Suk-Yong Jang

Background: Declining fertility rates challenge urban health systems. In 2024, South Korea recorded the lowest total fertility rate (0.68) among OECD countries. Existing financial incentives have shown limited effectiveness, particularly in complex urban settings. This study examines the association between young adults’ future expectations and fertility intentions, drawing on Snyder’s Hope Theory (1994) as a conceptual lens. Methods: This quantitative study used secondary data from the nationally representative 2023 Korea Youth Life Survey. A self-reported scale assessed perceived feasibility of achieving one’s desired future. Generalized linear models (GLMs) with a Poisson distribution estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Stepwise adjustments controlled for confounders, and subgroup analyses explored demographic variations. Results: Young adults with positive future expectations were 1.46 times (PR: 1.46; 95% CI: 1.34–1.59) more likely to have fertility intentions. The association remained significant after adjusting for income, employment, and perceived socioeconomic status. Stronger effects were observed among men (PR: 2.87; 95% CI: 2.32–3.54), low-SES individuals (PR: 2.60; 95% CI: 2.22–3.05), and non-metropolitan residents (PR: 2.89; 95% CI: 2.37–3.51). Conclusion: Positive future expectations were associated with higher fertility intentions among young adults in South Korea. Policies supporting career development, stable employment, and mental well-being may complement traditional financial incentives by addressing psychological dimensions of fertility-related decision-making. Further research is needed to determine whether these approaches translate into fertility behavior or population-level fertility changes.

INTRODUCTION: Dementia is a major public health concern, and cognitive screening may improve dementia management. We examined the impact of the 2007 introduction of a national cognitive screening program in South Korea on subsequent dementia care and hospitalization. METHODS: A nationwide cohort of 76,640 dementia‐free, policy‐eligible adults aged 66 who underwent screening between 2004 and 2009 was used. Dementia care was defined as ≥1 dementia‐related outpatient visit or anti‐dementia medication within 2 years of screening and dementia‐related hospitalization as post‐screening hospitalization for dementia. Adjusted multivariable logistic regression and Cox proportional hazards regression models were used. RESULTS: Overall, 1.4% received dementia care within 2 years, and 3.0% were hospitalized for dementia within 10 years. Cognitive screening was associated with a 37% higher likelihood of subsequent dementia care and a 12% lower risk of dementia‐related hospitalization than those without screening. DISCUSSION: Cognitive screening may facilitate earlier dementia care and reduce the risk of dementia‐related hospitalization.

Background: Wearable devices are increasingly adopted for personal health monitoring, but evidence on their long-term associations with health-related lifestyle behaviors in real-world population settings remains limited. Objective: This study examined the longitudinal association between wearable device adoption and engagement in health-related lifestyle behaviors using a nationally representative panel dataset from South Korea. Methods: We analyzed lifestyle activity outcomes from the 2016 and 2022 waves and wearable device ownership from the 2017 and 2022 waves of the Korea Media Panel survey. Health-related lifestyle behaviors in the physical, social, and cultural domains were operationalized as estimated annual activity counts based on self-reported frequency measures. We used a difference-in-differences framework with generalized estimating equations to compare changes in these behaviors between new wearable adopters and nonadopters adjusting for demographic and socioeconomic characteristics. Relative changes were estimated using Poisson models with a log link, and subgroup analyses were conducted to explore variation across sociodemographic groups. As a sensitivity analysis, inverse probability of treatment weighting was additionally applied to assess the robustness of the findings to observed baseline imbalance. Results: Wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time. In the difference-in-differences model, adopters showed greater relative increases in total activity (rate ratio [RR] 1.24, 95% CI 1.08-1.35), physical activity (RR 1.36, 95% CI 1.12-1.64), and cultural activity (RR 1.78, 95% CI 1.31-2.42) than nonadopters. Subgroup analyses showed limited evidence of consistent heterogeneity and should be interpreted cautiously. Sensitivity analyses using inverse probability of treatment weighting showed overall patterns broadly similar to those of the primary analyses. Conclusions: In this nationally representative panel study, wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time, whereas no clear association was observed for social activity. These findings should be interpreted as associative rather than causal given the observational design and the inability to directly assess parallel trends.

Purpose Tuberculosis (TB) remains a major public health challenge in low- and middle-income countries, including Nepal. Understanding the factors associated with TB treatment outcomes is essential for improving disease control and patient management. Methods A retrospective study was conducted using TB program data from Lalitpur District, Nepal. De-identified patient records were extracted from the Health Information Management System and the national e-TB register. Sociodemographic, behavioral, and clinical variables were analyzed. Descriptive statistics summarized patient characteristics, while Pearson’s chi-square test assessed associations between variables and treatment outcomes. Multivariable logistic regression was used to identify predictors of treatment success. Results A total of 2,779 TB patients were included in the study. The overall treatment success rate was high, with most patients completing treatment successfully. Age, gender, and HIV status were significantly associated with treatment outcomes. Patients older than 60 years had higher odds of unsuccessful treatment compared with younger patients. Female patients showed higher odds of treatment success than males. HIV-positive patients had significantly poorer treatment outcomes compared with HIV-negative individuals. Other factors, including ethnicity, residence, smoking status, TB type, registration type, treatment category, DOTS delivery approach, and GeneXpert results, were not significantly associated with treatment success. Conclusion Age, gender, and HIV status were key predictors of TB treatment outcomes in Lalitpur District. Strengthening integrated TB–HIV care, improving follow-up among older patients, and enhancing treatment adherence among male patients may help improve treatment success rates. These findings provide evidence to support targeted TB control strategies and contribute to achieving the World Health Organization’s End TB Strategy goals.

Background: Hypertension represents an important global health challenge, closely linked to cardiovascular diseases and elevated premature mortality rates. Prehypertension, defined as elevated blood pressure not meeting the diagnostic criteria for hypertension, necessitates early intervention to prevent disease progression. Health literacy, defined as the capacity to comprehend and use health-related information, is a key determinant of health outcomes but has rarely been studied in the context of prehypertension prevention. Objective: This study investigated the association between health literacy and prehypertension in South Korean adults. Unlike prior research focusing on treatment adherence in diagnosed patients, this study used the most recent nationally representative data to explore how domain-specific health literacy is associated with prehypertension across various subgroups, identifying potential mechanisms for intervention. Methods: Data were obtained from the 2023 Korea National Health and Nutrition Examination Survey, a nationally representative cross-sectional study. A stratified, multistage clustered sampling design was used to invite participants. Adults aged 19 years and older (N=1873) who completed the Korean Health Literacy Index were included. Prehypertension was defined as a systolic blood pressure of 130 to 139 mm Hg or a diastolic blood pressure of 80 to 89 mm Hg. A multivariable survey-weighted logistic regression model was used to assess the associations between health literacy and prehypertension, adjusting for sociodemographic and health-related covariates. Results: Of the 1873 participants, 319 (17.0%) had prehypertension, and 1098 (58.6%) showed low health literacy. After adjustment, those with low health literacy had a 43% higher likelihood of prehypertension (odds ratio 1.43, 95% CI 1.07‐1.91) than those with high health literacy. Subgroup analyses revealed that the protective impact of health literacy is not uniform but is modulated by demographic contexts. Conclusions: The observed patterns may reflect three potential mechanisms: (1) motivation for and dependency on health information (eg, in women, middle-aged, lower education, and unemployed groups), (2) synergy between health literacy and resources (eg, in high-income, urban, married, and employer-insured groups), and (3) preventive efficacy in low-risk populations. Low health literacy was significantly associated with prehypertension, with variations across subgroups suggesting context-dependent mechanisms. Health literacy may serve as a modifiable determinant and compensatory resource for cardiovascular risk prevention, particularly in populations with limited access to health care. Targeted interventions that address domain-specific health literacy deficits are needed to reduce the prehypertension burden.

Background: The growth of mobile health has underscored the critical importance of equitable internet access in promoting healthy aging. Among older adults, particularly those in digitally underserved populations, access to mobile data is often limited due to affordability and technological barriers, leading to a phenomenon known as “data deprivation.” This form of digital inequality limits the older adults’ ability to participate in social, recreational, and community-based activities, which are protective against isolation and decline in later life. In South Korea, where unlimited smartphone data plans have become increasingly accessible, a unique opportunity exists to examine the real-world association of improved data accessibility on older adults’ social lives and digital engagement. Objective: This study aimed to examine whether switching to unlimited smartphone data plans enhances social participation among older adults in South Korea. It also explored whether this relationship differs by demographic and socioeconomic characteristics, such as age, gender, region, household composition, and income level. The study focused on offline domains of social participation, including hobby gatherings, religious services, volunteering, and routine activities such as shopping. Methods: Data were drawn from the Korea Media Panel Survey (2016‐2022), a nationally representative longitudinal dataset. The final sample included 5021 individuals. Social participation was measured using a self-reported 8-item scale (8‐64 points) covering outdoor activities, volunteering, and more. A difference-in-differences approach was used to assess the association of switching from limited to unlimited smartphone data plans on social activity scores. Subgroup analyses examined heterogeneity by gender, household composition, income, and region. Results: Overall, among individuals aged 60 years and older, switching to an unlimited data plan was not associated with a statistically significant change in social activity scores. However, within this group, those aged 70 years and older showed a more notable—though not statistically significant—improvement (differential of 1.54, 95% CI −0.41 to 3.50). In contrast, older men living alone experienced a significant differential improvement of 6.44 (95% CI 3.39 to 9.50) points, compared with those who remained on limited plans. Conclusions: Although the overall association of unlimited data plans was limited, certain vulnerable subgroups—particularly older men living alone—experienced meaningful gains. These findings suggest that improving mobile data accessibility may enhance social engagement among digitally underserved older adults. Compared with more complex or resource-intensive interventions, expanding access to unlimited smartphone data plans may offer a relatively simple and scalable strategy to support healthy aging and reduce social isolation.

Objectives: This study was performed to quantify the impact of coronavirus disease 2019 (COVID-19) on hospital profitability in Korea by analyzing changes in the medical revenue-to-profit ratio (MRPR) and net income before reserve fund allocation (NIBR) before and after the pandemic onset. Additionally, it examined how financial outcomes varied by hospital ownership, geographic location, and type (secondary or tertiary), providing insights into the financial resilience of various hospital types during public health crises.Methods: We conducted a longitudinal analysis using publicly available financial disclosure data from 243 general hospitals in Korea (2016–2022). We then performed a quadrant analysis to classify hospitals based on changes in MRPR and NIBR, identifying patterns of financial impact. For inferential analysis, we employed linear mixed-effects models incorporating a difference-in-differences framework, enabling estimation of both time-varying and hospital-specific effects.Results: Following the onset of COVID-19, MRPR declined significantly, reaching −10.62% in 2020. NIBR initially dropped but later increased, reaching 21.09 billion Korean won per 100 beds in 2022. Quadrant analysis revealed substantial heterogeneity in financial responses, with national/public hospitals experiencing the most severe MRPR decline, whereas educational foundation and medical corporation hospitals displayed stronger financial recovery. Regression results confirmed significant interactions between outcomes after COVID-19 onset and hospital ownership type, indicating differential financial impacts across hospital categories.Conclusions: The findings highlight the uneven financial effects of COVID-19 on Korean hospitals, emphasizing the importance of targeted government financial support. Policy measures should prioritize structural financial reforms to ensure hospital sustainability beyond short-term crisis management.