Yunfei Liu

Systematic investigations of biological development trajectories among ethnic minority adolescent populations are crucial for advancing health equity within the context of the Sustainable Development Goals [1,2]. Age at menarche (AAM) is a widely used marker of female pubertal development and is associated with socioeconomic, nutritional, environmental, and broader ecological conditions [3,4]. Long-term declines in AAM […]

Exploring how multidimensional social factors are linked with adolescent health could inform policies to achieve equitable and sustainable well-being. We aimed to examine the associations between adolescent health and three dimensions of social development globally. We conducted a global ecological analysis across 193 countries using data from the Global Burden of Disease 2021. We analysed age-standardised DALY rates (ASDR) for adolescents aged 10–24 years (2010–2035) in relation to well-being (human development index (HDI)), inclusion (gender inequality index (GII)), and sustainability (adjusted net savings (ANS)). We performed the main analyses using data from 2010 to 2021. We generated forecasts to 2035, presented as scenario analyses, using autoregressive integrated moving average models, and log-linear regressions were used to estimate associations and temporal trends. Global adolescent ASDR declined from 14 280.1 (95% uncertainty interval (UI) = 14 264.3, 14 296.0) in 2010 to 13 260.5 (95% UI = 13 245.2, 13 275.8) in 2021, and is forecasted to be 11 187.7 (95% UI = 11 173.8, 11 201.6) per 100 000 by 2035. HDI showed attenuating negative associations with all-cause ASDR (rate ratio (RR) = 0.79; 95% confidence interval (CI) = 0.74, 0.84 in 2010 vs. RR = 0.84; 95% CI = 0.79, 0.89 in 2021), with further attenuation in the scenario analysis to 2035 (RR = 0.92; 95% CI = 0.88, 0.96). GII demonstrated strengthening positive associations (RR = 1.09; 95% CI = 1.02, 1.15 in 2010 vs. RR = 1.11; 95% CI = 1.06, 1.17 in 2021), with further strengthening in the scenario analysis (RR = 1.15; 95% CI = 1.11, 1.20). ANS showed no significant associations in 2010 or 2021, but showed emerging associations with the adolescent health burden of non-communicable diseases (NCDs) in NCD-predominant countries. While gains in well-being were linked to reduced adolescent health burden, this relationship appeared to attenuate in our main analysis between 2010 and 2021 and the scenario analysis for 2035. Inclusion shows increasingly strong associations with the adolescent health burden across diseases, and sustainability is emerging in developed regions. Findings indicate the benefits of equity-focused, intersectoral policies that promote inclusive development and intergenerational justice.

Objectives: This study aimed to explore whether the association of lifestyle behaviors with mental well-being differed by sports app use among college students, while also examining differences by sex. Methods: A total of 38,738 Chinese college students aged 19–22 years from a nationally cross-sectional survey in 2019 were included in this study. The Warwick Edinburgh Mental Wellbeing Scale was applied to evaluate mental well-being. Clustered lifestyle behaviors were defined as unfavorable (zero to two healthy factors), intermediate (three healthy factors), or favorable (four to five healthy factors). The use of sports apps was classified as dichotomized frequently (sometimes and often) and infrequently (never, rarely, and occasionally). Log-binomial regression was used to investigate the associations. Results: Intermediate (PR = 1.14, 95% CI: 1.11–1.18) and unfavorable (PR = 1.29, 95% CI: 1.26–1.33) lifestyles were positively associated with low mental well-being. Infrequently using sports apps was associated with low mental well-being (PR = 1.08, 95% CI: 1.06–1.10). The magnitude of the association between an unfavorable lifestyle and low mental well-being was smaller among girls who frequently used sports apps (PR = 1.22, 95% CI: 1.16–1.27) than among those who used them infrequently (PR = 1.31, 95% CI: 1.24–1.38). Conclusion: These findings suggest that integrating engagement with digital sports apps into campus health promotion strategies might help support mental well-being, especially for college students with multiple unhealthy lifestyle behaviors.

Background/Objectives: The potential of outdoor physical activity as an intervention strategy to promote height growth velocity via stimulating growth hormone secretion and vitamin D synthesis has been scarcely investigated. The present study aimed to investigate the associations between outdoor physical activity duration and height growth velocity, and differences in gender, age, exposure time period (daily, school days vs. weekends), and body mass index (BMI) category. Methods: We performed a secondary analysis of longitudinal data from the 2019–2020 Chinese National Survey on Students’ Constitution and Health. The analytic sample included 5029 adolescents aged 9–18 years. High or low height growth velocity was defined as sex- and age-specific percentiles. Associations of high height growth velocity with outdoor activity duration (≥1 h, ≥2 h) on school days and weekends were investigated using multivariable logistic regression models. Analyses were stratified by sex, age group (9–12, 13–15, 16–18 years), and BMI category (normal weight, overweight, and obese). Results: Results from this cross-sectional analysis indicate that ≥1 h of daily outdoor physical activity is significantly associated with higher height growth velocity among normal-weight boys aged 9–15 years (OR range: 1.71–2.01) and girls aged 9–12 years (OR = 1.68). The positive association increased with ≥2 h (ORs up to 7.96). Consistently positive associations were found for activity during the school day compared to weekends. No significant associations were found in overweight and obese children. Conclusions: Ensuring adequate daily outdoor physical activity—especially on weekends—for at least two hours may be an important potential strategy to promote height growth in normal-weight children and adolescents. Interventions should consider differences in weight status and timing of activity.

Background/Objectives: The potential of relative grip strength as a biomarker for cardiovascular risk in college students is not well understood. Methods: Blood pressure status and grip strength metrics were analysed with multivariate logistic regression and restricted cubic spline models, utilising nationwide cross-sectional data from 42,591 Chinese college students. Results: After adjustment, higher absolute grip strength increased hypertension risk (High-level OR = 2.66; 95% CI: 2.21–3.20). In contrast, higher relative grip strength not only reduced risk overall (High-level OR = 0.41; 95% CI: 0.36–0.46) but also demonstrated consistent protective effects across all BMI subgroups (e.g., OR = 0.83 in overweight/obese individuals). Conclusions: Relative grip strength may present a valuable biomarker for cardiovascular risk assessment and the easy identification of at-risk individuals in all BMI categories.

Objective: To describe the secular trends of cause-specific mortality among adolescents aged 10 to 24 years from 2004 to 2019 and explore the association between mortality and economic status, education level as well as health investment. Methods: Mortality data of adolescents aged 10 to 24 years were obtained from the national disease surveillance points system. The age-standardized mortality rate (ASMR) was calculated by using the population data from the sixth national population census in 2010. GDP per capita, urbanization rate, illiteracy rate of the population over 15 years old, government education expenditure per capita, number of health service providers per 1000 people, and number of health beds per 1000 people were collected from China’s Economic and Social Big Data Research Platform. Age-period-cohort analysis was used to analyse the net age, period, and cohort effects of mortality among adolescents, while panel data regression was used to explore the association between mortality and economic status, education level as well as health investment. Results: Overall, the ASMR was 28.84 per 100,000 and the top five causes of mortality were road injuries, drowning, intentional self-harm and sequelae, leukaemia, and falls among adolescents aged 10 to 24 years in China in 2019. All-cause mortality declined with an annual percentage change of 4.02% (95% Confidence interval: 3.74% to 4.30%) from 2004 to 2019 yet with persistent differences across different demographic (gender and age) and geographical (urban-rural, and regional) subgroups. Notably, the ASMR for HIV/AIDS in males, lower respiratory infections in urban adolescents, and iron deficiency anaemia as well as cervical cancer in adolescents aged 20 to 24 years showed an increase over time. The multivariate panel data regression showed that the ASMR decreased by 5.18 (3.27, 7.08) per 100,000 for every increase in the number of health beds per 1000 population, but with insignificant association with GDP per capita and illiteracy rate in the total sample. Health beds investment was positively associated with ASMR at almost all subgroups except for adolescents aged 10 to 14 years; GDP per capita increase was helpful to males and rural adolescents while an increasing literacy rate was beneficial for females and adolescents aged 15 to 19 years. Conclusion: Given the persistent differences between subgroups, further investments including improving health services, especially increasing health bed investment, GDP per capita, and reducing the illiteracy rate and concern for adolescents in males, rural areas, the western regions, and aged 15 to 24 years are needed. Additionally, the increased burden of some diseases, such as HIV/AIDS, must be of further concern.

Background: Evidence in adults suggests that exposure to artificial light-at-night (ALAN) leads to obesity. However, little is known about whether this effect exists in children and adolescents. We aimed to investigate whether ALAN exposure was associated with overweight and obesity in school-aged children and adolescents and whether this association varied with socioeconomic status. Methods: Data on the height and weight of 129,500 children and adolescents aged 10–18 years from 72 cities were extracted from the 2014 Chinese National Survey on Students’ Constitution and Health (CNSSCH). The ALAN area percentage and average ALAN intensity were calculated using the Visible/Infrared Imager/Radiometer Suite. The subjects were separated into three categories based on the cities’ gross domestic product per capita (GDPPC). A mixed-effect logistic regression model and generalized additive model (GAM) were utilized to evaluate the association between ALAN exposure and overweight and obesity in children and adolescents stratified by municipal GDPPC. Results: Both ALAN area (OR = 1.194, 95% CI: 1.175–1.212) and ALAN intensity (OR = 1.019, 95% CI: 1.017–1.020) were positively associated with overweight and obesity in children and adolescents, and the associations remained robust after adjusting for covariates. ORs for overweight and obesity and ALAN area decreased as GDPPC level increased (first tertile: OR = 1.457, 95% CI: 1.335–1.590; second tertile: OR = 1.350, 95% CI: 1.245–1.464; third tertile: OR = 1.100, 95% CI: 1.081–1.119). Similar results were observed for ALAN intensity. In the GAM models, thresholds existed in almost all these spline trends, indicating that ALAN might have a nonlinear association with overweight and obesity. Conclusions: ALAN contributed to the development of overweight and obesity in children and adolescents and this effect differed with GDPPC. Future longitudinal studies should confirm the causal relationship between ALAN and obesity. Moreover, reducing unnecessary exposure to artificial light at night may have beneficial implications for controlling childhood and adolescent obesity, particularly in low-income areas.

Background: Due to the adverse effects of cardio-metabolic risk factors (CMRFs) in children and adolescents on their current and later life health, and the growing evidence that birth weight and lifestyle have on CMRFs, we aimed to estimate the combined effect of birth weight and lifestyle on clustered CMRFs in children and adolescents. Methods: We enrolled 11,509 participants aged 7–18 years old in a national school-based cross-sectional study in seven provinces in China in 2013. Information on CMRFs was collected through anthropometric measurements and blood sample testing. Information on birth weight, lifestyle and other basic information were investigated through children and adolescents’ as well as parents’ questionnaires. The generalized linear mixed model was applied to estimate the odd ratio (OR) and 95% confidence interval (95% CI) for the associations between CMRFs, clustered CMRFs and birth weight, lifestyle, and the combinations of birth weight and lifestyle. Results: Overall, the prevalence of clustered CMRFs was 3.6% in children and adolescents aged 7–18 years, higher in boys (4.4%) than girls (2.9%). The combination of LBW/ideal lifestyle (OR = 2.00, 95% CI: 1.07–3.72) was associated with higher risk of clustered CMRFs, as well as in adolescents aged 13–18 years and in boys. The combination of HBW/poor lifestyle (OR = 1.74, 95% CI: 1.13–2.68) was related to elevated risk of clustered CMRFs, especially in children aged 7–12 years. Conclusions: CMRFs in Chinese children and adolescents is concerning, ideal lifestyle could weaken the association of birth weight with clustered CMRFs, especially in younger age, indicating that programs to prevent abnormal birth weight or poor lifestyle or both among children and adolescents may reduce CMRFs in China.