term effects of exposures to 5 major air pollutants . PM10, CO, O3, NO2 and SO2 . on respiratory diseases. The health risks are evaluated by estimating concentration-response (CR) functions. Individual CR functions are estimated depending on air-pollutants, provinces, and age groups. The results of health risks are presented in terms of the changes in mortality and morbidity associated with policy scenarios. Step 3 is monetary valuation of human health effects. Monetary valuation begins with estimating unit-values for health end-points which are mortality and morbidity in our cases. The unit values for mortality and morbidity are estimated with value of statistical life (VSL) and cost of illness (COI), respectively. The total economic costs are calculated, in turn, by multiplying the changes in mortality and morbidity by corresponding unit values. The final step is synthesis. In this step, uncertainty issues are considered and sensitivity analyses are conducted. In addition, qualitative information which cannot be incorporated in the procedure is specified for further consideration in the assessment. Although the proposed policy-evaluation framework is explained as a step-by-step procedure, working operation of the project is rather parallel and emphasizes the importance of feedbacks between the steps. Three-year project begins with cleaning and re-constructing cohort DB for the assessment of long-term health effects from exposure to 5 selected air-pollutants. The first-year (2015) preliminary results show that the health risks, measured by new hospital admissions of respiratory diseases using the time-varying survival analysis, are statistically higher in Seoul than nation-wide for all of the 5 pollutants and higher for the age group 15 and younger than the pooled group for CO, NO2 and SO2. In addition the health risks, measured by repetitive hospital admissions of respiratory diseases using panel data, are relatively higher for the age group 65 and older than the pooled group for PM10, CO, O3, and SO2. The COI for the respiratory diseases are calculated by including direct medical expenditures covered by insurance and individuals, personal out-of-pocket expenses such as transportation costs and costs of employing nursing services, and opportunity costs associated with lost productivity due to the illness. The main data sources are the cohort DB provided by the National Health Insurance Service and the Korea Health Panel Survey. In 2013, the total COI is estimated as 3,766 thousand won per hospital-admission episode of respiratory diseases where direct medical expenditures, personal out-of-pocket expenses, and opportunity costs associated with lost productivity comprise 51.1%, 15.2%, and 33.7%, respectively. Based on the preliminary results, study is planned to continue in the second year (2016) to refine the assessment of health effects by incorporating demographic and socio-economic variables in estimating CR functions. Estimation of VSL in Korean context using the stated preference method will be added to the economic analysis.

건강증진 프로그램 효과에 영향을 미치는 프로그램 관련 요소 분석 - 문헌고찰을 중심으로 -

장원기,정경래,김철웅 한국보건행정학회 2002 보건행정학회지 Vol.12 No.1

To find out more efficient ways of implementing health promotion programs and to determine the factors affecting the results of various interventions, we reviewed 73 articles on the effectiveness of health promotion programs. These include the papers on the smoking, alcohol, drug abuse, nutrition(obesity) and stress management etc. Specific interventions evaluated in this review are education based on the lecture or video shows, health-related event activities, modifications of policy or the environment, health risk appraisal etc. By using KIHASA Line of Korea Institute of Health and Social Affairs, National Congress Library Database and MEDLINE, we identified 201 articles published from 1980 to Jun. 1999 and finally selected 73 papers which contain the implementation process, and result of each program. The factors used in the analysis of the programs are (1) characteristics of participants (2) interventions evaluated (3) research design (4) length of programs and evaluation point (5) outcome indices (6) effect of program evaluated by each author. The study results did not prove positive effect of education based on lectures or video shows etc. Rather, it was suggested that lecture-based education has negative effect on the result. Event activity such as contest or health festivals has positive effect, and policy change or environmental change is closely related to the event activity. Also, the result shows that the overall effect of programs for the students is less than that of the programs for the others. The programs conducted over 1-year are more likely to have positive outcomes than shorter ones. And, the outcomes of the programs with controlled research design such as experimental or quasi-experimental study tend to be evaluated inferiorly to those with non-experimental design.

영유아 구강검진의 효과: 치과방문횟수 및 치료 비용을 중심으로

안은숙 ( Eunsuk Ahn ),신호성 ( Hosung Shin ) 대한예방치과·구강보건학회 2017 大韓口腔保健學會誌 Vol.41 No.2

Objectives: With increasing emphasis being placed on early interventions for health promotion, early dental visits to prevent early childhood caries have been receiving more attention. Infant oral health examinations have been implemented as a component of early health examination in South Korea, but there is a lack of research on its effectiveness. This study aimed to estimate the effectiveness of infant and toddler oral health examinations by performing economic analyses of infant health examinations and dental treatment costs after examinations. Methods: The analyses were conducted using the National Health Insurance Service claims data. Sub-jects included in this study were children who had undergone their “3^rd infant oral health examination (54-65 months)” between 2010 and 2014. To estimate dental treatment costs over the five years, four retrospective cohorts were evaluated, which included a total of 256,965 subjects. The direct medical costs following infant oral health examinations were calculated over five years (including only costs from health insurance claims), and the effects of infant oral health examinations were compared. Results: Although the rate of infant oral health examinations showed a persistently increasing trend, dif-ferences were observed according to the type of health insurance. Children who underwent infant oral health examinations showed a higher number of visits to the dentist, but lower dental treatment costs compared with children who did not undergo examinations. Conclusions: This study confirmed, from an economic perspective, the effects of policy interventions that emphasize the necessity of early intervention and a life-course health management strategy, based on the concept that oral health is not determined at specific time points, but rather is determined by the accumulation of exposure to various factors over the course of life.

여가 웰니스관광 프로그램이 건강만족도에 미치는 영향

윤기선(Yun, Gi-Seon) 한국여가복지학회 2020 여가복지경영연구(여가복지) Vol.1 No.1

본 연구는 충청남도 충주, 경상남도 산청 등에서 웰니스 클러스터를 구성하여 프로그램을 운영하는 지역에 참가한 대상자를 토대로 2019년 10월 01일 ~ 2019년 12월 30일까지 웰니스관광 클러스터 프로그램에 참가했던 이용자 306명을 대상으로 조사하였다. 웰니관광 프로그램의 생활관리, 신체관리, 뷰티관리가 자연치유 효과에 영향을 미치는 것으로 분석되었다. 웰니스관광 프로그램의 생활관리, 신체관리, 뷰티관리가 건강만족에 영향을 미치는 것으로 분석되었다. 끝으로 웰니스관광 프로그램이 건강만족도에 미치는 영향에 있어서 자연치유의 매개효과는 부분적으로 영향을 미치는 것으로 분석되었다. 매개효과검증 결과는 총효과는 .319, 직접효과는 .242, 간접효과는 .048로 분석되었다. 이에 웰니스 프로그램을 운영하는 것보다는 자연치유 효과 때문에 관광객의 만족도는 .048만큼 매개효과가 있는 것으로 분석되었다. 따라서 자연치유 효과를 살리는 것이 웰니스관광 프로그램과 자연치유 효과를 얻기 위해 자연치유상품을 프로그램으로 더 활성화 하는 것이 건강만족도를 높일 수 있다. In order to analyze the effect of the wellness tourism program on the natural healing effect and satisfaction, based on the participants who participated in the region operating the program by constructing wellness clusters in Chungju, Chungcheongnam-do, and Sancheong, Gyeongsangnam-do, October 01, 2019 ~ December 12, 2019 The survey was conducted on 306 users who participated in the Wellness Tourism Cluster Program until the 30th of the month. First, the relationship was analyzed by analyzing the difference between the variables and the characteristics of the participants by one-way ANOVA. Life management affects the number of participants, companions, and natural healing products, body management affects gender, place of residence, number of participants, natural healing products, beauty management affects gender, education, and natural healing products. , The mind and body effect affects gender and natural healing products, and the dietary effect affects the number of participation and companions, and the handwriting effect affects the number of participation and natural healing products, and satisfaction refers to gender and natural healing products. It was analyzed that there was a difference. Second, regression analysis was used to analyze the cause and effect between variables. It was analyzed that life management, body management, and beauty management of the well-nine tourism program have an effect on the mind and body effect among natural healing effects. It was analyzed that the wellness tourism program s life management, body management, and beauty management influenced the dietary effect among natural healing effects. It was analyzed that health management, body management, and beauty management of the wellness tourism program affect health satisfaction. Participate in programs for occupational disease management, diet improvement, leisure and sports healing, toxin removal and detoxification healing, stress management through lifestyle management, or physical fitness management, chronic disease management, herbal treatment, health checkups, and overall natural healing for management Tourists who participate in the program for the purpose of spa treatment, massage, anti-aging, diet, or cosmetic use for beauty management, are satisfied with maintaining normal temperature, have a good night s sleep, are satisfied with stress healing, and have blood circulation It was analyzed that they were satisfied with the improvement. It was analyzed that the physical management of the wellness tourism program influences the intention to reuse. However, it was analyzed that life management and beauty management did not significantly affect reuse intention. Therefore, for management, tourists who participated in the program for physical fitness management, chronic disease management, herbal treatment, health checkup, and overall natural healing, intend to reuse for wellness tourism, intend to reuse for wellness cluster program, and natural healing products. Would recommend to reuse, family, friends. The natural healing effect was analyzed to affect health satisfaction. Therefore, stress, fear, trauma, depression are relieved, digestive function, comfortable to see stools, weight loss, blood pressure is lowered, flexibility of the arms, flexibility of the waist is improved, weight is reduced, and muscle pain is reduced. It was analyzed that tourists with are satisfied with maintaining normal temperature, satisfied with getting a good night s sleep, satisfied with stress healing, and improved blood circulation.

대학생의 기질 및 성격이 정신건강에 미치는 영향

노성현,채경선 한국효학회 2023 효학연구 Vol.- No.38

Background: According to Cloninger's personality model, factors in the temperament and character affect an individual's cognition, emotion, and behavior independently or through interaction between temperament and character. Through studies using the Temperament and Character Inventory(TCI-RS) developed based on Cloninger's theory, the relationship between temperament/character and psychopathology such as anxiety or depression has been confirmed. However, there is a lack of research to identify the relationship between temperament/character and non-pathological level of mental health experienced in daily life. If the relationship between temperament/character and mental health is identified, it will be possible to help discover and deal with potential risk factors for mental health through individual temperament and character traits. Purpose: The purpose of this study is to examine the affect of temperament and character factors on mental health and to verify the mediating effect of character in the affect of temperament on mental health. Methodology/Approach: The subjects of this study were 330 university students who were surveyed by temperament/character scale and mental health scale, and the effects of temperament/character on mental health and the mediating effects of character were verified using Baron & Kenny's three-step mediated regression analysis. Findings/Conclusions: First, factors that significantly affect mental health were identified as novelty seeking, harm avoidance, reward dependence, persistence, and self-directedness. Second, self-directedness showed a complete mediating effect in‘the relationship between novelty seeking and mental health’and ‘the relationship between persistence and mental health’, and a partial mediating effect in‘the relationship between harm avoidance and mental health’. Implications: This study is significant in that it identified the vulnerability of mental health through temperament and character traits and provided a basis for using self-directedness as a means of intervention in mental health problems.

유아기 자녀를 둔 아버지의 원가족 건강성이 양육 태도에 미치는 영향: 30-40대 아버지의 가족 건강성 매개 효과를 중심으로

방효국 한국영유아교원교육학회 2023 유아교육학논집 Vol.27 No.2

The purpose of this study is to examine the effect of family of origin health on childrearing attitudes in fathers with children in infancy and to find out the mediating effect of family health of fathers in their 30s and 40s. Accordingly, the data of 207 fathers attending kindergartens located in K-city, Gyeonggi-do were analyzed. For the data, frequency analysis, Pearson-correlation analysis, regression analysis, and bootstrapping mediating effect significance verification were conducted using SPSS 26.0. Looking at the results according to the research question, the father's family of origin health, family health, and parenting attitude appeared to be positively correlated. Finally, in the relationship between father's family of origin health and parenting attitude, family health had a partial mediating effect. This significant affects father's parenting attitude on family of origin health and family health. Therefore, if a program that can strengthen the family health of fathers is developed and information is delivered to the fathers, it will have a positive effect on the health of the child's family of origin, thereby positively affecting the parenting attitude. 본 연구의 목적은 유아기 자녀를 둔 아버지를 대상으로 원가족 건강성이 양육 태도에 미치는 영향을 살펴보고 30-40대 아버지의 가족 건강성의 매개효과를 밝히는 것이다. 이에 따라 경기도 K시에 위치한 유치원을 다니고 있는 재원생 아버지 207명의 데이터를 분석하였다. 자료는 SPSS 26.0을 사용하여 빈도분석, Pearson 적률상관분석, 회귀분석, Bootstrapping 매개효과 유의성 검증 등을 실시하였다. 연구문제에 따라 결과를 살펴보면 아버지의 원가족 건강성, 가족 건강성, 양육 태도는 정적 상관으로 나타났다. 마지막으로 아버지의 원가족 건강성과 양육 태도 간의 관계에서 가족 건강성은 부분 매개효과가 있었다. 이러한 점은 아버지의양육 태도에 원가족 건강성과 가족 건강성이 유의미한 영향이 있음을 나타냈다. 따라서 아버지들의 가족 건강성을 강화할 수 있는 프로그램 개발, 아버지를 위한 정보 전달 등이 이루어진다면 자녀의 원가족 건강성에도 긍정적 영향을 줌으로써 양육 태도에 긍정적인 영향을 줄것이다.