BACKGROUND: Evidence on the relations of the American Heart Association's ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps. METHODS: A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis. RESULTS: During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed. CONCLUSIONS ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.
Adult ; Humans ; Cardiovascular Diseases/prevention & control* ; East Asian People ; Prospective Studies ; Risk Factors ; Smoking

Humans ; Smoking Cessation ; Beijing/epidemiology* ; COVID-19/epidemiology* ; Pandemics/prevention & control* ; Smoking/epidemiology*

Objective: based on summarizing the simulation and prediction of tobacco control measures across the globe and sorting out the various scenarios of tobacco control measures, the potential short-term effects of seven tobacco control measures in different scenarios were systematically analyzed. Methods: Until April 2022, PubMed, Embase, EconLit, PsychINFO, and CINAHL databases were used to retrieve literature about tobacco control measures simulation and prediction models across the globe. Inclusion and exclusion criteria were strictly followed. Meta-analysis for the potential short-term effects of seven tobacco control measures in different scenarios was performed using the R software. Results: A total of 22 papers covering 16 countries were selected. Five studies were conducted in the United States, three in Mexico, and two in Italy. There were all papers with the measures to tax increases, smoke-free air laws, and mass media campaigns, 21 papers with youth access restrictions, 20 with marketing restrictions, and 19 with cessation treatment programs and health warnings. The tax increases had diverse influences on the price elasticity of different age groups. The price elasticity in the age group 15-17 years was the highest, which was 0.044 (95%CI: 0.038-0.051). The potential short-term effects of smoke-free air laws in workplaces were higher than in restaurants and other indoor public places. The effects of youth access restrictions were greater in the age group <16 years than in the age group 16-17. The stronger the implementation of other measures, the greater the potential short-term effects. A comparison of seven tobacco control measures showed that the cessation treatment programs increase in cessation rate was the highest, 0.404 (95%CI: 0.357-0.456). The reduction in smoking rate and reduction in initiation rate of youth access restrictions strongly enforced and publicized was the highest in the age group <16 years, 0.292 (95%CI: 0.269-0.315), and 0.292 (95%CI: 0.270-0.316). Conclusions: The potential short-term effects of seven tobacco control measures in different scenarios were evaluated more accurately and objectively through Meta-analysis. In the short term, cessation treatment programs will substantially increase smoking cessation rates, and strong youth access enforcement will sharply reduce smoking and initiation rates among adolescents under 16. These results also offer strong data-related support for the simulation and prediction of tobacco control measures in China and other countries.
Adolescent ; Humans ; United States ; Tobacco Control ; Prevalence ; Computer Simulation ; Smoking Cessation ; Health Behavior ; Smoking Prevention

This paper proposes a conceptual model for establishing a new approach to improvise anti-smoking strategies. The Tobacco Control programme under the World Health Organization (WHO) has established MPOWER measures to be applied globally. Although numerous approaches have been implemented, there is a knowledge gap pertaining to the positive impact of these strategies. Therefore, analyzing current approaches and establishing new strategies will be beneficial for the tobacco control movement. The proposed model has been adapted from the Medical Research Council (MRC), United Kingdom framework for complex interventions which can be used as reference for researchers to develop a new initiative or strategy for tobacco control. This proposed model incorporates three phases, which are (i) Phase 1: To identify factors influencing stop smoking desires and their successfulness among “specific location” population, (ii) Phase 2: To analyse available smoking cessation strategies globally using systematic review, and (iii) Phase 3: To develop new potential tools/products/guidelines for anti-smoking promotions based on Phase 1 and 2. The novelty of this concept in developing anti-smoking strategies is the incorporation of local needs in Phase 1. This research may contribute significantly to stop or quit smoking behavior among Malaysians. At the end of this study, researchers will be able to recommend new and/or adapted tools/products/guidelines based on the framework discussed. Also, government regulations regarding cigarettes should be properly reviewed in order to achieve more significant results whilst minimizing expenses for anti-smoking campaigns.
Smoking Prevention

OBJECTIVES: In South Korea, there are two nationwide health surveys conducted by the Korea Centers for Disease Control and Prevention: the Korea Community Health Survey (KCHS) and Korea National Health and Nutrition Examination Survey (KNHANES). The two surveys are directly comparable, as they have the same target population with some common items, and because both surveys are used in various analyses, identifying the similarities and disparities between the two surveys would promote their appropriate use. Therefore, this study aimed to compare the estimates of six variables in KCHS and eight variables in KNHANES over a six-year period and compare time series stability of region-specific and sex- and age-specific subgroup estimates. METHODS: Data from adults aged 19 years or older in the 2010-2015 KCHS and KNHANES were examined to analyze the differences of estimates and 95% confidence interval for self-rated health, current smoking rate, monthly drinking rate, hypertension diagnosis rate, diabetes diagnosis rate, obesity prevalence, hypertension prevalence, and diabetes prevalence. The variables were then clustered into subgroups by city as well as sex and age to assess the time series stability of the estimates based on mean square error. RESULTS: With the exception of self-rated health, the estimates taken based on questionnaires, namely current smoking rate, monthly drinking rate, hypertension diagnosis rate, and diabetes diagnosis rate, only differed by less than 1.0%p for both KCHS and KNHANES. However, for KNHANES, estimates taken from physical examination data, namely obesity prevalence, hypertension prevalence, and diabetes prevalence, differed by 1.9-8.4%p, which was greater than the gap in the estimates taken from questionnaires. KCHS had a greater time series stability for subgroup estimates than KNHANES. CONCLUSIONS: When using the data from KCHS and KNHANES, the data should be selected and used based on the purpose of analysis and policy and in consideration of the various differences between the two data.
Adult ; Centers for Disease Control and Prevention (U.S.) ; Diagnosis ; Drinking ; Health Services Needs and Demand ; Health Surveys ; Humans ; Hypertension ; Korea ; Nutrition Surveys ; Obesity ; Physical Examination ; Prevalence ; Smoke ; Smoking

OBJECTIVES: This study investigates the relationship between risky health behaviors, occurrence of oral symptoms, and oral health-related behaviors. METHODS: The subjects were 60,040 adolescents selected from the web-based survey from the 2018 Korean Youth Health Behavior of Korean Center for Disease Control. The data were analyzed using a combined sample analysis method. The software SPSS version 12.0 was used to conduct the analyses. RESULTS: 1. Men were observed to partake in risky health behavior at significantly higher rates than were women in terms of smoking, drinking, drugs, and sexual intercourse. Our data showed the percentages of men taking part in these behaviors to be 21.1%, 46.4%, 1.3%, and 7.6%, respectively (P<0.01). 2. Of all subjects, 49.1% brushed their teeth more than three times a day, and 43.6% brushed more than twice a day. Further, a significantly higher number of men (46.0%) did not brush their teeth after lunch compared with women (29.1%) (P<0.01). 3. Of all subjects, 52.9% had developed oral symptoms in the previous year. The rate of women experiencing oral symptoms was significantly higher, at 58.1%, compared with men (48.1%, P<0.01). 4. Risky health behavior, such as smoking, drinking, drugs, and sexual intercourse, was significantly associated with occurrence of oral symptoms (P<0.01). Those that had not partaken in smoking, drinking, and sexual intercourse were significantly lower by 0.73, 0.87, and 0.89 times, respectively, compared with those that responded with “yes” (P<0.01). CONCLUSIONS: We have evaluated the rates of risky health and oral health-related behavior in Korean youth and identify their association with the oral symptoms. It is essential to understand the risks of oral diseases so that appropriate oral health education can be provided to adolescents for promoting behavioral changes.
Adolescent ; Centers for Disease Control and Prevention (U.S.) ; Coitus ; Drinking ; Education ; Female ; Health Behavior ; Humans ; Korea ; Lunch ; Male ; Methods ; Oral Health ; Risk-Taking ; Smoke ; Smoking ; Tooth

Although colorectal cancer emerged as a major public health concern, its incidence as well as mortality are decreasing during recent years in Korea. Most important contributor for these reduction in disease burden is colorectal cancer screening. Besides screening, primary prevention through risk factor modification could reduce 10% to 54% of colorectal cancer incidence. These factors include limiting alcohol, processed and red meat consumption, and cigarette smoking, maintaining optimal weight, and engaging physical activities.
Colorectal Neoplasms ; Epidemiology ; Incidence ; Korea ; Mass Screening ; Mortality ; Motor Activity ; Primary Prevention ; Public Health ; Red Meat ; Risk Factors ; Smoking

Rapid aging, economic development, lifestyle westernization, hygiene improvement, and scientific development have contributed for the epidemiologic changes of gastric cancer. This study aimed to review the descriptive epidemiology, risk factors, and prevention of gastric cancer in Korea. Age-standardized incidence and mortality of gastric cancer have decreased and showed age effect and cohort effect. Annual percent change in the incidence of gastric cancer has been prominent in recent years. Major risk factor of gastric cancer is Helicobacter pylori infection. Although H. pylori infection was associated with only non-cardia gastric cancer in meta-analysis, H. pylori infection was associated with both non-cardia and cardia gastric cancer in Asian studies. The estimated population attributable fraction of H. pylori regarding gastric cancer incidence was about 76% in Korean. Cigarette smoking and alcohol drinking was associated with gastric cancer regardless of cardia and non-cardia gastric cancer. Cigarette smoking was estimated to be responsible for 28% of gastric cancer incidence in men and 2% in women. Obesity was risk factor for cardia gastric cancer but not non-cardia gastric cancer. This discrepancy between cardia and non-cardia gastric cancer was consistently shown in epidemiologic studies in Korea. Salt intake was also well-known risk factor of gastric cancer and prevalence of high sodium intake more than 2,000mg in Korean was 81.5%. For primary prevention of gastric cancer, eradication of H. pylori and life-style modification including no smoking, no alcohol drinking, weight control, and low sodium intake are important. Gastric endoscopy is recommended for secondary prevention of gastric cancer.
Aging ; Alcohol Drinking ; Asian Continental Ancestry Group ; Cardia ; Cohort Effect ; Economic Development ; Endoscopy ; Epidemiologic Studies ; Epidemiology ; Female ; Helicobacter pylori ; Humans ; Hygiene ; Incidence ; Korea ; Life Style ; Male ; Mortality ; Obesity ; Prevalence ; Primary Prevention ; Risk Factors ; Secondary Prevention ; Smoke ; Smoking ; Sodium ; Stomach Neoplasms

Cancer incidence appears to be increased in both type 1 and type 2 diabetes mellitus (DM). DM represents a risk factor for cancer, particularly hepatocellular, hepatobiliary, pancreas, breast, ovarian, endometrial, and gastrointestinal cancers. In addition, there is evidence showing that DM is associated with increased cancer mortality. Common risk factors such as age, obesity, physical inactivity and smoking may contribute to increased cancer risk in patients with DM. Although the mechanistic process that may link diabetes to cancer is not completely understood yet, biological mechanisms linking DM and cancer are hyperglycemia, hyperinsulinemia, increased bioactivity of insulin-like growth factor 1, oxidative stress, dysregulations of sex hormones, and chronic inflammation. However, cancer screening rate is significantly lower in people with DM than that in people without diabetes. Evidence from previous studies suggests that some medications used to treat DM are associated with either increased or reduced risk of cancer. However, there is no strong evidence supporting the association between the use of anti-hyperglycemic medication and specific cancer. In conclusion, all patients with DM should be undergo recommended age- and sex appropriate cancer screenings to promote primary prevention and early detection. Furthermore, cancer should be screened in routine diabetes assessment.
Breast ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Early Detection of Cancer ; Gastrointestinal Neoplasms ; Gonadal Steroid Hormones ; Humans ; Hyperglycemia ; Hyperinsulinism ; Incidence ; Inflammation ; Mass Screening ; Mortality ; Obesity ; Oxidative Stress ; Pancreas ; Primary Prevention ; Risk Factors ; Smoke ; Smoking

OBJECTIVES: In South Korea, there are two nationwide health surveys conducted by the Korea Centers for Disease Control and Prevention: the Korea Community Health Survey (KCHS) and Korea National Health and Nutrition Examination Survey (KNHANES). The two surveys are directly comparable, as they have the same target population with some common items, and because both surveys are used in various analyses, identifying the similarities and disparities between the two surveys would promote their appropriate use. Therefore, this study aimed to compare the estimates of six variables in KCHS and eight variables in KNHANES over a six-year period and compare time series stability of region-specific and sex- and age-specific subgroup estimates.METHODS: Data from adults aged 19 years or older in the 2010-2015 KCHS and KNHANES were examined to analyze the differences of estimates and 95% confidence interval for self-rated health, current smoking rate, monthly drinking rate, hypertension diagnosis rate, diabetes diagnosis rate, obesity prevalence, hypertension prevalence, and diabetes prevalence. The variables were then clustered into subgroups by city as well as sex and age to assess the time series stability of the estimates based on mean square error.RESULTS: With the exception of self-rated health, the estimates taken based on questionnaires, namely current smoking rate, monthly drinking rate, hypertension diagnosis rate, and diabetes diagnosis rate, only differed by less than 1.0%p for both KCHS and KNHANES. However, for KNHANES, estimates taken from physical examination data, namely obesity prevalence, hypertension prevalence, and diabetes prevalence, differed by 1.9-8.4%p, which was greater than the gap in the estimates taken from questionnaires. KCHS had a greater time series stability for subgroup estimates than KNHANES.CONCLUSIONS: When using the data from KCHS and KNHANES, the data should be selected and used based on the purpose of analysis and policy and in consideration of the various differences between the two data.
Adult ; Centers for Disease Control and Prevention (U.S.) ; Diagnosis ; Drinking ; Health Services Needs and Demand ; Health Surveys ; Humans ; Hypertension ; Korea ; Nutrition Surveys ; Obesity ; Physical Examination ; Prevalence ; Smoke ; Smoking