Associations between Problematic Smartphone Use, Unhealthy Behaviors, and Mental Health Status in Korean Adolescents: Based on Data from the 13th Korea Youth Risk Behavior Survey (2017)

Mobile phone addiction and suicide behaviors among Chinese adolescents: The mediation of poor sleep quality

Background and aims

Mobile phone addiction (MPA) is emerging among adolescents, especially during the COVID-19 pandemic. Nevertheless, there is a dearth of knowledge regarding the correlation between MPA and suicide behaviors and its mechanism. The objective of the current study is exploring the direct effect of MPA on suicide behaviors and the indirect effect through poor sleep quality.

Methods

A total of 18,900 Chinese adolescents aged 12 to 18 were recruited via a multi-stage cluster sampling method.

Results

The prevalence of MPA and poor sleep quality was 26.2 and 23.1%, respectively. During the past year, 24.4% participants were involved in suicide behaviors. Specifically, suicide ideators, suicide planners, and suicide attempters were 10.7, 8.4, and 5.3%, respectively. Particularly, rural females had the highest prevalence of suicide behaviors, MPA, and poor sleep quality. Logistic regression analysis showed that MPA was significantly associated with suicide ideators (OR = 1.22, 95% CI: 1.09-1.37, p < 0.001) and planners (OR = 1.18, 95% CI: 1.04-1.34, p < 0.05), but not for suicide attempters (p > 0.05). Structural equation modelling demonstrated that MPA had direct effect on suicide behaviors (β = 0.145, 95% CI = 0.127-0.160), and poor sleep quality partially mediated the relationship (the mediating ratio was 46.7%). The mediating ratio of poor sleep quality was the highest in urban males.

Conclusions

MPA has both direct and indirect effects on suicide behaviors. For suicide prevention, limited mobile phone use and improvement sleep quality may be practical for adolescents. Additionally, more efforts of intervention could give priority to rural girls.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Association between smartphone usage and health outcomes of adolescents: A propensity analysis using the Korea youth risk behavior survey

OBJECTIVES

We aimed to investigate the association between smartphone use and adverse behavioral health outcomes using nationwide Korea Youth Risk Behavior Web-based Survey data for 2017 and 2020.

METHODS

The 2020 data (N = 54,809) were used to analyze the relationships between daily smartphone usage time (non-user, 0-2 h [hour], 2-4 h, 4-6 h, 6-8 h, and > 8 h), and adverse health outcomes (stress, sleep, depression, suicide, substance use, and smartphone overdependence). A 1:1 propensity score matching (PSM) was used to control for confounding variables.

RESULTS

A total of 40,998 adolescents with < 4 h/day and > 4 h/day of usage were included. Adolescents' mean smartphone usage time in 2020 increased compared to that in 2017 (weighted % of > 2 h/day; 64.3% vs. 85.7%). The curvilinear relationships between smartphone usage time and adverse health outcomes were prominent after > 4 h/day. Adolescents using smartphones 2-4 h/day showed no increased adverse health outcomes compared to non-users, except for smartphone overdependence. Using a smartphone > 4 h/day was significantly associated with stress perception (1.16; 1.11-1.22), suicidal ideation (1.22; 1.13-1.31), and substance use (alcohol, 1.66; 1.57-1.75) after PSM.

CONCLUSIONS

Our study demonstrated the curvilinear relationship between smartphone usage time and adverse health outcomes in adolescents. Our findings can help establish smartphone usage guidelines for adolescents.

Mental health of South Korean adolescents in the COVID-19 Era: Web-based survey focused on suicide-related factors

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted many aspects of life. Measures for preventing the spread of COVID-19 (e.g., school lockdowns, remote and hybrid classes, group and outdoor activity restrictions, and social distancing in the classroom and meal time) could have led to adolescents to experience anxiety and depressive symptoms. Such mental health impacts could increase the risk of suicidal ideation in this population. Moreover, according to a report by the Organization for Economic Co-operation and Development, although the total number of suicide deaths in South Korea decreased in 2021, the suicide rate of those aged 10-29 years increased. One factor affecting the result is adolescent mental health by COVID-19. This study examines the mental health status of South Korean adolescents amid the prolonged COVID-19 pandemic, and identifies and analyzes predictors of suicidal ideation, suicide planning, and suicide attempts.

METHODS

The study used data from 54,948 adolescents who participated in the 2020 Korea Youth Risk Behavior Web-based Survey. Based on their responses to suicide-related questions, the sample was divided into a healthy group, suicide-ideation group, suicide-planning group, and suicide-attempt group. The descriptive statistics of these groups were then analyzed. An analysis of covariance, post-hoc tests, and multiple logistic regression analysis were performed on the four groups.

RESULTS

Overall, 6.9% of the participants reported suicidal ideation, 2.2% reported planning suicide, and 1.9% reported attempting suicide in the previous 12 months.

CONCLUSIONS

During the prolonged COVID-19 pandemic, there is a strong need for various individualized programs that identify and intervene to support adolescents at risk of suicide by accurately assessing their mental health risk factors, such as stress, sadness and despair, loneliness, and generalized anxiety disorder. Accordingly, it is necessary to develop and distribute a mental health and well-being curriculum, strengthen suicide prevention programs and support services, expand mental health diagnostic tests, and school-based mental health programs.

A longitudinal study of protective factors against substance use in early adolescence. An ecological approach

BACKGROUND

Adolescent substance use has been widely related to different individual, school, family and community factors. Yet, the number of studies with all these variables together in a model from an ecological perspective is still low, and they rarely used a longitudinal design. The aim of this study was to explore, from an ecological perspective, the prospective impact of different individual, school, family and neighbourhood factors on adolescent substance use.

METHODS

This was a longitudinal study with a one-year follow up. There were 881 participants (M_age = 12.57; 48.1% females) at wave 1, of which 686 (M_age = 13.51; 51.8% females) were followed-up at wave 2. Validated questionnaires were used for data collection.

RESULTS

Regression analyses showed that higher substance use was predicted by high family socio-economic status cross-sectionally and longitudinally, and it was related to low neighbourhood socio-economic status cross-sectionally only. Participants who disliked school and had a poor academic performance were more likely to use substances, both cross-sectionally and longitudinally.

CONCLUSIONS

The inclusion of families in substance use prevention programmes could be a key component in these interventions. Moreover, promotion of a positive school climate could protect adolescents from using substances.

Developmental trajectories of tobacco use and risk factors from adolescence to emerging young adulthood: a population-based panel study

Background

Adolescence to young adulthood is a critical developmental period that determines lifelong patterns of tobacco use. We examined the longitudinal trajectories of tobacco use, and risk factors for its use, and explored the association between the trajectories of mobile phone dependency and smoking throughout the life-course among adolescents and young adults.

Methods

Data of 1,723 subjects (853 boys and 870 girls) were obtained from six waves of the Korean Children and Youth Panel Survey (mean age = 13.9–19.9 years). To identify trajectories of smoking and mobile phone dependency, group-based trajectory modelling (GBTM) was conducted. A multinomial logistic regression analysis was performed to identify the characteristics of the trajectory groups.

Results

GBTM identified four distinct smoking trajectories: never smokers (69.1%), persistent light smokers (8.7%), early established smokers (12.0%), and late escalators (10.3%). Successful school adjustment decreased the risk of being an early established smoker (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.27–0.78). The number of days not supervised by a guardian after school was positively associated with the risk of being an early established smoker (OR 1.96, 95% CI 1.23–3.13). Dependency on mobile phones throughout the life-course was positively associated with the risk of being a persistent light smoker (OR 4.04, 95% CI 1.32–12.34) or early established smoker (OR 8.18, 95% CI 4.04–16.56).

Conclusions

Based on the group-based modeling approach, we identified four distinctive smoking trajectories and highlight the long-term effects of mobile phone dependency, from early adolescence to young adulthood, on smoking patterns.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14070-3.

Social Media and Children's and Adolescents' Diets: A Systematic Review of the Underlying Social and Physiological Mechanisms

The association between social media (SM) and children's and adolescents' diet is poorly understood. This systematic literature review aims to explore the role of SM in children's and adolescents' diets and related behaviors, considering also the underlying mechanisms. We searched Medline, Scopus, and CINAHL (2008-December 2021) for studies assessing the relation of SM exposure with food intake, food preference, dietary behaviors, and the underlying mechanisms (e.g., brain activation to digital food images-as proxy for SM food images) among healthy children and adolescents aged 2-18 y. A total of 35 articles were included. Of 4 studies, 1 found that exposure to peers' videos on healthy eating, but not SM influencers', increased vegetable intake. Most studies reported that SM was associated with skipping breakfast, increased intake of unhealthy snacks and sugar-sweetened beverages, and lower fruit and vegetable intake, independent of age. Children and adolescents exposed to unhealthy compared with healthy digital food images showed increased brain response in reward- and attention-related regions. The mechanisms underpinning the abovementioned associations were 1) physiological (appetitive state, increased neural response to portion size and energy density of food depicted) and 2) social (food advertising via SM influencers and peers). SM exposure leads to unfavorable eating patterns both in children and adolescents. The identified mechanisms may help tailor future health interventions. Downregulating SM advertising and limiting SM exposure to children and adolescents may improve food intake and subsequent health outcomes. The protocol of this review was registered in PROSPERO as CRD42020213977 (https://www.crd.york.ac.uk/prospero/).

Longitudinal Effects of Stressful Life Events on Problematic Smartphone Use and the Mediating Roles of Mental Health Problems in Chinese Undergraduate Students

Background and Aims: This three-wave longitudinal study investigated the effects of stressful life events on problematic smartphone use and the mediating roles of mental health problems (i.e., depressive symptoms, poor sleep quality, and suicidal ideation) in Chinese undergraduate students. Methods: A total of 197 undergraduate students completed the three-wave surveys. Their severity of stressful life events, mental health problems, and problematic smartphone use were assessed. Results: Regression analyses revealed that stressful life events at T1 was significantly associated with problematic smartphone use at T3. Mediation analyses showed that mental health problems (i.e., depressive symptoms, poor sleep quality, and suicidal ideation) at T2 fully mediated the association between stressful life events at T1 and problematic smartphone use at T3 (B = 0.042, 0.034, and 0.022, respectively). Conclusions: The present study revealed that stressful life events and mental health problems (i.e., depressive symptoms, poor sleep quality, and suicidal ideation) are predictors of problematic smartphone use in Chinese college students.