A Study of Mental Health Literacy Among North Korean Refugees in South Korea

Objectives:

This study aimed to investigate North Korean refugees’ knowledge of mental illnesses and treatments and analyze the factors affecting this knowledge.

Methods:

Subjects were selected via a snowball sampling method, and the survey outcomes of 152 North Korean refugee participants were analyzed. The factors affecting knowledge of mental illnesses were analyzed via a regression analysis by constructing a multivariate model with mental illness knowledge score as the dependent variable.

Results:

The North Korean refugees’ mental illness scores ranged from 3 to 24 points, with an average score of 13.0. Regarding the factors that influence mental illness knowledge, the subjects with South Korean spouses and those who had spent more time in South Korea had higher knowledge scores. Furthermore, the subjects who considered the mental health of North Korean refugees to be a serious issue revealed lower knowledge scores than those who did not believe it was a serious issue. The subjects who visit psychiatric clinics showed higher knowledge scores than those who do not. The South Korean subjects who had at least a college education exhibited higher scores than did those without advanced education. The subjects who are satisfied with life in South Korea manifested a higher mental illness knowledge score than those who are not.

Conclusions:

This study is significant as being the first study to ever measure and evaluate the level of North Korean refugees’ knowledge of mental illnesses. In addition, the evaluations of North Korean refugees’ mental illness knowledge and influencing factors while residing in South Korea created basic data that formed the foundation of an effort to enhance mental health literacy and provide proper mental health services. The results of this study can be utilized to solve mental health problems that might frequently occur during the unification process of North and South Korea in the future.     

The effect of unusual social experience on the global health of North Korean asylum seekers

OBJECTIVES: This study examined the risk factors associated with a negative self-rating of subjective health among North Korean asylum seekers, paying particular attention to the unusual social experiences of this population. STUDY DESIGN: This study utilized the North Korean Health Care System Data Set (NKHCS). This data set is comprised of information on 221 North Korean asylum seekers (aged 20 years and over) who were housed in Hanawon, a South Korean government facility. We specifically examined the effect of three separate risk factors (major country of residence after exiting North Korea, duration of stay in country, and whom they were accompanied by during their migration event) associated with the unusual social experiences of North Korean asylum seekers on their global health. METHODS: Multivariate logistic regression analyses were carried out in order to assess the consistency and validity of extant hypotheses and general expectations. RESULTS: North Korean asylum seekers who entered South Korea within one year of their defection or were accompanied by non-family members tended to negatively self-report their health status. However, major intermediate country of residence after exiting North Korea showed no effect. Higher educational attainment and membership of the Labour Party of North Korea were negatively associated with the global health of this population, though this was not statistically significant. CONCLUSIONS: We found that the unusual social experiences of North Korean asylum-seekers, particularly intermediate country duration and companionship characteristics, were significantly associated with their health. Future studies need to examine the relationship between diverse social experiences during residence in intermediate countries and the health of this population.     

A Bi-National Comparative Study of Health Behaviors of Koreans in South Korea and Korean Americans in California

Few studies have compared health behaviors of Koreans in their home country and Korean Americans. Using 2009 data from the Community Health Survey (South Korea) and the California Health Interview Survey (USA), we compared native Koreans and Korean Americans, grouped by level of acculturation, on prevalence of specific health behaviors and self-rated health, and conducted multiple logistic regression comparing the odds of these behaviors among the groups adjusted for demographic variables. While Korean Americans exhibit healthier behaviors than Koreans in some areas (e.g., reduced smoking and binge drinking in men, increased utilization of flu vaccinations), we also identified problem behaviors (e.g., increased body weight in Korean American men, uptake of alcohol drinking and smoking among Korean American women). Findings support the critical need for health promotion programs addressing these health behaviors to prevent future health problems among Korean Americans.     

Psychometric properties of the Korean version of the effort–reward imbalance questionnaire: a study in a petrochemical company

Objective To evaluate the criterion validity, factorial validity, and internal consistency of Korean version of effort–reward imbalance (ERI) for the scales of effort, reward, and overcommitment as well as to examine the effect of psychosocial factors on physical and mental illness among petroleum refinery workers in South Korea. Methods The Korean version of ERI questionnaire was constructed using the translation and back-translation technique, and its psychometric properties were explored among 908 male workers in a large petroleum refinery in South Korea in 2002. Cronbach’s alpha coefficient was used to test internal consistency. An exploratory factor analysis was conducted on all items of the instrument. Confirmatory factor analyses were conducted on each dimension of effort, reward and overcommitment. Physical and mental health was measured by self-rated health (SF-8). The lowest tertiles of the scores were defined as illness. Multiple logistic regression models were used to test the effect of job stress on the physical and mental health (criterion validity of ERI scales). Results The Cronbach’s alpha coefficients for effort, reward, and overcommitment were 0.71, 0.86, and 0.75, respectively, indicating satisfactory internal consistency. Exploratory factor analysis found three latent factors, which closely corresponded to the theoretical structure of the ERI model. Acceptable construct validity was shown using confirmatory factor analysis. The highest tertile of effort–reward ratio was significantly associated with physical illness (OR 2.4, 95% CI 1.7–3.6) and mental illness (OR 2.9, 95% CI 2.0–4.2), compared to lower tertiles. Overcommitment was significantly associated with mental illness, but not with physical illness. Conclusions These findings contribute to the validity and reliability of the Korean ERI questionnaire. Importantly, in the context of a rapid change in the labour market, the lack of reciprocity between efforts and rewards at work is strongly associated with self-rated physical and mental health.     

Associations of self-rated health with different forms of leisure activities among ageing people

Summary Objectives:  This study examined associations between self-rated health and specific forms of leisure activities – i. e. singing in a choir, art painting, playing music; art exhibitions, theatre, movies, concerts; religious events; studying and self-development; voluntary work – and investigated how confounding factors contribute to these associations among ageing people in Finland. Methods:  A postal survey was conducted in 2002 among men and women born in 1926–30, 1936–40 and 1946–50. The final 2,815 participants represented 66% of the original sample drawn, stratified by age, gender, and municipality. Logistic regression analyses were used to investigate associations between specific forms of leisure activities and self-rated health. Results:  Going to art exhibitions, theatre, movies, and concerts among women and studying and self-development among men were significantly positively related to self-rated health, even after adjusting for socioeconomic status (SES), other sociodemographic variables, obesity, and health behaviours. Among women, active participation in religious events and voluntary work were negatively associated with self-rated health. Conclusions:  The association of leisure activities and good self-rated health may differ for genders due to their nature or meaning. Partial support was found for the assumption that leisure activities go together with better self-rated health among ageing people. Submitted: 14 December 2006; Revised: 04 July 2007; Accepted: 02 April 2008     

Health-Promoting Behavior and Influencing Factors in Young North Korean Refugees (NKRs) Living in South Korea

The number of young North Korean refugees (NKRs) entering South Korea to escape famine and poverty and improve their quality of life is drastically increasing. The aims of this study were to identify and compare health promoting lifestyle behaviors (HPLBs) of young NKRs, compared to South Koreans, and to investigate influencing factors related to HPLBs in young NKRs. Data were obtained from 150 NKRs residing in South Korea and 161 South Koreans. Respondents provided their psychological status (depression, stress, and life satisfaction) and HPLBs. The NKRs reported lower interpersonal relations scores and higher spiritual growth scores compared to the control group. Attendance in religious services, stress, and life satisfaction were significantly associated with HPLBs in young NKRs. Health education and/or promotion programs focusing interpersonal relations and spiritual growth may be beneficial. In addition, regular psychological health screening is proposed as part of health-checkup programs, potentially improving adjustment to South Korean society.     

Reactions to Secondhand Smoke by Nonsmokers of Korean Descent: Clash of Cultures?

Koreans hail from a culture where men’s smoking and secondhand smoke (SHS) exposure were the norm. Little is known about how nonsmokers of Korean descent respond to smokers in the United States. In 2007–2008, trained moderators conducted eight focus groups with nonsmokers (n = 47) of Korean descent in San Diego. Participants discussed their personal experiences and views concerning SHS. Most participants detected SHS quickly and disliked the smell. Their reactions differed by gender, age, and how well they knew the smoker. Reactions ranged from passive (e.g., tolerating SHS or staring) to assertive (moving or asking the smoker to stop smoking). Younger participants were more tolerant than older participants. Participants appeared caught between two cultures. Despite high awareness, they struggled with how to avoid SHS in a manner befitting of their social status and Korean values. Culturally sensitive programs are needed for immigrants such as Koreans in the United States.     

Socioeconomic status, social support and self-rated health among lone mothers in South Korea

Objectives  

This study examined the association of socioeconomic status and social support with the differences in self-rated health between lone and partnered mothers in South Korea.     

Colorectal cancer among Koreans living in South Korea versus California: incidence,mortality, and screening rates

Objectives. This study compared trends in colorectal cancer (CRC) incidence and mortality rates among Koreans in South Korea and Korean Americans and non-Hispanic whites in California between 1999 and 2009, and examined CRC screening rates and socio-demographic correlates of CRC screening in the two Korean populations.

Design. Age-standardized CRC incidence and mortality rates of Koreans in South Korea and Korean Americans and non-Hispanic whites in California for the years 1999–2009 were obtained from annual reports of cancer statistics and modeled using joinpoint regression. Using 2009 data from the Korean National Health and Nutrition Examination Survey and the California Health Interview Survey, we estimated and compared CRC screening rates and test modalities. We used multiple logistic regression to examine socio-demographic correlates of completion of CRC screening according to the guidelines among the two Korean populations.

Results. CRC incidence and mortality rates among South Koreans increased during 1999–2009 but more slowly during the late 2000s. In California, CRC incidence increased among Korean American females but decreased among non-Hispanic whites. About 37% of South Koreans and 60% of Korean Americans reported completion of CRC screening according to guidelines in 2009. Among South Koreans, married status, higher income, and private health insurance were associated with CRC screening, adjusting for other factors. Among Korean Americans, having health insurance was associated with CRC screening.

Conclusion. Despite almost identical CRC screening guidelines in South Korea and the USA and substantially higher screening rates among Korean Americans as compared to South Koreans, disparities remain in both populations with respect to CRC statistics. Thus, efforts to promote primary and secondary prevention of CRC in both Korean populations are critically important in both countries.     

Food security experiences of displaced North Korean households

BACKGROUND/OBJECTIVES

Food shortage situation in North Korea has gained much interest, however food insecurity caused by the food shortage in North Korean households has not been much investigated. This study examined food security experiences and food consumption pattern of displaced North Korean households currently living in South Korea.

SUBJECTS/METHODS

Food security experience among 51 North Korean households living in South Korea was examined using the Household Food Insecurity Access Scale (HFIAS) in three time points: immediately before childbirth, immediately before leaving North Korea, and immediately before entering South Korea. Meal/snack consumption frequencies and food diversity were also examined.

RESULTS

Food security situation was the worst at the time of immediately before leaving North Korea with the average HFIAS score of 10.05. The households that were food insecure, they tended to be "severely" insecure. Although majority of the subjects reported having three or more meals a day, food diversity in their diet was very low with the average food diversity score of 2.17 immediately before childbirth and 1.74 immediately before leaving North Korea. Their diet appeared to heavily rely on grain and vegetable.

CONCLUSIONS

This study is one of few that specifically examined food security of North Korean households with a pre-developed scale, and that demonstrated food security situation at different time points in quantified terms. Replicating this study with different groups of North Korean households for different time points would allow more complete understanding of impacts of food shortage. Food diversity score could provide a good way to examine changes of food consumption occurring to North Koreans in the process of adaptation. More attention to the changes occurring during adaption to South Korea should be given to understand the process and impact and to prepare public nutrition policy for the re-unified Korea.     

Factorial Invariance,Scale Reliability,and Construct Validity of the Job Control and Job Demands Scales for Immigrant Workers: The Multi-Ethnic Study of Atherosclerosis

Immigrants have a different social context from those who stay in their home country or those who were born to the country that immigrants now live. Cultural theory of risk perception suggests that social context influences one’s interpretation of questionnaire items. We examined psychometric properties of job control and job demand scales with US- and foreign-born workers who preferred English, Spanish, or Chinese (n = 3,114, mean age = 58.1). Across all groups, the job control scale had acceptable Cronbach’s alpha (0.78–0.83) and equivalent factor loadings (ΔCFI < 0.01). Immigrants had low alpha (0.42–0.65) for the job demands scale regardless of language, education, or age of migration. Two job-demand items had different factor loadings across groups. Among immigrants, both scales had inconsistent associations with perceived job stress and self-rated health. For a better understanding of immigrants’ job stress, the concept of job demands should be expanded and immigrants’ expectations for job control explored.     

Socioeconomic status, working conditions and self-rated health in Switzerland: explaining the gradient in men and women

Objectives:  Epidemiological research has confirmed the association between socioeconomic status (SES) and health, but only a few studies considered working conditions in this relationship. This study examined the contribution of physical and psychosocial working conditions in explaining the social gradient in self-rated health. Methods:  A representative sample of 10 101 employees, 5003 women and 5098 men, from the Swiss national health survey 2002 was used. SES was assessed according to the EGP-scheme. Working conditions included exposure to physical disturbances, physical strain, job insecurity, monotonous work and handling simultaneous tasks. For data analysis logistic regression analyses were performed. Results:  Data show a social gradient for self-rated health (SRH) as well as for physical and psychosocial working conditions. Logistic regression analysis controlling for age, gender and level of employment showed both physical and psychosocial working conditions to be significant predictors of SRH. Physical and psychosocial working conditions such as physical disturbances from work environment, physical strains in doing the job, monotony at work, job insecurity etc. could explain most of the social gradient of SRH in men and women. Conclusion:  The study confirmed the relevance of modifiable physical and psychosocial working conditions for reducing social inequality in health. Gender differences need to be considered in epidemiological and intervention studies. Submitted: 24 August 2007; revised: 06 May 2008, 11 August 2008; accepted: 19 October 2008     

Sociodemographic and socioeconomic variations in leisure time physical activity in a sample of Hungarian youth

Summary Objectives:  The main goal of the present study is to detect the relationship between youth’s leisure time physical activity and a set of sociodemographic (age, gender, family stucture) and socioeconomic variables (SES and parental schooling). Methods:  Data were collected among Hungarian youth (middle and high school students, N = 1662) aged between 10–20 years using a self-administered questionnaire. Results:  Our findings did not indicate gender differences during the years of middle school, whereas gender differences became significant during the years of high school. In multivariate analyses, parental schooling played a decisive role in youth’s physical activity, wheres SES self-assessment did not remain significant. Conclusion:  These findings provide some useful information on characteristics of the target groups for health education programs. Submitted: 06 December 2007; Revised: 05 May 2008; Accepted: 01 September 2008     

Performance of universal health insurance: lessons from South Korea

The aim of this study was to assess the maturity of the South Korean healthcare system in comparison with those of the 30 countries of the Organization for Economic Co-operation and Development (OECD) and to provide a foundation to evaluate the performance of the South Korean healthcare system. Using OECD Health Data 2005, we evaluated the performance of the healthcare system of the 30 industrialized countries. The evaluation focused on three dimensions that have remained central to healthcare debates internationally for years: access, cost and outcomes. Although South Korea has successfully implemented its universal health insurance scheme in a very short period of time and possesses highly advanced medical technologies, we found that South Koreans incurred more out-of-pocket expenditures on healthcare. Health outcomes were of relatively low quality compared with those of other OECD countries, but compared relatively well with the four countries (Greece, New Zealand, Portugal and Spain) with similar per capita gross domestic product (GDP).     

Behavioral and psychosocial influences of risk perception among Hungarian adolescents

Summary Objective:  The main goal of the present study was to assess adolescents’ risk perception, namely, their estimates of the likelihood of smoking and alcohol-related illnesses and accidents. Methods:  The survey was conducted among high school students in Szeged (N = 560, aged between 14–19 years; mean: 16.7; S.D.: 1.4 years). The self-administered questionnaire contained items on sociodemographics, risk perception, health risk behaviors, and certain psychosocial variables. Results:  Being a male was associated with risk perception only in terms of alcohol-related illnesses. Smokers, alcohol users, and those who engaged in reckless transportation, evaluated themselves as being at higher risk for substance related illnesses and accidents compared to those who did not report such behaviors. Those who tended to use a seat belt, however, estimated the same amount of risk for an accident as did those who tended not to use them. Social attitudes tended to positively, whereas personal attitudes tended to negatively influence perceptions of health risks. The role of social comparison and self-efficacy, however, depends on the nature of behavior. Conclusion:  Besides behavioral influences, psychosocial variables also play a role in adolescents’ risk perception. Submitted: 25 July 2007; Accepted: 14 January 2008     

Measuring Health Literacy Among Immigrants with a Phonetic Primary Language: A Case of Korean American Women

While the need for understanding the issue of health literacy among ethnic minority groups with limited English skills is rapidly increasing in the US, it is difficult to find valid and useful health literacy tools for certain linguistic minorities. This study was designed to validate the Korean translation of Rapid Estimate of Adult Literacy in Medicine (REALM) and Test of Functional Health Literacy in Adults-Short form (S-TOFHLA). Korean REALM and S-TOFHLA were administered to 98 Korean American women, together with REALM-English. Participants were first-generation immigrants who were educated in Korea. Both Korean REALM and S-TOFHLA resulted in a negatively-skewed distribution. REALM-English yielded well-distributed groups with significant correlations with Korean REALM and S-TOFHLA (Spearman’s rho = 0.30, P = 0.003 and 0.22, P = 0.03, respectively). Educational level was significantly correlated with REALM-English and Korean S-TOFHLA (Spearman’s rho = 0.39, P = 0.000 and 0.25, P = 0.014), but not with REALM-Korean. The translation of REALM and S-TOFHLA into the Korean language did not lead to a valid assessment of health literacy. A more systematic approach is needed to assess health literacy in immigrants with limited English skills, particularly those with a phonetic primary language. Meanwhile, REALM-English could be used as a crude health literacy test for individuals with some English skills.     

Individual Health Care System Distrust and Neighborhood Social Environment: How Are They Jointly Associated with Self-rated Health?

Americans’ distrust in the health care system has increased in the past decades; however, little research has explored the impact of distrust on self-rated health and even less is known about whether neighborhood social environment plays a role in understanding the relationship between distrust and self-rated health. This study fills these gaps by investigating both the direct and moderating associations of neighborhood social environment with self-rated health. Our analysis is based on the 2008 Philadelphia Health Management Corporation’s household survey and neighborhood-level data. Findings from multilevel logistic regression show that after controlling for individual- and neighborhood-level covariates, distrust is directly and adversely related to self-rated health, and that neighborhood social affluence and stability are directly and negatively associated with the odds of reporting poor/fair health. Neighborhood disadvantage and crime rates are not directly related to self-rated health, but increase the odds of having poor/fair health via distrust. Overall, our results suggest that macro-level actions can alter individual’s perception of residential environment and lead to improved health. To improve the public health in an urban setting, rebuilding confidence in the health care system is integral, and the policies that help establish safe and cohesive neighborhoods may reduce the adverse effect of distrust on self-rated health.