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Research Papers
Factors Influencing Sexual Experiences in Adolescents Using a Random Forest Model: Secondary Data Analysis of the 2019~2021 Korea Youth Risk Behavior Web-based Survey Data
Yang, Yoonseok , Kwon, Ju Won , Yang, Youngran
J Korean Acad Nurs 2024;54(2):193-210.   Published online May 31, 2024
DOI: https://doi.org/10.4040/jkan.23134
AbstractAbstract PDF
Purpose
The objective of this study was to develop a predictive model for the sexual experiences of adolescents using the random forest method and to identify the “variable importance.” Methods: The study utilized data from the 2019 to 2021 Korea Youth Risk Behavior Web-based Survey, which included 86,595 man and 80,504 woman participants. The number of independent variables stood at 44. SPSS was used to conduct Rao-Scott χ2 tests and complex sample t-tests. Modeling was performed using the random forest algorithm in Python. Performance evaluation of each model included assessments of precision, recall, F1-score, receiver operating characteristics curve, and area under the curve calculations derived from the confusion matrix.
Results
The prevalence of sexual experiences initially decreased during the COVID-19 pandemic, but later increased. “Variable importance” for predicting sexual experiences, ranked in the top six, included week and weekday sedentary time and internet usage time, followed by ease of cigarette purchase, age at first alcohol consumption, smoking initiation, breakfast consumption, and difficulty purchasing alcohol.
Conclusion
Education and support programs for promoting adolescent sexual health, based on the top-ranking important variables, should be integrated with health behavior intervention programs addressing internet usage, smoking, and alcohol consumption. We recommend active utilization of the random forest analysis method to develop high-performance predictive models for effective disease prevention, treatment, and nursing care.
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Adolescents’ Experiences of Non-Suicidal Self-Injury: An Interpretative Phenomenological Analysis Study
Ko, Jung A , Kim, Ji Young
J Korean Acad Nurs 2023;53(5):538-555.   Published online October 31, 2023
DOI: https://doi.org/10.4040/jkan.23075
AbstractAbstract PDF
Purpose
This qualitative study used interpretative phenomenological analysis and photovoice methods to explore the meaning of non-suicidal self-injury experienced by adolescents.
Methods
Participants were adolescents enrolled in middle and high schools in Gyeonggi-do and Jeollabuk-do who were selected through snowball sampling. Six participants had repeatedly engaged in self-injurious behavior for over a year. Data were collected through in-depth interviews and the photovoice method between November 2020 and July 2021. The collected data were analyzed using six steps of interpretative phenomenological analysis.
Results
The results yielded 5 main themes and 18 subthemes. The main themes were ‘a silent cry to an indifferent world’, ‘a heartache that one endures with scars’, ‘an inescapable cycle’, ‘filling the space in one’s heart’, and ‘healing the wounds’. The study findings revealed that the self-injurious behavior of adolescents began as a consequence of feeling lost and struggling with conflicts at home and school, which helped them relieve tension and pain. Nonetheless, inflicting self-injury only left signs of regret and remorse, which became a trace that the participants wanted to hide. However, the wounds healed after receiving attention and support from others. They were determined to stop engaging in repeated self-injurious behaviors and made efforts to do so.
Conclusion
This study can be used as a basis for the development of educational programs to prevent non-suicidal self-injury in adolescents. Additionally, it can inform nursing interventions that focus on building support systems to help adolescents who attempt self-injury.
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Effects of Health Education Using Virtual Reality for Adolescents: A Systematic Review and MetaAnalysis
Park, SoMi , Chung, ChaeWeon , Kim, Gaeun
J Korean Acad Nurs 2023;53(2):177-190.   Published online April 30, 2023
DOI: https://doi.org/10.4040/jkan.23003
AbstractAbstract PDF
Purpose
This study aimed to evaluate the effects of health interventions using virtual reality (VR) on improving knowledge, attitudes, and skills; and inducing behavioral change among adolescents.
Methods
This study is a systematic review and meta-analysis following PRISMA guidelines. We searched Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Korean databases between database inception and April 10, 2021. Based on heterogeneity, a random- or fixed-effects model was used, as appropriate, to calculate effect sizes in terms of the standardized mean difference (SMD) and odds ratio (OR). Studies were selected if they verified the effects of health education using VR on adolescents; there was an appropriate control group; and if the effects of education were reported in terms of changes in knowledge, attitudes, skills, or behaviors.
Results
This analysis included six studies (n = 1,086). The intervention groups showed greater responses in knowledge and attitudes (SMD = 0.57, 95% confidence interval (CI) [0.12 to 1.02]), skills related to health behavior (SMD = -0.45, 95% CI [-0.71 to -0.19]), and behavioral change after 12 months (OR = 2.36, 95% CI [1.03 to 5.41]).
Conclusion
The results confirm the effectiveness of health interventions using virtual reality (VR). Although the analysis include a small number of studies, a case can be made for health interventions using VR to be utilized as educational methods and strategies to prevent risky behaviors among adolescents.
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Associations between the Frequency and Quantity of Heated Tobacco Product Use and Smoking Characteristics among Korean Smoking Adolescents
Lee, Haein , Lee, Bo Gyeong
J Korean Acad Nurs 2023;53(2):155-166.   Published online April 30, 2023
DOI: https://doi.org/10.4040/jkan.22125
AbstractAbstract PDF
Purpose
Although heated tobacco product (HTP) use among adolescents is an emerging public health problem, little is known about the frequency and quantity of HTP use. Thus, we investigated the associations between the frequency and quantity of HTP use and smoking characteristics (i.e., combustible cigarette [CC] and electronic cigarette [EC] use, and attempts to quit smoking) among CC-smoking adolescents.
Methods
We analyzed nationally representative data from 2,470 Korean adolescents who were current CC smokers. To investigate our aim, we conducted multinomial logistic and logistic regression analyses.
Results
We found that daily and heavier CC users had greater likelihoods of more frequent and heavier HTP use. In addition, dual users of CCs and ECs were more likely to use HTPs more frequently and heavily than CC users who did not use ECs. Moreover, daily EC users had the highest risk of frequent and heavy HTP use. The frequency and quantity of HTP use were not associated with attempts to quit smoking. Compared to CC-only use, dual use of CCs and HTPs was not associated with quitting attempts, and triple use of CCs, ECs, and HTPs was associated with a lower likelihood of quitting attempts.
Conclusion
HTP use was less likely to displace CC use and promote attempts to quit smoking. Thus, strict regulations are required to prevent the promotion of HTPs as a substitute for CCs or as a means of quitting smoking. Additionally, health professionals should consider preventive interventions for HTP, as well as CC and EC use among adolescents.
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The Effects of the Combined Biofeedback and Brief Emotion Regulation Nursing Intervention Based on the Gross Model for Sexually Abused Adolescents
Kim, Jieun , Park, Wanju
J Korean Acad Nurs 2022;52(6):608-623.   Published online December 31, 2022
DOI: https://doi.org/10.4040/jkan.22088
AbstractAbstract PDF
Purpose
This study aimed to evaluate the effects of a combined biofeedback and brief emotion regulation (C-BABER) program for sexually abused adolescents.
Methods
This study employed a non-equivalent control group pretest-posttest design. The participants included 26 sexually abused adolescents from eight Sunflower Centers of South Korea–with 13 in the experimental group and 13 in the control group. The experimental group received four sessions of the individual C-BABER program, each lasting 60 minutes.
Results
Compared with the control group, sexually abused adolescents in the experimental group exhibited significant score differences in traumatic symptoms, including depression (Z = - 2.24, p = .025), dissociation (Z = - 2.21, p = .027), anxiety (Z = - 2.02, p = .044), and posttraumatic stress (Z = - 2.01 p = .045); and impulsivity, including positive urgency (Z = - 3.35, p = .001) and negative urgency (Z = - 2.28, v = .023). Additionally, the experimental group exhibited significant score differences in meta-mood, including emotional attention (Z = - 2.45, p = .014), emotional clarity (Z = - 2.30, p = .021), and emotional repair (Z = - 2.28, p = .022); and emotional regulation modes, including emotional suppression (Z = - 2.65,p = .008) and cognitive reappraisal (Z = - 1.98, p = .047). Regarding bio-attention, significant changes were identified in the experimental group for the bio-attention rate and attention maintenance time in the posttest compared to the pretest (p = .001).
Conclusion
The C-BABER program for sexually abused adolescents is effective in decreasing traumatic symptoms and impulsivity, and in improving meta-mood, emotional regulation mode, and bio-attention. Therefore, we recommend providing sexually abused adolescents the C-BABER program to help them regulate their emotions and effectively adapt to their lives.
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Moderating the Effects of Health Behaviors on Sexual Intercourse among Adolescents: A CrossSectional Study Using the 2020 Adolescent Health Behavior Survey
Lee, Eunmi , Yang, Youngran
J Korean Acad Nurs 2022;52(5):499-510.   Published online October 31, 2022
DOI: https://doi.org/10.4040/jkan.22080
AbstractAbstract PDF
Purpose
This study investigated the association between adolescent health behaviors (drinking, smoking, and drug use) and sexual intercourse, as well as the moderating effects of economic status, cohabitation with parents, and school type, among adolescents in Korea.
Methods
Secondary data from the 16th Adolescent Health Behavior Survey (2020) were used. A total of 395 schools and 54,948 middle and high school students participated in the study. Complex sample frequency analysis, the Rao–Scott test, and complex sample logistic regression analyses were performed.
Results
Sexual intercourse rates for men and women were 5.8% and 3.3%, respectively. Approximately 7.3% of high school students and 1.8% of middle school students reported having had sexual relations. Drinking (odds ratio [OR] = 3.15, 95% confidence interval [CI] = 2.82~3.52), smoking (OR = 6.75, 95% CI = 5.90~7.71), and drug use (OR = 3.03, 95% CI = 2.23~4.11) significantly increased the risk of sexual intercourse. Economic status and school type had moderating effects on the association between drinking and sexual intercourse.
Conclusion
Adolescent drinking, smoking, and drug use are associated with a higher risk of sexual experience. Thus, to reduce this risk, controlling alcohol consumption, smoking, and drug use is necessary. In addition, programs for healthy lifestyles and sexual intercourse should be differentiated according to the school type and the economic conditions of the adolescents’ households.
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Effect of Acculturative Stress on Multicultural Adolescents’ Life Satisfaction: Sequential Multiple Mediating Effects of Bicultural Acceptance Attitude, Self-Esteem, and Social Withdrawal -Using the 2016 Multicultural Adolescents Panel Study-
Kim, Soo Mi , Kim, Hyeon Ok
J Korean Acad Nurs 2022;52(3):324-340.   Published online June 30, 2022
DOI: https://doi.org/10.4040/jkan.22030
AbstractAbstract PDF
Purpose
This study determined acculturative stress’ effect on the life satisfaction of multicultural adolescents based on Roy’s Adaptation Model and some earlier studies. Further, it examined the sequential multiple mediating effects of bicultural acceptance attitude, self-esteem, and social withdrawal on life satisfaction.
Methods
Participants included 1,163 multicultural adolescents who participated in the sixth Multicultural Adolescents Panel Study. A hypothesis test was conducted using Hayes’ Process Macro Model 81.
Results
Life satisfaction increased with a decline in acculturative stress. Each of bicultural acceptance attitude, self-esteem, and social withdrawal had a single mediating effect on the relationship between acculturative stress and life satisfaction in multicultural adolescents. The sequential multiple mediating effects of bicultural acceptance attitude and self-esteem were confirmed significant after their impact on the relationship between acculturative stress and life satisfaction was analyzed. Bicultural acceptance attitude and social withdrawal were found to have a significant sequential multiple mediating effect on the relationship, as well.
Conclusion
This study’s results demonstrate that acculturative stress reduction is critical to improving multicultural adolescents’ life satisfaction. Bicultural acceptance attitude, self-esteem, and social withdrawal have a single mediating or sequential multiple mediating effect on the relationship between multicultural adolescents’ acculturative stress and life satisfaction. The findings, which highlight mediating effects, indicate that by increasing bicultural acceptance attitude and self-esteem, and reducing social withdrawal, multicultural adolescents’ life satisfaction can be improved.
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Effects of Electroencephalogram Biofeedback on Emotion Regulation and Brain Homeostasis of Late Adolescents in the COVID-19 Pandemic
Park, Wanju , Cho, Mina , Park, Shinjeong
J Korean Acad Nurs 2022;52(1):36-51.   Published online February 28, 2022
DOI: https://doi.org/10.4040/jkan.21155
AbstractAbstract PDF
Purpose
The purpose of this study was to examine the effects of electroencephalogram (EEG) biofeedback training for emotion regulation and brain homeostasis on anxiety about COVID-19 infection, impulsivity, anger rumination, meta-mood, and self-regulation ability of late adolescents in the prolonged COVID-19 pandemic situation.
Methods
A non-equivalent control group pretest-posttest design was used. The participants included 55 late adolescents in the experimental and control groups. The variables were evaluated using quantitative EEG at pre-post time points in the experimental group. The experimental groups received 10 sessions using the three-band protocol for five weeks. The collected data were analyzed using the Shapiro-Wilk test, Wilcoxon rank sum test, Wilcoxon signed-rank test, t-test and paired t-test using the SAS 9.3 program. The collected EEG data used a frequency series power spectrum analysis method through fast Fourier transform.
Results
Significant differences in emotion regulation between the two groups were observed in the anxiety about COVID-19 infection (W = 585.50, p = .002), mood repair of meta-mood (W = 889.50, p = .024), self-regulation ability (t = - 5.02, p < .001), self-regulation mode (t = - 4.74, p < .001), and volitional inhibition mode (t = - 2.61, p = .012). Neurofeedback training for brain homeostasis was effected on enhanced sensory-motor rhythm (S = 177.00, p < .001) and inhibited theta (S = - 166.00, p < .001).
Conclusion
The results demonstrate the potential of EEG biofeedback training as an independent nursing intervention that can markedly improve anxiety, mood-repair, and self-regulation ability for emotional distress during the COVID-19 pandemic.
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Review Paper
The Effects of Programs on Body-Image Improvement in Adolescents: A Systematic Review and Meta-Analysis
Yun, Hyun Jung , Seo, Kyoungsan , Han, Dallong
J Korean Acad Nurs 2021;51(5):597-616.   Published online October 31, 2021
DOI: https://doi.org/10.4040/jkan.21104
AbstractAbstract PDF
Purpose
This study’s objective was to investigate the effects of programs that improve adolescents’ body image, using a systematic review and meta-analysis.
Methods
A literature search was performed in eleven electronic databases, using preferred reporting items for systematic reviews and meta-analysis guidelines. Population characteristics, contents of the programs, and measured outcomes were systematically reviewed from 21 selected studies. To estimate the size of the effects, meta-analysis was conducted using Comprehensive Meta-Analysis software.
Results
The contents of the programs that aimed to improve body image included physical, psychological, interpersonal, and sociocultural interventions. Sixteen studies were meta-analyzed to estimate the effect size of body-image improvement programs. Results showed that the program for body-image improvement had significant effects on body satisfaction (effect size [ES] = 0.56, 95% confidence interval [CI] = 0.23 to 0.89), and body dissatisfaction (ES = - 0.15, 95% CI = - 0.23 to - 0.08).
Conclusion
The program for body image improvement in adolescents includes a combination of physical, psychological, interpersonal relationship, and socio-cultural dimensions. The program that seeks to improve body image appears to be effective at increasing body satisfaction, and at reducing body dissatisfaction in adolescents. Thus, it is necessary to develop and apply multidimensional programs for adolescents to have a positive body image.
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Research Papers
Associations between Cigarette and Electronic Cigarette Use and Sleep Health in Korean Adolescents: An Analysis of the 14th (2018) Korea Youth Risk Behavior Surveys
Lee, Bo Gyeong , Lee, Haein
J Korean Acad Nurs 2021;51(3):380-389.   Published online June 30, 2021
DOI: https://doi.org/10.4040/jkan.21034
AbstractAbstract PDF
Purpose
This study aimed to understand the relationship between cigarette and electronic cigarette (e-cigarette) use and sleep health among Korean adolescents.
Methods
Using the 14th Korea Youth Risk Behavior Survey, we included 52,928 adolescents who responded to sleep satisfaction and sleep duration. Participants were classified into four groups: non-users, cigarette-only users, e-cigarette-only users, and dual users of both products. To examine the associations between cigarette and e-cigarette use and sleep health, data were analyzed using complex samples cross tabulation and complex samples logistic regression.
Results
Of the four groups, dual users reported the lowest level of sleep satisfaction and sleep duration; 57.0% and 86.9% of dual users were not satisfied with their sleep and have insufficient sleep duration, respectively. The proportion of students who were not satisfied with their sleep was higher among cigarette-only users compared to e-cigarette-only users (52.7% vs. 45.8%), but the two groups reported similar rates of insufficient sleep duration (84.2% vs. 84.3%). Compared to non-users, cigarette-only users, e-cigarette-only users, and dual users were more likely to not be satisfied with sleep (odds ratios [ORs] were 1.49, 1.36, and 1.75, respectively) and had significantly higher odds of experiencing insufficient sleep duration (ORs were 1.85, 2.06, and 2.34, respectively).
Conclusion
E-cigarette-only use and dual use as well as cigarette-only use were associated with poor sleep health. Therefore, to improve adolescent sleep health, health professionals should provide sleep intervention strategies considering the association between smoking and sleep health.
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The Effect of Neighborhood Characteristics and Friends’ Smoking Status on the Habitual Smoking Onset in Adolescents
Choi, You-Jung , Kim, Gwang Suk
J Korean Acad Nurs 2021;51(1):54-67.   Published online February 28, 2021
DOI: https://doi.org/10.4040/jkan.20212
AbstractAbstract PDF
Purpose
The aim of this study was threefold, to longitudinally examine the risk of habitual smoking onset in adolescents, to delineate the effects of neighborhood characteristics and friends’ smoking status on the habitual smoking onset, and to investigate whether the association between friends’ smoking status and habitual smoking onset was moderated by neighborhood characteristics.
Methods
This study conducted multilevel discrete-time survival analysis, using cohort data from the 3rd to 6th waves of the Korean Child and Youth Panel Survey, which excluded habitual smokers, matched with 2010 census data on respondents’ residence.
Results
Habitual smoking onset risk increased from the 8th to the 11th grade, and then slightly decreased from the 11th to the 12th grade. Friends’ smoking status (B = 0.60, p < .001), smoking rate (B = 0.06, p = .038), and the number of tobacco outlets in the respondents’ neighborhood (B = 0.51, p = .003) were positively associated with habitual smoking onset risk. Furthermore, the association between friends’ smoking status and habitual smoking onset risk was moderated by the number of tobacco outlets in the neighborhood. Specifically, the association was stronger in neighborhoods with more tobacco outlets (B = 0.58, p = .048).
Conclusion
Friends’ smoking status and living in neighborhoods that are more susceptible to smoking increase the risk of habitual smoking. The number of tobacco outlets in the neighborhood enhances the peer effect of adolescent’s smoking behavior. Therefore, policies or interventions designed to reduce youth’s tobacco use should focus on not only on reducing peer smoking, but also restricting smoking by adults and the number of neighborhood tobacco outlets.
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Comparison of the Prediction Model of Adolescents’ Suicide Attempt Using Logistic Regression and Decision Tree: Secondary Data Analysis of the 2019 Youth Health Risk Behavior Web-Based Survey
Lee, Yoonju , Kim, Heejin , Lee, Yesul , Jeong, Hyesun
J Korean Acad Nurs 2021;51(1):40-53.   Published online February 28, 2021
DOI: https://doi.org/10.4040/jkan.20207
AbstractAbstract PDF
Purpose
The purpose of this study was to develop and compare the prediction model for suicide attempts by Korean adolescents using logistic regression and decision tree analysis. Methods: This study utilized secondary data drawn from the 2019 Youth Health Risk Behavior web-based survey. A total of 20 items were selected as the explanatory variables (5 of sociodemographic characteristics, 10 of health-related behaviors, and 5 of psychosocial characteristics). For data analysis, descriptive statistics and logistic regression with complex samples and decision tree analysis were performed using IBM SPSS ver. 25.0 and Stata ver. 16.0.
Results
A total of 1,731 participants (3.0%) out of 57,303 responded that they had attempted suicide. The most significant predictors of suicide attempts as determined using the logistic regression model were experience of sadness and hopelessness, substance abuse, and violent victimization. Girls who have experience of sadness and hopelessness, and experience of substance abuse have been identified as the most vulnerable group in suicide attempts in the decision tree model.
Conclusion
Experiences of sadness and hopelessness, experiences of substance abuse, and experiences of violent victimization are the common major predictors of suicide attempts in both logistic regression and decision tree models, and the predict rates of both models were similar. We suggest to provide programs considering combination of high-risk predictors for adolescents to prevent suicide attempt.
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Original Articles
Patterns of Drinking Behaviors and Predictors of Class Membership among Adolescents in the Republic of Korea: A Latent Class Analysis
Haein Lee, Sunhee Park
J Korean Acad Nurs 2019;49(6):701-712.   Published online January 17, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.6.701
AbstractAbstract PDF
Abstract Purpose:

Despite the high drinking rates and the complexity of drinking behaviors in adolescents, insufficient attention has been paid to their drinking patterns. Therefore, we aimed to identify patterns of adolescent drinking behaviors and factors predicting the distinct subgroups of adolescent drinking behaviors.

Methods:

We analyzed nationally representative secondary data obtained in 2017. Our final sample included 24,417 Korean adolescents who had consumed at least one glass of alcohol in their lifetime. To investigate patterns of drinking behaviors, we conducted a latent class analysis using nine alcohol-related characteristics, including alcohol consumption levels, solitary drinking, timing of drinking initiation, and negative consequences of drinking. Furthermore, we investigated differences in demographics, mental health status, and characteristics of substance use across the latent classes identified in our study. To do so, we used the PROC LCA with COVARIATES statement in the SAS software.

Results:

We identified three latent classes of drinking behaviors: current non-drinkers (CND), binge drinkers (BD), and problem drinkers (PD). Compared to the CND class, both BD and PD classes were strongly associated with higher academic year, lower academic performance, higher levels of stress, suicidal ideation, lifetime conventional or electronic cigarette use, and lifetime use of other drugs.

Conclusion:

Health professionals should develop and implement intervention strategies targeting individual subgroups of drinking behaviors to obtain better outcomes. In particular, health professionals should consider different characteristics across subgroups of adolescent drinking behaviors when developing the interventions, such as poor mental health status and other substance use among binge and problem drinkers.

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Development of a Quantitative Model on Adolescent Cyberbullying Victims in Korea: A System Dynamics Approach
Mi Jin You, Eun Mi Ham
J Korean Acad Nurs 2019;49(4):398-410.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.398
AbstractAbstract PDF
Abstract Purpose

This study used a system dynamics methodology to identify correlation and nonlinear feedback structures among factors affecting adolescent cyberbullying victims (CV) in Korea and to construct and verify a simulation model.

Methods

Factors affecting CV were identified by reviewing a theoretical background in existing literature and referencing various statistical data. Related variables were identified through content validity verification by an expert group, after which a causal loop diagram (CLD) was constructed based on the variables. A stock-flow diagram (SFD) using Vensim Professional 7.3 was used to establish a CV model.

Results

Based on the literature review and expert verification, 22 variables associated with CV were identified and the CLD was prepared. Next, a model was developed by converting the CLD to an SFD. The simulation results showed that the variables such as negative emotions, stress levels, high levels of conflict in schools, parental monitoring, and time spent using new media had the strongest effects on CV. The model's validity was verified using equation check, sensitivity analysis for timestep and simulation with 4 CV adolescent.

Conclusion

The system dynamics model constructed in this study can be used to develop intervention strategies in schools that are focused on counseling that can prevent cyberbullying and assist in the victims’ recovery by formulating a feedback structure and capturing the dynamic changes observed in CV. To prevent cyberbullying, it is necessary to develop more effective strategies such as prevention education, counseling and treatment that considers factors pertaining to the individual, family, school, and media.

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Validity and Reliability of a Korean Version of Yale Food Addiction Scale for Children (YFAS-C)
Jung Ho Kim, Ji Hyun Song, Ran Kim, Mi Young Jang, Hyon Joo Hong, Hyun Ji Kim, Sung Hee Shin
J Korean Acad Nurs 2019;49(1):59-68.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.1.59
AbstractAbstract PDF
Abstract Purpose

This study evaluated the psychometric properties of the Korean version of Yale Food Addiction Scale for Children (YFAS-C).

Methods

Participants were 419 young adolescent students (11~15 years old). The content validity of the expert group was calculated as the content validity index (CVI) after the translation and reverse translation process of the 25 items of the YFAS-C. The multitrait-multimethod matrix (MTMM) method was used to verify the construct validity; the generalized linear model (GLM) was used to evaluate the concurrent and incremental validity. Reliability was calculated as Kuder-Richardson-20 (KR-20) and Spearman-Brown coefficients.

Results

The CVI of the 25 items was greater than the item-level CVI .80 and the scale-level CVI .90. The Korean version of YFAS-C had verified convergent validity in emotional eating and external eating and discriminant validity in restrained eating. In addition, it had verified concurrent validity in emotional eating and external eating. Finally the incremental validity of the Korean version of YFAS-C was statistically significant on BMI. Reliability was KR-20 a=.69 and the Spearman-Brown coefficient was .64.

Conclusion

The Korean version of YFAS-C is a valid and reliable scale for measuring the severity of food addiction; it can be a useful scale for preventing obesity by predicting food addiction early.

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Differences in Factors Associated with Depressive Symptoms between Urban and Rural Female Adolescents in Korea
Gyuyoung Lee, Ok Kyung Ham, Bo Gyeong Lee, Abuan Micah Kim
J Korean Acad Nurs 2018;48(4):475-484.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.4.475
AbstractAbstract PDF
Abstract Purpose

To examine the prevalence of depressive symptoms and differentiate factors associated with them in urban and rural areas by applying the Ecological Models of Health Behavior.

Methods

We employed a cross-sectional design and convenience sample of 460 female adolescents. The instruments included the Adolescent Mental-Health Problem-Behavior Questionnaire (AMPQ-II) and the Beck Depression Inventory (BDI).

Results

Depressive symptoms were confirmed in 15.7% of urban adolescents and 22.9% of rural adolescents (p<.05). In the urban group, perception of health and stress associated with school performance were significantly associated with depressive symptoms. In the rural group, aca-demic/internet related problems and rule violations were significantly associated with depressive symptoms (p<.05). General life happiness, worry/ anxiety, and mood/suicidal ideation were common factors in both urban and rural areas (p<.05).

Conclusion

Multiple factors were associated with depressive symptoms, and those significant factors differed between urban and rural female youths. Accordingly, tailored approaches are required considering urban and rural differences. The approaches should include intrapersonal, interpersonal, and organizational levels of interventions.

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Self-Management Experiences of the Adolescents with Chronic Kidney Disease
Sug Young Lee, Heesun Shin
J Korean Acad Nurs 2018;48(3):266-278.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.3.266
AbstractAbstract PDF
Abstract Purpose

The aim of this study was to develop a substantive theory on self-management conducted by the adolescents with chronic kidney disease from their lived experience.

Methods

Data was collected through in-depth interviews from May to December in 2015 with thirteen adolescents with chronic kidney disease. The data collected were analyzed on the basis of Strauss and Corbin's grounded theory.

Results

The core of the category found in this study was “overcoming the unstable sense of self- control and integrating disease experience into their life”. The causal conditions triggering the central phenomenon were “restriction in daily life” and “manifestation and aggravation of symptom”. The central phenomenon in the experience of self-management within the adolescents with chronic kidney disease was “unstable sense of self control”. The intervening condition for unstable self control were “micro system support” and “motivational resources”. This study found that the adolescents with chronic kidney disease followed a series of strategies when they faced the central phenomenon, including; passive coping, reappraisal of illness, active coping, compliance with treatment, controlling physical activity, and adjusting school life. With these strategic approaches, the adolescents with chronic kidney disease could maintain their active lifestyles and achieve their health behaviors. The process of self-management by these adolescents passed through four phases; limited experience caused by diseases, effort for normalization, reorganizing their daily lives, and integration with daily lives and self-management.

Conclusion

This Study explored the process and experience of self-management of adolescents with chronic kidney disease. These findings can be used for basis for developing substantive theory and nursing intervention strategy for adolescents with chronic kidney diseases.

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Review Article
How Does Advance Provision of Emergency Contraceptives Affect Contraceptive Use and Sexual Activity Among Adolescents? Systematic Review and Meta-Analysis
Kyungsoon Ryu, Misoon Lee, Younghae Kim, Seonhwa Ban, Mihyang Choi
J Korean Acad Nurs 2018;48(3):255-265.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.3.255
AbstractAbstract PDF
Abstract Purpose

The purpose of this study was to analyze the effect of emergency contraceptive pill on adolescent sexuality and contraceptive behaviors through a meta - analysis of intervention studies on advance provision of emergency contraceptives. This study aimed to provide objective data on the transition of general medicines to be discussed in relation to the reclassification of emergency contraceptive pills.

Methods

Using electronic database, 1,820 studies written in Korean or English without limitation of the year were reviewed and for analysis, 5 studies were selected, in which emergency contraceptives were provided to adolescents.

Results

The advance provision of emergency contraceptives has increased their use and shortened the time it takes to take contraceptive pills after unprotected sex. There was no change in the frequency of engaging in sexual intercourse and unprotected sex or in existing contraceptive behavior, pregnancy rates decreased, but there was no increase in sexually transmitted infection.

Conclusion

The results of this study provide objective grounds for the reclassification of emergency contraceptive pills and propose effective interventional programs on contraceptive education, such as on efficacy and side effects of the contraceptive drug and its proper use among the youth who engage in sexual activity, to improve their reproductive health.

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Original Articles
Latent Class Analysis of Gambling Activities among Korean Adolescents
Kyonghwa Kang, Hyeongsu Kim, Ae Ran Park, Hee-Young Kim, Kunsei Lee
J Korean Acad Nurs 2018;48(2):232-240.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.2.232
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Abstract Purpose

The aim of this study is to identify the types of gambling among adolescents and provide basic prevention information regarding adolescents’ gambling problems.

Methods

Secondary data from representative national survey on 2015 Youth Gambling Problems of Korea Center on Gambling Problems were used. Using latent class analysis (LCA), 13 gambling types such as offline and online games of 14,011 adolescents were classified, and gambling experiences and characteristics were analyzed.

Results

The subgroups of adolescent gambling were identified as four latent classes: a rare group (84.5% of the sample), a risk group (1.0%), an offline group (11.9%), and an expanded group (2.6%). The types and characteristics of gambling among the latent classes differed. In the risk group, adolescents participated in online illegal sports betting and internet casino, and gambling time, gambling expenses, and the number of gambling types were higher than other groups.

Conclusion

Gambling frequently occur among adolescent, and the subtypes of gambling did not reveal homogeneous characteristics. In order to prevent adolescent gambling problems, it is a necessary to develop tailored prevention intervention in the nursing field, which is appropriate to the characteristics of adolescent gambling group and can help with early identification.

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The Effects of Neurofeedback Training on Physical, Psychoemotional Stress Response and Self-Regulation for Late Adolescence: A Non-Randomized Trial
Moon-Ji Choi, Wan-Ju Park
J Korean Acad Nurs 2018;48(2):208-220.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.2.208
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Abstract Purpose

The aim of this study was to analyze the effects of neurofeedback training for reducing stress and enhancing self-regulation in late adolescence to identify the possibility of use for nursing intervention.

Methods

A nonequivalent control group pre-post quasi-experimental design was used. Participants were 78 late adolescents assigned to the experimental group (n=39) that received the neurofeedback training and the control group (n=39). Data were collected on heart rate variability (HRV) and skin conductance level (SCL) to assess stress-biomarker response. The questionnaire contained 164 items from: Positive and Negative Affect Schedule (PANAS), Symptom Checklist-90-Revised (SCL-90-R) and Self-regulatory Ability scale. The neurofeedback training was based on the general adaptation syndrome and body-mind medicine. The intervention was conducted in a total of 10 sessions for 30 minutes per session with high-beta, theta and sensory motor rhythm training on scalp at central zero.

Results

There were significant difference in standard deviation of normal to normal interval (p=.036) in HRV and SCL (p=.029) of stress-biomarker response between the two groups. Negative affect (p=.036) in PANAS and obsessive compulsive (p=.023) and depression (p<.001) in SCL-90-R were statistically significant. Self-regulation mode (p=.004) in self-regulation ability scale showed a significant difference between the two groups.

Conclusion

The results indicated that the neurofeedback training is effective in stress-biomarkers, psy-choemotional stress response and self-regulation. Therefore, neurofeedback training using neuroscientific approach based on brain-mind-body model can be used as an effective nursing intervention for late adolescents in clinics and communities for effective stress responses.

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Effects of Group Counseling Program Based on Goal Attainment Theory for Middle School Students with Emotional and Behavioral Problems
In Ju Jeong, Soo Jin Kim
J Korean Acad Nurs 2017;47(2):199-210.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.199
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Purpose

The purpose of this study was to examine the effects of a group counseling program based on goal attainment theory on self-esteem, interpersonal relationships, and school adjustment of middle school students with emotional and behavioral problems.

Methods

Forty-four middle school students with emotional and behavioral problems (22 in the experimental group and 22 in the control group) from G city participated in this study. Data were collected from July 30 to September 24, 2015. The experimental group received the 8-session program, scheduled once a week, with each session lasting 45 minutes. Outcome variables included self-esteem, interpersonal relationship, and school adjustment.

Results

There were significant increases for self-esteem (t=3.69, p=.001), interpersonal relationship (t=8.88, p<.001), and school adjustment (t=4.92, p<.001) in the experimental group compared to the control group.

Conclusion

These results indicate that the group counseling program based on goal attainment theory is very effective in increasing self-esteem, interpersonal relationship, and school adjustment for middle school students with emotional and behavioral problems. Therefore, it is recommended that the group counseling program based on goal attainment theory be used as an effective psychiatric nursing intervention for mental health promotion and the prevention of mental illness in adolescents.

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Effects of a Strength Based I-Change Smoking Cessation Program for Smoking Middle School Boys
Jung Hee Kim, Yeon Hee Choi
J Korean Acad Nurs 2017;47(2):164-177.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.164
AbstractAbstract PDF
Purpose

This study was done to develop a strength based I-change smoking cessation program for middle school boys and identified its effects.

Methods

The study design was a nonequivalent control group pre-post test design. The participants were 97 middle school students from D city, who were in school from April 6 to September 25, 2015. The experimental group participated in the strength based I-change smoking cessation program, while the comparative group participated in a general smoking cessation program. The control group did not participate in any program. Data analyses involved χ2-test, Fishers' exact test, Bonferroni test, and Repeated measures ANOVA, with the IBM SPSS for Windows (version 20.0) program.

Results

Compared to the comparison and control groups, the experimental group showed significant improvement in knowledge, attitude, self-efficacy, behavior change. Also cotinine in urine and modeling of social influence in the experimental group significantly decreased after the strength based I-change smoking cessation program.

Conclusion

These findings indicate that the strength based I-change smoking cessation program is an effective intervention for middle school boys who smoke. The findings suggest that such programs can be used at public health centers or through school health education to decrease smoking in adolescents.

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Menstrual Experience of Adolescent Girls
Hyun Sook Chung
Journal of Nurses Academic Society 1996;26(2):257-270.   Published online March 30, 2017
DOI: https://doi.org/10.4040/jnas.1996.26.2.257
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Studies on menstruation have focused only on menstruation itself and menstrual disorders. The menstruating girls or women have been neglected. So, the purpose of this study was to understand menstrual experience of adolescent girls in their perspective and build a theory on it. The specific purpose of this study were to find initial reaction of the girls, their strategies to adapt to menstruation, consequences of their efforts, influencing factor, and patterns of experience. The subjects of this study were eleven adolescent girls who experienced menarche three months to twenty-six months before the interview time. They were selected purposively. Their ages were in range of twelve and sixteen. One of them was a elementary school girls, three high school girls, and seven middle school girls. Two girls were handicapped because of cerebral palsy. All of them had some knowledge about menstrual physiology and hygiene during menstruation. Data were collected from September, 1994 to July, 1995. Data collection and analysis were done according to the grounded theory methodology by Strauss and Corbin(1990). Data collecting method was the long interviews and observation. Each interview took from 1 hour to 2 hours. Interview were tape?recorded and transcribed later by author. Data were analyzed immediately after interviews. Based on the results of previous interview, next interview were planned until gathered data reached the saturation point. Results were as follows. One hundred and six concepts were found. Those concepts were grouped into twenty eight categories and then fourteen higher categories. Twenty eight categories were as follows, "want to hide", "bewildered", "sense of burden", "sense of heterogeneity", "gladness", "sense of superiority", "negative empathy", "positive empathy", "limited hygenic control", "sense of timing", "lack of knowledge", "lack of support", "advance knowledge", "informational support", "emotional support", "edurance", "prayer", "disclosing", "avoidance", "diversion", "sense of powerlessness", "discovery of sex identity", "sense of maturation", "sense of stability", "acceptance of menstruation". Fourteen higher categories were as follows, "negative feeling", "posive feeling", "exchange of feeling", "limited hygenic control", "sense of timing", "accumulated experience", "dysmen-orrhea", "level of knowledge", "need for support", "perceived support", "sharing of feeling", "self-control", "passive acceptance", "active acceptance". The core category was "emotional shaking", which consisted of "positive feeling" and "negative feeling". "Emotional shaking" comes up to every adolescent girls experiencing menarche, independently of any contextual conditions, and its demension has two directions: positive one and negative one. Its influencing factors were time of menarche, advance knowledge, support from the significant persons, expression and self?regulation. Even if they showed different process of adaptation to menstruation, general process of adaptation were as follows: 1. stage of emotional shaking 2. stage of acceptance 3. stage of internalization of the menstrual experience. Seven patterns existed on the process of adaptation to menstruation after menarche. Those are as follows. 1. If girls thought their menarche came too early and they had not much knowledge on menstruation, they had a kind of negative feeling. If they did not get enough support and dysmenorrhea superimposed, they came to accept menstruation passively. 2. If girls had menarche too early, they had negative feeling, even though they had enough advance knowledge. But support helped them accept menstruation easily. 3. If girls had menarche too early, they had negative feeling, even though they had enough advance knowledge on menstruation. But by experiencing subsequent menstruations and disclosing feeling, they began to accept menstruation. 4. If girls had menarche too lately and they had enough advance knowledge on menstruation, they had positive feeling. If dysmenorrhea superimposed later, their feeling turned in to negative one. But they came to accept menstruation positively by disclosing feeling and getting support. 5. If girls had menarche too early, they had negative feeling, even though they had enough advance knowledge on menstruation. In addition to this, if dysmenorrhes superimposed while they did not get enough support, they felt powerless and came to accept menstruation passively. 6. If girls had menarche too early and did not get enough advance knowledge, they had negative feeling. But disclosing feeling and support made them get sense of homogeneity and began to accept menstruation. 7. If girls had handicap, they had negative feeling, even though they had enough advance knowledge and menarche was late. But Menarche made them get feel sexual identity. Their limited hygenic control and negative empathy from their mothers made them accept menstruation passively. To let adolescent girls take their menstrual experience as a part of their lives forming a positive sense of feminine identity, it needs qualified teaching and, support and deep concern of the significant others. Nurses including school nurses should try to develop an educational program, which include menstrual physiology, hygiene during menstrual period, meaning of menstruation and impact of menstruation on the development of female sexual identity.

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Gender Difference in Delinquent Behavior among Korean Adolescents
Hyun Sil Kim
Journal of Korean Academy of Nursing 2002;32(4):492-505.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.4.492
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PURPOSE: This paper examined gender differences in a rate, type, relevant variables of delinquent behavior, and a gender differences regarding the relative influence of family,personality, academic achievement, sexual abuse and alcohol drug abuse on delinquent behavior among Korean adolescents. METHOD: Data were collected by self-report questionnaires. Subjects consisted of 2,100 adolescents (male 1,396, female 704) in Korea, using proportional stratified random sampling method. Statistical methods were Chi-square, t-test and path analysis. RESULT: Male adolescents had higher rate of delinquent behavior, and more all types of delinquent behavior (antisocial, aggressive, and psychopathic) than female. Male adolescents showed more dysfunctional family dynamic environments, higher antisocial personality and sociability than female adolescents. Female adolescents had higher depressive tendencies than male. The most powerful contributing variables on male delinquent behavior were age, antisocial personality, parent-child relationship, isolation feelings, and sexual abuse in this order named. Drug abuse, isolation feelings, antisocial personality and parent-child relationship tended to be contributing variables for female delinquent behaviors in this order named. CONCLUSION: This investigation will provides a foundation for theory that addresses the complexities of both gender-specific and gender influences on delinquent behavior and development of preventive strategies for female delinquency.

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Development and the Effect of Adolescent Smoking Prevention Video
Sung Rae Shin, Na Sun Ha
Journal of Korean Academy of Nursing 2002;32(3):336-343.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.3.336
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Recently the rate of adolescent smoking in Korea has increased rapidly, and various health problems related to smoking can be expected to increase in the future. Studies on smoking behavior report that assertiveness is important factor influencing on the adolescent smoking. PURPOSE: This study was conducted to develope a educational video for the purpose of adolescent's smoking prevention. METHOD: The 533 participating subjects, 269 in experimental group and 264 control group, in the study were 7th grade students. The content of video introduces three smoke tempting situations. The experimental group received 17 minute video education, and the control group did not receive any treatments. RESULT: The results show that the student's assertiveness was increased significantly in the experimental group after the video education. Student's attitude on smoking became more negative in the experimental group. However, in the control group, the intention, assertiveness, attitude was not changed. CONCLUSION: This assertiveness video can be useful educational resource for the smoking prevention program for adolescents. Also further study on longitudinal effect and application on drinking, drug abuse are needed.

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A Comparison of Stressors and Coping Behaviors of the High School Students who have Suicidal Ideation vs those who do not
Sook Bin Im, Chul Soon Jung
Journal of Korean Academy of Nursing 2002;32(2):254-264.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.2.254
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PURPOSE: This study was conducted to identify and compare the stressors and coping behaviors of high school students who experienced suicidal ideation vs those who do not. METHOD: The data were collected from 1,441 high school students living in the middle region of Korea. Researchers collected the data using Adolescent Stress Inventory and Adolescent Coping questionnare from February to May of 1999. Data were analyzed using X2, T-test. RESULT: A significant proportion (31.9%) of subjects had thought about suicide during the past 6 months, 297 girls (35.3%) and 163 boys (27.2%). Major stressors of subjects who experienced suicidal ideation were academic problems, conflicts between family members, and changes in sleeping or eating patterns. Conflicts with family members contributed to have suicidal ideation. There was no significant difference in helpful coping behaviors between the two groups. The group who experienced suicidal ideation had lower scores and fewer coping behaviors. Boys perceived more stressors and had fewer helpful coping behaviors than girls. CONCLUSION: It is necessary to develope school-based suicide prevention programs. Our findings suggest that the program should focus on problems related to studying and conflicts within the family.

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Correlation between Personality, Family Dynamic Environment and Suicidal attempt among Korean Adolescents Population
Hyun Sil Kim
Journal of Korean Academy of Nursing 2002;32(2):231-242.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.2.231
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PURPOSE: The purpose of this study was to identify the rate of suicidal attempts, investigate difference of rate of suicidal attempts between students and delinquents, and examine correlation between personality, family dynamics, environment, and suicidal attempts among Korean adolescents. METHOD: Data were collected through questionnaire surveys. Internal consistencies for this questionnaire ranged from 0.63 to 0.88. The subject used in this study consisted of 922(delinquent : 367, student : 555), using the proportional stratified random sampling method. Statistical methods employed were Chi-square and t-test. RESULTS: 1) The rate of suicidal attempts were 10.8%, and the highest peak age of suicidal attempt was 17-18 year old (16.9%).2) Delinquents(19.6%) showed a higher rate of suicidal attempts than students (5.1%). Among the students, girls (43.3%) showed a higher rate of suicidal attempt than boys (19.1%). Whereas, boys (80.9%) showed a higher rate of suicidal attempt than girls (56.7%) among delinquents.3) Those who attempt suicide have more familial problem such as incest, psychosis, depression, attempted suicide, committed suicide, and alcoholism in their family. They also have more dysfunctional family dynamics, environment, and maladaptive personalities than non-attempters. CONCLUSIONS: Suicide and suicidal behaviors are multifaceted events. For suicide prevention, independent assessments of variables such as familial problems, personality, family dynamics, and environment must be considered.

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The Correlational Analysis between Perceived Heath Status, Self-Esteem, and Self-Care Agencies among Adolescents
Hee Jung Jang, Yun Hee Shin
Journal of Korean Academy of Nursing 2002;32(2):186-195.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.2.186
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PURPOSE: This study was to identify and clarify the relationship between perceived health, self-esteem, and self-care agencies for promoting self care among Korean adolescents. METHOD: Data were collected from 817 adolescents in schools located in Seoul, Kyungki-do, and Chuncheon from Sept, 16th to Sept, 28th, 1999, and from Mar 10th to Mar 25th, 2000. The instruments used for this study were the Health Self-Rating Scale, Self-Care Agency Assessment Questionnaire (Denyes, 1981), the Self-Esteem Questionnaire (Rosenberg, 1971). RESULT: 1) The mean perceived health status among Korean adolescents was 8.75 (SD=1.72) 2) The mean self-esteem was 27.27 (SD=4.64). 3) The mean self-care agency was 99.64 (SD=21.02) and the average self-care agency score was 3.99 (SD=0.84). In the subcategories, the highest degree was feelings towards health (4.15), followed by ego strength (4.06), attending to health (3.87), general health knowledge (3.56), and the lowest degree was specific health knowledge (3.20) 4) There was statistical significant differences between demographic factors and self-care agencies, expecially, gender (t=28.65), grade (F=3.79), pocket money (t=5.72), and height (F=9.82) 5) The statistical relationship between perceived health status, self-esteem, and self-care agencies were found to have a positive correlation. 6) Self-care agencies among adolescents was the highest factor predicting self-esteem (15%). CONCLUSION: The relationship between perceived health status, self-esteem, and self-care agencies revealed a significant positive correlation among adolescents. Therefore, nursing intervention for adolescents needs to develop self-esteem programs to increase self-care agencies.

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The Influence of a Family Dynamic Environment, Personality, and Smoking on Delinquent Behavior Among Korean Adolescents
Hyun Sil Kim
Journal of Korean Academy of Nursing 2001;31(4):641-655.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2001.31.4.641
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PURPOSE: The purpose of this study was to determine the important factors on juvenile delinquency and to examine relationships between sex, age, the family environment, the personality of adolescents, smoking, and juvenile delinquency.
Methods
Data collection was done through questionnaire surveys. The subjects for this study consisted of 1,948 adolescents delinquents : 784, students : 1,164 in Korea, using proportional stratified random sampling method. Statistical methods employed were chi-square, t-test and path analysis. Results: The results of this study were as follows : 1. The delinquent adolescents were reared in a more dysfunctional family environment, and had a higher maladaptive personality than the other student adolescents. 2. The delinquent adolescents showed the larger amount of smoking than the student adolescents. The cause of increased smoking tendency among delinquents simply were 'for social relation', 'for diversion', 'for nicotine addiction', whereas 'for tension relieving' among non-delinquent adolescents. 3. The most powerful contributors on delinquent behavior were antisocial personality tendencies, smoking, sex, strength of parent- child relationships, and the age of the adolescents in this order.
Conclusions
Our cross-sectional findings indicate that smoking was one of the most powerful contributing variables to delinquent behavior, but family environment, personality, sex and age of adolescents were also proved to be strong exogenous variables to smoking in adolescents.

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A Phenomenological Approach to High School Student's Smoking Experiencing
Hae Kyung Chung
Journal of Korean Academy of Nursing 2001;31(4):610-618.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2001.31.4.610
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PURPOSE: This study attempted to grasp the significance of high school boys smoking experiences, and to define its structure, then utilizing the results to create effective nursing intervention in order to protect students from smoking habit. METHOD: This study is based on a phenomenological approach. A group of eight male high school students who had experience in smoking were selected as the subject of this study. Intimate interview with participatory observation were carried out from them and the
result
ed data were analyzed by Giorgi's method as below. Result: The male high school students' smoking experiences were found to be a direct result from the environments around them and misty curiosity, masculinity, maintenance of close relations with peers, habitualness, stress relief, and concealment from the family. CONCLUSION: The result indicates that the male high school students' smoking, especially in an aspect from its starting point, motivational perspective, attitudes, and recent increasing rate of the juvenile smoking should be recognized as one of the problems that should be resolved. Concurrently, programs for preventing and quitting smoking should be started from the early stage of childhood as possible.

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