School-based Chinese Adolescents Health Survey Research Articles

Childhood Adversity and Adolescent Smartphone Use Across Sexual Orientation and Gender Expression

Nonheterosexual and gender-nonconforming (GNC) individuals tend to report adverse childhood experiences (ACEs) more frequently compared with heterosexual and gender-conforming individuals, and individuals who have experienced ACEs, identify as nonheterosexual, or exhibit moderate to high levels of GNC are more prone to engaging in problematic smartphone use (PSU). However, there is limited school-based data among adolescents regarding this matter. To explore the associations between ACEs and PSU among adolescents across different sexual orientation and gender expression groups. Using data from the 2021 School-Based Chinese Adolescents Health Survey, this cross-sectional study includes participants from 288 public high schools across 8 provinces in China. Statistical analysis was performed from October 2023 to February 2024. Data on ACEs, sexual orientations, and gender expressions (high, moderate, and low GNC) were collected. PSU was assessed using the 10-item Smartphone Addiction Scale-Short Version (SAS-SV). Weighted linear, logistic, or Poisson regression models were used. Among the 85 064 adolescents included (mean [SD] age, 14.92 [1.77] years), 42 632 (50.1%) were female, 70 157 (83.2%) identified as Han Chinese, and 14 208 (16.8) identified as other ethnicities (Miao, Hui, Yi, Dai, and other ethnic groups). The prevalence of PSU among participants was 35.4%. Weighted Poisson regression models indicated that the interaction between GNC and ACE was significant (adjusted prevalence ratio [APR], 0.98; 95% CI, 0.97-0.99). Further stratified analysis demonstrated homosexual adolescents who experienced 4 or more ACEs showed a significantly increased prevalence of PSU (APR, 1.79; 95% CI, 1.64-1.96). Similarly, a markedly higher prevalence of PSU was observed among bisexual individuals with 4 or more ACEs (APR, 1.60; 95% CI, 1.41-1.80). Regarding gender expression categories, a significantly higher prevalence of PSU was noted among high GNC adolescents with 4 or more ACEs (APR, 1.78; 95% CI, 1.60-1.98) compared with low GNC adolescents without ACEs. Furthermore, experiencing any 3 ACE categories (abuse, neglect, and household dysfunction) was associated with an increased prevalence of PSU across different sexual orientation and gender expression subgroups. In this cross-sectional study, the amalgamation of elevated ACE scores with nonheterosexual orientations or GNC identities was significantly associated with increased PSU prevalence. These findings underscore that preventing ACEs may be beneficial in mitigating PSU among adolescents, particularly for nonheterosexual adolescents and those with high levels of GNC.

Nonconforming gender expression and associated problematic smartphone and internet use among Chinese adolescents.

Gender nonconformity (GNC), which refers to an individual's expression of gender that does not align with the socially prescribed norms for their biological sex, may be associated with adverse behavioral problems, such as problematic smartphone use (PSU) and problematic internet use (PIU). This study examined the associations between GNC and PSU and GNC and PIU among Chinese adolescents. This cross-sectional study utilized data from the 2021 School-based Chinese Adolescents Health Survey, recruiting 23,054 eligible adolescents aged 11 to 21, with an average age of 14.9 (SD: 1.7) years from 504 classes in 84 public high schools across 7 cities in China. Gender nonconformity, PSU/PIU, and demographics were measured. Mixed-effect linear regression models were performed. Among the participants (51.0% male), 5.3% reported high GNC and 26.9% reported moderate GNC. After adjusting for covariates, high GNC was significantly and positively associated with PSU (Β = 1.11, 95% CI = 0.49-1.72) and PIU severity (Β = 2.16, 95% CI = 1.40-2.93). Stratified analyses indicated that the associations between GNC and PSU differed between males andfemales, with a significant association observed only among male students (Β = 1.91, 95% CI=0.97-2.86). GNC is positively associated with the severity of PSU and PIU among Chinese adolescents, with male gender-nonconforming adolescents being more vulnerable to PSU. These results highlight the importance of implementing education on gender expression diversityin schools to create an inclusive school environment, which may potentially help prevent PSU and PIU among gender-nonconforming adolescents.

Association of emotional and behavioral problems with sleep disturbance among Chinese adolescents: The moderation effect of academic performance

BackgroundThis study aimed to explore the association of emotional and behavioral problems with sleep disturbance among Chinese adolescents, and to test whether these associations vary with adolescents' academic performance. MethodsData were from the 2021 School-based Chinese Adolescents Health Survey using a multistage, stratified-cluster, and random-sampling method to collect information from 22,684 middle school students in Guangdong Province, China. ResultsEmotional problems (aOR = 1.34, 95 % CI = 1.32–1.36), conduct problems (aOR = 1.19, 95 % CI = 1.16–1.21), hyperactivity (aOR = 1.35, 95 % CI = 1.33–1.37), and peer problems (aOR = 1.06, 95 % CI = 1.04–1.09) were significantly associated with the increased risk of sleep disturbance among middle school students in Guangdong Province. The prevalence of sleep disturbance among adolescents was 29.4 %. There were significant interactions of emotional problems/conduct problems/peer problems/prosocial behavior with academic performance on sleep disturbance. Further stratification analyses by academic performance showed that adolescents with self-reported good academic performance had a higher risk of sleep disturbance than those students with self-reported average or poor academic performance. LimitationsThis study only included school students and used the cross-sectional design to preclude causality determination. ConclusionsOur findings suggest that emotional and behavioral problems elevate the risk of sleep disturbance in adolescents. Adolescent academic performance plays a modulating role in these above-mentioned significant associations for sleep disturbance.

594ICE FALCON: a method more powerful than Mendelian Randomisation for causation assessment

Abstract Background Evidence shows that sexual minority adolescents (SMA) have a higher risk of developing emotional and behavioral problems (i.e., internalizing and externalizing problems) than their heterosexual peers, which may subsequently cause an increased risk of suicidality. However, the associations remain unclear and whether biological sex may moderate such associations is still unknown. The current study was conducted among Chinese adolescents to test whether emotional and behavioral problems mediates association between sexual minority status and suicidal behavior and to explore whether such mediation is moderated by biological sex. Methods Data were drawn from 7th to 12th grade students of the 2019 School-based Chinese Adolescents Health Survey (n = 16,663). Self-reported questionnaires were adopted and moderated mediation models were performed. Results Emotional and behavioral problems (peer, emotional, conduct problems and hyperactivity) partially mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.017, 95% CI = 0.012–0.022) and suicide attempts (indirect effect = 0.010, 95% CI = 0.007–0.014). Greater effects were found among female students than males who self-identified as sexual minorities, suggesting these indirect effects were moderated by biological sex. Conclusions Biological sex moderates the indirect effects of emotional and behavioral problems on association between sexual minority status and suicidal behaviors. Early school-based suicide prevention strategies can be targeted at SMA (particularly female students who suffer from emotional or behavioral problems). Key messages Emotional and behavioral problems are associated with an elevated risk of suicidality among SMA. Biological sex moderates these associations.

Associations of emotional and behavioral problems with Internet use among Chinese young adults: the role of academic performance

Background: To investigate the independent association between different types of emotional and behavioral problems and Internet use (i.e., Internet use time and problematic Internet use [PIU]) among Chinese young adults, and to test whether these associations vary by academic performance. Methods: Data was drawn from the 2019 National School-based Chinese Adolescents Health Survey, and 30,581 undergraduates (mean age: 19.9 [SD: 1.6] years) completed standard questionnaires qualifiedly. Daily hours of Internet use, PIU, emotional and behavioral problems, and academic performance were measured. Results: After adjusting for control variables and academic performance, students who reported having emotional problems (daily hours: adjusted unstandardized β estimate=0.14, 95% CI=0.12~0.15; PIU: adjusted unstandardized β estimate=1.82, 95% CI=1.77~1.89), conduct problems (daily hours: adjusted unstandardized β estimate=0.12, 95% CI=0.09~0.15; PIU: adjusted unstandardized β estimate=1.76, 95% CI=1.67~1.84), hyperactivity (daily hours: adjusted unstandardized β estimate=0.08, 95% CI=0.06~0.12; PIU: adjusted unstandardized β estimate=1.46, 95% CI=1.38~1.54), and peer problems (daily hours: adjusted unstandardized β estimate=0.03, 95% CI=0.002~0.05; PIU: adjusted unstandardized β estimate=0.53, 95% CI=0.44~0.62) were more likely to engaged in prolonged daily Internet use and PIU. In contrast, prosocial behavior was negatively associated with Internet use time and PIU. Stratified analyses showed that some of the associations in poor academic performers were stronger than in students with good and average academic performance. Limitations: The cross-sectional design limited the ability to make causal inferences. Conclusions:The findings suggest that the efforts to prevent abnormal Internet use should be focused on students with emotional and behavioral problems or poor academic performance.

Sex differences in the associations of nonmedical use of prescription drugs with self-injurious thoughts and behaviors among adolescents: A large-scale study in China

Background To investigate the sex differences in the associations of nonmedical use of opioids and sedatives with non-suicidal self-injury (NSSI), suicidal thoughts, and suicide attempts.Methods This study presents secondary analyses of the 2015 National School-based Chinese Adolescents Health Survey. A total of 152, 527 students (aged 10-20 years) completing standard questionnaires were included in analyses. Appropriate sampling weights were utilized.Results After adjusting for the demographic profile, academic pressure, and depressive symptoms, nonmedical use of opioids (adjusted odds ratio [aOR]=1.82, 95% confidence interval [CI]=1.69~1.96) and sedatives (aOR=2.03, 95% CI=1.90~2.18) remain positively associated with NSSI, and adolescents who reported opioids or sedatives misuse were at a higher risk for suicidal thoughts and suicide attempts. A significant sex difference was found in the effects of nonmedical use of sedatives on NSSI, with the effects in girls stronger than that in boys (Ratio of two odds ratio [ROR]=1.18, P=0.011). Girls reporting nonmedical use of opioids and sedatives also had an increased risk of suicidal thoughts than boys (opioids misuse: ROR=1.25, P=0.002; sedatives misuse: ROR=1.21, P=0.006).Limitations Causal inference could not be tested due to the cross-sectional design.Conclusion Although nonmedical use of opioids or sedatives was associated with the increased risks of NSSI, suicidal thoughts, and suicide attempts among both boys and girls, there exist significant sex differences in these associations, and girls exhibited a higher risk of NSSI and suicidal thoughts than boys. Intervention strategies are needed to help vulnerable adolescents (e.g., those involved in NMUPD), with a focus on girls.

Associations of Substance Use Behaviors With Suicidal Ideation and Suicide Attempts Among US and Chinese Adolescents.

Background: Adolescence has been described as a period of increased health risk-taking behaviors. Given the variety of cultural contexts, healthcare systems, and public health policies in different regions, the present study aimed to determine whether there are similar or different associations of substance use behaviors with suicidal ideation and suicide attempts among US and Chinese adolescents.Methods: This study included a total of 14,765 US adolescents from the 2017 National Youth Risk Behavior Surveillance System (YRBSS) and 24,345 Chinese adolescents from the 2017 School-based Chinese Adolescents Health Survey (SCAHS).Results: The proportions of suicidal ideation and suicide attempts were 17.4 and 5.7% among US adolescents, which were higher than those among Chinese adolescents (suicidal ideation: 13.7% and suicide attempts: 2.7%). Among Chinese adolescents, the most common substance use behavior was “alcohol use (55.4%),” followed by “cigarette use (11.6%).” Among US adolescents, the most popular substance was alcohol (ever used: 55.9%), followed by marijuana (ever used: 34.6%). Moreover, alcohol use was significantly related to suicidal ideation/suicide attempts only in Chinese adolescents [suicidal ideation: Adjusted odds ratio (AOR) = 1.88, 95% CI = 1.71~2.06; suicide attempts: AOR = 2.12, 95% CI = 1.71~2.63], and marijuana use was associated with suicidal ideation and suicide attempts only in the US adolescent group (suicidal ideation: AOR = 1.23, 95% CI = 1.06~1.44; suicide attempts: AOR = 1.51, 95% CI = 1.21~1.87). Moreover, although the associations of prescription pain medication use with suicide attempts were significant in both Chinese and US adolescent groups, the adjusted associations were stronger in Chinese adolescents than in US adolescents (Chinese adolescents: AOR = 3.97, 95% CI = 2.76~5.72; US adolescents: AOR = 1.76, 95% CI = 1.43~2.16; P < 0.05).Conclusions: The associations of alcohol use with suicidal ideation and suicide attempts were only significant in Chinese adolescents. Marijuana use was associated with suicidal ideation and suicide attempts only in the US adolescent group. Although the associations of prescription pain medication use with suicide attempts were significant in both Chinese and US adolescent groups, the adjusted associations were significantly stronger for Chinese adolescents. These findings might be related to the differences in cultural contexts, healthcare systems, and public health policies in the two different countries.

The Longitudinal Association between Sleep Duration and Suicidal Behavior among Chinese Adolescents: The Role of Nonmedical Use of Prescription Drug

ABSTRACT Objective/Background Abnormal sleep and nonmedical use of prescription drugs are known to be factors associated with suicidal behavior, but the nature of the association between weekday sleep duration and suicidal behavior has not been elucidated. Nonmedical use of prescription drugs may play a mediator role in the association mentioned above. Participants There were a total of 3,273 high school students interviewed at baseline with a response rate of 96.8% and followed up at one year (retention rate, 96.1%). The mean (SD) age of the students was 13.7 (1.0) years. Methods Data were drawn from the longitudinal data of the School-based Chinese Adolescents Health Survey. A total of 12 high schools were selected in Guangzhou. Suicidal behavior, weekday sleep duration, and nonmedical use of prescription drugs were measured. Results Sleeping < 7 hours/day at time 0 was positively associated with suicidal ideation (Adjusted odds ratio [AOR] = 1.51, 95% CI = 1.21–1.89) and suicide attempts (AOR = 2.35, 95% CI = 1.02–5.38) at time 1. The mediation analyses showed that baseline opioids misuse or sedatives misuse partially mediated the associations of baseline short weekday sleep duration with suicidal ideation and suicide attempts at one-year follow-up. Conclusions Baseline short weekday sleep duration was positively associated with subsequent suicidal ideation and suicide attempts, and nonmedical use of opioids or sedatives partially mediated the associations mentioned above. Suicidal behavior can be prevented, short weekday sleep duration and nonmedical use of prescription drugs may be risk factors for suicidal behavior, and the respective roles of these factors are needed to be better understood.

Problematic Internet Use, Non-Medical Use of Prescription Drugs, and Depressive Symptoms among Adolescents: A Large-Scale Study in China.

This large-scale study aimed to test, among Chinese adolescents, the association between problematic Internet use (PIU), non-medical use of prescription drugs (NMUPD), and depressive symptoms, as well as the mediating effects of NMUPD on the associations above. This study used the data from the 2017 National School-based Chinese Adolescents Health Survey, and 24,345 students’ questionnaires qualified for the analyses. Generalized linear mixed models and path models were performed. In the models without mediation, PIU was associated with depressive symptoms (unstandardized β estimate = 0.26, 95% CI = 0.25–0.27); frequent use of opioid or sedative was also related to depressive symptoms (unstandardized β estimate for opioid = 2.77, 95% CI = 1.90–3.63; unstandardized β estimate for sedative = 4.45, 95% CI = 3.02–5.88). Additionally, the results of the path models indicated that opioid misuse partially mediated the association between PIU and depressive symptoms. PIU and opioid/sedative misuse were related to the increased risk of depressive symptoms, respectively. The association above might be complicated, and PIU may elevate the risk of opioid or sedative misuse and depressive symptoms, which in turn could worsen the situation of PIU and vice versa. Multidisciplinary health intervention programs to prevent adolescents involving in PIU, as well as NMPUD, are recommended to be provided.

Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents

BackgroundTo explore the association between different types of childhood maltreatment and sleep disturbance among Chinese adolescents, with a particular focus on gender differences. MethodsA cross-sectional study was conducted in 7 randomly selected provinces of China via the 2015 School-Based Chinese Adolescents Health Survey. Questionnaires from 153,547 students were completed and were eligible for this study. The Chinese Version of the Pittsburgh Sleep Quality Index (CPSQI) and Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess sleep disturbance and childhood maltreatment, respectively. ResultsThe prevalence of sleep disturbance among adolescents in China was 21.6%. A significantly increased risk of sleep disturbance was associated with physical abuse (aOR=1.22, 95% CI=1.21–1.24), emotional abuse (aOR=1.15, 95% CI=1.14–1.15), sexual abuse (aOR=1.16, 95% CI=1.15–1.18), physical neglect (aOR=1.04, 95% CI=1.03–1.05), and emotional neglect (aOR=1.03, 95% CI=1.02–1.03). A significant dose-response relationship was found between cumulative childhood maltreatment experiences and sleep disturbance. The interaction terms (between physical abuse/emotional abuse/sexual abuse/physical neglect/emotional neglect/number of childhood traumas and gender) were significantly associated with sleep disturbance. Further stratification analyses by gender showed that girls who reported experiencing one or more of these five types of childhood maltreatment had a higher risk of sleep disturbance than boys. LimitationsThe study only included school students, and the cross-sectional design limited our ability to make causal inferences. ConclusionsThe study findings suggest that childhood maltreatment increases the risk of sleep disturbance in adolescents. Furthermore, exposure to single and multiple types of childhood maltreatment predicts lower sleep quality in girls.

Association between habitual weekday sleep duration and depressive symptoms among Chinese adolescents:The role of mode of birth delivery

BackgroundDepressive symptoms among adolescents are common. This study aimed to assess, among Chinese adolescents, the associations of habitual weekday sleep duration with depressive symptoms and whether these associations varied with the mode of birth delivery. MethodsData were from the 2015 School-based Chinese Adolescents Health Survey, and 150,053 students’ questionnaires were qualified for analysis. Multi-level logistic regression models were performed. ResultsA weekday sleep duration of ≤5 h/night was associated with depressive symptoms (adjusted odds ratio [aOR]=2.98, 95% CI=2.75–3.24), and adolescents who reported a weekday sleep duration of 5–7 h/night (aOR=1.69, 95% CI=1.60–1.79) and >9 h/night (aOR=1.28, 95% CI=1.11–1.45) were also at a higher risk of depressive symptoms. Stratification analyses showed that in both adolescents delivered by vaginal birth and cesarean section (CS), a weekday sleep duration of ≤5 h/night, 5–7 h/night, and >9 h/night were associated with the increased risk of depressive symptoms in the adjusted models, and the magnitudes of the aORs in adolescents delivered by CS were slightly higher than those in adolescents delivered by vaginal birth. LimitationsThe cross-sectional study design and self-reported sleep duration and depressive symptoms. ConclusionThis study demonstrates a significant U-shaped association between weekday sleep duration and depressive symptoms among Chinese adolescents. In both adolescents delivered by vaginal birth and CS, those who reported having abnormal sleep duration were at a high risk of depressive symptoms. Based on the findings of this study, we suggest sleep duration and mode of delivery should be a matter of concern for public health authorities.

Effect of Sex on the Association Between Nonmedical Use of Opioids and Sleep Disturbance Among Chinese Adolescents: A Cross-Sectional Study.

Sleep disturbance and non-medical prescription opioid use (NMPOU) are currently growing public health concerns, and sex differences may result in differential exposure to frequency of NMPOU or sleep disturbance. This study aimed to explore the association between the frequency of lifetime or past-year NMPOU and sleep disturbance and to evaluate whether there was any sex difference in this association among Chinese adolescents. A cross-sectional study was performed in seven randomly selected Chinese provinces through the 2015 School-Based Chinese Adolescents Health Survey. A total of 159,640 adolescents were invited to participate and among them, 148,687 adolescents’ questionnaires were completed and qualified for this study (response rate: 93.14%). All analyses were performed for boys and girls separately. There were significant sex differences in the prevalence of lifetime or past-year opioid misuse and sleep disturbance (p < 0.05). Among girls, frequent lifetime NMPOU (adjusted odds ratio [aOR] = 2.09, 95% CI = 1.80–2.44) and past-year NMPOU (aOR = 2.16, 95% CI = 1.68–2.77) were positively associated with sleep disturbance. Among boys, these associations were also statistically significant, while the magnitudes of associations between frequent lifetime NMPOU or past-year NMPOU and sleep disturbance were greater in girls than those in boys. There is a significant sex difference in the prevalence of lifetime or past-year NMPOU and sleep disturbance. Furthermore, exposure to more frequent lifetime or past-year NMPOU is associated with a greater risk of sleep disturbance, especially among girls. Taking into account the sex difference for lifetime or past-year NMPOU may help to decrease the risk of sleep disturbance.

Long-term exposure to ambient fine particulate pollution, sleep disturbance and their interaction effects on suicide attempts among Chinese adolescents

BackgroundThere is a lack of literature about the joint effects of PM2.5 exposure and sleep disturbance on suicide attempts. This study aimed to estimate the association of PM2.5 exposure or sleep disturbance with suicide attempts among Chinese adolescents and to test their interaction effects on both additive and multiplicative scales. MethodsData was drawn from a subsample of the School-based Chinese Adolescents Health Survey (SCAHS) during 2014–2015 in Guangdong province, including 21,780 eligible participants. The 3-year (2011–2013) annual average concentration of PM2.5 was estimated using satellite data. Multi-level logistic regression models with weights were fitted, and both multiplicative and additive interactions for PM2.5 and sleep disturbance were tested. ResultsA total of 608 students (2.8%) reported having suicide attempts. After adjusting for significant demographics and depressive symptoms, PM2.5 exposure (Adjusted odds ratio [AOR] = 1.25, 95% CI = 1.03–1.56) and sleep disturbance (AOR = 1.69, 95% CI = 1.41–2.02) were positively associated with suicide attempts, respectively. The adjusted additive interaction effect of PM2.5 and sleep disturbance was 2.42 (95% CI = 1.80–3.26) with a synergistic index of 1.31. The multivariable multi-level logistic regression models did not find any significant multiplicative interaction item (P > 0.05). LimitationThe school-based cross-sectional study design ConclusionLong-term exposure to PM2.5 may elevate the risks of suicide attempts among Chinese adolescents. Moreover, the significant interaction effects of PM2.5 exposure and sleep disturbance on suicide attempts were found in the additive model, suggesting decreasing long-term exposure to a higher level of PM2.5 may be helpful to reduce the risk of suicide attempts among adolescents with sleep disturbance.

Association of emotional and behavioral problems with single and multiple suicide attempts among Chinese adolescents: Modulated by academic performance

BackgroundThere were differences in the characteristics and prevalence rates between individuals with a history of one suicide attempt and those with multiple suicide attempts. This large-scale study was conducted to test, among Chinese adolescents, the associations of emotional and behavioral problems with single and multiple suicide attempts and whether these associations vary with adolescents’ academic performance. MethodsData were drawn from the 2019 School-based Chinese Adolescents Health Survey (n = 20,702). Information about emotional and behavioral problems, suicide attempts, suicidal ideation, academic performance, and sleep duration was gathered. Multinomial logistic regression models using Firth penalized likelihood approach and appropriate sampling weights were performed. ResultsCompared with no suicide attempt, peer problems, emotional problems, conduct problems, and hyperactivity were associated with an elevated risk of both a single suicide attempt and multiple suicide attempts, respectively (P < 0.05); the magnitudes of these associations in multiple suicide attempters were higher than those in single suicide attempters. Further stratification analyses by academic performance showed a greater association of the four difficulties with multiple suicide attempts in adolescents reporting poor academic performance than in those with good or average academic performance. LimitationsThe school-based study sample only included students, and causal inference could not be delineated due to the cross-sectional design. ConclusionsEmotional and behavioral problems are associated with an elevated risk of single and multiple suicide attempts with differences between multiple suicide attempters and single suicide attempters. Adolescent academic performance plays a modulating role in these associations for multiple suicide attempts.

Trends in Health-Risk Behaviors among Chinese Adolescents.

Adolescent health-risk behaviors can have long lasting negative effects throughout an individual’s life, and cause a major economic and social burden to society. This study aimed to estimate the prevalence of the health-risk behaviors among Chinese adolescents and to test the trends in health-risk behaviors without and with adjusting for sociodemographic characteristics. Data were drawn from the School-based Chinese Adolescents Health Survey, which is an ongoing school-based study about the health-risk behaviors among Chinese adolescents (7th to 12th grade). During the first wave through the third wave, the prevalence of lifetime, past 12-month, and past 30-day use of opioid decreased by 4.19%, 0.63%, and 0.56%, respectively. Moreover, the prevalence of lifetime, past 12-month, and past 30-day sedative use decreased by 3.03%, 0.65%, and 0.35%, respectively. During the three waves, most trends in the prevalence of health-risk behaviors were downward, with a few exceptions: The prevalence of lifetime smoking, drinking, methamphetamine use, and sleep disturbance increased by 7.15%, 13.08%, 0.48%, and 9.06%, respectively. The prevalence of lifetime 3,4-methylene dioxy methamphetamine use (from 0.49% to 0.48%), lifetime mephedrone use (from 0.30% to 0.24%), or suicide attempts (from 2.41% to 2.46%) remained stable.

Association between weekday sleep duration and nonmedical use of prescription drug among adolescents: the role of academic performance.

Nonmedical use of prescription drug (NMUPD) among adolescents has increased substantially over the last 2 decades, and evidence suggests that sleep duration may impact upon drug use and academic performance. This study aimed to estimate the prevalence of sleep duration, NMUPD, and academic performance among Chinese adolescents, to test the independent associations of sleep duration with NMUPD, and to investigate whether these associations vary by academic performance. Data were from the 2015 School-based Chinese Adolescents Health Survey using a multi-stage, stratified-cluster, random-sampling method to collect information from 162,601 high school students [mean age (SD) =15.2 (1.9) years; 47.4% were male] from 42 cities in China. The weighted prevalence of sleeping ≤ 5h/weekday was 1.1% (95% CI, 1.0-1.1%), and the weighted prevalence of sleeping > 9h/weekday was 7.6% (95% CI 7.4-7.7%). After adjusting for significant covariates and academic performance, the results showed that compared with those with 7-9h/weekday sleep duration, students reporting ≤5h/weekday were more likely to misuse opioids (AOR = 2.12, 95% CI 1.73-2.59), sedatives (AOR = 2.00, 95% CI 1.65-2.42), and any prescription drug use (AOR = 1.89, 95% CI 1.60-2.23); students with>9h/weekday sleep duration were also at a higher risk of opioids use, sedative use, and any prescription drug misuse; the U-shaped association of sleep duration with NMUPD was found. Moreover, there exist significant associations between weekday sleep duration and NMUPD among Chinese adolescents, and academic performance plays a moderating role in the aforementioned associations. The efforts to prevent NMUPD should be focused on adolescents who report abnormal sleep duration or poor academic performance.

Association between body weight status and suicidal ideation among Chinese adolescents: the moderating role of the child's sex.

Suicidality (ranging from suicidal ideation to suicidal attempts and completed suicide) is a major and preventable public health concern, and body weight is considered a modifiable factor which might be helpful to the early risk assessment of suicidal ideation. This study aimed to comprehensively evaluate the association of body weight status with suicidal ideation across sex among Chinese adolescents. Data were drawn from the 2015 National School-based Chinese Adolescents Health Survey, and 54,640 students' questionnaires were completed and qualified for the survey. Body mass index z scores were calculated and categorized into four levels: underweight (less than the 5th percentile for sex and age), normal weight (between the 5th and 85th percentile), overweight (between the 85th and 95th percentile), and obese (above the 95th percentile). Of the total sample, 47.3% (25,852) were boys. The weighted prevalence of suicidal ideation among Chinese adolescents is 15.7% (14.6% in boys and 17.3% in girls). After adjusting for demographics, smoking, drinking, and depressive symptoms, our final multivariate logistic regression models demonstrated that only boys identified as underweight (Adjusted odds ratio [AOR] = 1.23, 95% CI = 1.06-1.44) or obese (AOR = 1.19, 95% CI = 1.02-1.38) were at a higher risk of suicidal ideation. Additionally, the association between weight status and suicidal ideation among boys might be moderated by academic pressure, smoking, and depressive symptoms. There was a significant J-shaped association between relative body weight and suicidal ideation in boys. The child's sex should be taken into consideration when developing interventions against unhealthy weight and suicidal ideation.

Association between nonmedical use of opioids or sedatives and suicidal behavior among Chinese adolescents: An analysis of sex differences.

The rising rate of suicidal behavior among adolescents is a growing concern, and sex differences may induce differential exposure to prescription drug misuse or suicidal behavior. We estimated, among Chinese adolescents, (1) the prevalence of nonmedical use of prescription drugs, suicidal ideation and suicide attempts; (2) whether nonmedical use of prescription drugs was independently associated with suicidal ideation and suicide attempts; and (3) whether there were sex differences in the associations. This was a secondary analysis of the data drawn from the 2015 National School-based Chinese Adolescents Health Survey. A total of 94,911 students completed questionnaires and qualified for our survey (response rate: 93.7%). All analyses were conducted separately for boys and girls. There were significant sex differences in the prevalence of opioid or sedative misuse, and the sources and reasons for nonmedical use of prescription drugs ( p < 0.05). The prevalence of suicidal ideation or suicide attempts was significantly higher in girls than in boys (suicidal ideation: 17.9% among girls vs 14.1% among boys; suicide attempts: 3.5% among girls vs 2.7% among boys). Among girls, frequent use of opioids was associated with an increased risk of suicidal ideation (adjusted odds ratio = 1.84, 95% confidence interval = [1.57, 2.17]) and suicide attempts (adjusted odds ratio = 2.96, 95% confidence interval = [2.34, 3.74]), and frequent use of sedatives was also positively associated with suicidal ideation (adjusted odds ratio = 2.23, 95% confidence interval = [1.91, 2.60]) and suicide attempts (adjusted odds ratio = 4.02, 95% confidence interval = [3.25, 4.99]). These associations were also statistically significant in boys, but the magnitudes of adjusted odds ratios for the associations between frequent use of opioids and sedatives and suicidal behavior were greater in girls than boys. There exist significant sex differences in the prevalence rates of nonmedical use of prescription drugs and suicidal behavior, and the child's sex plays a role in the association between nonmedical use of prescription drugs and suicidal behavior. The significant sex differences found above may provide a basis for early identification of adolescents at high risk of suicidal behavior.

Role of sleep quality in mediating the relationship between sexual minority status and suicidal behavior among Chinese adolescents.

BackgroundStudies suggest that sexual minority adolescents experience higher rates of sleep disturbance than their heterosexual peers, and disturbed sleep is a well-known risk factor for suicidality. This study aimed to explore whether sleep quality had mediating effects on the relationship between sexual minority status and suicidal behavior in Chinese adolescents.MethodsWe analyzed data collected from 7th to 12th graders from seven randomly selected provinces of People’s Republic of China in the 2015 School-Based Chinese Adolescents Health Survey. The 123,459 students who completed questionnaires regarding sexual attraction, the Pittsburgh Sleep Quality Index, past-year suicidal ideation, and past-year suicide attempts were included in our study (response rate: 95.9%).ResultsAfter adjustment for covariates, sexual minority status was associated with suicidal ideation (adjusted odds ratio =1.82, 95% CI=1.69–1.95) and suicide attempts (adjusted odds ratio =2.16, 95% CI=1.82–2.56). Sleep quality partially mediated the effects of sexual minority status on suicidal ideation (standardized β estimate=0.009, 95% CI=0.007–0.012) and suicide attempts (standardized β estimate=0.004, 95% CI=0.003–0.005).ConclusionPoor sleep quality partially explained the increased risk of suicidality for Chinese sexual minority adolescents. To prevent subsequent suicidality, suicide interventions targeting sexual minorities should be made, with a focus on their disparities in sleep disturbance and sleep health promotion.

Association between problematic Internet use, sleep disturbance, and suicidal behavior in Chinese adolescents.

Background and aimsThis large-scale study aimed to test (a) associations of problematic Internet use (PIU) and sleep disturbance with suicidal ideation and suicide attempts among Chinese adolescents and (b) whether sleep disturbance mediates the association between PIU and suicidal behavior.MethodsData were drawn from the 2017 National School-based Chinese Adolescents Health Survey. A total of 20,895 students’ questionnaires were qualified for analysis. The Young’s Internet Addiction Test was used to assess PIU, and level of sleep disturbance was measured by the Pittsburgh Sleep Quality Index. Multilevel logistic regression models and path models were utilized in analyses.ResultsOf the total sample, 2,864 (13.7%) reported having suicidal ideation, and 537 (2.6%) reported having suicide attempts. After adjusting for control variables and sleep disturbance, PIU was associated with an increased risk of suicidal ideation (AOR = 1.04, 95% CI = 1.03−1.04) and suicide attempts (AOR = 1.03, 95% CI = 1.02−1.04). Findings of the path models showed that the standardized indirect effects of PIU on suicidal ideation (standardized β estimate = 0.092, 95% CI = 0.082−0.102) and on suicide attempts (standardized β estimate = 0.082, 95% CI = 0.068−0.096) through sleep disturbance were significant. Conversely, sleep disturbance significantly mediated the association of suicidal behavior on PIU.Discussion and conclusionsThere may be a complex transactional association between PIU, sleep disturbance, and suicidal behavior. The estimates of the mediator role of sleep disturbance provide evidence for the current understanding of the mechanism of the association between PIU and suicidal behavior. Possible concomitant treatment services for PIU, sleep disturbance, and suicidal behavior were recommended.