School-Based Intervention of Smoking Media Literacy Among South Korean Adolescents: A Cluster Randomized Trial Sunhee Park, Haein Lee Asian Nursing Research, 2026 PURPOSE: Western literature has well established that (a) exposure to pro-smoking media messages is positively associated with adolescent smoking, and (b) an increase in smoking media literacy (SML) can mitigate the harmful effects of pro-smoking advertisements on adolescent smoking behavior. However, little is currently known about this phenomenon in South Korea. Thus, we aimed to investigate the effects of a SML intervention on SML, smoking attitudes, and smoking norms among Korean adolescents. METHODS: Based on the media literacy framework, we developed a five-lesson SML education program. We conducted a cluster randomized trial in one male high school to investigate the effects of the intervention. We randomly allocated ten classes in a one-to-one ratio to either the intervention or control group (N = 250, 10th graders). The intervention group participated in the SML program; the control group participated in a traditional anti-smoking program. We assessed the three outcomes (i.e., SML, smoking attitudes, and norms) at 1-week and 3-month follow-ups. We analyzed data obtained from 249 students after excluding one participant who did not complete the baseline test. Specifically, we conducted a mixed-model regression analysis three times after accounting for intraclass correlations. RESULTS: SML, smoking attitudes, and norms assessed in a pre-test before the intervention did not significantly differ between the intervention and control groups. After the intervention, we found a significant increase in SML at both 1-week (coefficient = .91) and 3-month follow-ups (coefficient = .73), although we did not find important intervention effects on smoking attitudes and norms at both follow-ups. CONCLUSIONS: We found a strong effect of the SML education on an increase in SML, which could mitigate the negative effects of pro-smoking advertisements. Thus, health professionals need to actively incorporate strategies that enhance SML, developed based on the multidimensional core concepts of media literacy, into traditional anti-smoking programs. TRIAL REGISTRATION: Clinical Research Information Service, KCT0009514.
Factors Associated with Former and Current E-Cigarette Use Among Lifetime Cigarette-Smoking College Students Ahnna Lee, Sunhee Park, Junghee Kim International Journal of Mental Health and Addiction, 2023 Concurrent electronic cigarette (e-cigarette) and cigarette use has been rising among college students. Thus, we investigated the following aims in a sample of 533 Korean college students: (a) characteristics of cigarette consumption in three e-cigarette use groups, (b) perceived relative harm of e-cigarettes and the greatest reason for e-cigarette use (EU), and (c) factors associated with EU among lifetime cigarette smokers. We conducted descriptive statistics, analysis of variance, Fisher’s exact test, and multinomial logistic regression. EU was significantly associated with lifetime and past 30-day cigarette smoking and the number of cigarette-smoking days and cigarettes smoked. Most e-cigarette users considered e-cigarettes as less harmful. Main reasons for EU were no smell, lower harm, and feasibility to use in non-smoking areas. Finally, EU among lifetime cigarette smokers was strongly associated with male sex, younger age, and greater numbers of cigarette-smoking days. Anti-smoking education and anti-smoking regulations should be systematically implemented on campus.
Role of alcohol media literacy in alcohol use among children and adolescents: a systematic review Sunhee Park, Haein Lee, Junghee Kim Health Promotion International, 2022 Summary Enhancing alcohol media literacy (AML) is a critical strategy to attenuate negative effects of alcohol-related media messages. We aimed to systematically review previous studies on AML in children and adolescents. Through database and hand searches, we identified four non-experimental and 13 experimental studies. From the 17 studies, we extracted data on theoretical framework, AML measures, intervention contents and main findings. Our review revealed the following. First, nine and four studies used a single theory and at least two theories, respectively. The most frequently used theory was the Message Interpretation Process model. Second, 13 studies assessed AML using participant self-reporting or evaluators’ ratings of participant performance, but no study reported validities of AML measures. Eight studies assessed tobacco or general media literacy as well as AML. Third, all experimental studies used three to five media literacy core concepts proposed by the Center for Media Literacy in AML interventions. Finally, all non-experimental studies found strong cross-sectional associations between higher AML and improved drinking outcomes; all experimental studies found strong intervention effects, such as an increase in AML or improvement in drinking outcomes. In addition, intervention effects differed across participants’ gender and drinking experiences. Given our review, health professionals should implement strategies to enhance children and adolescents’ AML. Future research should investigate (i) causal inferences in non-experimental studies, (ii) long-term intervention effects in experimental studies and (iii) differences in intervention effects across participants’ characteristics, while using solid theoretical frameworks and multidimensional AML concepts.
Association Between Age at Smoking Onset and Binge Drinking Among Adults in the Republic of Korea Sunhee Park, Haein Lee, Junghee Kim, Soyoon Min, Saekyae Shin International Journal of Mental Health and Addiction, 2022 We aimed at investigating the association between age at smoking onset and adult binge drinking among Korean adults. We cross-sectionally analyzed nationally representative secondary data obtained from 11,296 adults in 2013. We conducted survey data analyses to incorporate a complex sampling design in our analyses. Specifically, we conducted a multivariate logistic regression analysis to investigate the relationship of age at smoking onset with binge drinking. In our study, about 28% of adults were past 30-day binge drinkers. We found the greatest risks of past 30-day binge drinking among those who started smoking at 14 years or younger. Additionally, greater risk of adult binge drinking was significantly associated with the male sex, younger age, higher income, employed status, past 30-day smoking, exercise, higher anxiety, and depressive feelings. Smoking prevention strategies should be implemented in earlier adolescence because they may play pivotal roles in reducing both alcohol- and cigarette-related problems in adulthood.
Relationships of Smoking Media Literacy with Smoking Behavior, Attitudes, and Susceptibility among Adolescents in the Republic of Korea Sunhee Park, Junghee Kim Journal of Health Communication, 2021 The literature has indicated that higher smoking media literacy (i.e., SML) can buffer adverse effects of exposure to pro-smoking media content (i.e., PMC) on smoking-related outcomes in adolescence. Thus, we aimed to investigate (a) SML levels among Korean adolescents and (b) relationships of SML with smoking behavior, attitudes, and susceptibility. In 2017, we collected cross-sectional data from nine middle or high schools in Korea, using a convenience sampling method (N = 476). For the first aim, we calculated the average score of SML. For the second aim, we conducted multinomial logistic regression (MLR), multiple linear regression, and binary multiple logistic regression. Additionally, we conducted Firth logistic regression and confirmed the robustness of our findings obtained from the MLR. The average SML score was 6.48 out of 10 points, indicating that our respondents' average SML was slightly above the middle level. In addition, after adjusting for factors potentially affecting associations between SML and the three smoking-related outcomes, we found significant protective relationships of SML with all smoking-related outcomes: smoking behavior, attitudes, and susceptibility. Given our findings, the enhancement of SML through education should be considered an important strategy to weaken the link between exposure to PMC and smoking-related outcomes.
Latent class analysis of drinking behaviors and predictors of latent class membership among college students in the Republic of Korea Haein Lee, Sunhee Park Journal of Substance Use, 2020 Objectives: We aimed to investigate the drinking patterns of college students and successful predictors of latent class membership (LCM). Methods: We analyzed cross-sectional data obtained from 1,338 Korean college students who had consumed at least one standard drink in their lifetime. Primary data were collected during December 2016. We conducted latent class analysis to investigate drinking patterns and successful predictors of latent class membership. Results: A three-latent class model best fit our data: low-risk drinking (34%), intermittent binge drinking (37%), and habitual binge drinking with negative experiences (29%) classes. In addition, successful predictors of LCM were gender, college year, monthly allowance, sensation seeking, age of drinking onset, current smoking, peer pressure, and friends’ drinking/smoking. Conclusions: Given that heavy drinkers were at greater risk of experiencing negative drinking consequences, health professionals should provide heavy-drinking college students with interventions that aim to equip students with protective behavioral strategies when drinking. In addition, in developing and providing interventions aiming to reduce at-risk drinking, health professionals should take into account the successful predictors of LCM.
Patterns of Problem Behaviors and Predictors of Class Membership among Adolescents in the Republic of Korea: A Latent Class Analysis Sunhee Park, Junghee Kim Journal of Child and Family Studies, 2020 Objectives Although subgroups of adolescent problem behaviors (PBs) may exist and have different characteristics, most available studies have focused on exploring a single PB. Thus, we aimed to investigate latent classes of adolescent PBs and to identify important predictors of latent class membership. Methods We analyzed nationally representative secondary data—Waves 4 and 5 of the Korean Children & Youth Panel Survey—obtained from the 2010 cohort of seventh graders and their parents. Specifically, using seven PBs (e.g., daily smoking, monthly drinking, and sexual intercourse) measured in Wave 5, we conducted a latent class analysis (LCA) to identify the model that best fit the data. In the next step, we conducted an LCA with covariates to investigate Wave-4 predictors of latent class membership. Results In our study, a three-latent-class model best fit the data: the Low Risk class (78%) characterized by low probabilities of engagement in all PBs, Non-Habitual Alcohol Use class (14%), and Habitual Cigarette and Alcohol Use class (7%). In addition, successful predictors of latent class membership included gender, parental education, friendships, relationships with teachers, parental affection, abuse inflicted by parents, and aggression. Conclusions Health professionals should develop interventions tailored to each homogeneous subgroups of PBs in order to obtain more effective outcomes. Additionally, when developing these interventions, they should consider multilevel characteristics (e.g., individual, peer, and parental factors) that differentiate these subgroups.
Patterns of drinking behaviors and predictors of class membership among adolescents in the Republic of Korea: A latent class analysis Haein Lee, Sunhee Park Journal of Korean Academy of Nursing, 2019 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.
Patterns of Online Activities and Related Psychosocial Factors in Adolescence: a Latent Class Analysis Sunhee Park, Haein Lee International Journal of Mental Health and Addiction, 2019 Special attention should be paid to the types of online activities in which adolescents engage, along with frequencies of the activities. Thus, we aimed to identify homogeneous subgroups of adolescents using five online activities and to examine differences in 12 characteristics across the subgroups we identified. We cross-sectionally analyzed nationally representative secondary data collected in Korea (N = 1827 adolescents who used a computer at the time of the survey). We performed latent class analysis, which is a person-centered approach, to understand the patterns of online activities in adolescence. A three-latent-class model best fit the data: frequent use for academics (FUA), non-frequent use for all activities (NFUAA), and frequent use for multiple activities (FUMA). In general, the FUA class differed from the other two classes. Specifically, the FUA class spent less time online and had better psychosocial conditions. Given these findings, health professionals should implement strategies aimed at assisting (a) adolescents to be aware that some types of online activities can potentially pose a risk to their psychosocial conditions and (b) parents to actively participate in guiding children’s Internet use.
