Adolescents In Mainland China Research Articles

Distribution of scoliosis in 2.22 million adolescents in mainland China: A population-wide analysis.

The characteristics of scoliosis afflicting school children and adolescents in mainland China are still unclear. Therefore, we conducted a systematic review to estimate scoliosis's prevalence and characterise its distribution in China. We screened PubMed, Scopus, WanFang, China National Knowledge Infrastructure, National Science and Technology Library, and WeiPu databases for mainland China articles published between 1 January 1980 and 31 October 2022. Among them, we identified population-wide scoliosis studies in school children and adolescents. The main outcomes were the positive rate of primary screening and the prevalence of final screening. Primary screening mainly included general examination with/without the forward bending test in school. The final screening entailed clinical diagnosis by Röntgen radiation in a hospital (based on primary screening). A meta-analysis of scoliosis distribution by gender was performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Further, we analysed the distributions of scoliosis by age, region, aetiological type, and severity of curvature, in addition to the correlation between its prevalence and altitude or latitude. 77 studies with 2 224 320 participants were included. The positive rate through primary screening was 3.97%, whereas the prevalence of scoliosis at final screening was 1.20%. Analysing the data revealed a higher prevalence of scoliosis in girls (OR = 1.57; 95% CI = 1.38-1.81). The age-wise peak rate of scoliosis was 15-16 years (1.07%) in boys and 13-14 years (1.42%) in girls. The mean prevalence of scoliosis was 1.07% in the western region, 1.54% in the central, and 1.35% in the eastern. Scoliosis prevalence was not correlated with either altitude or latitude. The prevalence of idiopathic and congenital scoliosis was 1.18 and 0.03%. Among all subjects with scoliosis, 79.10 and 16.80% had mild and medium disease severity. According to this comprehensive study using data sets of scoliosis in adolescents across mainland China, the mean prevalence of scoliosis is 1.20%, yet 1.57 times higher in girls than boys, and is most prevalent in the middle region. Overall, scoliosis in adolescents could pose a burden to public health in mainland China. PROSPERO CRD42021231987.

Psychometric properties of the Chinese version of the Exercise Self-Efficacy Scale for the Transtheoretical Model: a confirmatory analysis among Chinese children and adolescents

BackgroundSelf-efficacy has been recognized as a critical component in people’s participation and maintenance of physical activity. This study aims to validate the Chinese version of the Exercise Self-Efficacy Scale (ESE) among Chinese children and adolescents using confirmatory factor analysis (CFA).MethodsA cross-sectional study was conducted on two primary and two secondary schools in central China. The ESE scale was translated into Chinese (ESE-C) using the standard forward-backward translation method. Data were analyzed using Mplus 8 for the CFA.ResultsThe final model showed a satisfactory level of goodness-of-fit (CFI = 0.918; TLI = 0.905; SRMR = 0.043; RMSEA = 0.066), indicating a good construct validity of the ESE-C for children and adolescents in mainland China. Furthermore, the final ESE-C model achieved composite reliability values of 0.963 and average variance extraction values of 0.597, indicating sufficient convergent and discriminant validity. Besides, the Cronbach’s alpha value was 0.964, demonstrating excellent internal consistency of the ESE-C scale.ConclusionThe ESE-C scale is a valid instrument for assessing exercise self-efficacy among children and adolescents in mainland China.

The relation between family socioeconomic status and depressive symptoms among children and adolescents in mainland China: a meta-analysis.

Family socioeconomic status (SES) is widely believed to be associated with depressive symptoms in children and adolescents. The correlation between SES and depressive symptoms changes based on social culture and the economic development level. In China, which includes many children and adolescents, the magnitude of the relationship between SES and depressive symptoms and its potential moderators remains unclear. The current meta-analysis was conducted to determine the overall association between SES and depressive symptoms in children and adolescents in mainland China. We included 197 estimates in mainland China from 2000-2023. Among 147,613 children and adolescents aged 7-18 years, the results showed a weak but significant overall negative association between SES and depression (r = -0.076). Moderator testing showed that the composite SES indicator (r = -0.104) had a stronger association with depression than parental educational level (r = -0.065) and occupational status (r = -0.025) but not family income (r = -0.088). Additionally, the negative association between SES and depression became weaker over the past 20 years in China (β = 0.010). Furthermore, the magnitude of the relationship between SES and depression was stronger in West China (r = -0.094) than in Middle China (r = -0.065), but not East China (r = -0.075). These findings indicate that the relationship between SES and depression among children and adolescents in mainland China may vary based on social contexts. It is necessary to further explore the effect of these social factors and the underlying mechanisms.

The role of self-esteem in the relationship between parental support and monitoring and adolescents’ social initiative among adolescents in mainland China

ABSTRACT Previous literature demonstrates that parental support and parental monitoring play an essential role in adolescents’ social competence and their self-esteem. In addition, the relationship between self-esteem and adolescents’ social initiative has been examined. However, little is known about the underlying mechanism of the associations among parental support, parental monitoring, and social initiative. The purpose of this research project was to examine the role of self-esteem in the relationship between parental connection and adolescents’ social initiative among adolescents in mainland China. Self-report data were acquired for this research project from the 589 adolescents who attended secondary schools in Hangzhou and participated in the Cross-National Study of Adolescence. Results of structural equation modelling indicated that adolescents’ self-esteem mediated the association between paternal, not maternal, connection and adolescents’ social initiative. There was no direct effect between maternal connection to adolescents’ social initiative. Limitations and suggestions for future research are discussed.

Ecological factors associated with child sexual abuse among 15- to 17-year-old adolescents in mainland China: implications for intervention.

Child sexual abuse is a major public health problem with adverse consequences for victims' physical, mental, and reproductive health. This cross-sectional study aimed to determine the prevalence of child sexual abuse and its associated factors among 15- to 17-year-old adolescents in mainland China. From September 8, 2019 to January 17, 2020, a total of 48,660 participants were recruited by 58 colleges and universities across the whole country to complete the self-administered, structured, online questionnaire. This analysis was restricted to 3,215 adolescents aged between 15 and 17 years in mainland China. Chi-square tests and multivariate Logistic regression analyses were performed to identify individual, relationship, and community factors associated with child sexual abuse. The overall prevalence of child sexual abuse was 12.0%. More specifically, 13.0% of girls and 10.6% of boys reported that they were sexually abused prior to 18 years of age. At the individual level, being female, sexual minority identity, younger age, and higher levels of knowledge, skills and self-efficacy regarding condom use were significantly related to increased odds of reporting sexual abuse. At the relationship and community level, adolescents from disrupted families and those entering into a marriage, having casual sexual partners, and having first intercourse at a younger age were more likely to report sexual abuse. On the contrary, those who had never discussed sex-related topics with their family members at home and were offered school-based sexuality education later (vs. earlier) were less likely to report sexual abuse. Multilevel prevention programs and strategies, including targeting adolescents with high-risk characteristics, educating young children and their parents about child sexual abuse prevention and optimizing the involvement of parents, school, community, society and government in comprehensive sexuality education, should be taken to reduce child sexual abuse among 15- to 17-year-old adolescents.

Self-reported oral health habits, knowledge and conditions of schoolchildren and adolescents in mainland China.

To determine the oral health habits, knowledge and conditions of students in China and investigate the impact of associated factors. A self-reported online questionnaire was distributed through social networks in mainland China to assess the oral health habits, knowledge, and conditions of students aged 6-20 years attending primary, middle, and high schools. Factors potentially associated with oral health, such as oral health habits of their parents, family education level, and economic regions, were analyzed using McNemar's and Chi-square tests. Within one month, 5561 valid questionnaires were retrieved from all 31 provinces or equivalent regions in mainland China. The results showed that 46.9% of students suffered from bleeding when brushing their teeth, while only 11.8% reported professional teeth cleaning at a dental clinic. Soda beverages were widely consumed among them (75.4%). A significant minority of students brushed their teeth less than twice daily (22.8%) and for about 2 minutes each time (19.3%). Only 21.9% of the students had preventive oral health care. Students' toothbrushing habits and knowledge about interdental cleaning tools were associated with parental habits (p < 0.001). Overall, students from families with higher educational backgrounds and eastern China had better oral health habits, knowledge, and conditions. There is a need to pay more attention to gingival health and caries prevention among schoolchildren and adolescents in mainland China. Improving parental oral hygiene habits could have a positive impact on the oral health of students. Further research on oral health among students is needed in the middle and western regions of China.

The relationship between positive youth development and internet gaming disorder in Chinese adolescents: A moderated mediation model.

Internet gaming disorder (IGD) is a social problem that cannot be ignored. Considerable research has shown that IGD can impede the healthy physical and mental development of adolescents. Based on positive youth development theory and stage-environment fit theory, the current study explored the mediating effect of depression and the moderating effect of gender to determine the association between positive youth development (PYD) and IGD. A sample of 1970 Chinese adolescents aged 11-18 years (1021 boys, 940 girls, and 10 unidentifiable individuals) completed questionnaires related to PYD, depression, IGD, and their background information. The results revealed that PYD negatively predicted IGD. After controlling for gender and age, this study found that depression mediated the relationship between PYD and IGD. Furthermore, gender moderated the relationship between depression and IGD. Boys with depressive symptoms were more likely to indulge in IGD than girls. This research contributes to a more thorough understanding of how PYD decreases the risk of IGD. These findings suggest that cultivating PYD attributes is a promising approach to prevent or reduce depression and IGD among adolescents in mainland China.

The joint association of physical activity and sedentary behavior with health-related quality of life among children and adolescents in Mainland China.

ObjectivesThe objective of this study was to investigate the joint association of physical activity (PA) and sedentary behavior (SB) with health-related quality of life (HRQoL) among children in Mainland China.MethodsChildren were randomly recruited from primary, junior, and senior high schools (graders 4–12) in Nanjing municipality of China in this cross-sectional survey in 2018. The outcome variable, HRQoL, was assessed using the validated Chinese version of Child Health Utility 9D (CHU9D-CHN) instrument. PA and SB were measured using a validated Physical Activity Scale and Food Frequency Questionnaire for Chinese school-aged children. The associations of PA and SB with HRQoL were assessed using mixed-effects linear regression models and reported as mean difference (MD) and 95% confidence interval (CI).ResultsTotally, 4,388 participants completed the survey (response rate = 97.6%). After adjustment for potential confounders and class-level clustering effects, relative to those with insufficient PA and prolonged SB, students with insufficient PA and shortened SB (MD = 0.054, 95%CI = 0.018, 0.089), or children with sufficient PA and prolonged SB (MD = 0.034, 95%CI = −0.030, 0.098), or students with sufficient PA and shortened SB (MD = 0.083, 95%CI = 0.045, 0.120), respectively, reported increased HRQoL scores.ConclusionPA was positively associated with HRQoL, and SB was in negative relation to HRQoL. Furthermore, sufficient PA and shortened SB might exert additive influence on HRQoL among children and adolescents in China. This study has public health implications that PA promotion and SB reduction are encouraged to be considered simultaneously for the purpose to maximally improve HRQoL in population-based behavior intervention campaigns among children and adolescents.

Longitudinal Associations Between Depressive Symptoms and Preference for Solitude Among Chinese Early Adolescents: Separating Between-Person from Within-Person Effects

The goal of this study was to explore longitudinal associations between preference for solitude (PFS) and depressive symptoms among early adolescents in mainland China, with a focus on separating between-person and within-person effects using a random intercept cross-lagged panel model (RI-CLPM). Participants were N = 1039 Chinese early adolescents ( Mage= 12.37, 46.1% girls, at Time 1), who completed annual self-reports of depressive symptoms and peer-nominations of PFS over a 3-years period. Results revealed that fluctuations in depressive symptoms consistently predicted fluctuations in PFS 1 year later, but not vice versa, supporting a symptoms-driven model. Findings are discussed in terms of the role of depressive symptoms in promoting subsequent PFS among early adolescents.

Factor structure of the Chinese CES-D and invariance analyses across gender and over time among Chinese adolescents

BackgroundResearch findings on the factor structure and invariance of the Center for the Epidemiological Studies Depression Scale (CES-D) are inconclusive. Besides, very few studies have examined factorial invariance of the scale over time. Related studies based on Chinese adolescents are also sparse. This study attempted to examine the factor structure of the CES-D and its invariance across gender and time over a one-year period among adolescents in mainland China. MethodA total of 3,010 adolescents (mean age = 13.16 years, 1,730 boys) completed a questionnaire including the CES-D at Wave 1 and 2,648 of them completed the same survey one year later. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure of the CES-D. Factorial invariance of the resultant factor structure was tested using cross-sectional multi-group CFA (girls vs. boys) at Wave 1 and Wave 2 and longitudinal CFA (Wave 1 vs. Wave 2). ResultsEFA and CFA revealed a three-factor model of the CES-D, including “somatic complaints,” “depressed affect,” and “positive affect.” Additionally, findings supported the factorial invariance across gender and over time for the three-factor model. LimitationsLimitations of the present study included a lack of adolescents from different areas in mainland China (particularly rural areas) and only a one-year follow-up. ConclusionsThis pioneering study suggests that there are three stable dimensions of the CES-D in Chinese adolescents in mainland China which are invariant across gender and over time.

Feeling like the sky is falling down: Experiences of parents of adolescents diagnosed with cancer in one-child families in China - A qualitative study.

As a result of the one-child policy of 1979, today there are numerous one-child families with adolescents in Mainland China. Little is known about the experiences of parents of such adolescents diagnosed with cancer. This study explored the experiences of parents whose adolescent child was diagnosed with cancer in one-child families in China. A qualitative methodology based on hermeneutic phenomenology was employed. The participants were parents of adolescent cancer patients in one-child families. Data were collected usingin-depth semi-structured interviews and analysed using van Manen's hermeneutic phenomenological approach. The COREQ checklist was used for this study. Fourteen parents (eleven mothers, three fathers) participated in the study. One overarching theme emerged: feeling like the sky is falling down. In addition, there were five related themes: self-condemnation; 'white lies' - that is, difficulty in telling the truth; struggling with a sense of collapse; fear of losing the child and hopelessness. Almost all the participants experienced insomnia after learning about the diagnosis. In a few cases, hopelessness-induced suicidal ideation or even suicidal behaviour. Parents of adolescents diagnosed with cancer in one-child families in China experienced extremely painful emotions. The truth about their child's condition not only caused immense psychological trauma but also induced pessimism about their own future. The experiences of parents in one-child families where an adolescent child has been diagnosed with cancer should be taken seriously. In addition, support should be provided to help parents maintain a normal life and feel hopeful for their future.

Meta-Analysis of Zinc Deficiency and Its Influence Factors in Children Under 14-year-old in China

Background: In recent years, zinc deficiency in children has attracted global attention. There are some differences in zinc deficiency in different countries and regions. However, there are few multi-center and large-sample studies on zinc deficiency in children in mainland China. Objective: To evaluate the status of zinc deficiency and its influence factors in children under 14-year-old in mainland China, and to provide evidence-based evidence for the strategy of prevention and treatment of zinc deficiency in children. Methods: PubMed, Embase, CNKI and other databases were searched about the cross-sectional survey literature on zinc deficiency and its influencing factors of under 14-year-old children in mainland China from 2005 to 2021. Stata 14.0 statistical software was used for Meta-analysis. Two independent reviewers identified eligible studies. Results: We identified 55 studies with 292,877 healthy children and adolescents in the Meta-analysis. The overall zinc deficiency rate was 27.0% (95% CI 22.8%-31.3%). From coastal areas of China showed that the zinc deficiency rate was 21.7% (95% CI 16.2%-27.1%) as 29.6% (95% CI 24.9%- 34.4%) from inland area of China. The zinc deficiency rate in the male group was greater than in the female group, and the difference was statistically significant [OR=1.052, 95% CI (1.019, 1.087), p=0.002]. The zinc deficiency rate in infant group was higher than that in toddler group [OR=1.38, 95% CI (1.16, 1.64), p=0.000], preschool group [OR=1.475, 95% CI (1.163, 1.870), p=0.001], and school-age group [OR=1.746, 95% CI (1.257, 2.425), p=0.001], with statistical significance. There was no significant difference in zinc deficiency rate between the toddler group and the preschool group [OR=1.059, 95% CI (0.918, 1.222), p=0.429], the toddler group and the school-age group [OR=1.136, 95% CI (0.848, 1.523), p=0.394], and the preschool group and the school-age group [OR=0.986, 95% CI (0.754, 1.291), p=0.919]. There was no statistically significant difference in zinc deficiency rate between the groups of well-educated and the poor-educated dietary provider. (OR=1.095, 95% CI (0.867, 1.383), p=0.446), and no statistical significance in zinc deficiency rate between urban group and rural group [OR=1.152, 95% CI (0.810, 1.637), p=0.432]. Conclusions: At present, zinc deficiency in children and adolescents in mainland China is still serious, especially in infants. The zinc deficiency rate in male children was more serious than that of female children. The zinc deficiency rate of children in inland areas was higher than that in coastal areas. Factors such as different educational level of food providers and different areas from urban or rural were not the major influencing factors of zinc deficiency.

Based on a Decision Tree Model for Exploring the Risk Factors of Smartphone Addiction Among Children and Adolescents in China During the COVID-19 Pandemic.

Background: Smartphone addiction has emerged as a major concern among children and adolescents over the past few decades and may be heightened by the outbreak of COVID-19, posing a threat to their physical and mental health. Then we aimed to develop a decision tree model as a screening tool for unrecognized smartphone addiction by conducting large sample investigation in mainland China.Methods: The data from cross-sectional investigation of smartphone addiction among children and adolescents in mainland China (n = 3,615) was used to build models of smartphone addiction by employing logistic regression, visualized nomogram, and decision tree analysis.Results: Smartphone addiction was found in 849 (23.5%) of the 3,615 respondents. According to the results of logistic regression, nomogram, and decision tree analyses, Internet addiction, hours spend on smartphone during the epidemic, levels of clinical anxiety symptoms, fear of physical injury, and sex were used in predictive model of smartphone addiction among children and adolescents. The C-index of the final adjusted model of logistic regression was 0.804. The classification accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and AUC area of decision tree for detecting smartphone addiction were 87.3, 71.4, 92.1, 73.5, 91.4, and 0.884, respectively.Conclusions: It was found that the incidence of smartphone addiction among children and adolescents is significant during the epidemic. The decision tree model can be used to screen smartphone addiction among them. Findings of the five risk factors will help researchers and parents assess the risk of smartphone addiction quickly and easily.

The Impact of Positive Youth Development Attributes on Posttraumatic Stress Disorder Symptoms Among Chinese Adolescents Under COVID-19

PurposeThis study examined the prevalence of posttraumatic stress disorder (PTSD) symptoms among adolescents in mainland China under COVID-19. The direct effects of the perceived threat of COVID-19 and positive youth development (PYD) qualities, as well as the moderating effect of PYD qualities on PTSD symptoms, were studied. MethodsFive schools in Chengdu, Sichuan, China, participated in this study. Two waves of data were collected before school lockdown (Wave 1, between December 2019 and January 2020) and after school resumption (Wave 2, between June 2020 and July 2020), respectively. A total of 4,981 adolescents aged above 11 years (Mean age = 13.15, SD = 1.32 at Wave 1, 51.5% girls) completed questionnaires at both waves. Students responded to measures of PYD qualities at both waves and perceived threat and PTSD symptoms at Wave 2. ResultsA total of 517 adolescents (10.4%) could be regarded as having PTSD. Results indicated significant unique main effects of perceived threat (β = .13, p < .001) and Wave 1 PYD qualities (β = −.16, p < .001) on PTSD symptoms. Besides, results showed a significant moderating effect of PYD qualities in mitigating the negative impact of perceived threat on PTSD symptoms. ConclusionsThis study revealed the protective effect of PYD attributes in reducing the negative influence of traumatic situations such as COVID-19 on adolescent mental health. Results underscore the importance of promoting PYD qualities in adolescents in mainland China via effective PYD programs.

Epidemiology of periodontal disease in adolescents in mainland China, 1983-2020: a systematic review and meta-analysis.

Periodontal disease is a chronic inflammatory disease that includes primarily gingivitis and periodontitis, caused by bacterial infection of the supporting structures of the teeth. For years, much attention has been diverted to periodontal disease among the elderly, not enough attention is paid to adolescents. The purpose of this meta-analysis is to evaluate the epidemic trend of periodontal disease in adolescents in mainland China. We conducted a comprehensive literature search through PubMed, Embase, CNKI, Chongqing VIP database, Chinese Wan Fang Database, and CBM. A series of subgroup analyses were done to explore the epidemiological characteristics of periodontal disease (gender, location, age, survey year, and geographical distribution) with the help of related software. Thirty studies were included in this study. The data extraction and analysis were from three indexes, including bleeding on probing (BOP), pocket depth (PD), and dental calculus (DC). The detection rates of BOP(+), PD ≥4 mm and DC(+) were 48.8% (95% CI: 36.2-61.4%), 1.0% (0.0-2.0%), and 49.8% (41.0-58.6%), respectively. There were significant differences for the prevalence of gingivitis both in gender and area: the prevalence was higher in males than that in females, and risk ratio was 1.04 (95% CI, 1.01-1.06); a lower prevalence in urban areas compared with rural areas, and the risk ratio was 0.90 (95% CI, 0.85-0.96). This study shows a high prevalence of gingivitis among adolescents in China. Higher-quality epidemiological surveys with standard examination criteria are needed.

Predictive Effect of Positive Youth Development Attributes on Delinquency Among Adolescents in Mainland China.

The general proposition of the positive youth development (PYD) approach is that developmental assets such as psychosocial competence can promote healthy adolescent development and reduce problem behavior. Despite that many Western studies have shown that PYD attributes are negatively related to adolescent delinquency, not all empirical findings support the negative associations. Although different dimensions of PYD attributes may bear differential relationships with delinquency, this possibility has not been properly examined so far. In addition, related studies in mainland China do not exist. Finally, the possible mediating role of life satisfaction in linking PYD attributes to delinquency has rarely been studied. To address the research gaps and understand how PYD attributes are associated with adolescent delinquency and the underlying mediating effect of life satisfaction, matched longitudinal data were collected from 2,648 mainland Chinese secondary school students (1,109 girls, Mean age = 13.12 ± 0.81 years at Wave 1) at two waves which were separated by one year. On each occasion, participants completed a questionnaire containing validated measures of PYD attributes, life satisfaction, and delinquency. Congruent with the general theoretical prediction of the PYD approach, different PYD attributes were inversely related to concurrent and future adolescent delinquency in separate regression analyses. In addition, the negative predictions were mediated by life satisfaction. When all PYD attributes were included in a single path analysis model, three findings were observed. First, two PYD dimensions, including self-identity and general PYD attributes, showed robust negative predictions on delinquency via life satisfaction. Second, prosocial attributes displayed a weak and unstable negative predictive effect. Third, cognitive-behavioral competence showed an unexpected positive predictive effect on delinquency directly or via its negative effects on life satisfaction. The present findings add value to the existing literature by revealing the predictive role of PYD attributes on life satisfaction and delinquency among mainland Chinese adolescents. The findings also reinforce the importance of investigating individual dimensions of PYD attributes simultaneously in the research field. The present study suggests that it is promising to cultivate PYD attributes as a strategy to reduce delinquency among adolescents in mainland China.

Mental Health Status of Cisgender and Gender-Diverse Secondary School Students in China

Transgender or gender nonconforming (TGNC) adolescents face a wide range of physical and mental health concerns. However, there has been no school-based study to explore the prevalence and mental health status of these adolescents in mainland China. To assess the mental well-being of TGNC adolescents in China by comparing them with their cisgender peers. This was a cross-sectional survey study. Of the 12 354 adolescents who completed the questionnaire, 246 did not specify to which sex they identified and were therefore excluded from further analysis. Therefore, a total of 12 108 adolescents were included from 18 secondary schools in Suzhou city, China, from June 2019 to July 2019. Participants provided consent and answered questions on sex assigned at birth and gender identity. All participants completed questionnaires, including the Patient Health Questionnaire for the measurement of depressive symptoms, a generalized anxiety disorder screening, the Pittsburgh Sleep Quality Index, and a self-harm and suicide risk checklist. The frequency of being bullied at school was also measured. Participants who reported their perceived gender as the opposite of their assigned sex at birth were classified as transgender, those who identified as neither male nor female were classified as nonbinary, and those who were not sure about their perceived gender were classified as questioning. All of these participants were categorized as TGNC adolescents. A total of 12 108 adolescents (mean [SD] age, 15.8 [1.0] years; 6518 [53.8%] assigned male at birth [AMAB]) participated in the study. Of the 6518 participants AMAB in the sample, 5855 (89.8%) were classified as cisgender boys, 208 (3.2%) as transgender girls (transgender youth who perceive their current gender identity to be female), 138 (2.1%) as nonbinary youth AMAB, and 317 (4.9%) as questioning youth AMAB. Of the 5590 participants assigned female at birth (AFAB), 4142 (74.1%) were classified as cisgender girls, 861 (15.4%) as transgender boys (transgender youth who perceive their current gender identity to be male), 112 (2.0%) as nonbinary youth AFAB, and 475 (8.5%) as questioning youth AFAB. Compared with cisgender adolescents, TGNC adolescents reported significantly higher health concerns including lower overall health (t11 872 = -7.36; P < .001), poorer sleep (t11 683 = 10.49; P < .001), higher depression and anxiety symptoms (t11 830 = 12.43 and t11 847 = 11.47, respectively; P < .001), and higher rate of self-harm and suicide ideation (t11 860 = 12.22; P < .001). The TGNC youth who were AMAB were also more likely to be bullied at school than cisgender boys (transgender girls: odds ratio [OR], 2.34 [95% CI, 1.64-3.33]; nonbinary youth AMAB: OR, 1.97 [95% CI, 1.23-3.16]; and questioning youth AMAB: OR, 1.95 [95% CI, 1.43-2.67]). The TGNC groups also reported significantly greater amounts of thoughts of self-harm (transgender girls: OR, 3.06 [95% CI, 2.24-4.19]; transgender boys: OR, 4.06 [95% CI, 3.47-4.74]; nonbinary youth AMAB: OR, 2.86 [95% CI, 1.93-4.23]; nonbinary youth AFAB: OR, 3.71 [95% CI, 2.46-5.59]; questioning youth AMAB: OR, 2.61 [95% CI, 1.98-3.44]; and questioning youth AFAB: OR, 3.35 [95% CI, 2.70-4.16]), thoughts of suicide (transgender girls: OR, 3.93 [95% CI, 2.88-5.38]; transgender boys: OR, 3.71 [95% CI, 3.10-4.21]; nonbinary youth AMAB: OR, 3.13 [95% CI, 2.11-4.63]; nonbinary youth AFAB: OR, 3.78 [95% CI, 2.50-5.71]; questioning youth AMAB: OR, 2.53 [95% CI, 1.93-3.33]; and questioning youth AFAB: OR, 3.94 [95% CI, 3.17-4.88]), suicide plan formation (transgender girls: OR, 4.44 [95% CI, 2.88-6.83]; transgender boys: OR, 2.66 [95% CI, 2.03-3.50]; nonbinary youth AMAB: OR, 5.36 [95% CI, 3.22-8.93]; nonbinary youth AFAB: OR, 4.06 [95% CI, 2.25-7.30]; and questioning youth AFAB: OR, 2.36 [95% CI, 1.63-3.43]), deliberate self-harm during the last month (cisgender girls: OR, 1.49 [95% CI, 1.33-1.68]; transgender girls: OR, 2.74 [95% CI, 1.93-3.91]; transgender boys: OR, 3.06 [95% CI, 2.57-3.66]; nonbinary youth AMAB: OR, 2.56 [95% CI, 1.66-3.94]; nonbinary youth AFAB: OR, 3.06 [95% CI, 1.95-4.81]; questioning youth AMAB: OR, 2.14 [95% CI, 1.56-2.92]; and questioning youth AFAB: OR, 2.53 [95% CI, 2.00-3.01]), and attempts of suicide (transgender girls: OR, 4.35 [95% CI, 2.88-6.56]; transgender boys: OR, 2.92 [95% CI, 2.26-3.76]; nonbinary youth AMAB: OR, 3.94 [95% CI, 2.36-6.55]; nonbinary youth AFAB: OR, 3.06 [95% CI, 1.67-5.63]; questioning youth AMAB: OR, 2.61 [95% CI, 1.73-3.94]; and questioning youth AFAB: OR, 1.93 [95% CI, 1.33-2.81]) compared with cisgender boys. Results of this cross-sectional survey study suggest poor mental health status among TGNC adolescents in China; in addition, findings suggest a compelling need for researchers, practitioners, and policy makers to address these mental health problems. Particular school-based interventions are recommended to support the mental health well-being of TGNC adolescents.

Concurrent and Longitudinal Predictors of Adolescent Delinquency in Mainland Chinese Adolescents: The Role of Materialism and Egocentrism.

Background: Although studies have examined the influence of materialism on adolescent well-being, there are several methodological limitations: studies examining the influence of materialism on adolescent delinquency are almost non-existent; researchers commonly used cross-sectional designs; the sample size in some studies was not large; validated measures on materialism in non-Western contexts are rare; there are very few Chinese studies. Besides, no study has examined the hypothesis that egocentrism is the mediator in the influence of materialism on adolescent delinquency. Methods: Using a short-term longitudinal design, two waves of data were collected from 2648 early adolescents in mainland China. At each wave, students completed validated measures of materialism, egocentrism and delinquent behavior. Results: Materialism and egocentrism positively predicted adolescent delinquency at Wave 1 and Wave 2 and over time. While materialism at Wave 1 positively predicted increase in delinquency over time, egocentrism did not. However, PROCESS analysis showed that egocentrism mediated the longitudinal influence of materialism on adolescent delinquent behavior. Conclusions: Materialism and egocentrism are predictors of adolescent delinquency, with egocentrism serving as a mediator in the influence of materialism on adolescent delinquency.

Factor Structure and Construct Validity of the Proposed Specifiers for Conduct Disorder (PSCD) Scale in Chinese Adolescents.

The Proposed Specifiers for Conduct Disorder (PSCD) Scale is a new measure to assess psychopathic traits and symptoms of conduct disorder (CD) in children and adolescents. The current study examined the psychometric properties of the self-report version of the PSCD in a sample of community adolescents in mainland China (N = 1,683; mean age = 13.60, SD = 1.14; 54.1% boys). The new instrument showed good internal consistency (alpha) for the 24-item total scale and good mean interitem correlations for each of the six-item subscales. Confirmatory factor analyses (CFAs) were conducted on all 24 items, and also a subset of 13 items that demonstrated strong item-level reliabilities. Using all 24 items, CFA results supported a four-factor bifactor model indicating the total score reflects a broad syndrome with four factors. The four factors included grandiose-manipulative traits (GM traits), callous-unemotional traits (CU traits), daring-impulsive traits (DI traits), and CD traits. The 13-item CFA results provided further support for a four-factor conceptualization of the PSCD and evidence of strong measurement invariance across gender. Finally, the PSCD exhibited the expected relations with other psychopathy measures, anxiety and depression, and aggression, supporting the PSCD scores convergent, discriminant, and criterion related validity. The findings provide preliminary evidence for the four-factor structure of the PSCD and support for the utility of the self-report PSCD for measuring psychopathic traits and CD in Chinese adolescents.

Impact of social changes and birth cohort on anxiety in adolescents in mainland China (1992–2017): A cross-temporal meta-analysis

Anxiety is a common problem and has a significant impact on adolescent development. The present study performed a cross-temporal meta-analysis and found that the anxiety level of Chinese adolescents increased substantially between 1992 and 2017 (N = 65,932) when measured using the Self-reported Anxiety Scale (SAS). Correlation between Chinese adolescents’ anxiety and the year was significantly positive. Since 1992, the mean scores have increased by 5.45 during this period, about 0.63 standard deviations. Additionally, mean anxiety scores were significantly correlated with important social indicators of social connectedness (divorce rate, urbanization level, and family size), economic conditions (Gini coefficient and residents’ consumption level) and overall threat (crime rate), indicating that social changes may be responsible for the rise in anxiety level among Chinese adolescents. Results were discussed in terms of the antecedents of anxiety, including social connectedness, economic conditions, and overall threat.