Korea Youth Risk Behavior Survey Research Articles

Relationship between mental health and tooth fracture among Korean adolescents: analysis using data from the 19th Korea Youth Risk Behavior Survey, 2023

Objectives: This study aimed to evaluate the relationship between tooth fractures and overall mental health by data from the 19th Korea Youth Risk Behavior Survey, 2023. Methods: The participants were 52,880 adolescents attending middle and high schools. The chi-square test and multiple logistic regression analysis were used to examine the association between mental health and tooth fractures. Data were analyzed using SPSS 21.0. Results: Overall, 26.0%, 82.6%, 13.5%, and 55.6% of participants experienced sadness and despair, stress cognition, suicidal ideation, and loneliness, respectively. In the groups that experienced sadness·despair, stress, and loneliness, the experience of tooth fractures was significantly higher (1.28 [95% confidence interval, CI: 1.20-1.38], 1.09 [95% CI: 1.00-1.19], and 1.12 [95% CI: 1.05-1.20] times, respectively). Conclusions: We found an association between mental health and tooth fractures among adolescents.

Factors related to oral health and subjective health among Korean adolescents: the 18th Korea Youth Risk Behavior Survey (KYRBS)

Objectives: This study was conducted to investigate factors related to oral health and subjective health in Korean adolescents, a total of 51,850 people. Methods: Subjective health by general characteristics, subjective health by oral health characteristics, and subjective health by oral health symptoms were analyzed by a cross-analysis. Factors influencing subjective health were analyzed using multiple regression analysis. Results: As a factor influencing subjective health, the number of times teeth were brushed 0.62 times lower (p<0.001) for 0 times, and 0.91 times lower (p<0.05) for 1-2 times. The risk was 1.33 times higher (p<0.001) if teeth were brushed before going to bed, and 1.10 times higher (p<0.05) if an intrdental brush was used, In cases where oral health education was not received, subjective health was 0.86 times lower (p<0.001). In cases where there was no pain subjective health was 1.44 times higher (p<0.001), gingival bleeding was 1.51 times higher (p<0.001), or malodor was 1.53 times higher (p<0.001). Conclusions: Based on the above results, the relationship between oral health and subjective health was confirmed, and it is thought that opportunities to develop preventive programs to promote youth health should be expanded.

Factors Associated with Dental Care Utilization for Oral Disease Prevention Among Adolescents in Multicultural Families in Republic of Korea.

This study utilized data from the 2022 Korea Youth Risk Behavior Survey to examine the utilization of preventive dental care among adolescents from multicultural families and analyze the associated factors. The number of adolescents from multicultural families, based on parental nationality, was 1361. The dependent variables were asymptomatic dental visits, sealant experience, and scaling experience. The independent variables included health perception factors (subjective health status, subjective oral health status), health behaviors (fruit consumption frequency, vegetable consumption frequency, sugary drink consumption frequency, drinking experience, smoking experience), and oral health behaviors (daily tooth-brushing frequency, tooth brushing after lunch, use of oral care products, oral symptom experience). Confounding variables included demographic variables (age, grade) and socioeconomic variables (academic performance, economic level, parental education level, mother's nationality). Statistical analyses were conducted using a complex samples cross-tabulation and complex samples logistic regression. Asymptomatic dental visits were significantly associated with subjective oral health status and sugary drink consumption. Those who perceived their oral health as "Healthy" had an odds ratio (OR) of 3.34 (CI = 1.76-6.32; p < 0.001), and those who perceived themselves "Normal" had an OR of 2.03 (CI = 1.08-3.82; p = 0.029). A sugary drink consumption of less than three times per week was linked with an OR of 1.68 (CI = 1.05-2.70; p = 0.031). Sealant experience was associated with brushing before bedtime (OR = 2.27, CI = 1.18-4.35; p = 0.014) and using more than one oral care product (OR = 1.97, CI = 1.27-3.07; p = 0.003). Scaling experience associated with oral symptoms (OR = 1.94, CI = 1.21-3.11; p = 0.006). To enhance access to preventive dental care utilization for adolescents from multicultural families, efforts are needed to raise subjective oral health awareness, improve oral health behaviors, and develop strategies that ensure timely preventive dental care.

Analysis of traumatic dental injury experience and related factors among Korean adolescents: using the 19th (2023) Korea Youth Risk Behavior Survey data

Analysis of traumatic dental injury experience and related factors among Korean adolescents: using the 19th (2023) Korea Youth Risk Behavior Survey data

Does Stress Affect Adolescent Anxiety by Mediating Sleep Time?

Background: Health is essential for the sustainable well-being, yet high stress, anxiety, and lack of sleep among Korean adolescents have become significant social concerns.Methods: This study examined the impact of stress on anxiety and investigated whether sleep time mediates this relationship in 46,870 male and female adolescents, ranging from first-year of middle school students to third-year high school students. Data were obtained from the "18th Korea Youth Risk Behavior Survey" conducted by the Korea Disease Control and Prevention Agency.Results: The analysis showed that increased stress was associated with reduced sleep time and higher anxiety levels, stress was found to heighten anxiety, partly by reducing sleep time.Conclusions: Based on these findings, the study recommends: ① developing mental health indicators to quickly identify adolescents at risk for mental health issues, ② encouraging cooperation between schools, government agencies, healthcare providers to enhance access to mental health programs for adolescents, and ③ implementing policies that promote healthy behaviors, ensure adequate sleep, and improve overall well-being.

Comparative analysis of toothbrushing practices among multicultural adolescents and mono-cultural Korean adolescents: data from 19th Korea Youth Risk Behavior Survey

Comparative analysis of toothbrushing practices among multicultural adolescents and mono-cultural Korean adolescents: data from 19th Korea Youth Risk Behavior Survey

Factors associated with generalized anxiety disorder in adolescents with cultural diversity: secondary data analysis

BackgroundThe number of culturally diverse adolescents in South Korea has reached 290,000 and is increasing every year; however, they still represent only 2.5% of the total adolescent population in middle and high schools, making them a minority. Adolescents experiencing cultural diversity are psychologically vulnerable because they grow up in bicultural environments and experience prejudice. Given the nature of generalized anxiety disorder, which can be exacerbated by stress, these adolescents may face an increased risk of developing the disorder not only because of developmental stress but also because of the stress of cultural adaptation. To identify the prevalence of generalized anxiety disorder among adolescents with cultural diversity, we analyzed related factors. Based on the results, strategies have been proposed to reduce anxiety in adolescents with cultural diversity and generalized anxiety disorders.MethodsThis study used data from the 16th − 18th Korea Youth Risk Behavior Survey. Factors associated with generalized anxiety disorders were identified based on the social determinants of the health framework. Statistical analyses were conducted using IBM SPSS 25.0, and statistical methods were used for complex samples.ResultsAmong adolescents with cultural diversity, 12.8% exhibited generalized anxiety disorders. Among the structural factors, economic status, mother’s education level, and gender were significantly associated with the disorder, whereas among the psychosocial factors, suicidal ideation, depressive mood, loneliness, perceived stress level, and subjective health status were significant factors influencing it.ConclusionThe factors identified in our research can be used as a resource for the early identification of culturally diverse adolescents who are vulnerable to generalized anxiety disorders. To prevent generalized anxiety disorder among adolescents with cultural diversity, school or community nurses can implement interventions to reduce loneliness or stress management programs.

Association between secondhand smoke exposure and anxiety among adolescents: A nationwide cross-sectional study.

Adolescents are especially susceptible to the harmful effects of secondhand smoke exposure. Mental health issues may be one of these negative consequences. This study aimed to explore the association between secondhand smoke exposure and anxiety among Korean adolescents. This study used the nationwide representative cross-sectional data obtained from the 4-year (2020-2023) Korea Youth Risk Behavior Survey. In total, 214514 individuals aged 12-18 years were included in this study (109910 males and 104604 females). Secondhand smoke exposure was assessed based on responses to questions concerning the days they were exposed (at home and in public places), while anxiety levels were measured using the Generalized Anxiety Disorder 7 scale. Multivariable logistic regression analysis divided by sex was performed to explore the association (p=0.0173 for interaction by secondhand smoke exposure and sex), and adjusted odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Among the study population, 8.8% of the male and 15.6% of the female participants had anxiety. After adjusting for covariates, adolescents with secondhand smoke exposure had a higher likelihood of reporting anxiety than those without the exposure (male, OR=1.23; 95% CI: 1.16-1.29; female, OR=1.27; 95% CI: 1.21-1.33). In additional stratified analyses, this association was more prominent among those who were never smokers, were exposed for more days, and had severe levels of anxiety. This study found that secondhand smoke exposure was associated with anxiety in adolescents; hence, proper political interventions to reduce secondhand smoke exposure may be required.

Changes in Daily life due to the COVID-19 Pandemic and Mental Health Status in Korean Adolescents.

This study assessed the relationship between daily life changes and mental health in Korean adolescents during the COVID-19 pandemic. Data from middle and high school students who responded to the relevant survey items the 2021 Korea Youth Risk Behavior Survey were analyzed (n = 53,868). The survey assessed changes in economic status, physical activity, skipping breakfast, drinking, smoking, and mental health, including stress, depression, generalized anxiety disorder, and suicidal ideation, due to the COVID-19 pandemic. The overall prevalence of perceived stress, depression, generalized anxiety disorder, and suicidal ideation was 38.6%, 26.4%, 12.2%, and 12.4%. Adolescents whose economic status worsened due to COVID-19 had a higher risk of perceived stress, depression, generalized anxiety disorder, and suicidal ideation. Changes in physical activity and breakfast consumption due to the COVID-19 pandemic were significantly associated with increases in perceived stress, depression, generalized anxiety disorder, and suicidal ideation. Adolescents who increased their alcohol consumption had the highest risk of perceived stress, depression, generalized anxiety disorder, and suicidal ideation. Changes in economic status and health behaviors caused by the COVID-19 pandemic had a negative effect on the mental health of Korean adolescents. These results can be used to identify adolescents at high risk of developing mental health problems.

Association of sleep and generalized anxiety disorder in Korean adolescents

BackgroundGeneralized anxiety disorder (GAD) is a common anxiety disorder among adolescents, significantly impacting their concentration and learning capabilities. The connection between emotional well-being and sleep is well-established, and Korean adolescents are particularly prone to inadequate sleep. This study aimed to determine the association between sleep duration and GAD in Korean adolescents.MethodsThis study was conducted using data from 106,513 adolescents aged 12–18 years. Data from the 2020–2022 Korea Youth Risk Behavior Survey were used. Sleep duration was classified into five groups, based on an average sleep duration of 7–7.9 h in adolescents. Social jet lag was defined as a misalignment between an individual's biological and social clocks. Differences in sleep duration between weekdays and weekends, social jet lag, and bedtime were each classified into three categories. Multiple logistic regression analysis was performed to evaluate the association between sleep duration and GAD.ResultsComparing the five groups classified based on sleep duration, adolescents in the groups that slept less experienced a significant increase in the odds of developing GAD (adjusted odds ratio [aOR]: boys: 1.10 in the 6.0–6.9-h group, 1.14 in the 5.0–5.9-h group, and 1.23 in the ≤ 4.9-h group; girls: 1.05 in the 6.0–6.9-h group, 1.19 in the 5.0–5.9-h group, 1.22 in the ≤ 4.9-h group). Adolescents with poor sleep quality experienced more frequent instances of inadequate sleep (aOR: boys: 2.51; girls: 2.43).ConclusionsGAD is strongly associated with insufficient sleep. Consequently, it is imperative to assess and address GAD in adolescents with irregular sleep patterns.

Changes in Smartphone Usage among Adolescents and Associated Subjective Health Concerns: A Secondary Analysis of the Korea Youth Risk Behavior Survey.

We evaluated changes in the smartphone use rate and time among Korean adolescents and their awareness of associated health problems. This study was a secondary analysis of the Korea Youth Risk Behavior Survey (2020-2023) conducted by the Korean Disease Control and Prevention Agency. The total number of enrolled adolescents aged 12-18 years was 214,526. The weekly smartphone usage rate increased from 96.4% to 97.1% (p = 0.03), with no significant changes observed in weekend usage. The average smartphone use time was 4.7 h on weekdays (p = 0.17) and 6.6 h on weekends (p = 0.37). Middle school adolescents had a higher weekday use rate than high school adolescents, but the average smartphone use time was significantly less. By 2023, the proportion of adolescents with overdependence was 28% (n = 14,672). Additionally, 11.8% (n = 6255) responded that they had experienced health problems due to smartphone use. The longer they used their smartphones for on the weekends, the more likely they considered their health to be worse. In conclusion, our youth population needs to be educated on the proper use of smartphones.

Association between stress types and adolescent suicides: findings from the Korea Youth Risk Behavior Survey.

This study aims to explore the association between types of stress and suicidal behaviors-ideation and attempts-among Korean adolescents in two distinct years: 2015 and 2020. Data were acquired from the Korea Youth Risk Behavior Web-based Survey conducted in 2015 and 2020. Participants' desire for suicide was evaluated by asking questions about suicidal ideation and attempts, during the past year. Types of stress were divided into five categories: none, home, school, academic achievement, and appearance. Multiple logistic regression was used to investigate the association between variables of interest and dependent variables. Among the 77,363 adolescents included in this study, 8.8% male and 13.2% female participants had seriously thought about committing suicide, and the rate of male and female participants who tried committing suicide was 1.6% and 2.5%, respectively. While every type of stress was highly associated with suicidal ideation, family and home types of stress had the highest odds ratio (OR), that was statistically significant for both sexes (Male: OR 3.81, 95% Confidence Interval [CI] 2.81 to 5.15; Female: OR 3.64, 95% CI 2.42 to 5.50). Moreover, the OR increased in order of: appearance; academic achievement; school and friends; and family and home, compared to the group that perceived no stress. Suicidal attempts were statistically significant and higher in likelihood, only amongst the female group that experienced stress from family and home (OR 2.48, 95% CI 1.08 to 5.67). In comparison to year 2015, suicidal ideation and attempts decreased in year 2020, but participants experiencing stress from family and home had a higher tendency of attempting suicide, though not statistically significant, regardless of their sex (Male: OR 1.03, 95% CI 0.74 to 1.44; Female: OR 1.06, 95% CI 0.81 to 1.4). Adolescents who experience stress from family and home, or school and friends, are more likely to think about suicide, or carry it out, as compared to those having different causes of stress.

Development and psychometric testing of a questionnaire for the Korea Youth risk behavior survey to assess physical activity behaviors

BackgroundPhysical activity is essential for physical, mental, and cognitive health. Providing evidence to develop better public health policies to encourage increased physical activity is crucial. Therefore, we developed an in-depth survey as part of the Korea Youth Risk Behavior Survey to assess the current status and determinants of physical activity among Korean adolescents.MethodsWe developed an initial version of the questionnaire based on a review of validated questionnaires, recent trends and emerging issues related to adolescent physical activity, and the national public health agenda pertaining to health promotion. Content validity was confirmed by a panel of 10 experts. Face validity was confirmed through focus group interviews with 12 first-year middle school students. The test-retest reliability of the questionnaire was evaluated by administering it twice, approximately two weeks apart, to a sample of 360 middle and high school students. Additionally, the frequency or average number of responses was analyzed in a sample of 600 students who participated in the initial test-retest reliability evaluation of the questionnaire developed in this study.ResultsThrough item pool generation and content and face validity test, the final 15 questionnaire items were developed across five themes: levels of physical activity, school sports club activities, transportation-related physical activity, physical activity-promoting environments, and factors mediating physical activity. The test-retest reliability ranged from fair to substantial. Results from the newly developed survey reveal that only a minority of adolescents engage in sufficient physical activity, with only 17.2% and 21.5% participating in vigorous and moderate-intensity activities, respectively, for at least five days per week. Among school-based activities, 44.3% of students do not participate in school sports clubs due to reasons including absence of clubs and disinterest in exercise. The major motivators for physical activity are personal enjoyment and health benefits, whereas preferences for other leisure activities and academic pressures are the predominant barriers.ConclusionsThis study developed valid and reliable in-depth survey items to assess physical activity among Korean youths. It will hopefully enhance our understanding of adolescent physical activity, offering essential preliminary evidence to inform the development of public health strategies aimed at promoting adolescent health.

Effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents

Objective The daily lives of adolescents have changed significantly because of COVID-19 pandemic. We investigated the effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents. Methods Data from the 2021 Korea Youth Risk Behavior Survey were used. In total, 54,848 survey participants were included in the analysis. Allergic diseases included allergic rhinitis, atopic dermatitis, and asthma. Changes attributed to COVID-19 included family economic difficulties, physical activity, breakfast skipping frequency, alcohol consumption, smoking, and depressive moods. Chi-square tests and multiple logistic regression analyses were conducted to examine the impact of changes in daily life attributed to COVID-19 on allergic diseases. Results Among the Korean adolescents surveyed, 29.8% experienced a deterioration in their economic status due to COVID-19, 49.1% reported decreased physical activity, 2.8% reported increased alcohol consumption, 1.0% reported an increase in their smoking behavior, and 36.9% reported an increase in depressive moods. Those diagnosed with atopic dermatitis, allergic rhinitis, or asthma within the previous 12 months accounted for 17.1%, 6.2%, and 1.0% of the population, respectively. Adolescents who were significantly affected by COVID-19 in their daily lives were frequently diagnosed with allergic diseases within the last 12 months. Conclusion Changes in daily life due to COVID-19, including decreased physical activity and increased depressive mood, were common in adolescents and were associated with an increased prevalence of allergic diseases. Since changes in daily life due to the pandemic may increase the burden of allergic disease, additional interventions for disease management should be considered.

Association between watching eating shows and unhealthy food consumption in Korean adolescents

BackgroundEating habits formed during adolescence greatly influence the maintenance of health in adulthood. With the recent development of social media and easy access to the Internet, adolescents watch plenty of food videos, particularly Mukbang and Cookbnag(eating show)content. This media genre’s impact on food choices has been covered in several studies; however, studies on unhealthy eating habits directly related to adolescents’ exposure to eating shows are insufficient.MethodsFor this study, we used data from the 18th Korea Youth Risk Behavior Survey conducted in 2022 and finalized 50,451 participants. The extent of exposure to eating show media over the course of a week, as well as the consumption of fast food, sugar-sweetened beverages (SSBs), and high caffeinated beverages within that week were measured through self-reporting questionnaires. We classified the participants into two groups based on their frequency of watching eating shows. A multiple logistic regression analysis was performed to investigate the association between eating show and unhealthy food consumption.ResultsFor both males and females, eating show exposure was strongly associated with the consumption of fast food (male: OR:1.37, 95% CI:1.26–1.49; female: OR:1.46, 95% CI:1.36–1.57), SSB (male: OR:1.42, 95% CI:1.26–1.60; female: OR:1.51, 95% CI:1.35–1.70), and high caffeinated beverage (male: OR:1.30, 95% CI:1.23–1.37; female: OR:1.24, 95% CI:1.18–1.31). It was observed that both sexes were more likely to frequently eat unhealthy food than students who did not watch eating shows.ConclusionAmong Korean adolescents, students exposed to eating shows, which primarily aim to entertain, were more likely to consume fast food, SSBs, and high caffeinated beverages. Therefore, this study's findings suggest that eating show could influence adolescents' food choices, highlighting the need for interest in emerging cultures and corresponding health policies.

Unhealthy Weight Control Behaviors according to the Status of Combustible Cigarette and Noncombustible Nicotine or Tobacco Product Use among Korean Adolescents with Experience Attempting to Reduce or Maintain Their Body Weight: The 15th Korea Youth Risk Behavior Survey, 2019.

Noncombustible nicotine or tobacco product (NNTP) use, and cigarette smoking are associated with a high likelihood of unhealthy weight control behaviors (UWCBs) among adolescents. However, no study has addressed the differences in UWCBs among non-users, single users of combustible cigarettes (CCs) or NNTPs and dual users. This study compared the frequencies of weight control behaviors according to the status of CC and NNTP use among Korean adolescents. This was a cross-sectional study of 25,094 adolescents who had attempted to reduce or maintain their body weight during the past 30 days, using data from the 15th Korea Youth Risk Behavior Survey, 2019. Data on the status of CC and NNTP use, weight status, and weight control behaviors were obtained using self-report questionnaires. Subjects were categorized into four groups: non-users, cigarette-only users, NNTP-only users, and dual users. Among boys and girls, current smokers and NNTP users were 8.9%±0.3% and 5.5%±0.3%, and 4.2%±0.2% and 1.7%±0.1%, respectively. Among boys, NNTP-only users were more likely to engage in extreme weight control behaviors than non-users. Among girls, users of either CCs or NNTPs were more likely to engage in extreme weight control behaviors and less extreme weight control behaviors than non-users. This study shows that users of either CCs or NNTPs are more likely to engage in UWCBs, and NNTP-only users are the most likely to do so.

Association between allergic diseases, generalized anxiety disorder, and depressive symptoms in South Korean adolescents: a secondary data analysis of the 2022 Korea Youth Risk Behavior Survey.

This study investigated the relationship between allergic diseases, general anxiety disorder, and depressive symptoms among Korean adolescents. A secondary analysis was conducted on the findings of the 18th Korea Youth Risk Behavior Survey (2022). The study included 51,850 adolescents and analyzed the relationships among allergic diseases, general anxiety disorder, and depressive symptoms using complex samples logistic regression analysis. Among the Korean adolescents, 12.7% experienced general anxiety disorder, while 28.7% experienced depressive symptoms. The prevalence of allergic diseases was 5.7% for asthma, 36.3% for allergic rhinitis, and 22.2% for atopic dermatitis. General anxiety disorder was associated with asthma and allergic rhinitis but not atopic dermatitis. Depressive symptoms were associated asthma, allergic rhinitis, and atopic dermatitis. Examining the correlation among allergic diseases, general anxiety disorder, and depressive symptoms in adolescents underscores the need for implementing suitable strategies. Moreover, when addressing general anxiety disorder and depressive symptoms in adolescents, it becomes crucial to consider the presence of allergic diseases.

Factors influencing smartphone overdependence among adolescents

Adolescents are particularly vulnerable to smartphone overdependence. Therefore, we identified the factors influencing smartphone overdependence and risk subgroups among adolescents. The current study is a secondary analysis of nationally representative data from the 2020 Korea Youth Risk Behavior Survey. The survey targeted middle- and high-school students in South Korea aged 12–18 using stratified, clustered, multistage probability sampling, and 53,457 students from 793 schools participated in this study. Complex sample data were analyzed considering the strata, clusters, and weights. Multiple logistic regression analysis revealed age, gender, household economic status, anxiety, loneliness, depressive symptoms, and experience of violent treatment as significant predictors of smartphone overdependence. Adolescents with severe anxiety were at a 3.326 times higher risk of smartphone overdependence than adolescents with minimal anxiety. Decision tree analysis showed that anxiety, gender, loneliness, and depressive symptoms were important in differentiating risk subgroups, with anxiety being the most significant factor. Group 13, comprising girls with severe anxiety, had the highest risk at 52.9%. Thus, early detection and prevention of issues such as anxiety, loneliness, and depressive symptoms, as well as treatment for violence, can prevent smartphone overdependence among adolescents. Additionally, more thorough interventions for anxiety are warranted to prevent smartphone overdependence.

Trends in substance use among sexual minority adolescents in South Korea.

Substance use, that is of cigarettes, alcohol and chemical inhalants, is a major contributor to health-compromising behaviors and the related consequences among adolescents around the world. The purpose of this paper is to examine trends in this phenomenon in South Korea among sexually active adolescents who reported sexual minority behaviors as compared to their heterosexual (HS) peers. This study used data from the annual web-based survey called Korea Youth Risk Behavior Survey in 5-year intervals: 2006, 2011, and 2016. From 2017, the questions regarding the gender of sex partners were excluded from the survey, thus no data is available for sexual minorities after 2016. Selected data (Unweighted n = 10,029) was used to assess whether substance use increased, decreased, or remained unchanged among adolescents who reported same-sex (SS) behaviors and bisexual (BS) behaviors compared to their peers reporting HS behaviors. Demographic variables included age and assigned gender. Substances referred to are cigarettes, alcohol, and chemical inhalants. Logistic regression models were sex-stratified according to assigned gender. Trend analyses were carried out to examine disparities in substance use among sexually active adolescents across the three survey years. Across the three survey years, cigarette use, alcohol use, and problematic drinking declined among all sexually active youths, but there were some differences among the subgroups. In 2016, SS girls were more likely to use cigarettes than HS girls. The prevalence of alcohol use and problematic drinking among BS girls was relatively higher than among girls who exhibited either HS or SS behaviors. Inhalant use was very high among both boys and girls with SS and BS behaviors. The findings of the study reveal disparities in substance use between sexual minority and heterosexual adolescents in South Korea. This creates an alarm for collecting data separately for sexually diverse youth in future Korean national surveys with a goal of reducing substance use among all adolescents.

Mediating Effect of Loneliness on Anxiety and Smartphone Overdependence among Korean Adolescents: Based on the 16th Korea Youth Risk Behavior Survey

Background: This study aimed to determine the mediating role of loneliness in the relationship between anxiety and smartphone overdependence among Korean adolescents.Methods: This national cross-sectional secondary study used data from the 16th (2020) Korea Youth Risk Behavior Survey. The sample comprised 54,948 adolescents in middle and high schools. The mediating effects were analyzed using the procedure of Baron and Kenny and the Sobel test. Results: Anxiety impacted both loneliness and smartphone overdependence (P&lt;0.001). Additionally, loneliness was identified as a factor influencing smartphone overdependence (P&lt;0.001). Loneliness demonstrated a statistically significant mediating effect in the relationship between anxiety and smartphone overdependence (P&lt;0.001).Conclusions: It was concluded that smartphone overdependence increases with the heightened maladaptive emotions of adolescents, such as anxiety and loneliness. These findings confirmed the mediating role of loneliness in the relationship between anxiety and smartphone overdependence.