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The detrimental effect of secondhand smoke (SHS) on health is well known; due to various factors, efforts to prevent SHS cannot completely eliminate the effect of smoking substances, and SHS has not been sufficiently investigated among children. This study aimed to assess children’s smoke exposure with respect to parents smoking patterns using biomarkers. This study used data from the 2016/2017 Korea National Health and Nutrition Examination Survey. Data pertaining to 486 subjects was extracted. Exposure to smoking among non-smoking children was assessed based on urine levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). The urine NNAL concentration was highest among children with smoking parents and SHS exposure at home (3.829 pg/mg, 95% confidence interval [CI: 1.499–8.330), followed by children with smoking parents and no SHS exposure at home (1.297, 95% CI: 1.080–1.536), and children with nonsmoking parents and no SHS exposure at home (0.996 pg/mg, 95% CI: 1.026–1.427). Living with a smoking parent was associated with exposure to carcinogens, and a critical predictor of tobacco-specific nitrosamine. Prohibition of smoking at home is effective at preventing SHS in children. However, it cannot completely prevent passive smoking, which might be attributable to thirdhand smoking and undetected secondhand smoke.

There are substantial differences in long term health outcomes across countries, particularly in terms of both life expectancy at birth (LEAB) and healthy life expectancy (HALE). Socio-economic status, disease prevention approaches, life style and health financing systems all influence long-term health goals such as life expectancy. Within this context, universal health coverage (UHC) is expected to influence life expectancy as a comprehensive health policy. The aim of the study is to investigate this relationship between Universal Health Coverage (UHC) and life expectancy. A multi-country cross-sectional study was performed drawing on different sources of data (World Health Organization, UNDP-Education and World Bank) from 193 UN member countries, applying administrative record linkage theory. Descriptive statistics, -tests, Pearson correlations, hierarchical linear regressions were utilized as appropriate. Global average healthy life years was shown to be 61.34 ± 8.40 and life expectancy at birth was 70.00 ± 9.3. Standardized coefficients from regression analysis found UHC (0.34), child vaccination (Diphtheria Pertussis Tetanus-3: 0.17) and sanitation coverage (0.31) were associated with significantly increased life expectancy at birth. In contrast, population growth was associated with a decrease (0.29). Likewise, unit increases in child vaccination (DPT 3), sanitation and UHC would increase healthy life expectancy considerably (0.18, 0.31, and 0.40 respectively), whereas the same for population growth reduces healthy life expectancy by 0.28. Universal Health Coverage (UHC) is a comprehensive health system approach that facilitates a wide range of health services and significantly improves the life expectancy at birth and healthy life expectancy. This study suggests that specific programs to achieve UHC should be considered for countries that have not seen sufficient gains in life expectancy as part of the wider push to achieve the Sustainable Development Goal (SDG).

Children may be exposed to tobacco products in multiple ways if their parents smoke. The risks of exposure to secondhand smoke (SHS) are well known. This study aimed to investigate the association between parental smoking and the children's cotinine level in relation to restricting home smoking, in Korea. Using the Korea National Health and Nutrition Health Examination Survey data from 2014 to 2017, we analyzed urine cotinine data of parents and their non-smoking children (n = 1,403), in whose homes parents prohibited smoking. We performed linear regression analysis by adjusting age, sex, house type, and household income to determine if parent smoking was related to the urine cotinine concentration of their children. In addition, analysis of covariance and Tukey's post-hoc tests were performed according to parent smoking pattern. Children's urine cotinine concentrations were positively associated with those of their parents. Children of smoking parents had a significantly higher urine cotinine concentration than that in the group where both parents are non-smokers (diff = 0.933, P < .0001); mothers-only smoker group (diff = 0.511, P = 0.042); and fathers-only smoker group (diff = 0.712, P < .0001). In the fathers-only smoker group, the urine cotinine concentration was significantly higher than that in the group where both parents were non-smoker (diff = 0.221, P < .0001), but not significantly different compared to the mothers-only smoker group (diff = - -0.201, P = 0.388). Children living in apartments were more likely to be exposed to smoking substances. This study showed a correlation between parents' and children's urine cotinine concentrations, supporting the occurrence of home smoking exposure due to the parents' smoking habit in Korea. Although avoiding indoor home smoking can decrease the children's exposure to tobacco, there is a need to identify other ways of smoking exposure and ensure appropriate monitoring and enforcement of banning smoking in the home.

This study aimed to estimate the secondhand smoke (SHS) exposure using urinary cotinine (UCo) to prove that the SHS exposure could not be properly assessed by self-reporting (SR). In total, 28,574 nonsmokers aged >19 years were selected from the Korean National Health and Nutrition Examination Survey data (2009–2018). First, changes in the annual concentration of UCo were analyzed, and the annual SHS exposure rates were measured based on SR and UCo from 2009 to 2018. Then, the average UCo concentration and UCo-measured SHS exposure rate were confirmed according to the subjects’ characteristics. Finally, factors associated with the UCo-measured SHS exposure rate were identified based on multiple regression analysis. The findings showed that the annual UCo concentrations and self-reported SHS exposure rates dropped significantly over the past decade. In contrast, the UCo-measured SHS exposure rate indicated that >80% of nonsmokers are still exposed to SHS. Moreover, we found vulnerable groups using UCo-measured SHS exposure rate. In particular, the self-reported SHS exposure at home and in workplaces and house type was highly associated with SHS exposure. Thus, these findings indicate that the actual SHS exposure could not be properly assessed by SR and should be verified using a biomarker, such as UCo. Considering that even a short-term exposure can be harmful to health, the goal of the policy should be to keep cotinine concentration as low as possible.

[This corrects the article DOI: 10.1371/journal.pone.0248013.].[This corrects the article DOI: 10.1371/journal.pone.0248013.].

Background The coronavirus disease 2019 (COVID-19) pandemic has transitioned to a third phase and many variants have been originated. There has been millions of lives loss as well as billions in economic loss. The morbidity and mortality for COVID-19 varies by country. There were different preventive approaches and public restrictions policies have been applied to control the COVID-19 impacts and usually measured by Stringency Index. This study aimed to explore the COVID-19 trend, public restriction policies and vaccination status with economic ranking of countries. Methods We received open access data from Our World in Data. Data from 210 countries were available. Countries ( n  = 110) data related to testing, which is a key variable in the present study, were included for the analysis and remaining 100 countries were excluded due to incomplete data. The analysis period was set between January 22, 2020 (when COVID-19 was first officially reported) and December 28, 2021. All analyses were stratified by year and the World Bank income group. To analyze the associations among the major variables, we used a longitudinal fixed-effects model. Results Out of the 110 countries included in our analysis, there were 9 (8.18%), 25 (22.72%), 31 (28.18%), and 45 (40.90%) countries from low income countries (LIC), low and middle income countries (LMIC), upper middle income countries (UMIC) and high income countries (HIC) respectively. New case per million was similar in LMIC, UMIC and HIC but lower in LIC. The number of new COVID-19 test were reduced in HIC and LMIC but similar in UMIC and LIC. Stringency Index was negligible in LIC and similar in LMIC, UMIC and HIC. New positivity rate increased in LMIC and UMIC. The daily incidence rate was positively correlated with the daily mortality rate in both 2020 and 2021. In 2020, Stringency Index was positive in LIC and HIC but a negative association in LMIC and in 2021 there was a positive association between UMIC and HIC. Vaccination coverage did not appear to change with mortality in 2021. Conclusion New COVID-19 cases, tests, vaccinations, positivity rates, and Stringency indices were low in LIC and highest in UMIC. Our findings suggest that the available resources of COVID-19 pandemic would be allocated by need of countries; LIC and UMIC.

Background: In general, early intervention in disease based on early diagnosis is considered to be very important for improving health outcomes. However, there is still insufficient evidence regarding how medical care that is based on the early diagnosis of confirmed cases can affect the outcome of COVID-19 treatment. Objective: We aimed to investigate the effect of the duration from the onset of clinical symptoms to confirmation of COVID-19 on the duration from the onset of symptoms to the resolution of COVID-19 (release from quarantine). Methods: For preliminary data collection, we performed data crawling to extract data from social networks, blogs, and official websites operated by local governments. We collected data from the 4002 confirmed cases in 33 cities reported up to May 31, 2020, for whom sex and age information could be verified. Subsequently, 2494 patients with unclear symptom onset dates and 1349 patients who had not been released or had no data about their release dates were excluded. Thus, 159 patients were finally included in this study. To investigate whether rapid confirmation reduces the prevalence period, we divided the duration from symptom onset to confirmation into quartiles of ≤1, ≤3, ≤6, and ≥7 days, respectively. We investigated the duration from symptom onset to release and that from confirmation to release according to these quartiles. Furthermore, we performed multiple regression analysis to investigate the effects of rapid confirmation after symptom onset on the treatment period, duration of prevalence, and duration until release from isolation. Results: We performed multiple regression analysis to investigate the association between rapid confirmation after symptom onset and the total prevalence period (faster release from isolation). The time from symptom onset to confirmation showed a negative association with the time from confirmation to release (t1=−3.58; P<.001) and a positive association with the time from symptom onset to release (t1=5.86; P<.001); these associations were statistically significant. Conclusions: The duration from COVID-19 symptom onset to confirmation date is an important variable for predicting disease prevalence, and these results support the hypothesis that a short duration of symptom onset to confirmation can reduce the time from symptom onset to release.

This study aimed to examine the impacts of vaccination, testing, and government policies on COVID-19 mortality and incidence rates and compare these strategies' effectiveness across the seven super regions of the Global Burden of Disease (GBD) study. This study used data from January 3, 2020, to March 29, 2023. The incidence and mortality indices were calculated using \"daily cases\" and \"daily deaths\" and selected as dependent variables. Vaccination, COVID-19 tests, and strictness of a government's policy were explored using corresponding metrics. Daily cases were four times higher in the high-income (HI) region (371.1) than those in the Latin America and Caribbean region (98.3), but the mortality rate was similar (1.5). The number of vaccinated people did not consistently reduce the mortality across all GBD regions. However, full vaccination was associated with decreased mortality in all regions except Central, Eastern, and Southeastern Europe and Central Asia (CEEECA). Regarding daily testing, a favorable correlation was observed between daily deaths on a global scale, excluding Southeast Asia, East Asia, and Oceania. Overall, vaccination coverage and government policies were effective in reducing COVID-19 mortality and incidence rates. However, only the HI region showed a negative association between the COVID-19 stringency index and both incidence and mortality rates. Full vaccination significantly reduced COVID-19 mortality globally, except in the CEEECA region. The HI region showed lower incidence and mortality rates with stricter government measures. Effective vaccination programs and policies are crucial, emphasizing the need for strengthened international cooperation in future pandemics.

Background: High consumption of red meat, which is carcinogenic to humans, and misuse or abuse of alcohol drinking increase premature death and shortened life expectancy. The aim of this study was to examine the association of alcohol and red meat consumption with life expectancy (LE) by analyzing data from 164 countries using an ecological approach. Design: This was a longitudinal ecological study using data from the United Nation’s (UN) Food and Agriculture Organization (FAO) for 164 countries over the period 1992–2013. In regression analysis, the relationship of alcohol and red meat consumption with LE was estimated using a pooled ordinary least squares regression model. Alcohol and red meat consumption were measured every 5 years. Results: The consumption of alcohol and red meat in high-income countries (HIC) was about 4 times (36.8–143.0 kcal/capita/day) and 5 times (11.2–51.9 kcal/capita/day) higher than that in low-income countries (LIC). Red meat and alcohol consumption had a negative estimated effect on LE in HIC (b = −1.616 p = < 0.001 and b = −0.615, p = 0.003). Alcohol consumption was negatively associated with LE for all income groups, while positive relationships were found for all estimates associated with gross national income (GNI). Conclusions: Red meat and alcohol consumption appeared to have a negative impact on LE in high-income countries (HIC) and upper-middle-income countries (UMIC), although it had no significant association with LE in low-income countries (LIC) or lower-middle-income countries (LMIC). This study suggests reviewing the policies on the gradual reduction of alcohol abuse and the high consumption of red meat, particularly HIC and UMIC.

We investigate the mental health of multicultural families (CFs) in South Korea, identify risk factors, and propose interventions to improve mental health. Adults over 19 years of age were analyzed using the Community Health Survey 2019 in South Korea, consisting of 228,952 individuals including 3,524 from multi-CFs. We employed chi-squared tests and multiple logistic regression to compare mental health between multi- and mono-CFs, exploring the influence of various factors. Multi-CFs had significantly higher levels of stress recognition (P-value = 0.010) and experiences of extreme sadness or despair (P-value = 0.002) than mono-CFs. In multi-CFs, younger group, households with lower income and people with unhealthy behaviors regarding walking or sleeping were at risk of mental health. Socially isolated families, relative to the families participating in active social gatherings, had about a 1.36 times higher risk of stress, 2 times higher experiences of extreme sadness or despair and 5.32 times higher depressive symptoms. Multi-CFs are vulnerable to mental health problems, and even within multi-CFs, groups with relatively low socioeconomic status should be prioritized since problems are more significant among them. Activated social networks can help multi-CFs integrate into society and promote mental health.