To explore the independent and interactive effects of school green space exposure and outdoor activity duration on screening myopia among primary and secondary school students, so as to provide theoretical support for the prevention and control of screening myopia in children and adolescents.

From September to November 2023, 117 487 primary and secondary school students from 497 schools were selected using a cluster random sampling method, covering 98 counties (cities, districts) in Jiangsu Province. Data on the students' screening myopia status and associated health-influencing factors were collected and analyzed. School green space exposure was quantified using the normalized difference vegetation index (NDVI), which was extracted with ArcGIS Pro software; meanwhile, information on students' outdoor activity duration was gathered through self-reported questionnaires. Multivariate Logistic regression was applied to assess the independent and interactive effects of green space exposure and outdoor activity duration on screening myopia among primary and secondary school students.

Univariate analysis showed that there were statistically significant differences in screening myopia detection rates among primary and secondary school students of different genders, NDVI groups, every outdoor activity duration, monitoring points, school stages, parents' educational level, and whether they lived on campus or had parents with screening myopia (χ²=88.91-1 950.08, all P < 0.05); as the school age and sedentary time increased, the detection rate of screening myopia in primary and secondary school students also increased (χ_trend²=8 410.15, 2 028.91, both P < 0.05). Independent effects showed that compared to the low NDVI group, the medium and high NDVI groups had lower risks of screening myopia (OR=0.93, 0.95, both P < 0.05). Compared to those with outdoor activity duration < 2 h/d, students with outdoor activity duration≥2 h/d had a lower risk of screening myopia (OR=0.96, P < 0.05). When stratified by school level, compared to the low NDVI group, the medium NDVI group had lower risks of screening myopia in primary and junior high schools (primary school: OR=0.91; junior high school: OR=0.88, both P < 0.05). Compared to those with outdoor activity duration < 2 h/d, junior high school students with outdoor activity duration≥2 h/d had a lower risk of screening myopia (OR=0.90, P < 0.05). When stratified by monitoring site, urban primary and secondary school students in the medium and high NDVI groups and those with outdoor activity duration≥2 h/d had lower risks of screening myopia (OR=0.92, 0.92, 0.93, all P < 0.05). Interactive effects showed that when medium or high NDVI was combined with outdoor activity duration≥2 h/d, the risks of screening myopia among primary and secondary school students were lower (medium NDVI×≥2 h/d: OR=0.89; high NDVI×≥2 h/d: OR=0.89, both P < 0.05), and the combined effect was superior to that of a single factor.

Green space exposure and outdoor activity duration have negative correlations with screening myopia among primary and secondary students, and the combined effect is better than that of a single factor.

To investigate the latent classes, transition patterns and influencing factors of bullying victimization among rural junior high school students in Guangxi, so as to provide a theoretical basis for prevention and intervention strategies of school bulling.

In May 2024 (T1), 1 667 students from three rural junior high schools in Guigang and Qinzhou of Guangxi were selected by using convenience cluster sampling to complete the Delaware Bullying Victimization Scale-Student (DBVS-S), Childhood Trauma Questionnaire, School Connectedness Scale and Brief Resilience Scale. In May 2025 (T2), the DBVS-S was readministered. Latent transition analysis was employed to identify the best latent class model of bullying victimization at two time points and to examine the stability and transition characteristics of victimization types. Multinomial Logistic regression was further applied to examine the predictive effects of childhood trauma, psychological resilience, and school connectedness on transitions between bullying victimization categories.

Two distinct patterns of bullying victimization among rural junior high school students were identified at both time points: a low victimization group (91.8% at T1, 93.5% at T2) and a traditional victimization group(high scores in the dimensions of verbal, physical and relational bullying)(8.2% at T1, 6.5% at T2). The low victimization group showed a stability probability of 95.7%, while 59.1% of the traditional victimization group transitioned to the low victimization group. Using the subjects remaining in the original group as a reference, factors associated with increased likelihood of transitioning to or remaining in the traditional victimization group included being male (OR=2.05), emotional abuse (OR=1.21), and physical neglect (OR=1.11)(all P < 0.05). In contrast, psychological resilience and school connectedness were associated with reduced probability of the transition victimization group (OR=0.88, 0.94)(both P < 0.05). Additionally, emotional abuse decreased the probability of transitioning back to low victimization (OR=0.88), whereas psychological resilience increased the probability of students transitioning to the low bulling victim group (OR=1.09) (both P < 0.05).

Group heterageneity is evident in the school bullying victimization among rural junior high school students in Guangxi, and childhood trauma, psychological resilience and school connectedness are important predictors of the transformation of school bullying victim categories.

To investigate the association between outdoor light at night (LAN) exposure and sleep quality among primary and secondary school students, and to examine the pathways of negative affects including depressive, stress and anxiety symptoms, so as to provide a theoretical basis for optimizing the school environment and enhancing the physical and mental well-being of students.

In December 2024, a total of 36 885 students from 154 primary and secondary schools in Suzhou, Nantong, and Changzhou were included via a stratified cluster sampling method. Sleep quality and negative affect were assessed by using the Pittsburgh Sleep Quality Index (PSQI), Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 (GAD-7), and Depression, Anxiety and Stress Scale-21 (DASS-21), respectively. Outdoor LAN exposure data were obtained from the national polar-orbiting partnership visible infrared imaging radiometer suite nighttime light(NPP-VIIRS NTL) dataset provided by the National Earth System Science Data Center. Multivariate Logistic regression model was employed to analyze the association between LAN exposure and sleep quality across different regions, with stratification by monitoring site. Spearman correlation analysis was used to examine the relationships between LAN, negative affect, and sleep quality. The mediating role of negative affect was tested by using Model 4 of the PROCESS macro.

The detection rates among students were 13.95%(n=5 147) for depressive symptom, 16.72%(n=6 166) for stress symptom, and 17.49%(n=6 451) for anxiety symptom. The median outdoor LAN exposure was 28.85(19.10, 41.44)nW/(cm² · sr). After adjusting for confounders, multivariate Logistic regression analysis showed that high LAN exposure (Q4) was positively associated with sleep problems (urban areas: OR=1.28, 95%CI=1.17-1.41; rural areas: OR=1.21, 95%CI=1.07-1.36; both P < 0.05). Spearman correlation analysis revealed significant positive correlations between LAN exposure, depressive symptoms, stress symptoms, anxiety symptoms, and sleep quality (r=0.03-0.75, all P < 0.01). The mediation analysis indicated that all dimensions of negative affect significantly mediated the relationship between high LAN exposure and poor sleep quality (all P < 0.01). Specifically, the indirect effects were 0.03 (95%CI=0.02-0.05) for depressive symptom, 0.05(95%CI=0.03-0.08) for stress symptom, and 0.07(95%CI=0.05-0.09) for anxiety symptom. Overall, 31.9% of the total effect was mediated by negative affect, with anxiety (14.89%) being the strongest mediator, followed by stress (10.64%) and depression(6.38%).

Reducing high levels of outdoor LAN exposure and implementing interventions targeting negative affect may contribute to improved sleep quality among primary and secondary school students.

To analyze the association of participation in non-sports extracurricular tutoring classes with the prevalence of screening myopia, axial length (AL) and axial length to corneal radius ratio (AL/CR) among primary school students, so as to provide evidences for formulating myopia prevention and control policies.

In December 2024, combination of convenience and cluster sampling method was used to select 2 273 students from two primary schools in Hefei City, Anhui Province. Ophthalmic examinations and questionnaire surveys were conducted to obtain information on myopia, AL, AL/CR and participation in various types of extracurricular tutoring. A binary Logistic regression model was used to analyze the association between non-sports tutoring and screening myopia, and multiple linear regression models were used to examine the associations between non-sports tutoring and AL and AL/CR.

Among the surveyed students, the participation rate in non-sports extracurricular tutoring classes was 64.9%, and the overall prevalence of screening myopia was 39.1%. The average AL and AL/CR were (23.60±1.01) mm and (3.00±0.12), respectively. Univariate analysis showed that students who attended non-sports, music, or academic tutoring classes for ≥2 h per week had higher risks of screening myopia and greater AL/CR values than non-participants (screening myopia: OR=1.38, 1.82, 1.55; AL/CR: β=0.01, 0.03, 0.03; all P < 0.05). After adjusting for sex, grade, and participation in sports tutoring, multivariate analysis indicated that participation in non-sports and musical instrument tutoring classes for ≥2 h per week remained significantly associated with higher risks of screening myopia (OR=1.26, 1.49, both P < 0.05). Multiple linear regression showed that participation in musical instrument tutoring for ≥2 h per week was positively correlated with AL (β=0.14, P < 0.05).

s Participation in non-sports extracurricular tutoring is common among primary school students. Attending non-sports tutoring classes for ≥2 h per week increases the risk of screening myopia.

To analyze the changes in classroom lighting environment of schools in Suzhou and their impact on refractive progression among primary and secondary school students, so as to provide the basis for accurate provention and control of myopia.

A baseline investigation was conducted in October 2022 by using a stratified cluster random sampling method to recruit primary and secondary school students from Suzhou.A follow-up visit was performed in October 2023.A total of 12 302 students and 360 classrooms that participated in both surveys were included analysis.The visual acuity progression over one year and classroom lighting conditions were assessed.Group comparisons were performed by using the Wilcoxon or Kruskal-Wallis rank-sum, and Chi-square tests.Multivariate Logistic regression was employed to identify the major factors influencing refractive changes.

The compliance rate of average illuminance on classroom blackboard surface increased from 72.22% to 75.28%, while the compliance rate of average illuminance on desks decreased from 89.44% to 87.22%, the overall myopia rate among students rose from 59.63% to 66.99% from 2022 to 2023.The average annual progression of equivalent spherical power (SE) in the right eye of students was-0.25(-0.75, 0.06) D.Significant statistical differences were observed in the annual mean changes across different school levels, regions, baseline refractive statuses, and classroom lighting environment change groups (Z/H=316.59, -8.27, 38.80, 51.01, all P < 0.05).Multivariate Logistic regression analysis showed that pre-myopia, low myopia, junior high school, senior high school, vocational high school, and improved classroom lighting environment were protective factors of reducing the risk of rapid progression in refractive error (OR=0.58, 0.69, 0.81, 0.50, 0.28, 0.82, all P < 0.05).Conversely, female students and rural students had higher risks of rapid myopia progression (OR=1.09, 1.42, both P < 0.05).

Over one-year follow-up, the complance rate of classroom lighting indicators in Suzhou remaines stable, while students'refractive status shows a trend toward myopia.Improving classroom lighting environment can reduce the risk of rapid myopia progression.

Based on the theoretical framework of Risk Perception-Efficacy Appraisal-Behavioral Response, the study aims to explore the group heterogeneity in high-temperature health risk perception and behavioral responses among college students in Chongqing, so as to provide a scientific basis for implementing differentiated health interventions.

A multi-stage cluster sampling method was used to select 856 students from five universities in Chongqing.Data were collected using a validated questionnaire.One-way analysis of variance and independent samples t-test were used to analyze individual differences, Pearson correlation analysis was employed to examine relationships between variables, multiple linear regression was used to identify influencing factors, a structural equation model was constructed to validate the theoretical pathways, and the Bootstrap method was applied to test mediating effects.

In the risk perception dimension, the severity score of high-temperature health hazards among college students (3.28±0.89) was higher than that of susceptibility score (2.94±0.93).Efficacy appraisal showed that the response efficacy score was the highest (3.91±0.81).In behavioral responses, adaptive behaviors were most prominent (5.43±2.75), while emergency preparedness behaviors were the lowest (2.71±1.33).The structural equation model validated the pathway of "threat appraisal → efficacy appraisal → behavioral response" (χ²/df=2.49, RMSEA=0.05).Self-efficacy played a fully mediating role between threat appraisal and behavioral response, with a mediation effect value of 0.10(95%CI=0.02-0.19).K-means cluster analysis categorized the subjects into three groups, with the core barriers to behavior being economic constraints (22.3%), lack of motivation (34.8%), and insufficient cognition (34.1%), respectively.

Decision-making regarding high-temperature health behaviors among college students follows psychological pathway of "cognition-appraisal-action" with self-efficacy serving as a key mediating variable driving behavioral change.Targeted interventions should be implemented for groups with different characteristics.

To analyze the iodine nutritional status of children aged 8-10 in Baoshan City, so as to comprehensively evaluate the effectiveness of eliminating and consolidating iodine deficiency disorders in Baoshan City.

From 2018 to 2024, a stratified random sampling method was used to sample 7 363 non-boarding children aged 8-10 from 35 survey sites in 5 counties of Baoshan City (Longyang County, Shidian County, Changning County, Tengchong City, Longling County).The salt iodine content and urinary iodine concentration were detected, and the thyroid volume of children was measured by ultrasound.Group comparison was conducted by using Mann-Whitney U test, Kruskal-Wallis H test, and Chi-square test.Spearman rank correlation analysis was used to investigate the correlation of salt iodine, urinary iodine and thyroid volume.

A total of 7 361 samples of household edible salt for children were detected.The iodized salt coverage rate was 99.70%, the qualified iodized salt consumption rate was 97.02%.The proportion of unqualified iodized salt fluctuated and decreased from 3.14% in 2018 to 2.14% in 2024.The median iodine content of household edible salt for children was 23.70(21.60, 25.80) mg/kg.The median urinary iodine of children was 217.41(152.40, 294.59)μg/L, and the proportions of iodine deficiency, adequate iodine, and iodine excess were 9.75%, 66.66%, and 23.58%, respectively.There were statistically significant differences in the median urinary iodine of children among different years, ages, genders and before and after the supply of non-iodized salt (Z/H=134.88, 11.04, -4.28, -2.66, all P < 0.01).An average thyroid volume of children was 3.32(2.77, 3.93) mL, with a goiter rate of 1.91%.Before and after the implementation of non-iodized salt supply in Baoshan City in 2023, there were no statistically significant differences in the median iodine content of household edible salt and the goiter rate of children (Z/χ²=-1.54, 3.25, both P>0.05), but there were statistically significant differences in the qualified status of iodized salt, the median urinary iodine, and the frequency distribution of urinary iodine (χ²/Z=15.53, -2.66, 10.14, all P < 0.05).Salt iodine was positively correlated with urinary iodine (r=0.04) and negatively correlated with thyroid volume (r=-0.07), and urinary iodine was negatively correlated with thyroid volume (r=-0.03)(all P < 0.05).The thyroid volume of children consuming iodized salt was larger than that of children consuming non-iodized salt (H=9.99), and there were statistically significant differences in thyroid volume among children with different urinary iodine levels (H=15.13)(both P < 0.01).

From 2018 to 2024, the overall iodine nutritional level of children aged 8-10 in Baoshan City is at an adequate level.The elimination status of iodine deficiency disorders has been continuously consolidated.

To analyze the correlation between the levels of vitamin A, vitamin D, vitamin E with body fat mass percentage (FMP) as well as lifestyle factors among primary school students, so as to provide references for exploring the vitamin nutritional status of primary school students and its potential influencing factors.

From September 1 to October 30, 2021, a cluster sampling method was used to select 750 third-grade students from eight primary schools in Luohu District, Shenzhen.Their body composition was measured, and blood samples were collected to detect the serum levels of vitamin A, vitamin D, and vitamin E using a mass spectrometer.Dietary and exercise habits were collected through questionnaires.Mann-Whitney U test and Kruskal-Wallis H rank sum test were used for inter-group comparisons, spearman correlation was used for correlation analysis, and Logistic regression model was used to analyze the association between lifestyle and vitamin content.

The overall level of vitamin A in school-aged children was 0.4(0.4, 0.5) mg/L, with a deficiency rate of 0 and a marginal deficiency rate of 5.1%;the level of vitamin D was 26.0(22.0, 30.0) ng/mL, with a deficiency rate of 0.4% and an insufficiency rate of 12.7%;the content of vitamin E was 11.8(10.1, 13.5) mg/L, with an insufficiency rate of 0.8%.Spearman correlation analysis showed that vitamin A was positively correlated with FMP in the total population, boys, girls, and normal weight population (r=0.18, 0.18, 0.20, 0.10), and vitamin D was positively correlated with FMP in the total population and obese population (r=0.08, 0.16)(all P < 0.05).Logistic regression analysis showed that marginal deficiency of vitamin A was associated with consumption of animal, snack, and dairy/egg/bean foods (OR=0.45, 0.55, 0.59);whether vitamin D was deficient was influenced by gender (OR=2.65) and exercise (OR=1.96)(all P < 0.05).

Vitamin A, vitamin D and vitamin E levels are associated with body fat percentage, with significant variations in vitamin status among individuals of different body types, necessitating targeted supplementation.

To investigate the weight loss effect of a comprehensive intervention model combining caloric restriction (CR), physical activity (PA), behavioral therapy (BT), breathing exercise (BE), and functional movement corrective training (FMCT)-referred to as the"CPBBF "model in overweight and obese female college students, so as to provide a reference for scientific weight loss interventions for college students.

From March to May 2022, 46 overweight and obese female college students from Chongqing Water Resources and Electric Engineering College were recruited and randomly divided into an experimental group (24 participants) and a control group (22 participants).The control group received CR (prohibiting ad libitum snacking), PA in the first week, high-intensity interval training (HIIT) for 30 s, and moderate-intensity continuous training (MICT) for 1-5 min alternate 4 sets, duration 15-20 min.From the second week, adjust to HIIT and MICT alternating 3 min each for 5 sets, totaling 30 min, 4 times/week, 70 min/time and BT (60-90 min/session, 3 times/week).The experimental group incorporated FMCT (10-15 min of focused training per session, integrated with PA and daily life) and BE (advocating a gradual transition to proper breathing methods in daily life and low-intensity training, 5 sessions/day, 10 min each).Body oxygen level test (BOLT), Functional Movement Screen (FMS), sports exercise attitude, and body composition indicators were measured at baseline (T0), after 12 weeks of intervention (T1), and after one year of follow-up (T2).The differences were analyzed between groups through generalized estimation equations, and mixed effect model analysis was employed to explore predictive relationships among variables.

The results of the generalized estimation equation showed that time main effects of BOLT values, FMS scores, and exercise attitude among female college students were statistically significant (Wald χ²=18.75, 14.89, 12.45, all P < 0.01);further intragroup comparisons revealed that BOLT, functional motor screening (FMS) scores, and physical exercise attitudeof female college students in the experimental group increased compared to T0, while the control group only showed an increase at T1(all P < 0.05).The group main effects for the aforementioned three indicators were statistically significant (Wald χ²=6.33, 5.21, 4.88), and the time-by-group interactions of BOLT values and FMS scores were also statistically significant (Wald χ²=4.56, 3.97)(all P < 0.05).The time main effects of body weight, body mass index (BMI), and body fat ratio (BFR) in female college students were statistically significant (Wald χ²=44.27, 13.90, 82.33);further intragroup comparisons revealed that the experimental group of female college students showed a decrease in body weight, BMI and BFR at T1 and T2 compared to T0, while the control group only showed a decrease in these indicators at T1(all P < 0.05).The group main effects of weight and BFR were statistically significant (Wald χ²=4.11, 6.46), and the time-by-group interaction of BFR was statistically significant (Wald χ²=8.73)(all P < 0.05).The results of mixed effect model analysis showed that BOLT (β=1.52) and FMS (β=1.81) could both positively predict physical exercise attitude, and physical exercise attitude had statistically significant negative predictive effects on weight, BMI, and BFR (β=-0.08, -0.03, -0.03)(all P < 0.01).

The" CPBBF"comprehensive intervention effectively maintains weight loss effects by modulating the energy compensation mechanism with strong robustness.

To systematically evaluate the prevalence and influencing factors of screen exposure among preschool children in China, so as to provide evidence for formulating scientific intervention strategies.

Retrieve relevant studies on screen exposure among preschool children from PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Literature Database, CNKI, VIP, and Wanfang databases from the time of estaldishment to June 29, 2025.Meta-analysis was performed using Stata 16.0 software.

A total of 43 studies were included.Meta-analysis showed that the prevalence of screen exposure among preschool children in China was 46.0%(95%CI=38.9%-53.1%, P < 0.01).Girls, non-only child, father's age < 35 years, both parents having an educational level of high school or below, being cared for by grandparents, rural residence, parents having no exercise habit, parental support for the use of screen devices, and parental screen time>1 h/d were influencing factors for screen exposure among preschool children[OR(95%CI) were 0.85(0.78-0.92), 1.09(1.04-1.15), 1.45(1.22-1.71), 1.38(1.24-1.54), 1.78(1.32-2.40), 1.39(1.16-1.65), 1.38(1.13-1.69), 1.67(1.40-1.98), 1.70(1.38-2.10), 1.59(1.04-2.43), all P < 0.05].

The prevalence of screen exposure among preschool children in China is relatively high, and relevant child health promotion strategies should be formulated to reduce its occurrence.

To investigate the mediating role of vaccine literacy between vaccine knowledge and vaccine hesitancy and the moderating role of parental education level, so as to provide references for adjusting vaccination strategies.

From May to December 2024, a stratified random sampling method was used to select 10 community hospitals in Guiyang and Zunyi City, Guizhou Province. A total of 1 401 parents of children aged 0-6 years were surveyed regarding their socio-demographic characteristics, vaccine knowledge, vaccine literacy, and vaccine hesitancy levels. Data were analyzed using common method bias tests, Spearman correlation analysis, mediation and moderation effects tests.

The mean score for vaccine knowledge, vaccine literacy and vaccine hesitancy were (2.96±1.11, 14.25±2.64, 39.12±4.93) among the 1 401 participants. Mediating effect analysis showed that both parental vaccine knowledge (β=1.28, 95%CI=1.08-1.49) and vaccine literacy (β=0.75, 95%CI=0.66-0.84) positively predicted vaccine hesitancy (both P < 0.01). Meanwhile, vaccine literacy accounted for 28.1% of the total effect of mediation between knowledge and vaccine hesitancy. In the moderated effects analysis, education level positively predicted vaccine literacy (β=0.40, 95%CI=0.24-0.57), and education level moderated the pathway of vaccine knowledge on vaccine hesitancy (β=0.28, 95%CI=0.05-0.52) (both P < 0.01).

Vaccine literacy partially mediates the relationship between vaccine knowledge and vaccine hesitancy. Parental education level positively moderates the prediction of vaccine knowledge on vaccine hesitancy score.

To develop multiple machine learning models to identify college students at high risk of social network addiction (SNA) and to select key predictors, so as to provide evidences for tiered screening and interventions.

A multi-stage cluster sampling was conducted among 12 541 undergraduates at five universities in Guizhou Province from September to October 2024. The Chinese version of Social Networking Addiction Scale (SNAS-C) was used to classify high-risk individuals. Candidate variables included demographic characteristics, the total scores of Adult ADHD Self-report Scale (ASRS) and the Chinese version of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Self-rated level 1 Cross-cutting Symptom Measure (DSM-5 CCSM), academic stress and academic satisfaction and 24-hour Movement Guidelines. Four machine learning models including multilayer perceptron neural network (MLP), XGBoost, K-nearest neighbors (KNN), and gradient boosting decision trees (GBDT) were trained with an 8∶2 train-test split. Model performance was evaluated using accuracy, recall, F1 score, and the area under the ROC curve (AUC), followed by feature importance analysis.

The detection rate of high-risk SNA was 8.60%, higher in girls (10.10%) than boys (6.74%), with a statistically significant difference (χ²=44.42, P < 0.01). Compared with the low-risk group for SNA, the high-risk group had higher ASRS scores, more severe of depression and anxiety, greater academic stress, and lower academic satisfaction (t=-21.23, -16.12, -16.73, -13.81, 11.58, all P < 0.01). Regarding 24-hour movement behaviors (physical activity, sleep, sedentary/screen time), the high-risk SNA group showed lower compliance rates (11.77%, 5.65%, 57.92%) than the low-risk group (15.57%, 13.16%, 75.32%) (χ²=11.04, 50.72, 154.40, all P < 0.01). All four models demonstrated good discrimination; XGBoost performed the best (accuracy 88.18%, F1=0.881), while KNN achieved the highest AUC (0.90). Feature importance analysis indicated ASRS as the most critical predictor of SNA, followed by academic stress, depression, age, and academic satisfaction.

Machine learning models can effectively identify college students at high risk for SNA. ADHD symptoms, internalizing problems, and academic stress are major risk factors, while 24-hour movement behaviors are key intervention targets, especially sleep and screen time.

To analyze the association of mother-child interaction and screen exposure of preschool children with psychological and behavioural problems, so as to provide guidance for promoting the psychological development of preschool children.

From November to December 2024, a convenience cluster sampling method was used to survey 2 977 mothers of preschool children in Daguan and Yingjiang districts of Anqing City. The Chinese Parent-Child Interaction Scale (CPCIS) was applied to evaluate the quality of mother-child interaction, and the Conners' Parent Symptom Questionnaire (PSQ) was used to assess the psychological and behavioral problems of preschool children. Binary Logistic regression was applied to analyze the association of mother-child interaction, screen exposure and their combined effect on psychological and behavioral problems among preschool children.

The detection rate of psychological and behavioral problems among preschool children was 13.9%. Binary Logistic regression results showed that low scores of mother-child interaction (OR=2.31, 95%CI=1.72-3.11) and high screen exposure (OR=1.52, 95%CI=1.23-1.88) were higher risks for psychological and behavioral problems in preschool children; the results of the combined effect showed that preschool children in low scores of mother-child interaction and low screen exposure group (OR=2.18, 95%CI=1.46-3.28), low scores of mother-child interaction and high screen exposure group (OR=3.13, 95%CI=2.10-4.65) had significantly higher risks of abnormal detection in psychological and behavioral problems, compared to those in the high scores of mother-child interaction and low screen exposure group respectively (all P < 0.05).

Both screen exposure and mother-child interaction are associated with psychological and behavioral problems in preschool children. High-quality mother-child interaction can relieve the adverse effects of screen exposure on preschool children's psychological and behavioral development.

To explore the individual and joint effects of outdoor activities and different types of sedentary behavior on adolescent internalizing behaviors, so as to provide a basis for the prevention and intervention of such behaviors.

From July to December 2023, a stratified cluster random sampling method was used to select 1 691 primary and secondary school students in grades 5-12 from four primary and secondary schools in Baise City. Anonymous surveys were conducted by using the Outdoor Activities Questionnaire, Adolescent Sedentary Activity Questionnaire, and Youth Self-Report. The Chi-square test and Logistic regression analyses were used for statistical analysis.

The detection rate of internalizing behavior among adolescents was 13.13%, and the detection rate of internalizing behaviors in girls (15.53%) was significantly higher than that in boys (10.77%) (χ²=8.39, P < 0.01). Logistic regression analysis showed that outdoor activities ≥1 h/d (OR=0.56), screen-based entertainment sedentary behavior < 2 h/d (OR=0.58), and cultural sedentary behavior < 2 h/d (OR=0.55) significantly reduced the risk of internalizing behaviors (all P < 0.05). Logistic regression analysis of interaction effects revealed that the risks of internalizing behaviors were lower in the groups with "outdoor activities ≥1 h/d + screen-based entertainment sedentary behavior < 2 h/d" (OR=0.27) and "outdoor activities ≥1 h/d + cultural sedentary behavior < 2 h/d" (OR=0.30)(both P < 0.01).

Outdoor activities can mitigate the adverse effects of sedentary behaviors on adolescents' internalizing behaviors. Reducing screen time and leveraging the synergistic effects of "outdoor + cultural" activities may help reduce the risk of internalizing behaviors among primary and secondary school students.

To analyze the association of sedentary types with symptom of depressive and anxiety among college freshmen, so as to provide a reference for improving the mental health of college students.

From October to November 2022, all college freshmen at three colleges and universities in Anhui Province were selected by a cluster sampling method. The Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Youth Leisure-Time Sedentary Behavior Questionnaire (YLSBQ) were used for the investigation. A binary Logistic regression analysis was conducted to investigate the relationship of different types of sedentary behavior with anxiety and depressive symptom.

The detection rates of anxiety and depressive symptom among college freshmen were 32.8% and 49.9%, respectively. The results of the binary Logistic regression model analysis showed that after controlling for gender, family location, parental education level, self-rated family economic status and number of intimate partners, high-level overall, video based, and social based sedentary time were associated with an increased risk of anxiety (OR=1.26, 1.56, 1.27) and depressive symptom (OR=1.42, 1.94, 1.29) among college freshmen; the association between moderate level sedentary time and depressive symptom was statistically significant (OR=0.83) (all P < 0.05). The overall trends of the association between sedentary behavior with symptom of anxiety and depressive were similar in both boys and girls.

Sedentary behavior is associated with an increased risk of anxiety and depressive symptom in college students. Reducing video-based and social-based sedentary behaviors is beneficial for mental health promotion in college students.

To explore the dynamic relationship between depressive symptom and non-suicidal self-injury(NSSI) behavior among rural left-behind junior high school students, as well as the mediating role of social support, so as to provide a reference for preventing the occurrence of behaviors that endanger the physical and mental health of rural adolescents.

In October 2023, 828 rural left-behind junior high school students from four counties and cities in Xiangxi Autonomous Prefecture, namely Luxi County, Huayuan County, Baojing County and Longshan County, were selected by cluster random sampling for a one-year follow-up investigation (T1:October 2023, T2:April 2024, T3:October 2024). Depressive symptom, NSSI behavior and social support of junior high school students were evaluated by using the Patient Health Questionnaire-9(PHQ-9), Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ), and Social Support Scale for University Students(SSSUS). A cross-lag panel model was constructed to analyze the dynamic relationship between depression symptom and NSSI behavior, as well as the longitudinal mediating role of social support.

The levels of depressive symptoms(T1-T3:150.00±5.88, 14.29±7.52, 13.97±6.70) and NSSI behavior (T1-T3:6.91±4.65, 6.10±3.92, 4.79±3.51) of rural left-behind junior high school students both showed downward trends (F=13.41, η²=0.02; F=50.49, η²=0.06), the level of social support (59.17±14.68, 62.27±15.36, 61.82±15.90) showed an upward trend (F=20.94, η²=0.03), and the depressive symptom and NSSI behavior of girls were higher than those of boys (F=19.91, η²=0.02; F=4.57, η²=0.01)(all P < 0.05). The positive predictive relationships between depressive symptom and NSSI behavior among rural left-behind junior high school students [depressive symptom of T1 positively predicted NSSI behavior of T2 and T3 (β=0.10, 0.16); depressive symptom of T2 positively predicted NSSI behavior of T3 (β=0.14), all P < 0.01]. Social support during the T2 period played a partial mediating role between depressive symptom in T1 and NSSI in T3, with a mediating effect of 0.02 (95%CI=0.01-0.17, P < 0.05).

Depressive symptom positively predict the occurrence of NSSI behavior among rural left-behind junior high school students. Social support is an important mediating factor in alleviating the influence of depressive symptoms on the occurrence of NSSI behavior. It should prevent and reduce the occurrence of depression symptoms and NSSI behavior by improving the social support level of rural left behind junior high school students.

To analyze the factors associated with high-level fear of negative evaluation (FNE) among junior high school students and to construct a nomogram risk prediction model, so as to provide scientific tools for psychological health intervention for junior high school students.

A convenience sampling combined with cluster random sampling method was used to select 5 485 junior high school students from 4 cities (Wuhan, Huanggang, Xianning and Xiaogan) for an online questionnaire survey in March 2025. The total sample was randomly split into a training set (n=3 839) and a validation set (n=1 646). Univariate analysis was performed in the training set using Chi-square test and t-test. Variables with statistical significance were subsequently included in multivariate Logistic regression to identify independent predictors and to construct a nomogram-based risk prediction model. The discriminative ability and clinical utility of the model were evaluated in the validation set using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA).

There were 1 649 junior high school students with low-level FNE and 2 190 with high-level FNE in the training set. The self-control ability of junior high school students with low-level and high-level FNE showed a statistically significant difference (23.96±3.96, 21.48±3.37, t=25.15, P < 0.01). Statistically significant differences in the detection rate of high-level FNE were observed among junior high school students with different genders, family types, parenting styles, academic rankings, psychological flexibility, mobile phone addiction tendencies, emotional management training, exercise frequency, left-behind experiences, and places of origin (χ²=82.01-1 126.68, all P < 0.01). The results of Logistic regression analysis revealed that, the following factors were identified as significant factors influencing high-level FNE among junior high school students: exercise frequency (OR=0.21, 95%CI=0.17-0.26); parenting style (OR=0.48, 95%CI=0.40-0.58); left-behind experience (OR=3.88, 95%CI=3.27-4.61); smartphone addiction proneness (OR=2.19, 95%CI=0.89-0.93); self-control ability (OR=0.91, 95%CI=0.89-0.93); and psychological flexibility (OR=0.16, 95%CI=0.10-0.28) (all P < 0.05). The AUC for the training and validation set were 0.88 (95%CI=0.87-0.89) and 0.87 (95%CI=0.85-0.89), respectively. The Hosmer-Lemeshow goodness-of-fit test yielded χ²=8.57, 15.20 (both P>0.05).

The risk prediction model with high-level FNE demonstrates good accuracy and can assist educators and parents in timely screening of junior high school students with high-level FNE, thereby providing a basis for implementing targeted interventions.

To investigate the association between the physical fitness index (PFI) and symptoms of depressive, anxiety and stress symptoms among college students, providing a reference for mental health interventions.

From June to September 2025, combined convenience and cluster random sampling approach was used to administer questionnaire surveys and perform physical fitness tests on 2 712 college students from Zhejiang Chinese Medical University. The Depression Anxiety Stress Scales-21 Items (DASS-21) was used to assess mental health status. Chi-square test and multivariate Logistic regression analysis were used to determine the associations between the PFI and the PFI component indicators with depressive, anxiety and stress symptoms.

The prevalence of depressive, anxiety and stress among college students were 24.26%, 33.22% and 13.68%, respectively. Statistically significant differences in the prevalence of these symptoms were detected across groups differing in sleep quality, physical activity, weekly breakfast frequency, and history of low back or neck pain (χ²=9.33-151.83, all P < 0.05). After adjusting for confounding factors, Logistic regression revealed that the moderate and high PFI groups had significantly reduced risks of depressive and anxiety compared to the low PFI group (OR=0.73, 0.63; 0.61, 0.72, all P < 0.05). Poor speed (50 m run) and lower body strength (standing long jump) emerged as common risk factors affecting anxiety and depressive symptoms in both male and female college students (all P < 0.05). Increased muscle strength (sit-up for 1 min) in female students reduced the risk of depressive (OR=0.81), anxiety (OR=0.85), and stress symptoms (OR=0.79) (all P < 0.05). Enhanced lung capacity in male students decreased the risk of depressive (OR=0.84) and anxiety symptoms (OR=0.85) (both P < 0.05).

The PFI is negatively correlated with depressive and anxiety symptoms among college students with notable gender differences. Insufficient speed and lower body explosive power represent common risk factors for mental health among male and female college students.

To investigate the association between the parent-child relationship with depression among junior high school students, as well as the dual moderating effect of teacher support and gender, so as to provide a reference for depression interventions at family, school, and individual levels.

In November 2024, a cluster-sampling design was used to recruit 1 229 students from two junior high schools in Chengdu, Sichuan Province as participants. The survey employed the Interpersonal Relations Scale, the Patient Health Questionnaire-9 for depression, and the Students' Perceived Teacher Support Behavior Questionnaire. Spearman's rank correlation analyses were used to examine the associations among the parent-child relationship, teacher support, gender, and depression. Through linear regression analysis, the dual moderating effects of teacher support and gender on the association between parent-child relationship and depression in middle school students were evaluated.

Scores for the parent-child relationship and for teacher support among middle school students were (4.03±1.00) and (4.23±0.86), respectively, and the depression score was 1.13 (1.00, 1.63). Parent-child relationships and teacher support showed positive correlations, while both the parent-child relationship and teacher support were negatively correlated with depression among junior high school students (r=0.25, -0.55, -0.29, all P < 0.01). Linear regression analyses showed that teacher support and gender jointly moderated the association between the parent-child relationship and depression. Further simple-slopes analyses revealed that the negative impact of the parent-child relationship on depression was stronger in girls, peaking under low teacher-support conditions (β=-0.61); among boys, a negative effect was also present but weaker (β=-0.48) (both P < 0.05).

Teacher support and gender jointly moderated the association between the parent-child relationship and depression among junior high school students; girls' depression are more closely linked to the quality of the parent-child relationship, while boys are more sensitive to changes in teacher support.

To explore the potential subgroups of emotion regulation strategies among junior high school students and their moderating role in the relationship between parental psychological control and depressive symptom, so as to provide basis for improving mental health among junior high school students.

In October 2024, a cluster sampling method was used to select 3 389 junior high school students from 4 secondary schools across 2 districts in Chongqing. Surveys were conducted by using Center for Epidemiological Survey-Depression Scale (CES-D), Chinese Parental Psychological Control Scale (CPPCS), and Emotion Regulation Questionnaire (ERQ). Latent profile analysis was applied to identify subgroups based on emotion regulation strategies, and multiple linear regression model was used to test the moderating effect of emotion regulation strategies on the association between parental psychological control and depressive symptom among junior high school students.

According to the two dimensions of emotion regulation strategies-cognitive reappraisal and expressive suppression, three distinct subgroups were identified: the moderate cognitive reappraisal-moderate expressive suppression subgroup (moderate-moderate subgroup, 64.2%), the low cognitive reappraisal-moderate expressive suppression subgroup (low-moderate subgroup, 9.6%), and the high cognitive reappraisal-low expressive suppression subgroup (high-low subgroup, 26.1%). Hierarchical regression results indicated that both parental psychological control (β=0.70) and deficits in cognitive reappraisal (low-moderate subgroup, β=5.38) were associated with an increased risk of depressive symptoms, whereas the high-low subgroup appeared to mitigate depressive symptom (β=-3.47) (all P < 0.01). Compared to the moderate-moderate subgroup, the low-moderate subgroup showed a statistically significant positive moderating effect on the relationship between parental psychological control and depressive symptom (β=0.14, P < 0.05), while the negative moderating effect of the high-low subgroup was not statistically significant (β=-0.07, P>0.05).

The negative impact of parental psychological control on depressive symptom in junior high school students varies depending on the use of different emotion regulation strategies. For a majority of students, enhancing cognitive reappraisal training may help alleviate the adverse effects of parental psychological control and promote better mental health.

To analyze the distribution and related factors of spherical equivalent(SE) anisometropia in school-aged children in ethnic minority areas of Yunnan Province, so as to provide a scientific basis for the intervention and control of SE anisometropia.

In October 2021, a total of 1 852 school-aged children in three counties/cities(Lijiang City, Dali City, Xishuangbanna) in Yunnan Province were examined by multi-stage cluster random sampling method for computer optometry visual acuity examination for non-ciliary paralysis and questionnaire survey.Demographic characteristics, ocular biological parameters and SE data were obtained for SE anisometropia. Group comparisons were conducted using Mann-Whitney U test or Kruskal-Wallis H test, and Logistic regression was used to explore the related factors of anisometropia in SE.

The prevalence of SE anisometropia among school-age children was 23.0%, and the prevalence was higher in girls (24.2%) than that in boys (21.6%). Compared with non-anisometropic children, school-aged children with SE anisometropia had longer axial length (AL) [24.03 (23.41, 24.76), 23.93 (23.26, 24.61) mm] and corneal curvature radius (CR) [43.42 (42.43, 44.42), 43.14 (42.23, 44.04)mm], SE[-1.75(-2.75, -1.00), -0.94(-2.63, -0.25)D], smaller spherical scope [-1.38(-2.38, -0.75), -0.75(-2.38, 0)D], deeper anterior chamber depth(ACD)[3.77(3.62, 3.93), 3.72(3.55, 3.89)mm], and grater differences in AL[0.58(0.32, 0.82), 0.13(0.06, 0.22)mm], ACD[0.05(0.02, 0.08), 0.03(0.01, 0.06)mm] and AL/CR[0.01(0.01, 0.02), 0.01(0.00, 0.01)](Z=-22.47 to -2.41, all P < 0.05). The results of Logistic regression showed that mild myopia(OR=2.74), moderate myopia(OR=3.52), and high myopia(OR=8.92) had a relatively high risk of anisometropia SE in school-aged children(all P < 0.05).

The prevalence of SE anisometropia in school-aged children in ethnic minority areas of Yunnan Province is relatively high, and the prevalence and degree of anisometropia were closely related to myopia degree and related refractive parameters.

To apply network analysis for exploring the relationship of maltreatment experiences and peer relationships with school bullying among middle school students, so as to provide empirical evidences for the development of targeted intervention programs.

From March to April 2024, a total of 2 119 middle school students aged 12-18 in Shantou City were selected through stratified cluster random sampling. Self-administered questionnaire was used to collect data on bullying experiences, maltreatment, and peer relationships. The Glasso network model was employed to estimate network structure.

The strongest edge in the network of maltreatment experiences, peer relationships and school bullying was the connecting line connecting peer acceptance and peer terrorized low self-esteem (edge weight=0.59) among middle school students. The network faked fraudulent victimization was the most central node in the whole network (strength=7.98). The bridge symptoms of the network were sexual abuse, property bullying of others, relational bullying victimization, and verbal bullying of others, with the strongest bridge node being sexual abuse (bridge strength=1.07). In the accuracy estimation of centrality indices, closeness centrality demonstrated the highest accuracy, followed by strength and betweenness, with coefficient of stability of 0.60, 0.44 and 0.21, respectively. The stability of the network was good.

Peer acceptance has the strongest correlation with peer fear and inferiority, and is closely related to emotional abuse and emotional neglect.

To explore the prevalence of screening myopia and depressive symptom among primary and secondary school students in Xuzhou, and to explore the association of sleep and screen time on the coexistence of screening myopia and depressive symptom, so as to provide scientific references for developing intervention strategies to address the development of myopia and promote mental health in children and adolescents.

From September to October 2024, a stratified cluster random sampling method was used to select 6 605 students in grade 4 to 12 in 2 urban and 2 suburban districts in Xuzhou. The students' health condition and influencing factors questionnaire were used to assess students' basic information, sleep time, and screen time. The Center for Epidemiological Studies Depression Scale (CES-D) was used to assess primary and secondary school students' depressive symptom.Unaided distance visual acuity examination was conducted, and refractive assessment was performed using an automated refractometer without cycloplegic agents. The Chi-square test and multiple Logistic regression analysis were used to evaluate the association of sleep and screen time with the coexistence of screening myopia and depressive symptom.

The detection rates of screening myopia, depressive symptom, and screening myopia and depressive symptoms co-morbidity among primary and secondary school students in Xuzhou were 60.35%, 4.45% and 18.61% respectively. Results from the multinomial Logistic regression analysis, using the healthy group as the reference and after adjusting for confounding factors, showed that students with insufficient sleep duration were more likely to have depressive symptom (OR=1.57, 95%CI=1.08-2.27) and the coexistence of screening myopia and depressive symptom (OR=1.85, 95%CI=1.45-2.36). Students with daily screen time≥2 h were more likely to have depressive symptom only (OR=1.41, 95%CI=1.04-1.93) and the coexistence of screening myopia and depressive symptom (OR=1.31, 95%CI=1.06-1.61). Further stratified analysis based on sufficient and insufficient sleep duration revealed that only in the insufficient sleep duration group, students with daily screen time≥2 h had an increased risk of depressive symptom only (OR=1.49, 95%CI=1.07-2.07) and the coexistence of screening positive myopia and depressive symptom (OR=1.40, 95%CI=1.11-1.77) (all P < 0.05).

Primary and secondary school students with insufficient sleep duration and daily screen time≥2 h have higher risks of depressive symptoms and the coexistence of screening myopia and depressive symptoms. It is recommended to ensure adequate sleep duration and limit screen time for children and adolescents.

To investigate the current prevalence of myopia and the progression of the axial length/corneal radius ratio(AL/CR) among primary school students in Jing'an District, Shanghai, and to analyze the value of dynamic AL/CR monitoring and elucidate its longitudinal association with myopia progression, so as to provide evidences for supporting myopia prevention and control interventions.

From 2019 to 2023, by using a stratified cluster random sampling method, 17 624 students from two primary schools in Jing'an District, Shanghai were selected for annual vision screenings in five consecutive years. Additionally, a retrospective cohort of 480 eligible first-grade students identified in 2019 was followed up until 2023. The analysis focused on the myopia prevalence and the trend in the AL/CR. Differences in screening myopia rates across different student groups from 2019 to 2023 were compared using the Chi-square test. The trends in myopia rates were analyzed using the Chi-square trend test. The Kruskal-Wallis H test was employed to compare AL/CR and its annual increment across groups. A linear mixed-effects model was used to identify factors influencing AL/CR, and a time-dependent Cox regression model was developed to predict the risk of myopia onset.

From 2019 to 2023, the screening myopia rates were 36.65%, 38.31%, 40.47%, 39.56%, and 39.76% for each respective year. Cohort analyses revealed Grade 5 girls had significantly greater AL/CR increments than boys (Z=-2.05, P < 0.05). Linear mixed models identified baseline AL/CR (β=1.051, 95%CI=1.012-1.091), grade level (β=0.040, 95%CI=0.038-0.042), and first-year AL/CR increment (β=0.788, 95%CI=0.733-0.843) as primary determinants (all P < 0.01). Boys showed slower AL/CR progression than girls (β=-0.003, 95%CI=-0.005 to-0.001, P < 0.01). The time-dependent Cox model demonstrated that both baseline AL/CR (Z=3.40) and its time-varying effect (Z=10.41) significantly predicted myopia risk(both P < 0.01). The effect of AL/CR on myopia risk significantly increased with follow-up time, and the growth rate exceeded a linear progression pattern.

AL/CR progression is primarily driven by baseline values and grade advancement, with slower progression in boys. Dynamic AL/CR monitoring outperforms baseline measurements in predicting myopia progression. Students with rapid AL/CR increments require early intervention.

To investigation and analyze the causes and characteristics of a food poisoning incident caused by Clostridium perfringens in schools, so as to provide a reference for prevention and control of food poisoning incidents.

From March 11 to 12, 2024, on-site epidemiological and hygienic investigations were conducted by using food poisoning case questionnaires and on-site hygienic investigation forms in Shenzhen. Information related to the poisoning incident was collected through field investigations and telephone interviews. A case-control study was used to analyze the suspected food responsible for the incident. Risk analysis in χ² analysis was used to obtain OR values.

The Clostridium perfringens food poisoning incident involved two schools, with a cumulative total of 52 cases. School A had an attack rate of 2.21%(45/2 040), school B had an attack rate of 1.29% (7/544). The main clinical symptoms were diarrhea (100.00%) and abdominal pain (84.62%), with a minority experiencing fever (3.85%). Analysis via the case-control study indicated that consuming mushroom and meat sauce during lunch on March 11, 2024, was a risk factor for the poisoning incident (OR=124.50, 95%CI=14.53-937.51, P < 0.05). On-site investigation revealed that the mushroom and meat sauce provided by the schools on March 11 was prepared by the catering company the previous day, stored without refrigeration, and not reheated before serving the next day. A total of 31 patient anal swabs, 16 food samples, and 14 kitchen staff anal swabs were sent for laboratory testing. Clostridium perfringens was isolated from 22 case samples. Among these, type A Clostridium perfringens (alpha toxin) was detected in 8 case samples, 4 kitchen staff anal swabs, and 2 retained samples of the mushroom and meat sauce.

The incident is a food poisoning outbreak caused by Clostridium perfringens contamination in schools. Avoiding cross-contamination and ensuring proper storage are key to preventing Clostridium perfringens food poisoning.

To explore the association between blood pressure levels and brachial-ankle pulse wave velocity (baPWV) in adolescents, so as to provide a scientific basis for early prevention and control of cardiovascular disease.

The study utilized data from the October to December 2023 survey conducted by of the Huantai Child Cardiovascular Health Cohort, which included 1 197 adolescents aged 12-17 years. According to the Reference of Screening for Elevated Blood Pressure among Children and Adolescents aged 7-18 years, participants were classified into normal, high-normal, and elevated blood pressure groups. The baPWV elevation was defined as a baPWV value greater than or equal to the 90th percentile of the sex- and age-specific baPWV values in the study population. The association between elevated blood pressure and increased baPWV was assessed by binary Logistic regression models. Restricted cubic spline model was applied to evaluate the dose-response curve of the relationship between blood pressure Z-scores and increased baPWV.

Among adolescents, the prevalence of high-normal and elevated blood pressure were 22.6% and 14.1%, respectively. The mean baPWV values were 918, 978 and 1 030 cm/s in the normal, high-normal, and elevated blood pressure groups, respectively. The prevalence rates of elevated baPWV were 7.3%, 9.6% and 27.2% in these three groups correspondingly. Logistic regression analysis showed that, after adjusting for covariates, both high-normal and elevated blood pressure were significantly associated with higher odds of increased baPWV[OR(95%CI)=1.87(1.08-3.20) and 8.24(4.73-14.50), both P < 0.05]. Linear dose-response associations were identified between systolic and diastolic blood pressure Z-scores and increased baPWV (P_{non-linearity}>0.05).

Elevated blood pressure in adolescents is positively associated with high baPWV. Greater emphasis should therefore be placed on blood pressure monitoring and health management during adolescence.