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Yu X, Huang X, Liang X, Ou Q, Sun L, Ren J, Wu Q, Chen H, Huang Q, Zhao H, Wei J, Wu F, Huang S, Wang L. The effects of nutrition education on nutritional knowledge and dietary behaviours in primary school students in Zhongshan city. J Hum Nutr Diet 2024. [PMID: 38944880 DOI: 10.1111/jhn.13343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/09/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Adequate nutritional knowledge and healthy dietary behaviours are essential for promoting rational nutrition for children. However, lack of nutritional knowledge and unhealthy dietary behaviours are common among Chinese children. Therefore, we developed a school-based nutrition education (NE) program to assess its impacts on nutritional knowledge and dietary behaviours in pupils. METHODS In this trial, one school was assigned as an intervention group (n = 199) and the other two schools were designated as a control group (n = 140). Children in the intervention group received the NE program in addition to their regular health curriculum, whereas the control group continued with their usual health curriculum without any NE program materials. RESULTS Concerning nutritional knowledge, the mean difference (follow-up minus baseline) of average knowledge scores in the intervention group was significantly higher than that in the control group (1.99 ± 3.22 vs. 0.66 ± 3.60, p = 0.001). However, subgroup analysis revealed that this difference disappeared among boys and students with malnutrition status. Regarding dietary behaviours, the NE program significantly increased the proportion of children exhibiting high frequencies of meat and nuts consumption in the intervention group, along with diverse food choice at breakfast. Additionally, it markedly reduced the proportion of children exhibiting high frequencies of sugar-sweetened beverages and fast food consumption. Structural equation modelling analyses indicated a significant direct effect of NE intervention on nutritional knowledge and an indirect effect on dietary behaviours. CONCLUSIONS The NE program effectively enhanced nutritional knowledge scores and further improved dietary behaviours among Chinese primary school students. Future NE programs should pay more attention to boys and children with malnutrition.
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Affiliation(s)
- Xinxue Yu
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaoxia Huang
- Jiahe Community Health Service Centre of Baiyun District, Guangzhou, China
| | - Xiaoping Liang
- Health Care Centre for Primary and Secondary School of Zhongshan, Zhongshan, China
| | - Qian Ou
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
| | - Liuqiao Sun
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
| | - Jieru Ren
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
| | - Qiongmei Wu
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
| | - Hangjun Chen
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
| | - Qiaoli Huang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
| | - Hanqing Zhao
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
| | - Jun Wei
- Department of Science and Technology, Guangzhou Customs, Guangzhou, China
| | - Feng Wu
- Jiahe Community Health Service Centre of Baiyun District, Guangzhou, China
| | - Sizhe Huang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
| | - Lijun Wang
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China
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Song W, Su F, Li S, Song Y, Chai G. Association between sugar-sweetened beverages and duration of physical exercise with psychological symptoms among Tibetan university students at high altitude. Front Psychol 2024; 15:1380893. [PMID: 38725953 PMCID: PMC11079124 DOI: 10.3389/fpsyg.2024.1380893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Background Sugar-sweetened beverages (SSBs) and duration of physical exercise are strongly associated with physical health. Unfortunately, there are few studies focused on the association with psychological symptoms, let alone Tibetan university students at high altitudes in China. Methods A stratified cluster sampling method was used to include 8,268 Tibetan university students aged 19-22 years in Qinghai and Tibet, both of which are high-altitude regions of China. Self-assessment questionnaires on SSBs, duration of physical exercise, and psychological symptoms were administered. The chi-square test and logistic regression analysis were used to analyze the associations among them. Results The detection rate of psychological symptoms among Tibetan university students in high-altitude areas of China was 16.7%, with in girls (18.2%) higher than that in boys (14.8%), and the difference was statistically significant (χ2 = 11.73, p < 0.01). The proportion of SSBs for university students ≤1 time/week, 2-5 times/week, and ≥ 6 times/week were 54.2, 24.3, and 21.5%, respectively. The proportion of duration of physical exercise for >60 min/d was only 5.4%. Logistic regression analysis showed that compared with the SSBs ≤1 time/week group of university students, SSBs 2-5 times/week (OR = 1.45, 95% CI: 1.24-1.70) and ≥ 6 times/week (OR = 3.06, 95% CI: 2.62-3.57) had an increased risk of psychological symptoms (p < 0.001). In the reference group, the risk of psychological symptoms was also significantly increased in the group of university students with duration of physical exercise >60 min/d (OR = 2.08, 95% CI: 1.48-2.93), and the risk of psychological symptoms was also significantly increased in the group with duration of physical exercise <30 min/d (OR = 2.08, 95% CI: 1.48-2.93). The risk of psychological symptoms was also significantly increased in the university students with the duration of physical exercise <30 min/d (OR = 2.08, 95% CI: 1.48 ~ 2.93) group. Conclusion SSBs and exercise time may be important influences on the psychological symptoms of Tibetan university students at high altitudes in China. This study has important implications for mental health planning in universities in highland areas and may also provide guidance for mental health interventions for Tibetan university students.
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Affiliation(s)
- Wei Song
- College of Education and Sports Sciences, Yangtze University, Jingzhou, China
| | - Fan Su
- College of Physical Education, China Three Gorges University, Yichang, China
| | - Shengpeng Li
- School of Preschool Education, Jingzhou Institute of Technology, Jingzhou, China
| | - Yongjing Song
- College of Education and Sports Sciences, Yangtze University, Jingzhou, China
| | - Guangxin Chai
- School of Physical Education and Health, Jiangxi Science and Technology Normal University, Nanchang, China
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Huque R, Azad AK, Ahmed N. Own price elasticities of the demand for sugar-sweetened beverages in Bangladesh. BMC Public Health 2024; 24:1020. [PMID: 38609956 PMCID: PMC11010358 DOI: 10.1186/s12889-024-18544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 04/07/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Consumption of sugar-sweetened beverages (SSB) is a major global public health problem. Increasing the price of SSBs through taxation is an effective tool to reduce SSB consumption. Price-elasticity estimates are useful in measuring the effect of taxation on consumption. We estimated the own price elasticities of demand for SSBs in Bangladesh, which will inform how SSB taxes could affect behaviour. METHODS We used Household Income and Expenditure Survey (HIES) 2016 data, which is a nationally representative dataset at the household level across the country and is conducted using stratified random sampling method. Deaton's method was used to estimate the price elasticities for SSBs in Bangladesh. RESULTS We found that the own price elasticity for SSBs varied between - 0.53% to -1.17% by types of SSBs in Bangladesh. The price elasticity for soft drinks was - 1.17, indicating that if the price of soft drinks increases by 10% via taxes, the quantity consumed of these beverages would reduce by 11.7%. CONCLUSION This is the first study that estimates the own price elasticities of demand for SSBs in Bangladesh. Our results suggest to raise SSB prices through increased taxation in order to reduce SSB consumption and ensure public health gains in Bangladesh.
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Affiliation(s)
- Rumana Huque
- ARK Foundation, Flat C3 and C4, House # 6; Road # 109 Gulshan 2, Dhaka, 1212, Bangladesh.
| | - Abul Kalam Azad
- Department of Economics, Social Science Building, University of Dhaka, Nilkhet, Dhaka-1000, Bangladesh
| | - Nasiruddin Ahmed
- ARK Foundation, Flat C3 and C4, House # 6; Road # 109 Gulshan 2, Dhaka, 1212, Bangladesh
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Qu D, Zhang X, Wang J, Liu B, Wen X, Feng Y, Chen R. New form of addiction: An emerging hazardous addiction problem of milk tea among youths. J Affect Disord 2023; 341:26-34. [PMID: 37625703 DOI: 10.1016/j.jad.2023.08.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Milk tea has experienced tremendous growth in popularity in China, especially among youths. The primary objective of this study is to investigate whether milk tea addiction may have a detrimental impact on youths' mental health, such as anxiety, depression, and suicidal ideation. Additionally, we aim to explore its potential role in influencing various mental health outcomes. METHODS A large-scale, cross-sectional study was conducted from 5281 college students in Beijing, China. Participants self-reported depressive, anxiety symptoms, suicidal ideation, and milk tea addiction symptoms including milk tea consumption, dependence, guilty feelings, withdrawal, tolerance, unable to stop, craving, and intention to stop. RESULTS Nearly 77 % of participants consumed milk tea at least 6-11 cups in the last year. The confirmatory factor analysis (CFA) supported the one-factor structure of the milk tea addiction scale, developed according to DSM-5 substance use guidelines. Moreover, we found that a higher level of milk tea addiction was significantly associated with a higher risk of depression (b = 0.24, p < 0.001), anxiety (b = 0.21, p < 0.001), and suicidal ideation (b = 0.06, p < 0.001), respectively, after controlling confounding variables, among youths consuming milk tea. The possible mediating role of milk tea addiction between loneliness feelings and mental health outcomes was further addressed. CONCLUSIONS AND IMPLICATIONS Our findings highlighted that milk tea consumption might lead to addiction, and it is associated with depression, anxiety, and suicidal ideation. Current findings can assist policymakers in developing regulations such as restricting advertising, providing psycho-education, establishing food hygiene standards for such a prosperous youth-dominant consumption industry while protecting their mental health.
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Affiliation(s)
- Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Xuan Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Juan Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Bowen Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Xue Wen
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China; Psychology Application Center for Enterprise and Society, School of Sociology and Psychology, Central University of Finance and Economics, China.
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China.
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Yu J, Huang F, Zhang X, Xue H, Ni X, Yang J, Zou Z, Du W. Association of Sugar-Sweetened Beverage Consumption and Moderate-to-Vigorous Physical Activity with Childhood and Adolescent Overweight/Obesity: Findings from a Surveillance Project in Jiangsu Province of China. Nutrients 2023; 15:4164. [PMID: 37836448 PMCID: PMC10574764 DOI: 10.3390/nu15194164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Sugar-sweetened beverage (SSB) consumption and inadequate moderate-to-vigorous physical activity (MVPA) have been suggested as potential contributors to overweight/obesity during childhood or adolescence; however, the results of previous studies are inconsistent. It was crucial to estimate the independent and joint association of SSB consumption and inadequate MVPA for childhood and adolescent overweight/obesity. The "Surveillance for Common Disease and Health Risk Factors Among Students in Jiangsu Province 2021-2022" initiative provided us with representative population-based data that we studied. SSB consumption and inadequate MVPA were determined by self-reported SSB habit and MVPA frequency (days/week). The body mass index for each gender and age subgroup was used to identify those who were overweight or obese. With stratified analyses to ascertain differences in age or gender, we employed the logistic regression model to assess the association of SSB and MVPA with overweight/obesity and applied the likelihood ratio test to explore the interactions. Approximately 38.2% of the study population (119,467 students aged 8-17) were overweight/obese. After adjusting covariates, SSB consumption or inadequate MVPA was associated with overweight/obesity (OR = 1.05, 95% CI = 1.02-1.07; and OR = 1.07, 95% CI = 1.03-1.10). In comparison to students with "no SSB consumption and adequate MVPA", those with "SSB consumption and inadequate MVPA" had a higher risk of being overweight/obese (OR = 1.13, 95% CI = 1.08-1.18). Regardless of age and gender subgroups, the correlation of SSB and MVPA alone and together with being overweight/obese was generally similar, with the adolescent group aged 13-17 years (OR = 1.15, 95% CI = 1.09-1.22) and females (OR = 1.09, 95% CI = 1.02-1.17) being more susceptible. Moreover, there was a significant interaction between SSB consumption and gender (p < 0.001), as well as between SSB consumption and inadequate MVPA (p = 0.008). Hence, SSB consumption in students is significantly associated with overweight/obesity, especially when MVPA is inadequate. In light of the rapidly expanding childhood and adolescent obesity epidemic, proper attention should be given to these modifiable behaviors, particularly SSB and MVPA.
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Affiliation(s)
- Jinxia Yu
- School of Public Health, Southeast University, Nanjing 210009, China; (J.Y.); (H.X.); (X.N.)
| | - Feng Huang
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350001, China;
| | - Xiyan Zhang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China;
| | - Hui Xue
- School of Public Health, Southeast University, Nanjing 210009, China; (J.Y.); (H.X.); (X.N.)
| | - Xiaoyan Ni
- School of Public Health, Southeast University, Nanjing 210009, China; (J.Y.); (H.X.); (X.N.)
| | - Jie Yang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China;
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
| | - Wei Du
- School of Public Health, Southeast University, Nanjing 210009, China; (J.Y.); (H.X.); (X.N.)
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Zhang Y, Wang Q, Zhu Z, Zong Q, Wu X, Tao F. The link between unhealthy lifestyle behaviors and emotional and behavioral problems in children and adolescents: a latent class analysis. PSYCHOL HEALTH MED 2023; 28:2182-2197. [PMID: 37394763 DOI: 10.1080/13548506.2023.2229979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
Unhealthy lifestyle behaviors (ULBs) in children and adolescents are relatively common. Previous studies have shown an association between a single ULBs and emotional and behavioral problems (EBPs); however, few studies have explored the connection between multiple behavioral patterns and EBPs in children and adolescents. Hence, we aimed to investigate the link between ULBs clusters and EBPs among Chinese children and adolescents. From April to May 2019, we used cluster sampling to investigate children and adolescents in grades 1-12 from 14 schools located across six streets of Bao'an District in the city of Shenzhen. We measured emotional and behavioral problems using the Strengths and Difficulties Questionnaire (SDQ). ULBs included the consumption of sugar-sweetened beverages, takeaway and fast food consumption, lack of sleep, low outdoor activity, and excessive screen time. We performed clustering of ULBs using the regression hybrid modeling method of latent class analysis (LCA). We analyzed the association between ULBs and EBPs using logistic regression. In total, 30188 children and adolescents remained for analysis, with an average age of 12.44 ± 3.47 years. The LCA revealed four distinct patterns of ULBs: (1) lowest risk; (2) high-risk unhealthy lifestyle behaviors; (3) high-risk dietary unhealthy lifestyle behaviors; and (4) highest risk. Compared to ULBs with the lowest risk, high-risk ULBs, high-risk dietary ULBs, and highest risk ULBs were positively correlated with EBPs, with an adjusted odds ratio (aOR) (95% confidence interval [CI]) of 1.27, 1.34 and 2.05, respectively. Children and adolescents who reported engaging in multiple ULBs were also more likely to have poorer EBPs status. This implies that school administrations should pay more attention to the management of dietary and lifestyle behaviors to prevent EBPs in children and adolescents. Our findings highlight the need to focus on multiple clusters of ULBs among adolescents in a preventive care system and to validate EBP that may occur in children who are exposed to ULBs.
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Affiliation(s)
- Yi Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Qianling Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
- Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhuoyan Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
- School of Health Management, Anhui Medical University, Hefei, Anhui, China
| | - Qiao Zong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
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Logan AC, D'Adamo CR, Prescott SL. The Founder: Dispositional Greed, Showbiz, and the Commercial Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095616. [PMID: 37174136 PMCID: PMC10178243 DOI: 10.3390/ijerph20095616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Marketing unhealthy products by multinational corporations has caused considerable harm to individual health, collective wellbeing, and environmental sustainability. This is a growing threat to all societies and a significant contributor to the rising global burden of non-communicable diseases and early mortality. While there is growing consideration of the commercial determinants of health, this is largely focused on the methods by which unhealthy products are marketed and disseminated, including efforts to manipulate policy. Little attention has been paid to the underlying psychological traits and worldviews that are driving corporate greed. Here, we consider the role of "dispositional greed" in the commercial determinants of health with a focus on the historical attitudes and culture in the ultra-processed food industry-exemplified by "The Founder" of the McDonald's franchise. We argue that greed and associated psychological constructs, such as social dominance orientation and collective narcissism, permeate the commercial determinants of health at a collective level. This includes how a culture of greed within organizations, and individual dispositional greed, can magnify and cluster at scale, perpetuated by social dominance orientation. We also consider the ways in which "showbiz" marketing specifically targets marginalized populations and vulnerable groups, including children-in ways that are justified, or even celebrated despite clear links to non-communicable diseases and increased mortality. Finally, we consider how greed and exploitative mindsets mirror cultural values and priorities, with trends for increasing collective narcissism at scale, recognizing that many of these attitudes are cultivated in early life. A healthier future will depend on navigating a path that balances material prosperity with physical and spiritual wellbeing. This will require cultural change that places higher value on kindness, reciprocity, and mutualistic values especially in early life, for more equitable flourishing.
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Affiliation(s)
- Alan C Logan
- Nova Institute for Health, Baltimore, MD 21231, USA
| | - Christopher R D'Adamo
- Nova Institute for Health, Baltimore, MD 21231, USA
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Susan L Prescott
- Nova Institute for Health, Baltimore, MD 21231, USA
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
- The ORIGINS Project, Telethon Kids Institute, Nedlands, WA 6009, Australia
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Xu H, Zhang X, Wang J, Xie Y, Zhang Y, Xu S, Wan Y, Tao F. Exploring associations of adverse childhood experiences with patterns of 11 health risk behaviors in Chinese adolescents: focus on gender differences. Child Adolesc Psychiatry Ment Health 2023; 17:26. [PMID: 36803389 PMCID: PMC9940075 DOI: 10.1186/s13034-023-00575-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
PURPOSE Adolescents exposed to adverse childhood experiences (ACEs) are at increased risk for health-compromising behaviors. However, few studies have investigated how ACEs correlate with patterns of health risk behaviors (HRBs) during adolescence, a crucial developmental period. The aim was to extend the current knowledge about the relationship between ACEs and HRB patterns among adolescents, and to explore gender differences. METHODS A multi-centered population-based survey was conducted in 24 middle schools in three provinces across China between 2020 and 2021. A total of 16,853 adolescents effectively completed anonymous questionnaires covering exposure to eight ACE categories and 11 HRBs. Clusters were identified using latent class analysis. Logistic regression models were utilized to test the association between them. RESULTS There were four classes of HRB patterns: "Low all" (58.35%), "Unhealthy lifestyle" (18.23%), "Self-harm" (18.42%), and "High all" (5.0%). There were significant differences between HRB patterns in terms of the different numbers and types of ACEs in three logistic regression models. Specifically, compared to "Low all," different types of ACEs were positively associated with the three other HRB patterns, and there were significant trends toward increase in the three latent classes of HRBs with higher ACEs. In general, females with ACEs had a higher risk of "High all" except sexual abuse than males. CONCLUSION Our study comprehensively considers the association between ACEs and aggregation categories of HRBs. The results support efforts to improve clinical healthcare, and future work may explore protective factors based on individual, family, and peer education to mitigate the negative trajectory of ACEs.
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Affiliation(s)
- Huiqiong Xu
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, Hefei, 230032 Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, 81 Meishan Road, Hefei, 230032 Anhui China
| | - Xinyu Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, Hefei, 230032 Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, 81 Meishan Road, Hefei, 230032 Anhui China
| | - Jiaojiao Wang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, Hefei, 230032 Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, 81 Meishan Road, Hefei, 230032 Anhui China
| | - Yang Xie
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, Hefei, 230032 Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, 81 Meishan Road, Hefei, 230032 Anhui China
| | - Yi Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, Hefei, 230032 Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, 81 Meishan Road, Hefei, 230032 Anhui China
| | - Shaojun Xu
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XKey Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, No 81 Meishan Road, Hefei, 230032 Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, 81 Meishan Road, Hefei, 230032 Anhui China
| | - Yuhui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, 81 Meishan Road, Hefei, 230032, Anhui, China.
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9
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Ra JS. Consumption of sugar-sweetened beverages and fast foods deteriorates adolescents' mental health. Front Nutr 2022; 9:1058190. [PMID: 36618694 PMCID: PMC9817134 DOI: 10.3389/fnut.2022.1058190] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Sugar-sweetened beverage (SSB) and fast-food consumption is significantly associated with adolescents' poor mental health. Furthermore, sugar-sweetened beverage and fast-food consumption might form clustered diet patterns with significant positive associations in adolescent high school students. Thus, the combined consumption of SSBs and fast foods may have more negative effects on mental health with synergetic effects than the sum of their independent consumption. Methods This study aimed to identify the effects of combining the consumption of sugar-sweetened beverages and fast foods on mental health, including stress, depressive symptoms, and suicidal ideation among Korean high school students. Secondary data from 24,006 high school students were analyzed from the 17th Korea Youth Risk Behavior Web-based Survey, 2021. For statistical analysis, complex sampling analysis using the SPSS Statistics 26.0 software was applied for descriptive statistics and logistic regression analysis. Results In Korean adolescents, combining more than medium consumption of sugar-sweetened beverages and fast foods was associated with more stress, depressive symptoms, and suicidal ideation than their independent consumption. In addition, combining high consumption of sugar-sweetened beverages and low to high consumption of fast foods might have dose-dependent negative effects on stress, depressive symptoms, and suicidal ideation in Korean adolescents. Discussion Based on the results of this study, healthcare providers in schools and communities might develop various interventions including school/community-based feeding programs and policies targeting the restriction of SSB and fast-food consumption to improve adolescents' mental health.
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Li X, Sun M, Yao N, Liu J, Wang L, Hu W, Yang Y, Guo R, Li B, Liu Y. Association between patterns of eating habits and mental health problems in Chinese adolescents: A latent class analysis. Front Nutr 2022; 9:906883. [PMID: 35990360 PMCID: PMC9391054 DOI: 10.3389/fnut.2022.906883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022] Open
Abstract
Objective We aimed to investigate the association between different eating habit patterns and mental health problems among Chinese middle and high school students, and further to estimate the interaction effect of different grouping variables on eating habits. Methods One thousand three hundred and forty-eight adolescents from Jilin Province in China were involved in this cross-sectional study. Mental health and eating habits were assessed using General Health Questionnaire and questions on Nutrition Knowledge, Attitude and Practice, respectively. Latent class analysis (LCA) was performed to identify eating habit patterns. Binary logistic regression and generalized linear models were used to explore the association between eating habit patterns, energy-adjusted nutrient intakes and mental health problems. Interaction analysis was performed to analyze the association between eating habits and mental health in different groups. Results Based on the LCA results, a 3-class parallel model was identified: 648 adolescents (48.1%) were classified in class-1 “Healthy Eating Behavior/Eating at Home,” 452 adolescents (33.5%) in class-2 “Healthy Eating Behavior/Eating at School” and 248 adolescents (18.4%) in class-3 “Unhealthy Eating Behavior/Random Place.” Compared with class-1, participants in class-2 and class-3 were at higher risk of mental health problems, especially for class-3 (p < 0.05). The energy and nutrient intakes by different latent classes showed that adolescents who ate unhealthy had lower daily intake of energy, protein, carbohydrate, fiber, Vitamins and minerals (p < 0.05). The interaction between age, sleep duration and different eating habits was statistically significant (p for interaction < 0.1). Conclusion “Unhealthy eating behavior/random place pattern” was positively correlated with mental health problems of adolescents. The adolescents with health diet were accompanied by fewer mental health problems, especially for that eating at home. And there were interactions between eating habits and age, sleep duration on the mental health problems.
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Affiliation(s)
- Xiaotong Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Mengzi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Nan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Jiaqi Liu
- Department of Orthopedics, The Second Clinical Hospital, Jilin University, Changchun, China
| | - Ling Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Wenyu Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yixue Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Ruirui Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yajuan Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, Changchun, China
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11
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Wu Y, Lu Y, Xie G. Bubble tea consumption and its association with mental health symptoms: An observational cross-sectional study on Chinese young adults. J Affect Disord 2022; 299:620-627. [PMID: 34942229 DOI: 10.1016/j.jad.2021.12.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/23/2021] [Accepted: 12/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bubble tea has become enormously popular in China in recent years. This cross-sectional study investigated the association between bubble tea consumption and symptoms of anxiety and depression in a population-based sample. METHODS Self-report questionnaires were used to assess bubble tea consumption and mental status. Symptoms of depression were assessed using the self-rated Patient Health Questionnaire-2 (PHQ-2) and anxiety using the self-rated Generalized Anxiety Disorder Scale-2 (GAD-2). Logistic regressions were performed to evaluate the association between the frequency of bubble tea consumption (cups/week) (FBTC) and psychological symptoms, adjusting for demographic and socioeconomic characteristics. Path analysis was used to investigate the possible meditating effects of confounding factors. RESULTS After adjusting for potential confounding factors, high frequency of bubble tea consumption was observed to be significantly associated with high risk for depression in the regression model (p for trend = 0.045); no significant association was found with anxiety (p for trend = 0.332). In path analysis model, education mediated the association between FBTC and depression. Unlike the result in regression model, with education, exercise time and occupation as mediating factors, anxiety was found to be indirectly associated with FBTC. LIMITATIONS Symptoms of depression and anxiety were self-reported. And the cross-sectional nature of the study does not allow inferring causality. CONCLUSIONS Bubble tea consumption was associated with an increased risk of experiencing symptoms of depression and anxiety in Chinese young adults. Additional longitudinal research is required to elucidate the possible reverse causation from bubble tea consumption on symptoms of depression and anxiety.
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Affiliation(s)
- Yongzhong Wu
- School of Business Administration, South China University of Technology 381 Wushan Road, Guangzhou, China
| | - Yikuan Lu
- School of Business Administration, South China University of Technology 381 Wushan Road, Guangzhou, China
| | - Guie Xie
- KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, China.
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12
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Huang C, Yuan Q, Ge M, Sheng X, Yang M, Shi S, Cao P, Ye M, Peng R, Zhou R, Zhang K, Zhou X. Childhood Trauma and Non-suicidal Self-Injury Among Chinese Adolescents: The Mediating Role of Psychological Sub-health. Front Psychiatry 2022; 13:798369. [PMID: 35222116 PMCID: PMC8866574 DOI: 10.3389/fpsyt.2022.798369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
The factors associated with non-suicidal self-injury (NSSI) of adolescents have been widely researched. However, the underlying mechanism of the relationship between childhood trauma and NSSI is limited. This study aimed to explore the risk factors for NSSI among Chinese adolescents. Our hypothesis was that psychological sub-health (PSH) played a mediating role between childhood trauma and NSSI. The Childhood Trauma Questionnaire, the Multidimensional Sub-health Questionnaire of Adolescent, and the self-report NSSI were used to measure childhood trauma, PSH, and NSSI. Structural equation model (SEM) was performed to verify our hypothesis. The results showed that 33.9% of the participants in our survey had engaged in NSSI in the past year. Adolescents who were left-behind children or in primary schools were more likely to engage in NSSI. Additionally, 56.2% of the participants had moderate to severe childhood trauma, and 26.1% of the participants had PSH. Furthermore, childhood trauma and PSH would increase the risk of NSSI by 2 times (B = 0.79, p < 0.01) and 5 times (B = 1.64, p < 0.01), respectively. SEM was established (p = 0.512) and the goodness-of-fit indices were examined (CMIN/DF = 0.892; GFI = 0.997; AGFI = 0.992; NFI = 0.991; RFI = 0.980; IFI = 1.00; TLI = 1.00; CFI = 1.00; RMSEA < 0.001). The SEM indicated that childhood trauma positively predicted NSSI both directly and indirectly through PSH. PSH has been confirmed to have partial mediating effects between childhood trauma and NSSI. The assessment of PSH may be an operable and effective method to screen and predict NSSI. Meanwhile, the intervention of childhood trauma and PSH may effectively prevent and reduce the occurrence of NSSI among adolescents.
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Affiliation(s)
- Cui Huang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Qiuyu Yuan
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Menglin Ge
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Xuanlian Sheng
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Meng Yang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Shengya Shi
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Panpan Cao
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Mengting Ye
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Ran Peng
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Ruochen Zhou
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Kai Zhang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Xiaoqin Zhou
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
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13
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Xu H, Sheng J, Wu X, Zhan K, Tao S, Wen X, Liu W, Cudjoe O, Tao F. Moderating effects of plastic packaged food on association of urinary phthalate metabolites with emotional symptoms in Chinese adolescents. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 216:112171. [PMID: 33812210 DOI: 10.1016/j.ecoenv.2021.112171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/02/2021] [Accepted: 03/17/2021] [Indexed: 05/26/2023]
Abstract
Previous research reports that diet is the main source of phthalate exposure to adolescents, and phthalate is associated with adolescent mental and behavioral problems. However, no study has explored the moderating effects of eating behavior in this association. This study aimed to analyze the moderating effects of plastic packaged food consumption in the longitudinal association between phthalate metabolite concentration and emotional symptoms in adolescents. This school-based survey was carried out among adolescents in two Chinese provinces. We conducted a baseline and follow-up surveys for 893 freshmen using the purposive sampling method from December 2018 to November 2019. We used food frequency questionnaire to assess eating behavior. The Chinese version of 21-item Depression Anxiety Stress Scales was used to assess emotional symptoms, and high-performance liquid chromatography-tandem mass spectrometry was used to analyze the concentration of six urine phthalate metabolites. The results of latent moderation model indicated that plastic packaged food consumption moderated the association of low molecular weight phthalate (LMWP) with depressive symptoms (β = 0.27, P = 0.002), anxiety symptoms (β = 0.89, P < 0.01), and stress symptoms (β = 0.23, P = 0.019). The moderating effects were significant at the higher scores (β = 0.14-0.35, P < 0.05) and/or the lower scores (β = -0.35 to -0.12, P < 0.05) of plastic packaged food consumption. The results suggest that plastic packaged food consumption to some extent moderates the longitudinal association of phthalate exposure with emotional symptoms in adolescents.
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Affiliation(s)
- Honglv Xu
- School of Medicine, Kunming University, 2 Puxin Road, Kunming 650214, Yunnan, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Jie Sheng
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Kai Zhan
- Anhui Key Laboratory of Livestock and Poultry Product Safety Engineering, Institute of Animal Husbandry and Veterinary Medicine, Anhui Academy of Agricultural Science, Hefei 230031, Anhui, PR China
| | - Shuman Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Xing Wen
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Wenwen Liu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Obed Cudjoe
- University of Cape Coast, Department of Microbiology and Immunology, School of Medical Sciences, Cape Coast, Ghana; Department and the Key Laboratory of Microbiology and Parasitology, Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China.
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