Open Journal of Nursing, 2013, 3, 420-425 OJN
http://dx.doi.org/10.4236/ojn.2013.36057 Published Online October 2013 (http://www.scirp.org/journal/ojn/)
Gender differences of health behaviors and quality of life
of Koreans wit h a s t hma
Yeonsoo Jang1, Hyera Yoo2*
1College of Nursing, Nursing Policy and Research Institute, Yonsei University, South Korea
2College of Nursing, Ajou Univeristy, South Korea
Received 21 July 2013; revised 22 August 2013; accepted 19 September 2013
Copyright © 2013 Yeonsoo Jang, Hyera Yoo. This is an open access article distributed under the Creative Commons Attribution Li-
cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Purpose: The purpose of this study was to explore
gender differences in health-behaviors and quality of
life (QOL) in Koreans with asthma. Methods: Par-
ticipants, selected from the 2009 Korean National
Health and Nutritional Examination Survey VI, in-
cluded 305 individuals (men = 128, women = 177)
with asthma and over 19 years old. Health behaviors
were measured by questions about disease manage-
ment, health choices, and functional and psychologi-
cal status. QOL was measured with the European
Quality of Life-5D (EQ-5D). Results: In health be-
haviors, 51.3% of women and 37.7% of men suffered
from wheezing at rest. About 41% of men and 10% of
women were smokers. One half of the participants
were not taking medication and this was not signifi-
cantly different by gender. The number of women
with symptoms of depression was significantly higher
than men. The EQ-5D index score of women was sig-
nificantly lower than that of men. Conclusion: W ome n
with asthma were more likely to have psychological
problems and discomfort than men. Understanding
gender differences in asthma is important to the de-
velopment of effective, tailored asthma management
strategies to cope with symptoms and improve health
behaviors and QOL for people with asthma.
Keywords: Asthma; Health Behavior; Quality of Life;
Gender; Korean
1. INTRODUCTION
Asthma is a chronic disease characterized by recurrent
attacks of breathlessness and wheezing, which vary in
severity and frequency. The World Health Organization
reported that 235 million people suffer from asthma
across the world [1]. In 2007, 34 million people were
diagnosed with asthma in the United States, and asthma
accounted for 3447 deaths. After the age of 20, asthma
death rates are higher among women than men in the
United States [2]. In Korea, the prevalence of asthma
was 7.7% among adults aged 19 years and older in 2009;
in comparison, the prevalence of type II diabetes mellitus
and cancer were 9.6% and 2.9%, respectively, in the
same year [3].
Asthma impairs the quality of life (QOL) and physical
and psychological health status such as depression, dis-
tress, or limited activities [4]. Patients with asthma have
reduced exercise capacity and may be limited in work
performance [5]. Koreans with asthma are likely to have
similar health outcomes as patients in other countries.
Previous studies report that Koreans with chronic ob-
structive lung disease engaged in poor health behaviors.
Moreover, the QOL of Koreans with asthma is lower
than that of Koreans with chronic obstructive lung dis-
ease [6,7].
The results of previous studies suggest that tailored
interventions, based on gender, may be needed because
there are gender-related differences among people with
asthma. It is known that the prevalence of asthma and the
rates of mortality and hospitalization in women are
higher than those in men [8,9]. In addition, it has been
reported that the QOL and health status of women with
asthma are lower than those of men [10,11]. However,
gender differences in health behaviors and QOL among
Koreans with asthma are poorly understood.
The purpose of this study was to examine gender dif-
ferences in disease management, health behaviors, and
QOL using data from the 2009 Korean National Health
and Nutritional Examination Survey (KNHANES IV).
2. METHODS
2.1. Participants
The KNHANES IV was a nation-wide study using a
*Corresponding author.

Y. Jang, H. Yoo / Open Journal of Nursing 3 (2013) 420-425 421
complex sample design for the selection of representative
household units (N = 24,871) of non-institutionalized
civilians in South Korea conducted by the Korean Center
for Disease Control and Prevention in 2009. KNHANES
IV consisted of three components: the Health Interview
Survey, the Health Examination Survey, and the Nutri-
tion Survey [12]. From the KNHANES IV database, 305
individuals (men = 128, women = 177) aged 19 years or
over and diagnosed with asthma by a physician were
selected for the present study.
2.2. Measurements
Demographic characteristics. Age, marital status, educa-
tion level, occupation, household income, and comorbid-
ity were collected to identify the demographic character-
istics of the sample.
Health behaviors. Health behaviors were measured by
questions about disease management, health choices, and
functional and psychological status. The disease man-
agement category included questions about current
treatment status, medication compliance, the status of
symptoms (wheezing), and asthma attacks. The health
choices category assessed the use of tobacco or alcohol,
and the frequency of exercise, health examinations, and
influenza vaccinations.
Functional health was assessed by activity limitations,
measured using a dichotomous scale (yes/no), and per-
ceived health status, which was represented by the choice
of good, fair, or poor. Psychological health was assessed
by symptoms of depression in the last two weeks, meas-
ured with a dichotomous scale (yes/no), and the level of
stress, which was measured with a 4-point Likert scale (1
= very much to 4 = very little).
Quality of life. The European Quality of Life-5D (EQ-
5D) scale was used to assess the quality of life. The EQ-
5D consists of questions about five items—mobility,
self-care, normal activities, pain, and anxiety/depression
—on a dichotomous scale (no problems/problems). In
addition, the EQ-5D assesses overall QOL using a visual
analysis scale of 0 to 100.
The EQ-5D index scores are calculated based on re-
sponses to the five-item questionnaire, preference weights,
and an algorithm. The weights and algorithm were de-
termined by a study with a UK population that used data
from the Measurement and Valuation of Health survey
[13]. The index score was used to evaluate the overall
QOL.
2.3. Ethical Considerations
This study is a retrospective study that used and analyzed
the data from the 2009 KNHANES survey; therefore,
approval from IRB was not required.
2.4. Data Analysis
Using PASW Statistics 18, a general linear model and
cross-tabulation analysis were used to explore demo-
graphic characteristics and gender differences in health
behaviors and QOL. All values were weighted.
3. RESULTS
3.1. Demographic Characteristics
The demographic characteristics of participants are pre-
sented in Tabl e 1. The mean age of men was 48.1 years
(SE = 1.97, ranging: 19 - 89) and the mean age of
Table 1. Demographic characteristics by gender (N = 305).
Total Men Women
Variables N = 305 (%†) n = 128 (%†) n = 177 (%†) t or x2 (p value)
Age, years, mean† (SE†) 55.9 (17.43) 48.1 (1.97) 52.2 (1.57) −1.595 (0.113)
Marital status 32.98 (0.000)
Married/living with spouse 201 (61.3) 102 (92.3) 99 (61.9)
Single/Divorced/Widowed 104 (34.7) 8 (7.7) 62 (38.1)
Education 26.57 (0.000)
Elementary or less 136 (34.5) 42 (21.1) 94 (46.1)
Middle school 36 (11.0) 14 (11.1) 22 (11.0)
High school 77 (32.3) 45 (44.9) 32 (21.6)
College or over 56 (21.1) 27 (22.9) 29 (21.4)
Occupation 33.90 (0.000)
Yes 156 (53.9) 85 (71.9) 71 (38.5)
No 149 (46.1) 43 (28.1) 106 (61.5)
Monthly income, won, mean* (SE*) 2,957,917 (41.9) 2,810,271 (25.0) 3,087,244 (75.0) −0.352 (0.725)
Comorbidity††
Hypertension 103 (33.8) 40 (26.4) 63 (32.7) 1.46 (0.292)
Arthritis 106 (34.8) 27 (20.3) 79 (35.5) 8.75 (0.012)
Diabetes Mellitus 39 (10.6) 15 (10.6) 24 (10.6) 0.00 (0.991)
†weighted values. ††Multiple response.

Y. Jang, H. Yoo / Open Journal of Nursing 3 (2013) 420-425 422
women was 52.2 years (SE = 1.57, range: 41 - 88 year).
There was no significant difference for mean age be-
tween men and women. The number of women who were
diagnosed with arthritis was significantly higher than that
of men (p = 0.012).
3.2. Health Behaviors
The mean age at diagnosis of asthma of men (31.3 ± 2.66)
was significantly younger than that of women (40.8 ±
1.71) (p = 0.005). Women were more likely than men to
have wheezing at rest (p = 0.027). One half of both men
and women had never taken medication for asthma, and
there was no gender difference on this variable (Table 2).
One half of the men (41.1%) smoked and number of
cigarettes was 15.3 per day. Twenty-six percent of
women reported drinking. About 51% of the men and
64% of the women did not exercise (Table 3).
The number of women with symptoms of depression
Table 2. Comparison of disease management by gender (N = 305).
Total Men Women
Variables N = 305 (%†) n = 128(%†) n = 17 7 ( %†) t or x2 (p value)
Age at diagnosis, years, mean† (SE†) 36.66 (1.53) 31.3 (2.66) 40.8 (1.71) −2.89 (0.005)
Current treatment 1.98 (0.222)
Yes 76 (22.3) 33 (18.6) 43 (25.4)
No 229 (77.7) 95 (81.4) 137 (74.6)
Wheezing
Rest 152 (45.0) 56 (37.7) 96 (51.3) 5.70 (0.027)
Exercise 107 (31.8) 43 (28.9) 64 (34.4) 2.21 (0.329)
Taking Medication 3.52 (0.478)
Always, regular 49 (14.6) 25 (12.2) 24 (16.5)
Often, or as needed 83 (26.1) 27 (22.9) 56 (28.9)
Never 154 (52.2) 68 (57.7) 86 (47.5)
Unknown 19 (7.2) 8 (7.2) 11 (7.1)
Asthma attack in the previous year 0.32 (0.882)
Yes 35 (10.3) 16 (9.3) 19 (11.2)
No 251 (82.5) 104 (83.5) 147 (81.6)
Unknown 19 (7.2) 8 (7.2) 11 (7.1)
†weighted values.
Table 3. Comparison of health choices by gender (N = 305).
Total Men Women
Variables N = 305 (%†) n = 128 (%†) n = 177 (%†) t or x2 (p value)
Smoking 99.0 (0.000)
Current 67 (24.6) 50 (41.1) 17 (10.5)
Quit 65 (21.3) 50 (35.5) 15 (9.1)
No 173 (54.1) 28 (23.5) 145 (80.4)
Smoking, cigarettes/day, mean† (SE†) 13.44 (0.754) 15.3 (0.983) 7.12 (0.754) 9.43 (0.000)
Drinking 16.35 (0.000)
Yes 63 (17.9) 12 (8.3) 51 (26.1)
No 242 (82.1) 116 (91.7) 126 (73.9)
Regular exercise (moderate) 5.01 (0.174)
Not at all 186 (58.0) 73 (51.2) 113 (63.8)
Less than 3 days 66 (23.8) 27 (27.2) 39 (20.8)
3 days or more 53 (18.2 28 (21.6) 25 (15.3)
Health Examination in last years 0.37 (0.597)
Yes 165 (48.9) 72 (47.0) 93 (50.5)
No 140 (51.1) 56 (53.0) 84 (49.5)
Influenza Vaccination 1.11 (0.444)
Yes 161 (46.9) 64 (43.7) 97 (49.7)
No 144 (53.1) 64 (56.3) 80 (50.3)
†weighted values.

Y. Jang, H. Yoo / Open Journal of Nursing 3 (2013) 420-425 423
in the last two weeks was significantly higher than the
number of men (p = 0.022). Approximately 26% of men
and 33% of women reported some limits on activity, but
there were no gender differences. Similarly, current
health status was not significantly different between men
and women (Table 4).
3.3. Quality of Life
The overall QOL of all subjects was moderate and there
was no gender difference. However, there were signifi-
cant differences on subscales of EQ-5D: women reported
more problems related to mobility (p = 0.001), usual
activity (p = 0.036), and pain/discomfort (p = 0.001) than
men. The EQ-5D index score of women was signifi-
cantly lower than that of men (p = 0.003) (Table 5).
4. DISCUSSION
This study was conducted to explore gender differences
Table 4. Comparison of functional and psychological health status by gender (N = 305).
Total Men Women
Variables N = 305 (%†) n = 128 (%†) n = 177 (%†) t or x2 (p value)
Stress 0.90 (0.881)
Very much 25 (9.6) 12 (10.6) 13 (8.7)
Much 91 (32.4) 38 (32.9) 53 (31.9)
Little 143 (46.1) 56 (43.5) 87 (48.3)
Very little 46 (12.0) 22 (13.0) 24 (11.1)
Depression in last two weeks 6.51 (0.022)
Yes 68 (21.2) 21 (14.7) 47 (26.7)
No 237 (78.8) 107 (85.3) 130 (73.3)
Activity limitation 1.45 (0.225)
Yes 108 (29.6) 42 (26.2) 66 (32.6)
No 197 (70.4) 86 (73.8) 111 (67.4)
Current Health Status 0.67 (0.788)
Good 78 (27.4) 38 (29.7) 40 (25.5)
Moderate 80 (26.8) 34 (28.1) 46 (29.0)
Poor 147 (44.0) 56 (42.3) 91 (45.4)
†weighted values.
Table 5. Comparison of quality of life by gender (N = 305).
Total Men Women
Variables N = 305 (%†) n = 128 (%†) n = 17 7 ( %†) t or x2 (p value)
Mobility 12.61 (0.001)
No Problems 205 (72.2) 96 (82.0) 109 (63.8)
Problems 100 (27.8) 32 (18.0) 68 (36.2)
Self-Care 1.24 (0.303)
No Problems 268 (90.8) 114 (92.8) 154 (89.1)
Problems 37 (9.2) 14 (7.2) 23 (10.9)
Usual Activity 6.06 (0.036)
No Problems 235 (79.7) 105 (85.8) 130 (74.4)
Problems 20.3 (70) 23 (14.2) 47 (25.6)
Pain/Discomfort 11.30 (0.001)
No Problems 190 (67.1) 93 (76.8) 97 (58.7)
Problems 32.9 (115) 35 (23.2) 80 (41.3)
Anxiety/Depression 0.31 (0.638)
No Problems 254 (80.7) 111 (82.0) 143 (79.5)
Problems 19.3 (51) 17 (18.0) 34 (20.5)
Overall QOL, VAS, mean† (SE†) 70.45 (2.6) 71.6 (1.82) 69.5 (1.72) 0.81 (0.419)
EQ-5D index 0.88 (0.02) 0.91 (0.01) 0.85 (0.02) 3.07 (0.003)
†weighted values.

Y. Jang, H. Yoo / Open Journal of Nursing 3 (2013) 420-425 424
in disease management, health behaviors, and QOL in
Koreans with asthma. The mean age at diagnosis among
men was significantly lower than that of women in this
study. This result is consistent with previous studies
[14,15], which reported that the incidence of asthma
among women 35 years or older was increasing, and that
the number of women with asthma was higher than that
of men in individuals over 40 years of age [14]. The age
at diagnosis of asthma seems to differ by gender.
Both men and women had poor health behaviors in
this study, and there were gender differences in asthma
symptoms. Manfreda and his colleges [16] reported that
women experienced more symptoms, such as dyspnea
and wheezing, than men; therefore, women received
more medical treatments. In this study, more women also
reported wheezing at rest than men. However, although
51% women reported wheezing at rest, only 25% of this
sample received asthma treatments. Adherence to asthma
medication schedules was moderate for both men and
women and there were no significant gender differences.
Therefore, effective interventions to improve self-man-
agement of their disease should be developed for Kore-
ans with asthma.
In psychological health status, the rate of women with
depression was significantly higher than that of men.
This result is consistent with the results of a previous
study that found women with mild asthma had more
episodes of anxiety and depression than men [17]. In
addition, Koreans women with asthma might be likely to
be more depressed than overall Korean populations even
though we did not compare depression between Korean
women with asthma and without asthma in this study.
However, Sung [18] reported that 13% of participants
were depressed in last two weeks and 3% of them were
diagnosed depression generally using national data,
while about 27% of women with asthma reported de-
pression in this sample. Interventions focusing on psy-
chological issues may need to be tailored more toward
women.
The overall QOL of this sample was moderate and a
gender difference was not observed. However, the EQ-
5D index score of women was significantly lower than
the score of men. The EQ-5D index scores of the par-
ticipants was lower than the scores of overall Koreans
aged 19 years or over and Koreans with osteoarthritis
and hypertension [19], and was similar to the scores of
Koreans with cancer and chronic obstructive pulmonary
disease [6]. The results of prior QOL studies are similar
to the results of this study; in those studies, the overall
QOL of patients with asthma was low, and women had a
lower QOL than men [10,20,21].
In the subscales of the EQ-5D, the number of women
reporting problems with mobility, usual activities, and
pain/discomfort was significantly higher than the number
of men. More women than men also reported problems
on the subscales of self-care and anxiety/depression,
even though there were no significant gender differences.
Sinclaire and Tolsma [21] found that women with asthma
were more likely to complain of discomfort, symptoms
of wheezing, and shortness of breath, which supports the
results of this study. Therefore, women with asthma
might need different symptom management and health
behavior strategies than men. Health care providers
should evaluate and address health status by gender for
individuals with asthma.
The study has some limitations. First, there is sam-
pling bias due to the use of the self-report instruments in
the KNHANES IV. Some of the information was subjec-
tive and might differ from a professional evaluation.
Second, the KNHANES IV used the EQ-5D to evaluate
QOL, which is useful when comparing QOL among peo-
ple with varying diseases and countries, but this instru-
ment lacks sensitivity in the assessment of specific issues
affecting people with asthma. Third, we did not compare
health status and health behaviors between Koreans with
asthma and without asthma. Because the differences s of
sample sizes between them was big, there was the lack of
statistical stability. Further study needs to examine the
difference between people with asthma and without asthma.
5. CONCLUSION
Although there are some limitations, this study found
gender differences in disease management, health status,
and QOL of Koreans with asthma. Women with asthma
were more likely to have psychological problems and
discomfort related to asthma symptoms than men. The
findings of this study are important for the development
of effective and gender-sensitive interventions aimed at
enhancing health status and QOL among patients with
asthma.
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