Minsoo Jung

The communications revolution and health inequalities in the 21st century: implications for cancer control.

The radical and transformative developments in information and communication technologies (ICT) offer unprecedented opportunities to promote cancer control and enhance population and individual health. However, the current context in which these technologies are being deployed—where cancer incidence and mortality and communication are characterized by inequalities among different racial/ethnic and socioeconomic status groups—raises important questions for cancer communication research, policy, and practice. Drawing on illustrative data, this essay characterizes the communications revolution and elucidates its implications for cancer control, with a particular focus on communication inequalities and cancer disparities. Cancer Epidemiol Biomarkers Prev; 21(10); 1701–8. ©2012 AACR.

Effect of information seeking and avoidance behavior on self-rated health status among cancer survivors

OBJECTIVE Social determinants, such as socioeconomic status (SES) and race/ethnicity are linked to striking health disparities across the cancer continuum. One important mechanism linking social determinants and health disparities may be communication inequalities that are caused by differences in accessing, processing and utilizing cancer information. In this context, we examined health information-seeking/avoidance as a potential mediator between social determinants and self-rated health (SRH) status among cancer survivors. METHODS Data came from the 2008 well-informed, thriving and surviving (WITS) study of post-treatment cancer survivors (n=501). We examined the mediating effect of health communication-related behavior between SES and disparities in SRH. RESULTS The likelihood of belonging to the Low SRH group was higher among patients who had avoided health information and whose family members had not sought health information on behalf of the survivor, those in the lowest household income bracket, and those who had high school or less education after adjusting for potential confounders. CONCLUSION Differences in SRH among cancer survivors are associated with SES as well as communication inequalities. PRACTICE IMPLICATIONS It is necessary to provide a supportive environment in which health information is made available if disparities in health-related quality of life among cancer survivors are to be reduced.

Media Use and Communication Inequalities in a Public Health Emergency: A Case Study of 2009–2010 Pandemic Influenza A Virus Subtype H1N1

Objectives. Studies have shown that differences among individuals and social groups in accessing and using information on health and specific threats have an impact on their knowledge and behaviors. These differences, characterized as communication inequalities, may hamper the strength of a societys response to a public health emergency. Such inequalities not only make vulnerable populations subject to a disproportionate burden of adversity, but also compromise the public health systems efforts to prevent and respond to pandemic influenza outbreaks. We investigated the effect of socioeconomic status (SES) and health communication behaviors (including barriers) on peoples knowledge and misconceptions about pandemic influenza A(H1N1) (pH1N1) and adoption of prevention behaviors. Methods. The data for this study came from a survey of 1,569 respondents drawn from a nationally representative sample of American adults during pH1N1. We conducted logistic regression analyses when appropriate. Results. We found that (1) SES has a significant association with barriers to information access and processing, levels of pH1N1-related knowledge, and misconceptions; (2) levels of pH1N1-related knowledge are associated positively with the adoption of recommended prevention measures and negatively with the adoption of incorrect protective behaviors; and (3) people with higher SES, higher news exposure, and higher levels of pH1N1-related knowledge, as well as those who actively seek information, are less likely than their counterparts to adopt incorrect prevention behaviors. Conclusion. Strategic public health communication efforts in public health preparedness and during emergencies should take into account potential communication inequalities and develop campaigns that reach across different social groups.

Class, race and ethnicity and information avoidance among cancer survivors

Background:Information seeking may increase cancer survivors’ ability to make decisions and cope with the disease, but many also avoid cancer information after diagnosis. The social determinants and subsequent communication barriers that lead to avoidance have not been explored. The purpose of this study is to examine the influence of social determinants on information avoidance among cancer survivors.Methods:We examined how health information avoidance is associated with structural and individual factors in a mail-based survey of 519 cancer survivors. Factor analysis was conducted to determine barriers to obtaining cancer information, and multivariable logistic regression models by gender were run to analyze social determinants of avoidance from an intersectional approach.Results:Participants who were younger, female, had greater debt and lower income, and had difficulty finding suitable information were more likely to avoid information. The probability of information avoidance increased when survivors reported barriers to information use or comprehension.Conclusion:These results indicate that survivors’ information avoidance may be driven, in part, by social determinants, particularly among those at the intersection of multiple social status categories. Customized strategies are needed that maximize the likelihood that information will be used by vulnerable groups such as those from a lower socioeconomic position.

Associations of Income and Wealth with Health Status in the Korean Elderly

OBJECTIVES This study aimed to verify the association between wealth or income level and health status after adjusting for other socio-economic position (SEP) indicators among Korean adults aged 45 and over. METHODS Data were obtained from the 1st wave of Korean Longitudinal Study of Ageing (households: 6,171, persons: 10,254). We used self-rated health status and activities of daily living (ADLs) as dependent variables. Explanatory variables included both net wealth measured by savings, immovables, the other valuated assets and total income including pay, transfer, property and so on. Binary logistic regression was conducted to examine the relationships. Also, in order to determine the relative health inequality across economic groups, we estimated the relative index of inequality (RII). RESULTS The inequality of health status was evident among various wealth and income groups. The wealthiest group (5th quintile) was much healthier than the poorest group, and this differential increased with age. Likewise, higher income was associated with better health status among the elderly. However, these effects, as measured by the odds ratio and RII, showed that wealth was more important in determining health status of elderly people. CONCLUSIONS This study suggests that economic capability plays a significant role in determining the health status and other health-related problems among the elderly. Particularly, our results show that health status of the aged is related more closely to the individuals wealth than income.

National Cancer Screening Programs and Evidence-Based Healthcare Policy in South Korea

BACKGROUND South Korea has managed its National Cancer Screening Program (NCSP) since 1999 with free cancer screenings for the five major types of cancer (stomach, liver, colorectal, breast, and cervical cancer). Despite the tremendous amount of government funding, the necessity of this policy and scientific evidence pertaining to it have been questioned. OBJECTIVE This study reviewed the NCSPs effectiveness and its evidence. FINDINGS First, the lead-time bias of diagnosis and the length-time bias regarding the average survival time may increase the misunderstanding that the early detection of cancer will contribute to lower mortality rates and higher survival rates. Second, the positive predictive values (PPVs) of the five major types of cancer checked by the NCSP have remained at 0.6-5.7%. The sensitivity of the screening programs also stood at less than 50% on average. CONCLUSION This study showed that the NCSP program has been less effective, as shown by its low PPVs and sensitivity values, and that its anticipated contribution to lowering the number of cancer-related deaths may have been a product of biased reasoning. To develop the NCSP, adequate explanations of the benefits and potential risks of cancer examinations as well as the accuracy of examinations need to be provided to patients.

Effect of Media Use on HIV/AIDS-Related Knowledge and Condom Use in Sub-Saharan Africa: A Cross-Sectional Study

It is known that the level of HIV/AIDS-related knowledge and the degree of condom use varies by socioeconomic status (SES). However, there is limited research on the effect of mass media use on HIV/AIDS-related cognitive and behavioral outcomes in low-income countries and how it might influence the association between SES and HIV-related outcomes. We investigated the moderating effect of media use on the relationship between SES and HIV/AIDS-related knowledge and condom use in sub-Saharan Africa in terms of communication inequalities. Cross-sectional data from the Demographic Health Surveys from 13 sub-Saharan countries (2004–10) were pooled. Gender-stratified multivariable poisson regression of 151,209 women and 68,890 men were used to calculate adjusted relative ratios and 95% confidence intervals for the associations between SES, media use, HIV-related outcomes, and condom use. We found significant disparities in mass media use among people from different SES groups as well as among countries. Education and wealth are strongly and positively associated with awareness of HIV/AIDS and knowledge about transmission and prevention of HIV/AIDS and are significantly associated with condom use. These associations are attenuated when the use of various types of mass media is added to the models, with newspapers showing the strongest effect. The findings of this study suggest that media use has the potential to blunt the impact of socioeconomic status though not completely eliminate it. Thus, we need to pay attention to reducing communication inequalities among social groups and countries to moderate the effect of wealth and SES on HIV/AIDS.

Factors related to perceived life satisfaction among the elderly in South Korea.

OBJECTIVES This study attempted to explore the aging phenomena that now characterize much of Korean society, and assessed issues associated with the life satisfaction experienced during the process of aging. METHODS By employing the National Survey on the State of Life and the Desire for Welfare of the Elderly, 2004 in South Korea this study attempted to identify the factors that determine subjective life satisfaction among the elderly. The data utilized herein consisted of 3278 elderly people aged 65 years or older, from 9308 households. RESULTS The results of analysis from the final model after the introduction of 19 variables in 8 factors showed statistically similar explanatory power in men (adj. R²=0.320) and in women (adj. R²=0.346). We found that economic condition was the most influential factor in both men (B=0.278) and women (B=0.336) except perceived health condition variables. The second most influential variable in life satisfaction was health checkups in men (B=0.128) and degree of nutritional diet in women (B=0.145). Those who had experience with chronic diseases also reported significantly lower perceived life satisfaction and this was particularly true of women. CONCLUSIONS The aging society requires an understanding of the lives of elderly individuals. This study explored factors associated with life satisfaction in old age by using a life satisfaction model. The success of an aging society begins with an accurate understanding of the elderly, and thus political attention will need to be focused on this matter.

Cancer Control and the Communication Innovation in South Korea: Implications for Cancer Disparities

Over the last 10 years, the number of cancer survivors in South Korea has reached nearly one million with a survival rate of 49.4%. However, integrated supportive care for cancer survivors is lagging. One area in which the current cancer control policy needs updating is in the utilization of information and communication technology (ICT). The remarkable progress in the field of ICT over the past 10 years presents exciting new opportunities for health promotion. Recent communication innovations are conducive to the exchange of meta-information, giving rise to a new service area and transforming patients into active medical consumers. Consequently, such innovations encourage active participation in the mutual utilization and sharing of high-quality information. However, these benefits from new ICTs will almost certainly not be equally available to all, leading to so-called communication inequalities where cancer survivors from lower socioeconomic classes will likely have more limited access to the best means of making use of the health information. Therefore, most essentially, emphasis must be placed on helping cancer survivors and their caregivers utilize such advances in ICT to create a more efficient flow of health information, thereby reducing communication inequalities and expanding social support. Once we enhance access to health information and better manage the quality of information, as a matter of fact, we can expect an alleviation of the health inequalities faced by cancer survivors.

Evidence of social contextual effects on adolescent smoking in South Korea.

This study explores the effect of psychological and social factors on smoking behavior among male and female adolescents in South Korea. A cross-sectional analysis was carried out via multilevel logistic regression with pupils at the first level and schools at the second level. The data were collected in 2003 using a nationally representative sample of 3449 students from 100 South Korean middle schools. For both genders, adolescents were more likely to smoke if and when they had lower academic grades, had a higher disposable monetary allowance from their parents, had more friends who smoked, and if the smoking rate at their school was higher. Psychological factors, however, were not factors that significantly influenced smoking. Consequently, the principal contextual factors related to adolescent smoking are the smoking rates in schools and among peer groups. Thus, an antismoking campaign incorporating social environmental factors may be useful in reducing the rates of adolescent smoking.