1.Occupational stress (KOSS®19): scale development and validation in the Korean context
Hansoo SONG ; Hyoung Ryoul KIM ; Inah KIM ; Jin-Ha YOON ; Sang-Baek KOH ; Sung-Soo OH ; Hee-Tae KANG ; Da-Yee JEUNG ; Dae-Sung HYUN ; Chunhui SUH ; Sei-Jin CHANG
Annals of Occupational and Environmental Medicine 2025;37(1):e12-
Background:
The Korean Occupational Stress Scale (KOSS) was developed in 2004. During this time, industrial structures have evolved, and societal awareness of occupational stress has changed. This study aims to develop and validate a revised version of the Korean Occupational Stress Scale (KOSS®19), tailored for workers, reflecting these changes.
Methods:
The KOSS®19 was developed based on the 26-item KOSS–short form (SF) through a review by eight experts. A survey was conducted including 359 service industry workers, comprising the KOSS®19, Burnout, and Depression scales. The KOSS®19 subscales were restructured, and their reliability and validity were evaluated.
Results:
The KOSS®19 composed of eight subscales: hazardous physical environment (2 items), high job demand (3 items), insufficient job control (2 items), low social support (2 items), job insecurity (2 items), organizational injustice (4 items), lack of reward (2 items), and work-life imbalance (2 items). The reliability and validity of the KOSS®19 were found to be satisfactory.
Conclusions
The KOSS®19 is a suitable tool for assessing occupational stress, effectively replacing the original KOSS and KOSS-SF.
2.Emotional labor (KELS®11): scale development and validation in the Korean context
Da-Yee JEUNG ; Hyoung Ryoul KIM ; Hansoo SONG ; Inah KIM ; Jin-Ha YOON ; Sang-Baek KOH ; Sung-Soo OH ; Hee-Tae KANG ; Dae-Sung HYUN ; Chunhui SUH ; Sei Jin CHANG
Annals of Occupational and Environmental Medicine 2025;37(1):e13-
Background:
Emotional labor refers to the management of emotions and expressions to meet the emotional requirements of a job role. This study aimed to develop a revised version of the Korean Emotional Labor Scale (KELS®11), based on the first edition (KELS-24) introduced in 2014, and to provide practical applications and guidelines for its use in the Korean workplace through a validation process.
Methods:
The revised version of KELS®11 was derived from the 24-item KELS, following a review process involving eight experts. To validate the scale’s reliability and validity, a self-administered survey was conducted among 359 service industry workers using KELS®11, burnout, and depression scales. KELS®11 was reclassified, and its reliability and validity were evaluated. Receiver operating characteristic curve analysis was conducted to establish sex-specific cutoff values (normal vs. high-risk groups).
Results:
KELS®11 was designed to account for individual, organizational, and cultural contexts. It consists of four subscales and 11 items: “emotional regulation” (2 items), “emotional dissonance” (3 items), “organizational monitoring” (2 items), and “organizational protective system for emotional labor” (4 items). KELS®11 demonstrated good validity (content validity ratio: 0.84; item convergence/discriminant validity success rates: 100%; correlation with burnout: r = 0.185–0.436, p < 0.01; correlation with depression: r = 0.128–0.339, p < 0.05) and reliability (Cronbach’s alpha: 0.597–0.795). Additionally, sex-specific reference values were established to determine risk groups based on the intensity of emotional labor exposure.
Conclusions
KELS®11 is a validated and reliable measurement tool designed to assess the intensity and magnitude of emotional labor in the workplace. The revised tool reflects critical considerations in the development of emotional labor measurement scales.
3.Workplace Violence (KWVS®13): scale development and validation in the Korean context
Da-Yee JEUNG ; Hyoung Ryoul KIM ; Hansoo SONG ; Inah KIM ; Jin-Ha YOON ; Sang-Baek KOH ; Sung-Soo OH ; Hee-Tae KANG ; Dae-Sung HYUN ; Chunhui SUH ; Sei-Jin CHANG
Annals of Occupational and Environmental Medicine 2025;37(1):e14-
Background:
Workplace violence refers to any act or threat of physical violence, verbal abuse, harassment, intimidation, bullying, mobbing, or other aggressive and disruptive behaviors that occur at work. This study aims to develop and validate a revision of the Korean Workplace Violence Scale (KWVS®13), based on the first edition of the Korean Workplace Violence Scale (KWVS-24), and to provide practical applications and guidelines for the Korean workplace environment.
Methods:
The revised KWVS®13 was developed by restructuring the 24-item KWVS through a review process involving eight experts. To validate the reliability and validity of KWVS®13, a self-administered survey comprising KWVS®13, burnout, and depression scales was conducted among 359 service industry workers. KWVS®13 was reclassified, and its reliability and validity were assessed. Receiver operating characteristic curve analysis was performed to establish sex-specific cutoff values (normal vs. risk) of the scale.
Results:
KWVS®13 consists of 13 items across four subscales: “psychological and sexual violence from customers” (4 items), “psychological and sexual violence from supervisors or coworkers” (4 items), “physical assault from customers, supervisors, or coworkers” (2 items), and “organizational protective system for workplace violence” (3 items). We found that KWVS®13 shows relatively good validity (content validity ratio for content validity: 0.888; success rate of item convergent and discriminant validity: 100%, and significant correlation coefficient with burnout (r = 0.115–0.83, p < 0.05) and depression (r = 0.098–0.348, p < 0.05) with the exception of Organizational Violence Protection System for Workplace Violence) and reliability (Cronbach’s alpha: 0.827–0.860). The reference values for determining risk groups according to the intensity of exposure to workplace violence are presented separately by sex.
Conclusions
KWVS®13 is a robust and useful measurement tool to objectively and quantitatively assess the intensity and magnitude of workplace violence. It incorporates important considerations for workplace violence assessment and provides a reliable framework for evaluating workplace violence in various professional settings.
4.Development of standard job classification codes for building a job-exposure matrix for police officers
Sangjun CHOI ; Ju-Hyun PARK ; Inah KIM ; Jungwon JANG ; Jeehee MIN ; Sang Baek KOH ; Seongwon KIM ; Yeji SUNG ; Kyoung Yoon KO ; Su Min OH ; Un-Yeol JEON
Annals of Occupational and Environmental Medicine 2025;37(1):e10-
Background:
This study aimed to develop standard job categories for constructing a job-exposure matrix (JEM) for police officers in South Korea and to evaluate their applicability.
Methods:
We examined standard job codes related to police personnel management and compared them with job classifications from police publications. Using R Shiny, we developed a web-based search tool for standard codes. A pilot survey of 130 police officers assessed the codes' applicability and relevance to health-related hazardous factors.
Results:
Eighty-seven standard functional codes used in the police personnel management system POOL were organized into minor categories as the basic units of standard jobs. These were grouped into 20 sub-major categories and further consolidated into 10 major categories to develop the standard job codes. The responses to the standard job codes in the pilot survey were 75% accurate compared with the final expert evaluation results and 99.2% accurate compared with the algorithm-based automatic allocation results. The results of the job-hazardous factor network analysis revealed that the most frequently reported hazardous factor was emotional labor, followed by night shifts and electromagnetic waves. Emotional labor was identified as the top hazardous factor in six out of the nine standard job categories.
Conclusions
The standard job codes developed in this study were designed in connection with the personnel management system for police officers, making them well-suited for constructing a comprehensive JEM for the entire police force.
5.The status and implications of paid sick leave and sickness benefits in OECD countries
Jaehoon LEE ; Jinwoo LEE ; Sang Baek KOH
Annals of Occupational and Environmental Medicine 2025;37(1):e21-
The experience of the coronavirus disease 2019 pandemic has highlighted the importance of paid sick leave and sickness benefits, and is creating an international movement to introduce or improve real-world systems. The Organisation for Economic Co-operation and Development (OECD) countries except Korea and the United States already have statutory paid sick leave or sickness benefits, with the United Kingdom extending statutory paid sick leave to low-income workers in 2025, and Ireland introducing statutory paid sick leave in 2023. In the United States, 19 states, including Minnesota in 2024 and Alaska and Missouri in 2025, as well as the District of Columbia, have introduced statutory paid sick leave (as of December 2024). Furthermore, an analysis of 33 OECD countries with statutory paid sick leave or sickness benefits suggests that 21 countries comply with the International Labour Organization (ILO) Convention standards for adequacy of benefits and comprehensiveness of coverage, while six countries with social assistance have high comprehensiveness of coverage but low adequacy of benefits. There was not a single country with a program that had low levels of both benefit adequacy and coverage. In Korea, the pilot sickness benefit program has been extended until 2027, and the system has been delayed. The principles of benefit adequacy and coverage comprehensiveness must be upheld for the purpose and intent of the program to ensure adequate care and rest. Consequently, in addition to adhering to the standards outlined in the ILO Convention, the implementation of paid sick leave should be codified in legislation to enhance employer accountability.
7.Sex-specific associations between dietary legume subtypes and type 2 diabetes in a prospective cohort study
Hye Won WOO ; Sangmo HONG ; Min-Ho SHIN ; Sang Baek KOH ; Hyeon Chang KIM ; Yu-Mi KIM ; Mi Kyung KIM
Epidemiology and Health 2024;46(1):e2024083-
OBJECTIVES:
Dietary soy, known for its high phytoestrogen content, has been suggested to exhibit a sex-specific association with type 2 diabetes. However, evidence regarding the sex-specific associations of different legume subtypes with type 2 diabetes remains scarce. We aimed to evaluate whether habitual consumption of soy and non-soy legumes (beans and peanuts) was prospectively and sex-specifically associated with the risk of type 2 diabetes incidence, taking into considering significant sex-specific genetic factors beyond legume consumption.
METHODS:
A total of 16,666 participants (96,945 person-years) were followed and 945 incident cases were observed. Cumulative intake of legume subtypes was calculated using a food frequency questionnaire administered at baseline and during the revisit surveys.
RESULTS:
Non-soy legumes are inversely associated with type 2 diabetes in both men and women. Dietary soy intake, however, demonstrated a unilaterally interacting sex-specific association with type 2 diabetes risk (pinteraction for sex=0.017). Specifically, there was a significant inverse association with type 2 diabetes risk in women (incidence rate ratio, 0.66; 95% confidence interval, 0.48 to 0.80; ptrend=0.007), but no such association was observed in men. This sex-specific association persisted and even appeared antagonistic in minor allele carriers of 2 novel single nucleotide polymorphisms, rs10196939 (LRRTM4) and rs11750158 (near GFPT2) (pinteraction for sex=0.001 and 0.011, respectively).
CONCLUSIONS
Habitual consumption of legumes shows protective impacts against type 2 diabetes, although these benefits vary by sex. Non-soy legumes provide health advantages for both men and women, whereas soy consumption seems to be beneficial exclusively for women.
8.Polycyclic Aromatic Hydrocarbons Mediate the Association between Tobacco Smoking and Alcohol Use Disorder
Dongkyu LEE ; Mun-Joo BAE ; Mi-Ji KIM ; Sung Soo OH ; Ki Soo PARK ; Chan Joo LEE ; Sungha PARK ; Seung-Koo LEE ; Sang-Baek KOH ; Sun Jae JUNG ; Changsoo KIM ; Jaelim CHO
Yonsei Medical Journal 2024;65(12):752-760
Purpose:
Smoking is causally related to alcohol use disorder. Although polycyclic aromatic hydrocarbons (PAHs) are major neurotoxic pollutants in tobacco smoke, evidence is lacking on the role of PAHs in the relationship between smoking and alcohol use disorder. This study investigated the types of PAHs associated with smoking and whether exposure to those PAHs mediated the effect of smoking on alcohol use disorder.
Materials and Methods:
A total of 968 male firefighters were analyzed. Smoking history and cumulative pack-years were obtained using self-reported questionnaires. Alcohol use disorder was defined using the Alcohol Use Disorder Identification Test.PAH exposure was assessed by urinary metabolites. Regression analyses were performed between exposure (smoking), outcome (alcohol use disorder), and mediator (PAH metabolites) variables. A mediation analysis was performed to test the indirect effect of PAH metabolites on the association between smoking and alcohol use disorder. All analyses were repeated for 770 participants who were followed up after 2 years, while alcohol use disorder was redefined from follow-up data ensuring the temporal sequence of the variables.
Results:
Both 2-naphthol [β=0.78, 95% confidence interval (CI): 0.59–0.98] and 2-hydroxyfluorene (β=0.69, 95% CI: 0.56–0.82) were associated with smoking history. Furthermore, 2-naphthol and 2-hydroxyfluorene mediated the associations of smoking history (proportion mediated: 14.2%, 23.6% respectively) or cumulative pack-years (proportion mediated: 14.4%, 25.4% respectively) with alcohol use disorder. The results were consistent in longitudinal settings.
Conclusion
Exposure to PAHs mediated the association between tobacco smoking and alcohol use disorder. PAH exposure from tobacco may increase the risk of addictive disorders.
9.Sex-specific associations between dietary legume subtypes and type 2 diabetes in a prospective cohort study
Hye Won WOO ; Sangmo HONG ; Min-Ho SHIN ; Sang Baek KOH ; Hyeon Chang KIM ; Yu-Mi KIM ; Mi Kyung KIM
Epidemiology and Health 2024;46(1):e2024083-
OBJECTIVES:
Dietary soy, known for its high phytoestrogen content, has been suggested to exhibit a sex-specific association with type 2 diabetes. However, evidence regarding the sex-specific associations of different legume subtypes with type 2 diabetes remains scarce. We aimed to evaluate whether habitual consumption of soy and non-soy legumes (beans and peanuts) was prospectively and sex-specifically associated with the risk of type 2 diabetes incidence, taking into considering significant sex-specific genetic factors beyond legume consumption.
METHODS:
A total of 16,666 participants (96,945 person-years) were followed and 945 incident cases were observed. Cumulative intake of legume subtypes was calculated using a food frequency questionnaire administered at baseline and during the revisit surveys.
RESULTS:
Non-soy legumes are inversely associated with type 2 diabetes in both men and women. Dietary soy intake, however, demonstrated a unilaterally interacting sex-specific association with type 2 diabetes risk (pinteraction for sex=0.017). Specifically, there was a significant inverse association with type 2 diabetes risk in women (incidence rate ratio, 0.66; 95% confidence interval, 0.48 to 0.80; ptrend=0.007), but no such association was observed in men. This sex-specific association persisted and even appeared antagonistic in minor allele carriers of 2 novel single nucleotide polymorphisms, rs10196939 (LRRTM4) and rs11750158 (near GFPT2) (pinteraction for sex=0.001 and 0.011, respectively).
CONCLUSIONS
Habitual consumption of legumes shows protective impacts against type 2 diabetes, although these benefits vary by sex. Non-soy legumes provide health advantages for both men and women, whereas soy consumption seems to be beneficial exclusively for women.
10.Polycyclic Aromatic Hydrocarbons Mediate the Association between Tobacco Smoking and Alcohol Use Disorder
Dongkyu LEE ; Mun-Joo BAE ; Mi-Ji KIM ; Sung Soo OH ; Ki Soo PARK ; Chan Joo LEE ; Sungha PARK ; Seung-Koo LEE ; Sang-Baek KOH ; Sun Jae JUNG ; Changsoo KIM ; Jaelim CHO
Yonsei Medical Journal 2024;65(12):752-760
Purpose:
Smoking is causally related to alcohol use disorder. Although polycyclic aromatic hydrocarbons (PAHs) are major neurotoxic pollutants in tobacco smoke, evidence is lacking on the role of PAHs in the relationship between smoking and alcohol use disorder. This study investigated the types of PAHs associated with smoking and whether exposure to those PAHs mediated the effect of smoking on alcohol use disorder.
Materials and Methods:
A total of 968 male firefighters were analyzed. Smoking history and cumulative pack-years were obtained using self-reported questionnaires. Alcohol use disorder was defined using the Alcohol Use Disorder Identification Test.PAH exposure was assessed by urinary metabolites. Regression analyses were performed between exposure (smoking), outcome (alcohol use disorder), and mediator (PAH metabolites) variables. A mediation analysis was performed to test the indirect effect of PAH metabolites on the association between smoking and alcohol use disorder. All analyses were repeated for 770 participants who were followed up after 2 years, while alcohol use disorder was redefined from follow-up data ensuring the temporal sequence of the variables.
Results:
Both 2-naphthol [β=0.78, 95% confidence interval (CI): 0.59–0.98] and 2-hydroxyfluorene (β=0.69, 95% CI: 0.56–0.82) were associated with smoking history. Furthermore, 2-naphthol and 2-hydroxyfluorene mediated the associations of smoking history (proportion mediated: 14.2%, 23.6% respectively) or cumulative pack-years (proportion mediated: 14.4%, 25.4% respectively) with alcohol use disorder. The results were consistent in longitudinal settings.
Conclusion
Exposure to PAHs mediated the association between tobacco smoking and alcohol use disorder. PAH exposure from tobacco may increase the risk of addictive disorders.

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