BACKGROUND: Individual-level social capital is an important determinant of older adults' long-term care needs; however, there is scant evidence regarding community-level social capital. Therefore, we investigated the association between community-level social capital and the prevalence of the need for long-term care among older adults. METHODS: Between January and February 2018, a cross-sectional survey was conducted among all older adults (n = 13,558) aged 65 to 74 years in a rural municipality in Japan (total population, n = 72,833). A self-reported questionnaire was used to identify community-level social capital, comprising civic participation, social cohesion, and reciprocity. A multilevel logistic regression analysis was performed to estimate the odds ratios of the need for long-term care and a decline in social activity competence as assessed by instrumental activities of daily living. For the analysis, the community levels were divided into 76 voting districts and adjusted for daily life, lifestyle, socioeconomic status, health conditions, and the three social capital subscale scores at the individual level. RESULTS: After adjusting for the covariates, we observed a tendency that a higher community level of reciprocity was associated with a lower prevalence of long-term care needs (OR: 0.86, 95% confidence interval: 0.75-1.00), whereas a high community level of social cohesion was associated with a significantly reduced decline in instrumental activities of daily living (OR per standard deviation increase: 0.87, 95% confidence interval: 0.79-0.96). No significant association was found with civic participation. Similarly, individual-level social capital was associated with the need for long-term care and decline in instrumental activities of daily living. CONCLUSIONS Our findings suggest that good community-level reciprocity or social cohesion as well as good individual social capital status may help prevent the need for long-term care among older adults.
Humans ; Aged ; Interpersonal Relations ; Activities of Daily Living ; Social Participation ; Social Capital ; Multilevel Analysis ; Cross-Sectional Studies ; Long-Term Care ; Japan/epidemiology* ; Social Support

OBJECTIVES: This study aimed to identify the individual and regional characteristics that influence suicidal ideation among the Korean elderly population. METHODS: Using data collected from the 2013 Korea Community Health Survey, a multilevel analysis was performed to establish an understanding of individual behavioral patterns and regional influences on suicidal ideation. RESULTS: Among the 77,407 individuals sampled, 11,236 (14.5%) elderly people over 60 years of age experienced suicidal ideation. Among individual factors, age, frequency of communication with friends, religious activity, social activity, leisure activity, trust in neighbors, subjective stress level, depressive symptoms, and subjective health status were significantly associated with suicidal ideation. The results showed that the lower the regional deprivation level, the higher the suicidal ideation odds ratio. In terms of regional size, the most significant effects were found in rural areas. CONCLUSIONS: This study suggested that suicidal ideation in the elderly is associated with community factors, such as the regional deprivation index, as well as personal factors.
Age Factors ; Aged ; Depression ; Diagnostic Self Evaluation ; Friends ; Health Surveys ; Humans ; Korea ; Leisure Activities ; Multilevel Analysis ; Odds Ratio ; Socioeconomic Factors ; Suicidal Ideation

OBJECTIVES: This study aimed to identify the individual and regional characteristics that influence suicidal ideation among the Korean elderly population.METHODS: Using data collected from the 2013 Korea Community Health Survey, a multilevel analysis was performed to establish an understanding of individual behavioral patterns and regional influences on suicidal ideation.RESULTS: Among the 77,407 individuals sampled, 11,236 (14.5%) elderly people over 60 years of age experienced suicidal ideation. Among individual factors, age, frequency of communication with friends, religious activity, social activity, leisure activity, trust in neighbors, subjective stress level, depressive symptoms, and subjective health status were significantly associated with suicidal ideation. The results showed that the lower the regional deprivation level, the higher the suicidal ideation odds ratio. In terms of regional size, the most significant effects were found in rural areas.CONCLUSIONS: This study suggested that suicidal ideation in the elderly is associated with community factors, such as the regional deprivation index, as well as personal factors.
Age Factors ; Aged ; Depression ; Diagnostic Self Evaluation ; Friends ; Health Surveys ; Humans ; Korea ; Leisure Activities ; Multilevel Analysis ; Odds Ratio ; Socioeconomic Factors ; Suicidal Ideation

OBJECTIVES: The objective of this study was to examine the socio-demographic disparities in obesity among US adults across 130 metropolitan and micropolitan statistical areas. METHODS: This study used data from the 2015 Behavioral Risk Factor Surveillance System and Selected Metropolitan/Micropolitan Area Risk Trend of 159,827 US adults aged 18 years and older. Data were analyzed using the multilevel linear regression models. RESULTS: According to individual level analyses, socio-demographic disparities in obesity exist in the United States. Individuals with low socioeconomic status were associated with a higher body mass index. The participants from the Midwest United States tend to have higher body mass index than those who from the South. According to metropolitan and micropolitan statistical area level analyses, secondly, there were significant differences in obesity status between different areas and the relation of obesity with 5 socio-demographic factors varied across different areas. According to geospatial mapping analyses, even though obesity status by metropolitan and micropolitan statistical area level has improved overtime, differences in body mass index between United States regions are increasing from 2007 to 2015. CONCLUSION: Socio-demographic and regional disparities in obesity status persist among US adults. Hence, these findings underscore the need to take socio-environmental factors into account when planning obesity prevention on vulnerable populations and areas.
Adult ; Behavioral Risk Factor Surveillance System ; Body Mass Index ; Humans ; Linear Models ; Multilevel Analysis ; Obesity ; Social Class ; United States ; Vulnerable Populations

OBJECTIVES: In this study the relationship between neighborhood deprivation and the unmet health care needs of elderly individuals (≥ 65 years) was examined. Some previous studies suggested that neighborhood characteristics affect access to health care, yet research on the unmet needs of older individuals is limited. METHODS: Multilevel logistic regression analysis was used to assess the relationship of neighborhood-level factors with unmet health care needs due to costs, adjusting for individual-level factors, in individuals ≥ 65 years in the 2017 Korean Community Health Survey (n = 63,388). RESULTS: There were 2.6% of elderly individuals who experienced unmet health care needs due to costs. Following adjustment for individual and neighborhood characteristics, the neighborhood deprivation in urban areas was found to have an inverse association with unmet needs (odds ratio = 0.50; 95% confidence interval = 0.24–1.06) for the most deprived quartile versus the least deprived quartile). However, in rural areas neighborhood deprivation was not a significant variable. Among the individual-level variables, household income was one of the strongest correlates with unmet needs in both urban and rural areas. CONCLUSION: The present findings suggest that targeted policy interventions reflecting both neighborhood and individual characteristics, should be implemented to reduce the unmet health care needs of elderly individuals.
Aged ; Delivery of Health Care ; Family Characteristics ; Health Services Accessibility ; Health Surveys ; Humans ; Korea ; Logistic Models ; Multilevel Analysis ; Residence Characteristics

OBJECTIVES: This study investigates investigated the relationship between social and physical environments, and moderate to vigorous physical activity (MVPA) amongst adults in both rural and urban areas within Korea. METHODS: A sample of 128,735 adults from the 2013 Community Health Survey (CHS) was analyzed using a multilevel logistic analysis. RESULTS: Urban residents with higher satisfaction in public transportation satisfaction and rural residents with more access to sports parks, hiking trails, and bike cycle paths were more likely to be active. The MVPA of adults from rural areas correlated urban adults was uncorrelatedwith neighborhood factors, but that of rural adults was whereas no correlations were observed in adults from urban areas. CONCLUSION: These differences should be considered when developing interventions strategies to enhance adult physical activity in different communities.
Adult ; Health Surveys ; Humans ; Korea ; Motor Activity ; Multilevel Analysis ; Residence Characteristics ; Social Environment ; Sports ; Transportation

OBJECTIVES: To examine health behaviors among Korean adolescents with a focus on both individual and school-based factors, specifically in relation to predictors of high-risk groups. METHODS: Secondary data analysis was conducted with data from the 8th Korea Youth Risk Behavior Web-Based Survey, using descriptive statistics, t tests, χ2 test, and multilevel logistic regression analysis. Health Practice Index was calculated and a range of 0 to 2 was classified as a high-risk group. RESULTS: The results revealed that the individual-level variables of sex, age, stress, depression, subjective health status, school performance, health education, father’s level of education, and living situation were significant predictors of high-risk behaviors. The risk was greater in girls, greater with higher age and higher stress scores, greater in adolescents with depression, greater with lower paternal educational level, and greater in adolescents who did not live with both parents, as were the school-level variables of school grade and school affluence score. The possibility of being in the high-risk group in health behavior was greater if a student attended a school where the Family Affluence Score (FAS) was lower. CONCLUSION: School health education should be expanded to manage students’ high-risk health behaviors, especially in schools that have many students from families with a low affluence status.
Adolescent ; Depression ; Diagnostic Self Evaluation ; Education ; Female ; Health Behavior ; Health Education ; Humans ; Korea ; Logistic Models ; Multilevel Analysis ; Parents ; Risk Factors ; Risk-Taking ; School Health Services ; Statistics as Topic

PURPOSE: This study attempted to identify regional disparities of self-rated health among Korean wage workers and to investigate the influencing factors on them. METHODS: The study subjects were 25,069 workers in 16 regions who were extracted from the 2014 Korean Working Condition Survey (KWCS). A multilevel analysis was conducted by building hierarchical data at individual and regional level. RESULTS: In this study, ‘financial autonomy rate’ and ‘current smoking rate’ were identified as regional factors influencing the workers' self-rated health. When the socio-demographic and occupational factors of the workers were controlled, ‘current smoking rate’, a health policy factor, explained the regional disparity of workers' health status. CONCLUSION: We found that the health status of workers can be affected by the health behavior level of the whole population in their residential area. In order to improve the health status of working population and to alleviate their regional health inequalities, it is necessary to strengthen macro and structural level interventions.
Health Behavior ; Health Policy ; Health Status Disparities ; Multilevel Analysis ; Occupational Health ; Residence Characteristics ; Salaries and Fringe Benefits ; Smoke ; Smoking ; Socioeconomic Factors

PURPOSE: The present study is focused on understanding weight perception related with individual- and school-level multifactorial origins, underestimated and overestimated respectively, in normal body weight adolescents. METHODS: Using the 2017 Korea Youth Risk Behavior Web-based Survey data of 45,902 students from 799 secondary schools, a multilevel multinomial logistic regression analysis was performed where adolescents (level1) were nested within schools (level 2). RESULTS: At the school level, the average school body mass index (BMI, kg/m²) and physical education were associated with weight perception among both boys and girls. In boys, geographic areas were associated with weight underestimation. At the individual level, perceived economic status, weekly allowance, BMI (kg/m²), smartphone usage time (hrs/day) and perceived stress were associated with weight perception among both boys and girls. Age, paternal education, academic achievement and alcohol use were associated with weight perception among girls, while part-time job and physical activity were associated with weight perception among boys. CONCLUSION: Our findings underscore the importance of individual- and school-level environments in developing correct weight perception and have implications for school health education to establish healthy lifestyle behaviors for all adolescents.
Adolescent ; Body Mass Index ; Education ; Female ; Humans ; Ideal Body Weight ; Korea ; Life Style ; Logistic Models ; Motor Activity ; Multilevel Analysis ; Paternal Age ; Physical Education and Training ; Risk-Taking ; School Health Services ; Smartphone ; Weight Perception

PURPOSE: This study aims to investigate the individual and environmental factors related to emotional/behavioral problems to early adolescence in Korea by applying multilevel modeling. METHODS: From the database of the 2014 Korean Child and Youth Panel Survey (KCYPS), the researchers selected 1,977 adolescents who are in the second year of middle school. Multilevel model analysis was performed to estimate the impact of relevant factors at the individual and environmental levels. RESULTS: At the individual level, the significant factors associated with emotional/behavioral problems included BMI and study tendency in boys, and drinking, study tendency and economic levels in girls. At the environmental level, the significant factor associated with emotional/behavioral problems included relationship with the teacher. CONCLUSION: The emotional/behavioral problems of early adolescence are influenced not only by the individual factors but also by the environment factor. Therefore, the environment surrounding the adolescents should also be considered to prevent emotional/behavioral problems.
Adolescent* ; Child ; Drinking ; Female ; Humans ; Korea ; Multilevel Analysis ; Problem Behavior*