Browsing by Author "Seo, Bojung"

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    Association Between Built Environment or Health Behavior and Good Health Status Using ACSM American Fitness Index® Data Between 2018 and 2022
    (2023-12) Seo, Bojung; Han, Jiali; Nan, Hongmei; Monahan, Patrick O.; Duszynski, Thomas J.
    The US cities still have room for improvement in residents’ health and there are significant differences in general health measures between the cities. High quality environment assets and personal healthier behaviors of residents were known as factors related to better health. Because both sufficient sleep and higher level of personal physical activity are well-known indicators to attain optimal health of individuals, city-level measures of resident health behaviors, such as sleep quantity, and environmental assets that support physical activity may jointly improve residents’ general health. Further, sufficient sleep may mediate the effect of activity-related environmental factors on general health. However, evidence regarding such associations at the city level is lacking. The American College of Sports Medicine (ACSM) American Fitness Index® (AFI) data currently provide both environment assets and health indicators for the 100 largest US cities. The aim of this research was to test the following three hypotheses using the 2018 to 2022 AFI data. First, the association between environment indicators of cities and good health status of residents was examined. Second, the association between personal health behaviors of residents and good health status was also examined. Lastly, the moderating or mediating effect of sleep on the association between significant environmental factors and good health status was examined. This study discovered that activity-related environment factors, such as availability of parks within a 10-minute walk, Walk Score®, Bike Score®, and adoption of Complete Streets policy, were significantly associated with the self-reported general health status of residents. This study also demonstrated all measured healthy behaviors including meeting physical activity guidelines, using active transport to work, sufficient intake of fruits and vegetables, sufficient sleep, and non-smoking were positively related to general health status of city residents. This study also identified the synergistic interaction between sufficient daily sleeping and environment factors related to the level of physical activity on residents’ good health status. Overall, these findings will provide evidence for better understanding the health-related unmet needs of residents in US cities, and also create valuable context and support for development and targeting of more efficacious public health interventions and messaging.
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    Association of omega-3 and omega-6 fatty acid intake with leukocyte telomere length in US males
    (Elsevier, 2022-12) Seo, Bojung; Yang, Keming; Kahe, Ka; Qureshi, Abrar A.; Chan, Andrew T.; De Vivo, Immaculata; Cho, Eunyoung; Giovannucci, Edward L.; Nan, Hongmei; Community and Global Health, Richard M. Fairbanks School of Public Health
    Background Omega-3 (n–3) and omega-6 (n–6) fatty acids may contribute to oxidative stress and inflammation, which are related to telomere shortening. Evidence supporting an association between intake of n–3 or n–6 fatty acids and leukocyte telomere length (LTL) in males has been limited. Objectives We conducted a cross-sectional study to examine the associations of total or individual n–3 or total n–6 fatty acid intake with LTL in US males. Methods We included 2,494 US males with LTL measurement from 4 nested case–control studies within the Health Professionals Follow-Up Study. Individuals with previous histories of cancers, diabetes, and cardiovascular diseases at or before blood collection were excluded. Blood collection was performed between 1993 and 1995, and relevant information including n–3 and n–6 intake was collected in 1994 by questionnaire. The LTL was log-transformed and Z scores of the LTL were calculated for statistical analyses by standardizing the LTL in comparison with the mean within each selected nested case–control study. Results We found that consumption of DHA (22:6n–3) was positively associated with LTL. In the multivariable-adjusted model, compared with individuals who had the lowest intake of DHA (i.e., first quartile group), the percentage differences (95% CIs) of LTL were −3.7 (−13.7, 7.5), 7.0 (−4.3, 19.7), and 8.2 (−3.5, 21.3) for individuals in the second, third, and fourth quartiles of consumption, respectively (P-trend = 0.0498). We did not find significant associations between total n–3 or total n–6 fatty acid intakes and LTL. In addition, we found that males who consumed canned tuna had longer LTL than those who did not; in the multivariable-adjusted model, the percentage difference of LTL was 10.5 (95% CI: 1.3, 20.4) (P = 0.02). Conclusions Our results suggest that higher intakes of DHA and canned tuna consumption are associated with longer LTL.
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    Association of sun-seeking behaviors with indoor tanning behavior in US white females during high school/college in Nurses' Health Study II
    (Springer Nature, 2024-01-11) Seo, Bojung; Yang, Sheng; Cho, Eunyoung; Qureshi, Abrar A.; Han, Jiali; Epidemiology, Richard M. Fairbanks School of Public Health
    Background: Frequent exposure to ultraviolet light has more detrimental and longer-term effects on the skin in early life than in adulthood. Teenagers with strong sun-seeking behaviors may be more likely to use an indoor tanning bed than those who seek less sun. We aimed to examine associations between sun-seeking behaviors and indoor tanning behavior during high school/college in US females. Methods: In this cross-sectional study, we used data from The Nurses' Health Study II, a large prospective cohort of US female nurses. We included a total of 81,746 white females who provided responses on the average annual frequency of indoor tanning during high school/college. Our study exposures were number of times/week spent outdoors in a swimsuit and percentage of time wearing sunscreen at the pool/beach as a teenager, weekly hours spent outdoors in direct sunlight during the daytime during high school/college, and number of severe sunburns that blistered between ages 15-20 years. The main outcome was annual frequency of indoor tanning bed usage during high school/college. Results: In multivariable-adjusted logistic regression, we demonstrated positive associations between sun-seeking behaviors and indoor tanning use. Specifically, teenagers who spent 7 times/week outdoors in a swimsuit (adjusted odds ratio [aOR], 95% confidence interval [CI] for daily vs. <1/week: 2.68, 1.76-4.09) were more likely to use indoor tanning beds ≥ 12 times/year. Teenagers with ≥ 10 sunburns (aOR, 95% CI for ≥ 10 vs. never: 2.18, 1.53-3.10) were more likely to use indoor tanning beds ≥ 12 times/year. Also, teenagers/undergraduates who spent ≥ 5 h/week outdoors in direct sunlight (aOR, 95% CI for ≥ 5 h/week vs. <1 h/week: 2.18, 1.39-3.44) were more likely to use indoor tanning ≥ 12 times/year. However, there was not a significant association between average usage of sunscreen at the pool/beach and average usage of indoor tanning beds. Multivariable-adjusted linear regression models also showed similar results. Conclusions: Teenagers who spent more time outdoors in a swimsuit/direct sunlight or got more sunburns tended to use indoor tanning more frequently. These findings provide evidence that teenagers with stronger sun-seeking behaviors may have more exposure to artificial ultraviolet radiation as well.
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    Comparative Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Serum Electrolyte Levels in Patients with Type 2 Diabetes: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials
    (Wolters Kluwer, 2022-01-19) Zhang, Jingjing; Huan, Yonghong; Leibensperger, Mark; Seo, Bojung; Song, Yiqing; Epidemiology, School of Public Health
    Background: Previous studies have reported that sodium-glucose co-transporter 2 (SGLT2) inhibitors (SGLT2is) affect levels of serum electrolytes, especially magnesium. This study aimed to integrate direct and indirect trial evidence to maximize statistical power to clarify their overall and comparative effects in patients with type 2 diabetes (T2D). Methods: We systematically searched PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov up to January 2021 to identify eligible randomized controlled trials (RCTs) of SGLT2is that reported mean changes in serum electrolytes, including magnesium, sodium, potassium, phosphate, and calcium. We performed both random-effects pairwise and network meta-analyses to calculate the weighted mean difference (WMD) and 95% confidence intervals (CI). Results: In total, we included 25 RCTs involving 28,269 patients with T2D and 6 SGLT2is. Compared with placebo, SGLT2is were significantly associated with elevations in serum magnesium by 0.07 mmol/L (95% CI, 0.06 to 0.08 mmol/L) and serum phosphate by 0.03 mmol/L (95% CI, 0.02 to 0.04 mmol/L). Our network meta-analysis showed no evidence of significantly superior efficacy of any specific SGLT2 inhibitor over the others, although dapagliflozin was associated with a larger increment in serum magnesium (WMD=0.16 mmol/L) compared with other SGLT2is. Similarly, no statistically detectable differences among the effects of SGLT2is on serum levels of other electrolytes were detected. Conclusions: SGLT2is significantly increased serum magnesium and phosphate levels, consistent with a class effect of SGLT2 inhibition. However, further investigations of long-term efficacy and safety in patients with T2D with different clinical phenotypes are needed.
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    Health insurance coverage and poverty status of postpartum women in the United States in 2019: an ACS-PUMS population-based cross-sectional study
    (Springer Nature, 2023-11-08) Seo, Bojung; Turman, Jack Edward; Nan, Hongmei; Epidemiology, Richard M. Fairbanks School of Public Health
    Background: A quarter of United States (US) postpartum women still report unmet health care needs and health care unaffordability. We aimed to study associations between receipt of health insurance coverage and poverty status/receipt of government financial support and determine coverage gaps overall and by social factors among US postpartum women in poverty. Methods: This study design is a cross-sectional study using secondary data. We included women who gave birth within the last 12 months from 2019 American Community Survey Public Use Microdata Sample. Poverty was defined as having an income-to-poverty ratio of less than 100%. We explored Medicaid/government medical assistance gaps among women in poverty. To examine the associations between Medicaid/government medical assistance (exposures) and poverty/government financial support (outcomes), we used age-, race-, and multivariable-adjusted logistic regression models. We also evaluated the associations of state, race, citizenship status, or language other than English spoken at home (exposures) with receipt of Medicaid/government medical assistance (outcomes) among women in poverty through multivariable-adjusted logistic regression. Results: It was notable that 35.6% of US postpartum women in poverty did not have Medicaid/government medical assistance and only a small proportion received public assistance income (9.8%)/supplementary security income (3.1%). Women with Medicaid/government medical assistance, compared with those without the coverage, had statistically significantly higher odds of poverty [adjusted odds ratio (aOR): 3.15, 95% confidence interval (95% CI): 2.85-3.48], having public assistance income (aOR: 24.52 [95% CI: 17.31-34.73]), or having supplementary security income (aOR: 4.22 [95% CI: 2.81-6.36]). Also, among postpartum women in poverty, women in states that had not expanded Medicaid, those of Asian or other race, non-US citizens, and those speaking another language had statistically significantly higher odds of not receiving Medicaid/government medical assistance [aORs (95% CIs): 2.93 (2.55-3.37); 1.30 (1.04-1.63); 3.65 (3.05-4.38); and 2.08 (1.86-2.32), respectively]. Conclusions: Our results showed that the receipt of Medicaid/government medical assistance is significantly associated with poverty and having government financial support. However, postpartum women in poverty still had Medicaid/government medical assistance gaps, especially those who lived in states that had not expanded Medicaid, those of Asian or other races, non-US citizens, and other language speakers.
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    Major Occupations and Private Insurance of Working Postpartum Women in Poverty in the United States, 2019
    (Mary Ann Liebert, 2023-10-18) Seo, Bojung; Nan, Hongmei; Epidemiology, School of Public Health
    Background: Although working postpartum women in poverty still have unmet medical needs, relevant research is lacking. Thus, we aimed to determine the five most frequent occupations of U.S. postpartum women in poverty and further examine whether the most frequent occupations are associated with poverty/being uninsured by an employer. Methods: This is a cross-sectional study. We included women who had a job and gave birth within the last 12 months from a 2019 American Community Survey Public Use Microdata Sample. To examine the associations between the most frequent occupations and being in poverty/uninsured through an employer/union, we used age- and race-adjusted and multivariable-adjusted logistic regression models. Results: A total of 14.3% of working postpartum women lived in poverty, and their most frequent major occupations were sales and related work, followed by food preparation and serving-related work, office and administrative support work, health care support work, and cleaning and ground maintenance. A total of 51.2% of women in the most frequent major occupations were uninsured through an employer/union. Compared with women in other occupations, women in the most frequent major occupations had fewer working hours and weeks that included paid leave. In particular, cleaners and ground maintenance workers and food preparation and serving-related workers were most likely to be in poverty and uninsured through an employer/union. Conclusions: Compared with other occupations, the most frequent occupations were more likely to be insecure and less likely to provide health insurance. Our U.S.-based study suggested that current policies regarding employee benefits needed to be improved especially for the most frequent major occupations.