Hyekyeong Kim

Purpose: This study aimed to determine whether placing anti-smoking campaign messages in designated smoking areas elicits psychological reactance among female smokers and to assess whether message framing (controlling vs. non-controlling) moderates the association between psychological reactance and intention to quit smoking.Methods: A quasi-experimental survey was conducted with 259 female smokers. Of these, 58 participants completed the survey before exposure to smoking-cessation messages, and 201 completed the survey after exposure. Among the exposed participants, 100 were assigned to the controlling condition and 101 to the non-controlling condition. Measures included psychological reactance, intention to quit smoking, trait reactance, smoking disclosure, and smoking-related covariates. Data were analyzed using analysis of covariance and Hayes’ PROCESS Model 1, with statistical significance set at p<.05.Results: Smokers exposed to anti-smoking messages within designated smoking areas reported higher psychological reactance (mean±standard deviation: 2.10±0.94) than those not exposed (1.81±0.77), with a significant between-group difference (p=.017). Simple slope analysis revealed that psychological reactance was negatively associated with quit intention under controlling messages (B=–0.20, p=.031), but not under non-controlling messages (B=–0.05, p=.591).Conclusion: Exposure to anti-smoking messages within designated smoking areas was associated with increased psychological reactance toward smoking cessation. In contrast, autonomy-supportive, non-controlling messages attenuated this effect. These findings suggest that smoking areas may serve as strategic behavioral intervention points when campaigns employ context-sensitive, autonomy-supportive message framing.This study was registered with the Clinical Research Information Service (CRIS) of the Republic of Korea (KCT0012514) on 27 August 2026.

Objectives: In prehospital and in-hospital emergency care, artificial intelligence (AI)-enabled emergency medical services (EMS) systems are reshaping clinical workflows through real-time triage, automated hospital assignment, telemedicine, and biometric monitoring. However, their implementation in Korea has revealed substantial legal and regulatory barriers. This study analyzed the structural incompatibilities between AI-enabled EMS and Korea’s current legal framework, with particular attention to the Medical Service Act, Emergency Medical Service Act, and Personal Information Protection Act.Methods: We conducted a statutory review and case analysis of pilot projects, including the Chungbuk Smart EMS Project, the AI HOTline in Ilsan, and Yonsei’s AI-Ambulance model. We also performed a comparative assessment of foreign regulatory frameworks, including the US Health Insurance Portability and Accountability Act and the EU General Data Protection Regulation.Results: Key barriers included the restriction of remote care to interphysician communication under Article 34 of the Medical Service Act, the lack of legal mandates for real-time hospital capacity sharing under the Emergency Medical Service Act, and limits on real-time sensitive-data processing caused by vague emergency clauses in the Personal Information Protection Act. These barriers constrain the scalability of AI-enabled EMS in Korea.Conclusions: To support lawful and secure integration of AI-driven emergency care in Korea, we propose legislative revisions that establish emergency exceptions for remote AI-supported guidance, require hospital resource disclosure, and provide safe-harbor protections for healthcare professionals who rely on certified AI tools. A harmonized legal infrastructure is essential for realizing the potential of digital transformation in emergency care.

Purpose: This mixed-methods study investigated determinants of behaviors and intention related to sedentary behavior (SB) reduction among Korean white-collar workers by applying the Integrated Behavioral Model (IBM) in a collectivist workplace context. Design: Sequential exploratory mixed-methods design. Setting: Korean workplaces where excessive SB may be a concern. Sample: Twenty-one workers participated in the qualitative phase, and 497 employees from 21 workplaces completed the survey. Measures: Three semi-structured focus group interviews across job-position groups explored social norms and barriers to SB reduction. Insights informed selected survey items and interpretation. The survey assessed individual, job, and health factors, IBM constructs (attitudes, norms, self-efficacy, skills, intentions), SB reduction practices, and workplace factors. Analysis: Data were analyzed using thematic coding and multilevel regression. Results: Participants reported high SB and often avoided standing to prevent drawing attention, though some developed strategies to reduce sitting. Intention to reduce SB was associated with positive emotions, beliefs that colleagues reduce sitting, high self-efficacy, low job stress, and lower job position. SB reduction behavior was associated with stronger intentions, better skills/abilities, and more sit-stand workstations. Conclusion: Applying the IBM within a collectivist cultural framework underscores the relevance of perceived norms and hierarchical workplace dynamics for health-related behaviors. Workplace health promotion may benefit from emotional benefits, skill building, and position-specific, norm-based strategies acknowledging organizational hierarchy and employees’ sensitivity to social norms, alongside practical support and supportive environments.

Background: Resilience is a key protective factor in mitigating substance use behaviors in adolescence, but the effectiveness of school‐based resilience interventions remains unclear. Methods: Randomized and quasi‐experimental studies evaluating school‐based resilience interventions for tobacco, alcohol, or illicit substance use among students aged 6–18 years were identified. Pooled effect sizes were estimated using random‐effects meta‐analysis, with subgroup and meta‐regression analyses. Results: From 3504 records, 13 studies on tobacco, 14 on alcohol, and 12 on illicit substances met the inclusion criteria. The pooled results showed significant reductions in tobacco (OR = 0.83, 95% CI = 0.73–0.93, I ² = 61.0%), alcohol use (OR = 0.81, 95% CI = 0.74–0.90, I ² = 57.1%), and illicit substance use (OR = 0.80, 95% CI = 0.70–0.92, I ² = 45.3%). Subgroup analysis revealed that multi‐level interventions yielded a greater reduction. Implications for School Health Policy, Practice, and Equity: School‐based resilience interventions reduce adolescent substance use, providing insight into how resilience strategies operate across ecological domains. Embedding sustained, multi‐level approaches within whole‐school prevention frameworks may strengthen effectiveness and promote equity in school health. Conclusions: School‐based resilience interventions are effective in reducing adolescent substance use, underscoring the need for multi‐level intervention strategies.

The emerging non-combustible tobacco products have complicated the tobacco landscape in Korea. This study aimed to assess subgroup trends in conventional cigarette (CC), electronic cigarette (EC), heated tobacco product (HTP), and poly-tobacco use in South Korea from 2013 to 2023. We analyzed secondary data from the 2013–2023 Korea National Health and Nutrition Examination Survey, a nationally-representative cross-sectional data of adults (aged ≥19 years) (n=62935). Joinpoint regressions were used to estimate average annual percent changes (AAPCs) in tobacco use, stratified by sociodemographic and health-related characteristics. All measures were based on self-reports. Among men, the prevalence of CC smoking declined from 42.1% in 2013 to 32.2% in 2023 (AAPC= -3.4; 95% CI: -4.6 – -2.3), with small declines among those with a lower income, less-educated, manual workers, and those with multiple risk behaviors, and severe mental illness. EC use increased modestly overall, with a significant rise among in men aged 25–39 years; HTP use showed a slight overall decline. Poly-tobacco use increased, particularly among young adults (aged 19–24 years) and middle-aged adults (aged 40–64 years) the lowest-income group, manual workers, and those with multiple risk behaviors. Among women, overall prevalence of CC, EC, and HTP use remained below 7%, but prevalence rose among young women aged 19–24 years (CC: 9.6% to 16.1%; EC: 0.7% to 5.6%; HTP: 3.1% to 5.8%), although the corresponding AAPCs were not statistically significant (CC: 4.6; 95% CI: -1.9–12.4; EC: 15.1; 95% CI: -0.1–39.7; HTP: 26.3; 95% CI: -21.4–125.0). Korea's progress in reducing CC smoking has not extended to vulnerable populations, and rising EC and poly-tobacco use, particularly among young adults, present new challenges. These findings underscore the need for tailored cessation interventions for vulnerable populations and for ongoing efforts to tackle the emerging use of novel tobacco products.

Objectives: This study examined multi-level determinants of job stress among early-career workers using an ecological model and assessed moderating factors influencing stress levels. Methods: A quantitative survey was conducted with 494 workers aged 20 and older. Data were collected via an online questionnaire measuring ecological factors across five levels and job stress. Statistical analyses included correlation, multiple regression, and hierarchical regression. Results: Ecological factors significantly predicted job stress, with individual-level variables explaining the largest share of variance (68.9%, p < .001). Coping skills moderated the effect of satisfaction with the physical environment, while social support mitigated stress at the individual, microsystem, community, and national levels. Conclusion: Job stress among early-career workers arises from interplay of personal, organizational, and environmental factors. Effective interventions should target multiple ecological levels and incorporate coping skill development and social support systems.

Objectives: This study explored motivations for e-cigarette use, usage patterns, experiences with smoking cessation, and perceptions of e-cigarettes among adult employees in an workplace setting. Methods: In-depth, semi-structured interviews were conducted with 22 adult smokers who participated in a workplace smoking cessation program. Data were analyzed using thematic analysis. Results: Three major themes were identified. First, motivations for using e-cigarettes include odor avoidance, convenience, and the belief that they were less harmful than conventional cigarettes. Social and relational factors often influenced such decisions. Second, usage patterns revealed increased smoking frequency, dissatisfaction with e-cigarettes leading to a relapse involving the use of conventional cigarettes and dual use of e-cigarettes. These patterns indicate that e-cigarettes may reinforce rather than reduce smoking habits. Third, many participants reported that e-cigarettes weakened their motivation to quit smoking. While a few cited positive effects, such as reducing cigarette use or quitting after losing a device, most perceived e-cigarettes as delaying or undermining cessation owing to ease of use and reduced guilt. Conclusion: E-cigarette use may serve as a barrier to cessation and contribute to ongoing tobacco use. Public health efforts should address the misperceptions of reduced harm and provide cessation strategies tailored to e-cigarette users.

Objective Non-pharmacological interventions (NPIs) are effective in treating gaming disorder (GD). However, studies have not comprehensively evaluated the most effective NPIs. This systematic review and meta-analysis aimed to evaluate the effects of NPIs on the prevention and reduction of GD in the general population with GD.Methods We searched five databases (MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, and CINAHL) for English-language randomized controlled trials (RCTs) published till May 12, 2024, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two independent reviewers selected studies, extracted data, and assessed quality using the Cochrane Risk of Bias Tool (RoB2). Meta-analyses were conducted using a random-effect model, with effect sizes calculated using Hedges’s g and heterogeneity assessed using I2 statistics.Results A total of 18 RCTs involving 1,950 participants were included. The NPIs included psychotherapy, behavioral interventions, and other strategies. The pooled analysis showed a significant reduction in GD severity (Hedges’s g=-0.82; 95% confidence interval, -1.23 to -0.52; I2=90.36%). Psychotherapy, particularly cognitive-behavioral therapy, showed the most substantial effect (10 studies, 1,036 participants; Hedges’s g=-1.34). Behavioral interventions (4 studies, 456 participants) and prevention-focused interventions (6 studies, 1,164 participants) had smaller but positive effects. Subgroup analyses revealed greater effectiveness of treatment interventions in adults than in adolescents. Sensitivity analyses confirmed the robustness of these results despite high heterogeneity (I2=90.36%).Conclusion NPIs, particularly psychotherapy, are effective in reducing GD severity. However, more high-quality RCTs are needed robust, evidence-based treatment guidelines.

Objectives: This study aimed to identify the health problems and risk behaviors that exist in Seoul counties, as well as to understand how health risk behaviors are related to quality of life. Methods: Fuzzy-set ideal type analysis was used to categorize health risk behaviors affecting the quality of life of residents from 25 districts in Seoul. Eight ideal sets were created based on the independent variables: smoking, high-risk drinking, and physical inactivity. Each variable was judged to have attributes based on the average of Seoul. Factors associated with health-related quality of life were identified by type by multiple regression analysis. Results: Those with high scores for two or more health risk behaviors accounted for a larger proportion of the population. Some districts had high scores for specific behaviors with an affiliation score (0-1) of 0.7 or higher, indicating that the health problem is more prevalent in these regions than in other areas. The EQ-5D index found that physical inactivity was the most strongly associated of the three health risk behaviors. Conclusion: Combinations of health risk behaviors have different effects on health levels in different districts, necessitating the consideration of multiple factors. Types of health risk behaviors show potential for use as a basis for selecting and identifying priority health problems for community health promotion projects.