Earticle

Purpose: This study examined the parallel multiple mediating effects of anxiety, loneliness, and depression on the relationship between violence victimization experiences and suicidal behavior among Korean middle & high school students. Methods: Secondary analysis of the raw data from the 20th (2024) Korea Youth Risk Behavior Survey employed a predictive correlational design. The sample comprised 54,653 students from 799 schools (399 middle, 400 high), representing 2,612,077 adolescents. Complex sample Rao-Scott chi-square, Complex sample logistic regression, and Complex sample general linear models were conducted using SPSS 29.0. Results: Violence victimization experiences significantly predicted anxiety (B=2.67), loneliness (B=0.37), depression (B=1.07), suicidal ideation (B=1.47), such planning (B=1.90), and actual attempts (B=2.26). Parallel multiple partial mediation was evident, with direct effects on suicidal ideation (B=1.03), such planning (B=1.42), and actual attempts (B=1.78), plus indirect effects via anxiety, loneliness, and depression. Conclusion: Experiences of violence victimization elevate adolescent suicidality through emotional distress, emphasizing the necessity to identify distressed adolescents as a high-risk group and enhance suicide risk prediction using validated mediating variable assessments.

Purpose: This study aimed to develop a Zero Waste Practice Scale tailored to college students by integrating theoretical evidence, actual experiences, & expert validation, and to identify its preliminary factor structure. Methods: A multi-source qualitative design was employed. First, a systematic literature review (2010~2023) was conducted to identify key domains of zero waste and waste reduction behaviors. Second, qualitative content analysis was applied to 141 college students’ zero waste practice reports to obtain context-specific behaviors reflecting university life. Third, written consultations with four environmental experts and expert consultations with two experts were conducted to review and refine the initial items. Findings from the three data sources were integrated using triangulation to construct the final measurement framework. Results: The integration process resulted in a 31-item scale comprising five factors: (1) Waste Management and Recycling Behaviors, (2) Disposable Reduction and Eco-friendly Alternatives, (3) Environmental Impact and Waste Reduction Behaviors, (4) Microplastics and Health-related Behaviors, and (5) Environmental Engagement and Campaign Participation. Notably, the “Microplastics and Health-related Behaviors” factor was newly introduced based on expert recommendations, extending zero waste practice beyond environmental concern to include preventive health-oriented behaviors. The final scale reflects both theoretical foundations and the present realities of college students, including independent living, online shopping, digital engagement, and civic participation.Conclusion: This study provides a context-sensitive and health-integrated framework for measuring zero waste practices among college students. The developed scale offers a multidimensional tool for assessing behavioral competence and may serve as a foundation for future psychometric validation and intervention research.

Purpose: This study aimed to identify factors associated with habitual substance use among adolescents and to evaluate the predictive performance of a risk prediction model. Methods: This secondary analysis used the data from the 2022~2024 Korea Youth Risk Behavior Web-based Survey of middle and high school students. Complex sample analyses that account for stratification, clustering, and weight scaling were conducted. Differences depending on substance use experience were examined using the Rao-Scott x2 test, and associated factors were identified using complex-sample logistic regression. The dataset was randomly divided into a development sample (70.0%) and a validation sample (30.0%). Model performance was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Results: Habitual substance use was significantly associated with sociodemographic characteristics, mental and emotional factors, and health risk behaviors. Significant factors included females, average academic achievement, average economic status, not living with family, poorer perceived health, insufficient sleep for fatigue recovery, sadness or hopelessness, suicidal attempts, generalized anxiety, violence-related medical treatment, alcohol use, smoking, exposure to secondhand smoke, sexual experience, skipping breakfast, and frequent consumption of sugary beverages. The predictive model showed good discrimination, with an AUC of 0.831 in the development sample and 0.839 in the validation sample. Using the optimal cutoff value (0.010), sensitivity was 0.802 and specificity was 0.689 in the development sample, and sensitivity was 0.827 and specificity was 0.686 in the validation sample. Conclusion: The proposed model may help identify adolescents at high risk for habitual substance use and support the development of school- and community-based prevention programs.

Purpose: The purpose of this study was to analyze the correlation between objective obesity levels and obesity stress & eating behaviors in middle and high school students, and to provide the basic data for the development of an adolescent obesity prevention program. Methods: Three middle and high schools were selected using a convenience sampling method, and the data were collected by distributing self-report questionnaires to the study subjects and analyzed using the SPSS 25.0 program. Results: There was a difference between the objective obesity level and the subjective body shape perception of adolescents. Additionally, overweight or obese adolescents were found to have higher stress levels and higher negative and positive eating habits compared to adolescents with normal or lower weight. Conclusion: Adolescent obesity is a phenomenon resulting from the complex interplay of cognitive factors (body shape perception), psychological factors (stress), and behavioral factors (eating habits). Therefore, schools should actively introduce programs that integrate psychological stress relief and eating habit correction, based on the accurate recognition of objective obesity levels.

Purpose: This study aims to compare the prevalence of nutritional deficiency between adolescents from immigrant backgrounds and those from native Korean families. To achieve this, the study utilizes data from the Multicultural Adolescents Panel Study (MAPS), which tracks the growth and development of multicultural youth in South Korea, alongside the Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative dataset for the health status of the Korean population. Methods: A total of 3,420 adolescents were analyzed, consisting of 2,269 from immigrant backgrounds and 1,151 from native Korean families. Chronic malnutrition (stunting) was defined as a height-for-age Z-score (HAZ) lower than -2.0, and underweight was defined as a weight-for-age Z-score (WAZ) lower than -2.0. Acute malnutrition (wasting) was identified when the weight-for-height Z-score (WHZ) was below -2.0, while obesity was defined as a BMI-for-age Z-score of 2.0 or higher. Results: The overall prevalence of stunting, underweight, wasting, and obesity was 4.0%, 2.7%, 2.6%, and 9.1%, respectively. Adolescents from immigrant backgrounds showed significantly higher rates of stunting (5.6% vs. 0.9%) and underweight (3.3% vs. 1.5%) compared to their native Korean counterparts. No significant difference was observed in the prevalence of wasting between the two groups (2.7% vs. 2.5%). Conclusion: The implementation of systematic counseling programs tailored for adolescents from immigrant families is expected to yield significant health benefits, including the establishment of healthy dietary habits, the maintenance of optimal body weight, and the overall enhancement of their health status.

Purpose: This study aimed to identify factors associated with suicidal ideation and to explore risk pathways among adolescents from multicultural families. Methods: The study used the data from the 18th to 20th Korea Youth Risk Behavior Web-based Survey. A total of 5,140 multicultural adolescents were included. Complex sample logistic regression analysis and decision tree analysis (classification and regression tree) were conducted to identify significant predictors and risk pathways of suicidal ideation. Results: The prevalence of suicidal ideation was 14.8%. Logistic regression analysis revealed that school level, economic status, father’s foreign nationality, smartphone usage time, alcohol experience, experience of hospital treatment due to violence, perceived health status, stress, sleep recovery, sadness and despair, and loneliness were significantly associated with suicidal ideation. In particular, sadness and despair showed the closest association (OR=5.86, 95% CI=4.72~7.29). Decision tree analysis identified sadness and despair as the most influential predictor, with markedly increasing suicidal ideation when combined with poorly perceived health status, loneliness, and insufficient sleep. Adolescents who experienced sadness and despair and perceived their health as poor showed the highest risk. Conclusion: Suicidal ideation among adolescents from multicultural families is influenced by multiple interacting factors rather than a single determinant. Emotional factors such as sadness, loneliness, and sleep problems play a central role in forming high-risk groups. These findings highlight the importance of early identification and tailored interventions targeting emotional vulnerability to prevent suicidal behaviors in this population.

Purpose: This study aimed to examine the effects of ethical sensitivity, confidence of ethical decision-making, and knowledge about advance directives on attitudes toward advance directives among nursing students. Methods: A descriptive cross-sectional survey was conducted with 119 nursing students enrolled at a university in Gyeonggi Province, South Korea. The data were collected using structured questionnaires and analyzed with t-test, ANOVA, Pearson’s correlation coefficients, and multiple linear regression. Results: Attitudes toward advance directives showed significant positive correlations with confidence in ethical decision-making (r=.29, p<.001) and knowledge of advance directives (r=.41, p<.001). Knowledge of advance directives was also positively correlated with confidence in ethical decision-making (r=.32, p<.001), and confidence in ethical decision-making was positively correlated with ethical sensitivity (r=.46, p<.001). In the multiple regression analysis, confidence in ethical decision-making (β=.20, p=.043) and knowledge of advance directives (β=.34, p=.001) were identified as significant predictors of attitudes toward advance directives. The explanatory influence of the model was 22.4%. Conclusion: Positive attitudes toward advance directives among nursing students were significantly influenced by confidence in ethical decision-making and knowledge of advance directives. These findings suggest that nursing education should include systematic and practice-oriented ethics education programs that strengthen both ethical decision-making confidence and knowledge of legal and institutional aspects of advance directives. Such efforts may help prepare nursing students to support patient autonomy and effectively participate in end-of-life decision-making in clinical practice.