Abstract
Health-related quality of life (HRQoL) is a health indicator that indicates the individual’s overall perception of physical, psychological, and social well-being. Air pollution potentially affects the individual’s HRQoL. However, the evidence about the effects of air pollution on HRQoL, particularly in adolescents, remains limited. This study explored the effects of air pollution exposure on adolescents’ HRQoL. Data were collected from a population-based cross-sectional survey conducted in Shandong Province of China. The Tobit regression model (Tobit-CF) combined with the control function (CF) based on instrumental variables was used as the main regression model, and causal mediation analysis was conducted to explore the mechanism with the time spent on outdoor activity (OA) as the mediator. The final analysis included a total of 266,138 adolescents with an average age of 13 years. This study found that long-term exposure to air pollution would impair the adolescent’s HRQoL, with the decrease in outdoor activities potentially serving as a mediator. Compared to males and older adolescents, females, and younger adolescents are more susceptible to experiencing HRQoL impairment induced by air pollution exposure. The empirical strategy used in this study also provides the reference and insight for future environmental health research to infer causality using cross-sectional data.
Published Version
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