Research in Community and Public Health Nursing

Original Articles

Trajectories of Depressive Symptoms among Multicultural Middle and High School Adolescents: A Longitudinal Study Using Latent Class Growth Model: Sujin Lee, Soo Jin Lee, Hyanglan Kim; Res Community Public Health Nurs. 2024;35(4):401-414. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00696

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Abstract PDF: Purpose
This study aimed to identify latent classifications based on trajectories of change in depressive symptoms among multicultural adolescents in middle and high school and to identify factors that influence classification.
Methods
This study used six time-point data from the Multicultural Adolescents Panel Study (MAPS) conducted by the National Youth Policy Institute (NYPI). We longitudinally analyzed data from 2014 to 2019, which corresponds to the participants' middle and high school years. Latent Growth Curve Modeling (LGCM) was used to analyze the depressive developmental trajectories of multicultural youth in middle and high school. Latent Class Growth Modeling (LCGM) was used to determine the number and shape of latent classes according to the type of depression among multicultural adolescents. We applied multinomial logistics regression analysis to explore the predictors of each class.
Results
A model with three latent classes was identified: (1) low-decreasing class (intercept=13.34, slope=-0.07, 37.9%), (2) moderate-increasing class (intercept=17.76, slope=0.41, 47.6%), (3) high-increasing class (intercept=23.22, slope=0.44, 14.5%). Multinomial logistic regression showed multicultural adolescents who were male, experienced high acculturative stress and social withdrawal, and had low self-esteem, life satisfaction, and family support tended to belong to either the moderate-increasing or high-increasing class.
Conclusion
These findings suggest that preliminary assessments of gender, acculturation stress, self-esteem, life satisfaction, social withdrawal, and family support among multicultural adolescents may be valuable for developing tailored mental health programs.

Exploring the Prevalence and Influencing Factors of Sexually Explicit Internet Material (SEIM) Consumption among Adolescents and Young Adults in Cambodia: Hyunjeong Cheon, Youngran Yang; Res Community Public Health Nurs. 2024;35(3):284-296. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00633

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Abstract PDF: Purpose
This study investigates the prevalence and factors associated with the consumption of sexually explicit Internet material (SEIM) among adolescents and young adults in Cambodia.
Methods
Utilizing a cross-sectional study design, data were collected through a survey administered to 1,271 participants. The survey focused on measuring SEIM consumption, sexual sensation seeking, perceived reality of SEIM, and sexual attitudes. Findings: The study revealed a SEIM prevalence of 27.2%, with notably higher rates among males (35.5%) than females (18.6%). Significant predictors of SEIM consumption included being male, having a father with a middle-level education, engaging in alcohol or substance consumption, spending more than five hours daily on electronic devices, having friends with sexual experience, frequent thoughts about sex, a heightened interest in sex compared to peers, perceiving SEIM as realistic, and maintaining a permissive attitude towards sex.
Conclusions
These findings underscore the importance of implementing education programs to address SEIM consumption and its potential risk factors. Such initiatives are crucial for preventing the use of SEIM among Cambodian youth, promoting a healthier understanding of sexuality, and fostering responsible online behavior.

The moderated mediating effect of parental smartphone addiction in the relationship between smartphone addiction, sleep duration, and depression among adolescents: Eunha Jeong; Res Community Public Health Nurs. 2024;35(3):216-225. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00549

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Abstract PDF: Purpose
This study aimed to examine whether sleep duration mediated the relationship between adolescent smartphone addiction and depression. Moreover, we investigated whether the mediating effects of sleep duration were moderated by parental smartphone addiction.
Methods
Wave 4(2021) data collected in 2021 from the Korean Children and Youth Panel Survey (KCYPS) 2018 was used. The data collected from 4,392 matched pairs of parents and their children was analyzed, using the SPSS PROCESS macro.
Results
Sleep duration partially mediated the relationship between adolescent smartphone addiction and depression. Also, parental smartphone addiction moderated the indirect effect of this mediation model.
Conclusion
This suggests that it is necessary to include content on the use of smartphones by adolescents as well as their parents when designing education and intervention programs to prevent depression in adolescents.

Factors Associated with Homosexual Adolescents in South Korea: Jong Gun Kim; Res Community Public Health Nurs. 2024;35(3):207-215. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00332

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Abstract PDF: Purpose
The purpose of this study was to investigate factors related to homosexual adolescents in South Korea.
Methods
Using statistics from the 12th (2016) Korea Youth Risk Behavior Web-based Survey, hierarchical logistic regression analysis was conducted. The study sample comprised 65,528 middle and high school students aged 12 to 18 years.
Results
The significant predictors of homosexual intercourse were gender, attempted suicide, bullying at school experience, ever drinking, ever smoking, habitual or purposeful drug use, cohabitation with family, weekly allowance, and mother’s education levels.
Conclusions
The results suggest that gender-related interventions should be considered in school health education programs and that sexual health interventions for high-risk groups may be needed, given the factors predicting homosexual intercourse.

Patterns of Adolescent Substance Use: A Comparative Study among the United States, Canada, England, and South Korea from 2014-2021: Chaehee Kim, Kihye Han, Jieun Kim, Alison M. Trinkoff, Sihyun Park, Hyejin Kim; Res Community Public Health Nurs. 2024;35(2):179-193. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00535

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Abstract PDF: Purpose
This study aimed to identify the cross-national estimates of substance use, explore problematic substance use patterns among adolescents across countries and over time, and examine the relationship of individual characteristics on substance use patterns.
Methods
This study employed a time-series secondary data analysis spanning from 2014 to 2021 across four countries (United States, Canada, England, and South Korea). We analyzed the usage of five substances (alcohol, binge drinking, cigarettes, electronic cigarettes, and illicit drugs) alongside demographic characteristics. A descriptive analysis was performed to identify estimates of substance use across countries. Latent class analysis was employed to examine adolescents’ substance use patterns across time and countries. A multinomial logistic regression model was fit to assess the relationship between latent class and demographic characteristics.
Results
Adolescents in the United States and Canada had the highest substance use, while Korean adolescents had the lowest, particularly concerning drugs. Latent class analysis revealed two classes (light-user and heavy-user), with the addition of a third class (moderate-user) in some instances. The substance use patterns, while differing significantly among nations, exhibited consistency over time. During COVID-19, a decrease in heavy-substance users was observed across countries. Male or older participants were more likely to belong to the heavy-user class.
Conclusion
This research offers valuable insights into the variations in substance use patterns between nations and over time. A tailored approach is essential to prevent adolescents from becoming heavy-substance users. This approach should consider country regulations and demographics for a targeted and comprehensive preventive strategy.

Smartphone dependency latent profile classification and association with emotional and behavioral difficulties among high school students in Korea: Eunjoo Kim, Min Kyung Song; Res Community Public Health Nurs. 2024;35(1):84-98. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00465

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Abstract PDF: Purpose
The pervasive integration of smartphones into adolescents’ daily lives has resulted in a concerning upsurge in smartphone dependency among high school students. Due to the diverse types and severity levels of smartphone dependency, there is a critical need for research to explore its heterogeneity. This study aimed to identify latent profile of smartphone dependency in high school students based on the four subdomains of smartphone dependency: disturbance of adaptive functions, virtual life orientation, withdrawal, and tolerance. In addition, we explored how emotional and behavioral difficulties differ according to the profiles.
Methods
We used data from 2,195 Korean high school students from the Korean Children and Youth Panel Survey 2018. Latent profile analysis (LPA) was performed to identify smartphone dependency latent profile. Statistical analysis including chi-square test, Analysis of Variance (ANOVA), and ranked Analysis of Covariance (ANCOVA) confirmed differences in smartphone use characteristics and emotional-behavioral difficulties according to the classified latent profile.
Results
LPA identified four distinct latent profiles of smartphone dependency among high school students; 1) Underdependent type, 2) Moderate type, 3) Habitual user type, and 4) Virtual space dependent type. The results of ranked ANCOVA, controlling for gender, geographical location, economic status, parental smartphone dependency, and relational variables, revealed that habitual user type exhibited significantly higher rates of attention deficit hyperactivity disorder, social withdrawal, and depressive symptoms compared to other types.
Conclusion
The identification of these profiles provides a foundation for developing tailored intervention programs for adolescents with different levels and patterns of smartphone dependency.

Factors affecting cultural adaptation stress by gender among multicultural adolescents in Korea: Seungwoo Han; Res Community Public Health Nurs. 2023;34(4):320-331. Published online December 29, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00276

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Abstract PDF: Purpose
This paper is a descriptive survey research to identify factors that affect acculturation stress in multicultural adolescents, and provide basic information that can be used to develop ways to improve their mental health.
Methods
This study used the data of the 2nd multicultural adolescents panel study provided on December 30, 2022 by the National Youth Policy Institute. The subjects of this study were 1,520 multicultural adolescents in the fourth grade of elementary school and the survey period was from July to November 2020. The dependent variable was acculturation stress, and the explanatory variables were as follows: mother’s and father’s country of origin, region size, home economic conditions, academic achievement, experience of discrimination, mother’s level of education, father’s level of education, and number of close friends. Data analysis involved calculation of descriptive statistics, analysis of differences in the level of acculturative stress and general characteristics between male and female adolescents, and multiple regression analysis.
Results
This study found that there are gender differences in significant influencing factors for acculturation stress among multicultural adolescents. For males, factors influencing acculturation stress were identified as regional size, mother's education level, parental support, and teacher support. For females, they were regional size, experience of discrimination, number of close friends, parental support, and self-esteem.
Conclusion
The results of this study suggest that psychiatric nurses should provide psychiatric nursing and counseling to multicultural adolescents in addition to clinical psychiatric nursing. Various mental health programs should be developed for multicultural adolescents, with a focus on counseling, education, and family therapy.

The Prediction Model of Body Image Distortion in Korean Adolescent in the Era of COVID-19 Using Decision Tree Analysis: Myeunghee Han; Res Community Public Health Nurs. 2023;34(2):96-107. Published online June 30, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00052

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Abstract PDF: Purpose
Body image distortion (BID) in adolescents is a crucial problem that causes both abnormal eating habits and unhealthy weight control behaviors. COVID-19 has had a negative impact on adolescents’ psychological and behavioral status, and this might influence the onset of BID in adolescents. This study aimed to develop a prediction model for BID in Korean adolescents using decision tree analysis.
Methods
The decision tree analysis was used to develop a prediction model for BID in Korean adolescents using the data of 2021 Korea Youth Risk Behavior Survey Web-based (KYRBS).
Results
In the present study, about one-third of the study subjects (31%, n=6,316) showed BID. The BID rate was higher in females (37.2%, node1) than in males (21.2%, node2). Female students with severe GAD-7 level and smartphone use on the weekend over 12h showed the highest rate of BID (66.9%). As to males, the BID rate was the highest (33.1%) among middle school male students who did strength training once a week or none.
Conclusion
In order to reduce BID, there is a need to develop a customized BID education and management programs.

Latent Classes of Depressive Symptom Trajectories of Adolescents and Determinants of Classes: Eun Joo Kim; J Korean Acad Community Health Nurs. 2022;33(3):299-311. Published online September 30, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.3.299

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Abstract PDF

Purpose
Untreated depression in adolescents affects their entire life. It is important to detect and intervene early depression in adolescence considering the characteristics of adolescent’s depressive symptoms accompanied by internalization and externalization. The aim of this study was to identify latent classes of depressive symptom trajectories of adolescents and determinants of classes in Korea. Methods: The three time-point (2018~2020) data derived from the Korean Children and Youth Panel Survey 2018 were used (N=2,325). Latent Growth Curve Modeling (LGCM) was conducted to explore the depressive symptom trajectories in all adolescents, and Latent Class Growth Modeling (LCGM) was conducted to identify each latent class. Multinomial logistic regression analysis was performed to confirm the determinants of each latent class. Results: The LGCM results showed that there was no statistically significant change in all adolescents' depressive symptoms for 3 years. However, the LCGM results showed that four latent classes showing different trajectories were distinguished: 1) Low-stable (intercept=14.39, non-significant slope), 2) moderate-increasing (intercept=19.62, significantly increasing slope), 3) high-stable (intercept=26.30, non-significant slope), and 4) high-rapidly decreasing (intercept=26.34, significantly rapidly decreasing slope). The multinomial logistic regression analysis showed that the significant determinants (i.e., gender, self-esteem, aggression, somatization, peer relationship) of each latent class were different. Conclusion: When screening adolescent’s depression, it is necessary to monitor not only direct depression symptoms but also self-esteem, aggression, somatization symptoms, and peer relationships. The findings of this study may be valuable for nurses and policy makers to develop mental health programs for adolescents.

Citations

Citations to this article as recorded by

How final year high school students’ depression develop during COVID-19 in China? A latent class growth modeling analysis
Xinyu Zhang, Guangdong Zhou
Current Psychology.2024; 43(13): 12221. CrossRef
What differentiates suicidal ideation from depressive symptoms amongst Korean young adults aged 20–39 years?
Jiwon Kang, Soong-nang Jang, Hyun-soo Kim
International Review of Psychiatry.2024; 36(4-5): 315. CrossRef
Trajectories of Depressive Symptoms among Multicultural Middle and High School Adolescents: A Longitudinal Study Using Latent Class Growth Model
Sujin Lee, Soo Jin Lee, Hyanglan Kim
Research in Community and Public Health Nursing.2024; 35: 401. CrossRef
Factors Influencing Depression in Adolescents Focusing on the Degree of Appearance Stress
Mihye Lim, Myoungjin Kwon
Nursing Reports.2023; 13(1): 518. CrossRef

Factors Influencing Self-esteem Changes in Multicultural Adolescents: Using a Linear Mixed Model: Ji Yeong Seo, Min Ah Park, Myeung Hee Han; J Korean Acad Community Health Nurs. 2022;33(3):290-298. Published online September 30, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.3.290

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Abstract PDF: Purpose
This study was conducted to determine factors influencing changes in the self-esteem of multicultural adolescents over time. Methods: A longitudinal design was adopted to analyze secondary data. This study used the 2nd, 4th, and 6th year data of Multicultural Adolescents Panel Study (MAPS) collected by the Korea Youth Policy Institute. The linear mixed model was utilized to analyze self-esteem changes over time. Results: The factors of sex and age of the students, the mother’s Korean writing ability, and the Filipino or Japanese mothers had a significant effect on the self-esteem change of multi-cultural adolescents over time. Specifically, it was found that female students’ self-esteem was decreased by 0.04 (t=-2.39, p=.017) more than male students over time. As the subject’s age and mother’s Korean writing ability increased, self-esteem was decreased by 0.01 (t=-2.53, p=.011) and 0.03 (t=-2.52, p=.012) over time. In addition, compared to that of those who had mothers from Korea, self-esteem of those who had Filipino or Japanese mothers was decreased by 0.04 significantly. Conclusion: Therefore, when developing a self-esteem promotion program, it is necessary to develop content by reflecting the characteristics of mothers as well as the gender and age of students. Furthermore, the significance of this study is in that it established a foundation for a positive self-identity of multicultural adolescents whose number is increasing recently by identifying factors affecting their self-esteem.

Factors Affecting Suicidal Ideation in Multicultural Adolescents: The Mediating Role of Happiness: Kyung Ah Nam, Hun Ha Cho; J Korean Acad Community Health Nurs. 2022;33(2):228-236. Published online June 30, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.2.228

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Abstract PDF: Purpose
The purpose of this study is to demonstrate the mediating effect of happiness in the relationship between internet addiction, depression and suicidal ideation among adolescents from multicultural families. Methods 1,065 adolescents from multicultural families who participated in the 16th (2020) Adolescent Health Behavior Survey were selected as the final subjects for the study, and were analyzed with descriptive statistics, independent t-test, ANOVA, Pearson’s correlation coefficient, and stepwise multiple regression. Results There was a fully mediating effect of happiness in the relationship between internet addiction and suicidal ideation of the adolescents from multicultural families (F=6.65, p<.001). There was a partial mediating effect of happiness in the relationship between depression and suicidal ideation of the adolescents from multicultural families (F=10.01, p<.001). Conclusion To mitigate the suicidal ideation of adolescents from multicultural families, it is necessary to develop and apply a positive psychological treatment program that enhances happiness for adolescents from multicultural families who are experiencing internet addiction and depression.

The Effect of Mother’s Self-esteem, Acculturation Stress and Children’s Perceived Parenting Attitude on Self-esteem of Multicultural Adolescents: An Application of the Family Stress Model: Hun Ha Cho, Jung Mi Kang, Yu Jin Jung; J Korean Acad Community Health Nurs. 2022;33(1):32-42. Published online March 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.1.32

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Abstract PDF: Purpose
This study was conducted to develop a predictive model for self-esteem of adolescents in multicultural families. The study was based on the theory of family stress model and literature review.
Methods
This study used some of the data from the 1st year (2011) to the 6th year (2016) of the ‘Multicultural Adolescents Panel Study (MAPS)'. Data analysis was conducted for 1,208 children and 1,208 mothers from the data of the 4th MAPS (2014), which was the first year of the middle school students. The collected data were analyzed using SPSS-WIN Version 20.0 and AMOS Version 20.0.
Results
The factors that have influence on the self-esteem of multicultural adolescents are mother’s parenting attitude and mother’s self-esteem. The explanatory power of these variables was 14%.
Conclusion
To increase the self-esteem of multicultural adolescents, a program that can positively change the self-esteem and parenting attitudes of multicultural mothers should be developed, and various social supports should be provided for multicultural mothers.

Community Case Managers’ Experiences of Overcoming Suicide Crises among Late Adolescents in South Korea: Yeo Won Jeong, Kyung Im Kang; J Korean Acad Community Health Nurs. 2021;32(4):477-484. Published online December 31, 2021; DOI: https://doi.org/10.12799/jkachn.2021.32.4.477

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Abstract PDF: Purpose
Various intervention strategies are needed to reduce the suicide rate among late adolescents. Therefore, we aimed to investigate the factors that can help overcome suicidal tendencies in late adolescents from the perspective of case managers.
Methods
This qualitative study explored the reinforcing factors that can help overcome suicidal behaviors in late adolescents, by conducting focus group interviews with case managers from the local community. Interviews with 10 case managers were recorded and transcribed, and the data were analyzed using the content analysis method.
Results
The main theme of this study was “a step in a new direction”. Three categories were derived: “inner changes”, “another possibility opened up by the interest of significant others”, and “connecting with community resources to help overcome”. Each category had subcategories that influenced the intention and course of action of behaviors to overcome the suicide crises.
Conclusion
Our findings, from the exploration of the experiences of case managers, provide an in-depth understanding of the reinforcing factors for overcoming suicide among late adolescents. They provide useful preliminary data for the development of effective suicide prevention programs for the adolescents.

The Effect of Senior Elementary School Students’ Emotional Perception Clarity, Emotion Regulation, and Family Relationship on Non-Suicidal Self-Injury and Depression: Ji-hye Shin, Suk-Sun Kim; J Korean Acad Community Health Nurs. 2021;32(4):457-466. Published online December 31, 2021; DOI: https://doi.org/10.12799/jkachn.2021.32.4.457

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Abstract PDF

Purpose
The purpose of this study was to examine the correlations among emotional perception clarity, emotion regulation, family relationship, non-suicidal self-injury, and depression, and to determine associated factors of non-suicidal self-injury and depression for senior elementary school students.
Methods
Data were collected from 150 early adolescences in K region, Korea. A self-report questionnaire consisted of Trait Meta-Mood Scale, Cognitive Emotion Regulation Questionnaire, Family Relationship Assessment Scale, Functional Assessment of Self-Mutilation, and Children's Depression Inventory. The data were analyzed using t-test, Pearson’s correlation coefficient, logistic regression, and multiple regression analysis. Results: Non-suicidal self-injury and depression were positively associated with maladaptive emotion regulation strategy and family conflict, but negatively related to emotional perception clarity and family support. Adaptive emotion regulation strategy and family togetherness were only significantly correlated with depression. In logistic regression analysis, significant predictors of non-suicidal self-injury were emotional perception clarity, maladaptive emotion regulation strategy, and family support. Multiple regression analysis found that significant factors of depression were adaptive and maladaptive emotion regulation strategies, which explained 38.0% of the variance.
Conclusion
Our study findings suggest that targeted intervention to reinforce the adaptive emotion regulation strategy and family relationship may prevent non-suicidal self-injury, and depression for senior elementary school students.

Citations

Citations to this article as recorded by

학교모래놀이 집단상담이 초기자해행동 초등학생의 애착에 미치는 효과:예비연구
Ester Park, Un-Kyoung Ahn
School Counselling and Sandplay.2024; 6(2): 18. CrossRef

Social Determinants of Health of Multicultural Adolescents in South Korea: An Integrated Literature Review (2018~2020): You Lim Kim, Hyeon Kyeong Lee, Hye Yeon Lee, Mi Kyung Lee, Soo Kyung Kim, Diema Konlan Kennedy; J Korean Acad Community Health Nurs. 2021;32(4):430-444. Published online December 31, 2021; DOI: https://doi.org/10.12799/jkachn.2021.32.4.430

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4 Citations

Abstract PDF

Purpose
This study is an integrated literature review to analyze health problems and social determinants of multicultural adolescents in South Korea.
Methods
An integrative review was conducted according to Whittemore & Knafl’s guideline. An electronic search that included publications from 2018 to 2020 in the PubMed, EMBASE, Cochrane Library, CINAHL, RISS, and KISS databases was conducted. Of a total of 67 records that were identified, 13 finally met full inclusion criteria. Text network analysis was also conducted to identify keywords network trends using NetMiner program.
Results
The health problems of multicultural adolescents were classified into mental health (depression, anxiety, suicide and acculturative stress) and health risk behaviors (smoking, risky drinking, smartphone dependence and sexual behavior). As social determinants affecting the health of multicultural adolescents, the biological factors such as gender, age, and visible minority, and the psychological factors such as acculturative stress, self-esteem, family support, and ego-resiliency were identified. The sociocultural factors were identified as family economic status, residential area, parental education level, and parents' country of birth. As a result of text network analysis, a total of 41 words were identified.
Conclusion
Based on these results, mental health and health risk behaviors should be considered as interventions for health promotion of multicultural adolescents. Our findings suggest that further research should be conducted to broaden the scope of health determinants to account for the effects of the physical environment and health care system.

Citations

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Navigating healthier beverage consumption in adolescents using the “R-Ma Bot” chatbot: A usability and evaluation study
Jisu Lee, Hyeonkyeong Lee, Hyeyeon Lee
DIGITAL HEALTH.2024;[Epub] CrossRef
A Study on the Factors Influencing Smoking in Multicultural Youths in Korea
Jin-Hee Park, Mi-Jin Kim, Hee-Joo Lee
Healthcare.2023; 11(10): 1437. CrossRef
Social determinants of health of racial and ethnic minority adolescents: An integrative literature review
Youlim Kim, Hyeonkyeong Lee, Hyeyeon Lee, Mikyung Lee, Sookyung Kim, Kennedy Diema Konlan
Heliyon.2023; 9(10): e20738. CrossRef
Factors Influencing Smoking among Multicultural Adolescents
Jin-Hee Park, Mi-Jin Kim, Sung-Eun Kim
International Journal of Environmental Research and Public Health.2022; 19(18): 11219. CrossRef

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