To develop the Adolescent Peer Bullying Knowledge-Attitude-Practice (KAP) Questionnaire and to evaluate its reliability and validity, so as to provide an effective tool for evaluating the KAP level regarding peer bullying among adolescents.

A preliminary framework was developed through literature review, expert consultation, and group discussions. In September 2024, 2 203 students in grades 7 to 9 from two regular junior high schools in Anhui Province were selected using cluster sampling for a preliminary survey aimed at questionnaire development, including item screening and reliability and validity testing.

The initial KAP questionnaire on adolescent peer bullying consisted of 25 items: two items, "Behavior 6" and "Behavior 7", were excluded as their correlation coefficients with the total KAP score being only 0.08 and 0.05, respectively, falling below the preset criteria(0.4). The final questionnaire comprised 23 items, divided into three dimensions: knowledge, attitude, and behavior. Reliability testing showed that the overall Cronbach α coefficient of the questionnaire was 0.89, with Cronbach α coefficients for the knowledge, attitude, and behavior dimensions being 0.91, 0.67 and 0.79, respectively. The overall split-half reliability of the questionnaire was 0.87, with split-half reliabilities for the knowledge, attitude, and behavior dimensions being 0.82, 0.64, and 0.66, respectively. Test-retest reliability ranged from 0.82 to 0.97. Confirmatory factor analysis results indicated that the questionnaire had RMSEA=0.062, NFI=0.924, CFI=0.931, with good discriminant validity.

The developed KAP questionnaire on adolescent peer bullying demonstrates good reliability and validity and can be used as an assessment tool for evaluating the KAP level regarding peer bullying among adolescents.

To evaluate the effectiveness of a family-school-community integrated intervention based on the microsystem theory in reducing peer bullying among junior high school students, so as to provide empirical evidence and feasible pathways for junior high school students bullying prevention and control in China.

A combining convenience with clustering method was employed to select 6 268 students from three regular junior high schools in Fuyang and Anqing cities, Anhui Province, as the study subjects in October 2024, and randomly assigned by drawing lots to three groups: family-school-community integrated intervention (n=2 063), school-only intervention (n=1 864), and control group (n=2 341). From October 10, 2024, to January 10, 2025, the intervention was implemented for three months using posters, brochures, and videos, with one session every half month, each lasting 40 minutes. The family-school-community integrated intervention group received multi-level interventions involving families, schools, and communities, while the school-only intervention group received only school-based interventions. The control group received routine school health education but no other interventions. Before and after the intervention, data on peer bullying among junior high school students were collected using the Peer Bullying Scale, and comparison of detection rate of peer bullying by Chi-square test.

After the intervention, group comparison results showed that the incidence rates of various types of peer bullying in the family-school-community integrated intervention group, the school-only intervention group, and the control group all showed statistically significant differences (χ²=28.61-66.85, all P < 0.05). The detection rates of verbal bullying (7.51%), relational bullying (5.62%), physical bullying (3.34%), cyberbullying (1.75%), being bullied (10.81%), verbal bullying others (2.67%), relational bullying others (1.55%), physical bullying others (1.36%), cyberbullying others (1.41%), and overall peer bullying (3.64%) in the family-school-community integrated intervention group were all lower than those in the control group (12.52%, 11.58%, 6.24%, 5.00%, 19.14%, 7.56%, 4.49%, 4.53%, 3.80%, 9.40%); additionally, the detection rates of verbal bullying others, overall peer bullying, verbal bullying, and being bullied, in the family-school-community integrated intervention group were all lower than those in the school-only intervention group (4.67%, 6.65%, 13.14%, 16.42%), with statistically significant differences (χ²=30.04, 48.49, 19.75, 34.60, 58.89, 52.65, 31.32, 37.37, 24.14, 58.26; 11.25, 18.53, 33.93, 26.41, all P < 0.016 7). Group comparison showed that in both intervention groups, the majority of peer bullying behaviors decreased after the intervention (χ²=4.86-171.01, all P < 0.05).

The family-school-community integrated intervention based on the microsystem can effectively reduce peer bullying among junior high school students, with better efficacy than the single-school intervention. The model can serve as a practical reference for establishing a multi-level prevention and intervention system for junior high school students bullying in China.

To examine the associations between peer bullying and parental phubbing with executive function and their combined effect among primary and secondary school students, so as to provide scientific evidence for promoting healthy development of executive function among primary and secondary school students.

In November 2024, a combining convenience with clustering method was used to select 3 547 primary and secondary school students in Shenzhen City. The Chinese versions of the Delaware Bullying Victimization Scale-Student (DBVS-S), the Parental Phubbing Scale (PPS), and the Teenage Executive Functioning Inventory (TEXI) were used to assess peer bullying, parental phubbing, and executive function, respectively. Generalized linear regression models were applied to analyze the associations of peer bullying and parental phubbing with executive function, and to assess their joint effects. Subgroup analyses were performed by ages and genders, and multiplicative interaction terms were used to test for interactions.

The score for peer bullying among primary and secondary school students was (15.27±5.67), with verbal bullying, physical bullying, and relational bullying scores being (5.64±2.77) (4.70±1.62) (4.93±2.07), respectively. The score for parental phubbing was (13.98±5.00). Executive function score was (47.35±15.89), while inhibitory control and working memory scores were (26.44±9.00) (20.91±7.49), respectively. After adjusting for confounding factors such as age, gender, self-reported family relationship, self-reported family economic status, parental education level, both peer bullying (β=0.75, 95%CI=0.67-0.84), verbal bullying(β=1.41, 95%CI=1.23-1.58), physical bullying (β=2.18, 95%CI=1.87-2.49), relational bullying (β=1.78, 95%CI=1.54-2.01) and parental phubbing (β=0.88, 95%CI=0.79-0.98) were significantly positively associated with the degree of executive function impairment (all P < 0.01). Joint effect analysis showed that, compared with the "no bullying-low phubbing" group, the total executive function scores in other combined exposure groups were all higher (β=6.78-15.96, all P < 0.01). Among them, the "bullying-high phubbing" group exhibited the highest level of executive function impairment (β=14.17, 95%CI=12.61-15.73, P < 0.01). Subgroup analysis indicated significant interactions between verbal bullying and age on total executive function, inhibitory control, and working memory (all P_interaction < 0.01). The association of verbal bullying with executive function was slightly higher in primary and secondary school students younger than 13 years (β=1.80, 95%CI=1.45-2.16) than in those aged 13 years or older (β=1.25, 95%CI=1.05-1.45) (both P < 0.01). Other types of bullying and parental phone neglect showed no statistically significant interaction with age or gender in executive function, inhibitory control, and working memory(all P_interaction>0.05).

Both peer bullying and parental phubbing are significantly associated with impaired executive function among primary and secondary school students, and there is a combined effect between them; among these, the association between verbal bullying and executive function impairment in younger primary and secondary school students is more pronounced.

To understand the association between beverage and snack intake and insufficient serum 25 hydroxyvitamin D [25(OH)D] among primary and secondary school students, so as to provide a scientific basis for targeted intervention measures.

From October to December 2021, a stratified random sampling method was used to select 2 477 primary and secondary school students aged 8 to 15 years old from 9 counties in Yunnan Province implemented the Nutrition Improvement Plan for Rural Compulsory Education Students. The intake of beverages and snacks was investigated using the Rural Student Nutrition Monitoring Questionnaire from Chinese Center for Disease Control and Prevention. The snack intake intensity was calculated and classified into no intake, extremely low, low, medium, and high intensity. Serum 25(OH)D levels were measured in the laboratory, and levels < 20 ng/mL were defined as insufficient. Chi-square tests, LASSO regression, random forest and binary Logistic regression were used to analyze the association between 20 types of beverages and snacks and serum 25(OH)D insufficiency.

Insufficient serum 25(OH)D was detected in 564 boys (45.9%) and 855 girls (68.5%), with a total of 1 419 cases (57.3%). Binary Logistic regression results showed that extremely low intake intensity of carbonated beverages (OR=1.51), plant protein beverages (OR=1.61), and milk tea beverages (OR=1.39) increased the risk of insufficient serum 25(OH)D, while protective factors were fruits and vegetables (OR=0.77) and pure milk and yogurt (OR=0.74) (all P < 0.05). Subgroup analysis showed that extremely low intake intensity of carbonated beverages, milk-containing beverages, tea beverages, fruit and vegetable juices, and plant protein beverages increased the risk of insufficient serum 25(OH)D in girls (OR=2.22, 1.72, 1.67, 1.74, 1.92), and high intake intensity increased the risk of insufficient serum 25(OH)D in boys (OR=1.73, 1.48, 1.52, 1.49, 1.97) (all P < 0.05). Extremely low intake intensity of carbonated beverages, plant protein beverages, and milk tea beverages in junior high school students (OR=1.92, 2.54, 1.68) and low intake intensity in primary school students (OR=1.40, 1.33, 1.45) increased the risk of insufficient serum 25(OH)D (all P < 0.05).

Frequent intake of beverages and highly processed snacks increases the risk of insufficient serum 25(OH)D in primary and secondary school students, while natural foods such as fruits, vegetables, pure milk and yogurt can reduce the risk. Girls and junior high school students are more susceptible to these effects.

To understand the current status of tuberculosis prevention and control knowledge and perceived stress among college and middle school students with pulmonary tuberculosis (PTB) in Yantai City, and to analyze the related factors, so as to provide a basis for the school to carry out health education and psychological counseling.

A matched case-control study was conducted, with 100 PTB student patients in junior high school and above who were diagnosed at designated medical institutions from October 2020 to October 2024. Four healthy control students of the same gender, same dormitory, or same class were selected for each case. Therefore, 100 cases and 400 controls were investigated by questionnaire. The following information was collected: personal basic information; tuberculosis prevention and control awareness; and scores of the Chinese Perceived Stress Scale (CPSS). Conditional Logistic regression model and mixed linear models were used to compare the PTB prevention and control awareness rate, as well as the perceived stress between the case and control groups. Multiple linear regression analysis was used to analyze the factors that may affect the perceived stress of students with PTB.

The awareness rates of four tuberculosis knowledge items (symptoms of PTB, main causes of onset after infection, consequences of PTB patients not receiving standardized and complete treatment, the most important method to prevent PTB) were higher in the case group (40.00%, 72.00%, 38.00%, 49.00%) than the control group (21.50%, 57.50%, 22.25%, 31.25%) and the differences were statistically significant (Wald χ²=18.44, 8.78, 13.20, 16.89, all P < 0.01). The tension score (10.49±4.20), loss of control score (11.21±4.58), and total score (21.70±6.88) in the case group were higher than the control group (9.35±4.73, 9.75±5.60, 19.09±8.36) and the differences were statistically significant (t=2.21, 2.42, 2.88, all P < 0.05). The results of multiple linear regression analysis showed that age ≥18 years and family history of tuberculosis were the related factors affecting the overall perceived stress and tension of college and middle school students with PTB (B_{total scores}=4.50, 5.91; B_{tension score}=2.39, 3.23, all P < 0.05).

The tuberculosis prevention and control awareness rate, and the perceived stress of college and middle school students with PTB in Yantai are both higher than students without tuberculosis. Moreover, the perceived stress of students with PTB who are aged ≥18 years or have a family history of tuberculosis is even higher.

To explore the network structure of dietary intake and physical fitness subtypes among junior and senior high school students, so as to provide precise and efficient intervention guidance for improving abnormal physical health issues in adolescents.

Based on the 2020-2021 Database of Youth Health (DYH), a total of 9 730 junior and senior high school students in Shandong Province were included for analysis. Dietary intake was assessed using a modified Chinese Dietary Quality Questionnaire, and physical fitness was evaluated according to the "2014 National Student Physical Fitness Standard". The K-means clustering algorithm was employed to identify potential subtypes of physical fitness in junior and high school students. Network analysis was used to construct a network linking dietary intake and physical fitness symptoms and to identify clusters of dietary behaviors and physical fitness symptoms among adolescents of different genders.

The physical fitness among junior and senior high school students of different genders were categorized into two subtypes: the baseline steady type (3 427 male students, 4 039 female students) and the morphological deviation type (1 294 male students, 970 female students). Statistically significant differences were observed in network strength and network connectivity strength among different genders and physical fitness subtypes (all P < 0.05). Connections between food intake and physical health symptom clusters across different genders and physical health types among junior and senior high school students were primarily achieved through instant noodle intake and physical fitness (males of morphological deviation type, weight=0.06), fruit intake and physical fitness (males of baseline steady type, weight=-0.07), potato intake and vital capacity (females of morphological deviation type, weight=0.09), and processed meat intake and vital capacity (females of baseline steady type, weight=0.05).

Dietary intake serves as a significant modifiable risk factor for the physical fitness of junior and high school students. Interventions should focus on promoting healthy eating habits.

To explore the intervention effects of high-intensity interval training (HIIT) on glucose metabolism, cortisol (Cor), and sleep quality among college students with comorbid depressive symptoms and obesity, so as to provide a reference for improving sleep quality among college students with comorbid depressive symptoms and obesity.

In March 2023, 45 college students with comorbid depressive symptoms and obesity were recruited and randomly assigned to an exercise group (n=23) and a control group (n=22) by random number table method. The exercise group received HIIT intervention for 12 weeks, three times a week, while the control group received no intervention. Blood samples were collected from participants to measure fasting insulin (FINS), fasting blood glucose (FBG), homeostatic model assessment of insulin resistance (HOMA-IR), Cor, and Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Statistical analysis was performed using t-test, repeated measures analysis of variance (ANOVA), simple effect analysis.

The repeated measures ANOVA revealed statistically significant time×group interaction effects for body composition (weight, body mass index, percentage of body fat, fat mass, waist-to-hip ratio), depressive symptoms, PSQI scores and its sub-dimensions (subjective sleep quality, sleep onset time, sleep efficiency, sleep disorders, daytime dysfunction), as well as FBG, FINS, and HOMA-IR between the exercise group and control group before and after intervention (F=7.10-53.38, all P < 0.05). Simple effect analysis showed that compared to the control group, the exercise group demonstrated significant improvements in body composition (body mass index, fat mass, waist-to-hip ratio), depressive symptoms, PSQI scores and its sub-dimensions (subjective sleep quality, sleep onset time, sleep efficiency, sleep disorders, daytime dysfunction), FBG, FINS, HOMA-IR, and Cor (all P < 0.05).

HIIT can improve the sleep quality of college students with comorbid depressive symptoms and obesity by enhancing glucose metabolism and regulating Cor levels.

To investigate the association between emotional intelligence and sleep problems at the symptom level among junior and senior high school students, so as to provide new insights for interventions targeting junior and senior high school students sleep disorders.

From November 2023 to May 2024, a stratified cluster random sampling method was employed to select 3 531 first-year junior high school and first-year senior high school students from 6 schools in Guangyuan City and Liangshan Yi Autonomous Prefecture in Sichuan Province, as well as Lhasa City in Tibet Autonomous Region. The Insomnia Severity Index Scale and the Wong and Law Emotional Intelligence Scale(WLEIS) were used to assess sleep problems and emotional intelligence. A network analysis was performed to explore the relationship between emotional intelligence and sleep disorders, and a gender-based network comparison analysis was conducted.

The reported rate of sleep problems among junior and senior high school students was 47.3%, with severe sleep problems of 2.2%. Difficulty maintaining sleep, worry about sleep, and emotional application were the core symptoms in the network (node strength values: 1.11, 0.98, and 0.82, respectively). Dissatisfaction with sleep and emotional application served as bridge symptoms connecting emotional intelligence and sleep problems (bridge strength values: 1.77 and 1.59, respectively). The edge weights of the emotional intelligence and sleep problems network differed significantly between genders (maximum difference in edge weight values was 0.13, P < 0.05).

Emotional application ability and dissatisfaction with sleep are the key nodes in the network connecting emotional intelligence and sleep problems. Targeted efforts to enhance emotional application ability may effectively reduce the risk of sleep problems among junior and senior high school students.

To determine the internal relationships pf perceived discrimination and rejection sensitivity with social adjustment among college students with left-behind experiences, so as to provide a reference for targeted prevention and intervention strategies for social adjustment issues in this population.

A cluster random sampling method was used to select 2 999 college students from 3 universities in Qiqihar and Daqing, Heilongjiang Province. In October, 2024 (T1) and April 2025 (T2), the Discrimination Perception Questionnaire of college students, Rejection Sensitivity Questionnaire, and the Chinese College Student Adjustment Scale (CCSAS) were used to assess students' perceptions of discrimination, rejection sensitivity, and social adjustment levels. Independent sample t-test was used for group comparisons. Traditional cross-sectional comparisons and cross-sectional network analysis were performed using T1 data for the core sample of 1 080 students with left-behind experiences (T1). Longitudinal network analysis was performed using paired data from T1 and T2 (n=1 024) and a preliminary cross-lagged model was used to determine the relationships between variables. Sensitivity analysis was performed by including follow-up data from students without left-behind experiences to test the robustness of the results.

After gender adjustment, students with left-behind experiences had higher scores on discrimination perception (13.14±0.16) and rejection sensitivity (92.82±0.73) compared to the non-left-behind group (10.25±0.12) (89.12±0.55) while the social adjustment score (194.94±1.05) was lower than the non-left-behind group (202.82±0.79). The differences were statistically significant (F=212.03, 16.52, 36.02, all P < 0.01). Cross-sectional network analysis showed that the "anticipated rejection likelihood" was the core node (EI=-2.27, BEI=-2.37), playing a key role in inter-network connections and overall dynamic regulation. Longitudinal network comparison revealed statistically significant changes in the intensity centrality of the nodes "individual discrimination perception" and "anticipated rejection likelihood" (both P < 0.05), while other nodes remained relatively stable. Cross-lagged network analysis showed that the predictive effects of T1 on the variables at T2 were not statistically significant (maximum |r|=0.05, FDR-corrected P>0.50), but the binomial test indicated a systematic positive correlation trend between the variables (66.7% positive correlation, P=0.04). Sensitivity analysis showed that the bridge effect of the "anticipated rejection likelihood" and "learning adjustment" nodes at T2 was more significant in the left-behind group compared to the non-left-behind group.

The social adjustment issues of college students with left-behind experiences require focused attention on the negative regulatory effect of "rejection cognition" and the positive regulatory effect of "learning adaptation".

To explore the influencing factors and pathways of suicidal ideation among children and adolescents with severe autism spectrum disorder (ASD), so as to provide references for clarifying the impact intensity and pathways of various factors on suicidal ideation in the population.

A cross-sectional study was conducted from June 17, 2024, to January 12, 2025, involving 96 severely affected ASD children and adolescents aged 8-18 years from Tianjin. Participants were assessed using the Puberty Development Scale (PDS), Children's Alexithymia Measure (CAM), Strengths and Difficulties Questionnaire (SDQ), and Positive and Negative Suicide Ideation (PANSI). The random forest Boruta algorithm was employed to screen core variables, and a Bayesian network model was constructed to analyze the influencing factors of suicidal ideation in children and adolescents with severe ASD.

Through the screening using the Boruta algorithm, the SDQ scale score, conduct problems, hyperactivity, peer relationship problems and prosocial behavior were identified as the key predictors of suicidal ideation. A Bayesian network model was established with hyperactivity as the central mediating node. The impact of hyperactivity on suicidal ideation exhibited a non-linear relationship: compared to the normal state (31.6%, 68.4%), the borderline state of hyperactivity was associated with a higher probability of low-risk suicidal ideation (47.1%) and a lower probability of high-risk suicidal ideation (52.9%). Suicidal ideation among children and adolescents with severe ASD was closely related to hyperactivity. In the state of hyperactivity, the abnormal peer relationship (95.2%) and the abnormal prosocial behavior (77.0%) were aggravated.

Suicide ideation among children and adolescents with severe ASD is strongly associated with hyperactivity traits. It is necessary to establish a prevention and control system centered on hyperactivity intervention to reduce this risk.

To explore the association between physical activity, anxiety symptoms and academic performance among junior high school students, so as to provide data support for optimizing school physical education and health work and formulating physical activity guidelines.

From September to December 2022, a convenience cluster sampling method was used to survey 2 800 junior high school students in a middle school from Anqing City, Anhui Province. Data were collected on the students' anxiety symptoms, academic performance, 24-hour physical activity [moderate to vigorous intensity physical activity(MVPA), light-intensity physical activity(LPA), sedentary behavior(SB), and sleep(SLP) duration] as well as demographic characteristics. Compositional data analysis was used to explore the associations between 24-hour physical activity, anxiety symptoms and academic performance among junior high school students, and to predict the optimal time-use combination pattern.

Among the junior high school students, 16.0% (447 students) reported anxiety symptoms, and 42.0% (1 175 students) achieved excellent or good academic performance. Compositional data analysis showed that increased SLP duration was associated with both reduced anxiety symptoms (β=-0.18) and decreased academic performance (β=-0.03) among junior high school students; increased MVPA duration was correlated with fewer anxiety symptoms (β=-0.02) and lower academic performance (β=-0.13); in contrast, increased SB duration was linked to more anxiety symptoms (β=0.09) and higher academic performance (β=0.09) (all P < 0.01). LPA duration exhibited a non-linear relationship with anxiety symptoms and academic performance in junior high school students (all P>0.05). The time use combination pattern corresponding to the lowest anxiety symptoms and highest academic performance (top 5%) in adolescents was 611 (520-640) minutes of SLP, 258 (230-320) minutes of SB, 454 (280-610) minutes of LPA, and 117 (20-200) minutes of MVPA per day.

The 24-hour physical activity of junior high school students is associated with anxiety symptoms and academic performance. Therefore, it is recommended to increase the time spent on SB, MVPA, and LPA for junior high school students, while reducing SB.

To investigate the prevalence of abnormal foot arch morphology and its associated factors among primary and secondary school students in Ganzhou City, so as to provide evidence for the prevention of such abnormalities.

From November 2023 to May 2024, a questionnaire was conducted among 1 013 primary and secondary school students, who were selected from one primary school and one nine-year continuous school with stratified cluster random sampling method. Professional equipment, including 2D foot scanning and plantar pressure plates, was utilized to screen pupils for abnormal foot arch morphology (including flatfoot and high-arched foot). The Chi-square was employed for intergroup comparisons, whilst multifactorial Logistic regression analysis was utilized to investigate the associated factors for the occurrence of foot morphological abnormality of arch among students.

The prevalence rate of flatfoot among primary and secondary school students at 61.1%, with bilateral cases accounting for 37.5% and unilateral cases for 23.6%; the prevalence of high-arched foot was 8.0%, comprising 3.9% in both feet and 4.0% in one foot. The prevalence rates of flatfoot among boys and girls were 68.7% and 53.6% respectively. Multivariate Logistic regression analysis revealed that boys had a 1.45 times higher risk of developing flatfoot compared to girls (OR=1.45, 95%CI=1.05-2.02), primary and secondary students aged 6-8 and 9-10 had 4.00, 3.81 times higher risk of flatfoot respectively compared to those aged 15-16 (OR=4.00, 3.81, 95%CI=2.18-7.36, 2.08-6.99) (all P < 0.05). Compared to girls, boys had a lower risk of developing high-arched foot (OR=0.52, 95%CI=0.28-0.95), primary and secondary students who frequently corrected their sitting and standing posture also had a lower risk of high-arched foot (OR=0.30, 95%CI=0.10-0.88) (both P < 0.05).

The prevalence of abnormal foot arch morphology among primary and secondary school students is relatively high, with exercise habits, and postural behaviour identified as associated factors. It is recommended to enhance early screening and behavioural interventions for key populations, thereby advancing the prevention and correction of foot morphological abnormality of arch.

To explore the association between school climate and suicide behavior among primary and secondary school students, so as to provide recommendations for preventing student suicide in schools.

From June to July 2024, a stratified cluster random sampling method was employed to conduct a questionnaire survey on suicidal behavior and school climate among 8 722 students from 36 schools in Lüliang, Linfen, and Datong cities, Shanxi Province. The relationship between school climate and suicidal behavior was analyzed using Chi-square test and binary Logistic regression, supplemented by gender heterogeneity and interaction analyses.

The prevalence of suicidal behavior among students in Shanxi Province was 11.1%. After adjusting for age, gender, educational stage, parents' educational level, residential status, family economic condition, parents' marital status and depressive symptoms, binary Logistic regression analysis revealed that peer relationships (OR=0.72, 95%CI=0.57-0.91), peer trust (OR=0.73, 95%CI=0.58-0.92), teacher support (OR=0.66, 95%CI=0.53-0.82), school safety (OR=0.61, 95%CI=0.48-0.78), having more than six friends (OR=0.64, 95%CI=0.43-0.98), and school belongingness (OR=0.70, 95%CI=0.56-0.88) among primary and secondary school students were associated with a lower risk of suicidal behavior (all P < 0.05). Students who experienced school bullying showed a higher risk of suicidal behavior (OR=2.95, 95%CI=1.80-4.82, P < 0.05). Gender-specific analysis revealed that peer relationships (OR=0.67, 95%CI=0.48-0.92), peer trust (OR=0.66, 95%CI=0.49-0.90), and school belongingness (OR=0.62, 95%CI=0.45-0.84) were associated with a lower risk of suicidal behavior suicide behavior in girls; teacher support (OR=0.50, 95%CI=0.36-0.70) and having more than six friends (OR=0.51, 95%CI=0.27-0.96) were associated with a lower risk of suicidal behavior in boys, who experienced school bullying showed a higher risk of suicidal behavior (OR=4.19, 95%CI=2.18-8.03) (all P < 0.05). Interactive analysis revealed that the dual interaction between peer support and school safety could reduced the risk of suicide behavior among primary and secondary school students safety (OR=0.83, 95%CI=0.70-0.99, P < 0.05).

School climate is closely associated with suicidal behavior among primary and secondary school students in Shanxi Province, with gender differences present. Schools should foster a positive school environment to prevent student suicide behaviors.

To analyze the current status of clinical trial registration for childhood and adolescent obesity, so as to provide insights for the registration and implementation of related trials.

ClinicalTrials.gov and the ChiCTR database were searched for obesity-related clinical trial registrations up to 1 June 2025. Data included basic characteristics (registration region, date, funding source, status, sample size), trial design features, participant demographics, interventions, outcome measures, methodology, and reporting quality. Statistical and descriptive analyses were conducted.

A total of 1 450 registered studies were included, covering 59 regions globally. North America hosted the highest number of registrations (876, 60.41%), with the United States accounting for the largest share (771, 53.17%). The earliest registered study dated to 1985, while 2016 saw the highest annual registrations (n=87). Funding sources predominantly originated from universities (834 studies, 57.52%). Currently, completed trials accounted for the majority (1 003 trials, 69.17%). Globally, the majority of studies employed sample sizes within the 11-50 range (331 studies, 22.83%). Interventional studies predominated in design type (1 186, 81.79%), predominantly employing randomized parallel-group controlled trials. Main interventions included comprehensive lifestyle interventions, physical activity and exercise interventions, and diet and nutrition interventions. High-frequency outcome indicators primarily involved body composition and anthropometric measurements, metabolic and biochemical indicators, etc. Methodology and reporting quality required improvement.

The registration of clinical trials related to childhood and adolescent obesity globally shows a positive development trend, but issues of regional imbalance and methodological limitations exist. It is necessary to strengthen clinical trial registration norms, optimize study designs, and focus on the innovation of interventions and the systematicity of outcome indicators.

To explore the association between various components of sleep quality and the co-occurrence of non-suicidal self-injury (NSSI) behaviors and depressive symptoms among junior high school students, so as to provide evidence for targeted prevention strategies of NSSI and depression.

From May to June 2024, a total of 5 008 junior high school students from 8 schools in 2 districts/counties of Chongqing were selected through a stratified cluster sampling method. The Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiological Studies Depression Scale (CES-D), and the Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ) were used to assess sleep quality, depressive symptoms, and NSSI, respectively. Data were analyzed by using the Chi-square test, Bonferroni correction, and multivariate Logistic regression.

Non-NSSI group and depressive symptoms group accounted for 68.11% among junior high school students, NSSI-only group accounted for 4.71%, only depressive symptoms group accounted for 14.94%, and co-occurrence of NSSI and depressive symptoms group accounted for 12.24%. The prevalence of the co-occurrence group was higher in girls (16.39%) than in boys (7.85%) (χ²=84.89, P < 0.01). After controlling for gender, grade, and boarding status etc., multivariate Logistic regression analysis revealed that five sleep components, including subjective sleep quality, sleep latency, sleep duration, sleep disturbances, and daytime dysfunction, were significantly and positively associated with the co-occurrence of NSSI and depressive symptoms (OR=1.30-3.86, all P < 0.05). The strength of association between these components and the co-occurrence group, in descending order, was: daytime dysfunction (OR=2.52), sleep disturbances (OR=2.36), subjective sleep quality (OR=1.76), sleep latency (OR=1.44), and sleep duration (OR=1.22) (all P < 0.01).

The co-occurrence of NSSI and depressive symptoms is prevalent among junior high school students, with girls being more significantly affected. Sleep disturbances and daytime dysfunction may represent particularly important risk factors. Targeted and prioritized intervention strategies addressing specific sleep components should be developed and implemented to reduce the co-occurrence of NSSI and depressive symptoms in junior high school students.

To explore the experience of self-growth among caregivers of adolescents with non-suicidal self-injury (NSSI), so as to provide practical reference for improving the family support system of adolescents with NSSI.

From August to November 2023, a purposive sampling method was used to select 21 caregivers of adolescents with NSSI who were treated in a tertiary grade A psychiatric hospital in Xinxiang City, Henan Province for semi-structured in-depth interviews. The Colaizzi's seven-step qualitative analysis method was applied to analyze the data and extract themes related to caregiver growth.

A total of 5 themes and 12 sub-themes of benefit finding were extracted from caregivers of adolescents with NSSI: personal growth (increased psychological resilience, enhanced awareness of independent learning, improved self-reflection ability, better understanding and acceptance of NSSI behaviors in adolescents), improvement of family relationships (improved parent-child relationship, improved relationships among family members), perceived social support (more peer support, support from close friends), improvement of caregiving ability (creating a favorable rehabilitation environment, improved caregiving skills), and changes in life and education attitudes (adopting a healthier lifestyle, reasonably adjusting expectations for children).

During the process of caring for adolescents with NSSI, caregivers from positive experiences in multiple aspects such as personal growth, family relationships, social support, and life-education attitudes. Improving the mental health level of caregivers and optimize the family rehabilitation environment, will help reduce the occurrence of NSSI behaviors among adolescents.

To explore the effects of sleep on subsequent-day physical activity (PA) in children and adolescents, so as to provide a reference for refining PA intervention strategies and further investigating their underlying mechanisms.

Through searching databases including Web of Science Core Collection, PubMed, EBSCOhost, ScienceDirect, Cochrane Library, CNKI, Wanfang and VIP cross-sectional, cohort and experimental studies on sleep and subsequent-day PA among children and adolescents were identified, with the searching period spanning from database inception to June, 2025. Based on the characteristics of the included literature, two sleep variables[sleep duration (SD) and sleep efficiency (SE)] and three physical activity variables[moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and total physical activity (TPA)] were selected. The relationship between these two types of variables was analyzed for pooled effect sizes using Stata 17.0.

A total of 14 studies were included, with 64.3% published in 2018 or later, involving 11 361 children and adolescents from 17 countries. Meta-analysis results showed that both SD (ES=0.04, 95%CI=0.01-0.07) and SE (ES=0.24, 95%CI=0.01-0.47) were positively correlated with subsequent-day MVPA (both P < 0.05). However, no statistically significant associations were found with LPA (ES=-0.04, 95%CI=-0.13 to 0.06; ES=-0.02, 95%CI=-0.15 to 0.11) or TPA(ES=0.09, 95%CI=-0.02 to 0.20; ES=0.02, 95%CI=-0.03 to 0.06)(all P>0.05). Subgroup analysis revealed that in the "≤6 years" subgroup, SD and SE were positively correlated with TPA (ES=0.22, 95%CI=0.09-0.35) and MVPA (ES=1.19, 95%CI=1.06-1.32), respectively; in the "6-12 years" subgroup, SD was positively correlated with MVPA (ES=0.05, 95%CI=0.02-0.08); in the "≥12 years" subgroup, SE was positively correlated with LPA (ES=0.08, 95%CI=0.00-0.16), while SD was negatively correlated with LPA (ES=-0.23, 95%CI=-0.31 to -0.16) (all P < 0.05).

Adequate SD and good SE can effectively enhance subsequent-day MVPA among children and adolescents, although these sleep effects vary by age group.

To explore the current status of hyperopic reserve and its related factors among non-myopia preschool and primary school students aged 5 to 12 years in Guangdong Province, so as to provide a basis for formulating intervention strategies for the pre-myopia stage of children.

From October to December 2023, by using stratified cluster random sampling method, a survey on hyperopic reserve among preschool children and primary school students in Guangdong were conducted. And a total of 10 567 children from the senior class of kindergarten to the sixth grade of primary school who completed autorefraction measurements with and without cycloplegia and the questionnaire survey were included in the study. The prevalence characteristics of low hyperopic reserve among non-myopia children were analyzed, and multivariable Logistic regression was used to analyze the related factors.

The prevalence rate of low hyperopic reserve among 8 790 non-myopia children was 62.4%. The average spherical equivalent (SE) for children aged 5 to 12 years was 0.88 (0.25, 1.25)D, decreasing from 1.13 (0.75, 1.50)D in senior kindergarten to -1.00 (-2.50, 0.38)D in sixth grade, with the difference was statistically significant (H=2 475.3, P < 0.01). Multivariable Logistic regression analysis, after adjusting for confounders including gender, urban and rural, and grade, revealed that parental myopia was a risk factor for low hyperopic reserve in the preschool stage (one parent with myopia: OR=1.62, 95%CI=1.35-1.93; both parents with myopia: OR=2.05, 95%CI=1.66-2.55); in the lower primary school stage, parental myopia (one parent with myopia: OR=1.46, 95%CI=1.27-1.68; both parents with myopia: OR=1.58, 95%CI=1.33-1.89), frequently or always reading or using electronic screens while lying down or on one's stomach (OR=1.43, 95%CI=1.13-1.81), and never or occasionally maintaining a viewing distance of over 3 meters when watching TV/playing video games (OR=1.34, 95%CI=1.04-1.72) were risk factors; in the higher primary school stage, failing to take a break every hour during near work (OR=1.79, 95%CI=1.16-2.75) was a risk factor (all P < 0.05).

The emmetropization of children aged 5-12 years in Guangdong Province is accelerated, and non-myopia children generally exhibit insufficient hyperopic reserve. The contributing factors for insufficient hyperopia reserve in non-myopia children vary across different educational stages, necessitating targeted precision interventions.

To explore the intra-class transmission pattern of acute hemorrhagic conjunctivitis (AHC) among students, so as to provide a basis for formulating precise prevention and control strategies.

The data of AHC students in 2023 was obtained from the teacher-student health information module of the "Xiamen i-Education" platform. Taking the onset date from January 1st to December 31st, 2023 as the search criteria, the epidemiological data of confirmed AHC cases among students in the whole city in 2023 was collected. And the Knox test method was employed to quantify cluster risk at the class level. Subgroup comparisons were conducted to examine differences in cluster risk between academic stages and gender combinations. Cross-analysis was performed to investigate the interactive effects of two characteristics on cluster risk.

In 2023, 708 cases of AHC students were reported in Xiamen, among which 54 class-clustered outbreaks were identified. These outbreaks accounted for 40.54% of total cases. Among them, the incidence of class-clustered outbreaks with male first-onset cases was higher than that with female first-onset cases (χ²=4.55, P < 0.05). The class cluster risk was at a relatively high level within the incubation period (0-2 d) after AHC onset (RR=4.61-6.43, P < 0.05). Subgroup analysis revealed that female-female case pairs had a higher class cluster risk (RR=4.81-10.29) compared to other gender combinations (P < 0.05). Primary school case pairs showed a higher risk (RR=4.60-6.77) than middle school case pairs (RR=3.85-4.57) (both P < 0.05). Cross-analysis indicated that primary school and female-female combinations had a higher risk (RR=4.70-11.24) than other combinations, while middle school and male-female combinations showed a positive interaction (RR=3.68-6.68)(both P < 0.05).

AHC infection among students is primarily transmitted within classes. Gender and educational stage are key demographic factors influencing class cluster transmission risks. Transmission risks should be assessed by analyzing population characteristics and contact patterns, and targeted interventions should be implemented.

To investigate the interactive effects of prenatal and postnatal factors on overweight and obesity in preschool children, so as to provide evidence for subsequent planning of prevention strategies and intervention measures.

Between October 2020 and June 2021, a convenience cluster sample of 918 preschool children from four kindergartens in Xuzhou urban area underwent questionnaire surveys and physical examinations. The Chi-square test was used to compare intergroup differences in overweight and obesity prevalence. Multivariate Logistic regression analysis was employed to investigate the effects of prenatal and postnatal factors, as well as their interactions, on overweight and obesity in preschool children.

The prevalence of overweight and obesity among preschool children was 30.8%, with boys exhibiting a higher rate (37.0%) than girls (24.8%). Statistically significant differences in overweight and obesity prevalence were observed across age groups, genders, paternal pre-pregnancy body mass index (BMI), paternal educational level, delivery mode, antibiotic use within the six months after birth, and rapid weight gain during infancy (χ²=5.08-17.67, all P < 0.05). After adjusting for confounding factors such as age, gender, the only child, parental educational level and parental average monthly income, interaction analysis revealed that when the father was overweight or obese before conception, children delivered by caesarean section had an increased risk of overweight or obesity (OR=2.05, 95%CI=1.02-3.39), and children with rapid weight gain during infancy also had an increased risk (OR=2.05, 95%CI=1.08-3.88) (both P < 0.05). Gender-stratified analysis revealed that the interaction between paternal pre-pregnancy BMI and mode of delivery on overweight and obesity was more pronounced among girls (OR=4.00, 95%CI=1.51-10.58, P < 0.05). While the interaction between the father's pre-pregnancy BMI and rapid weight gain during infancy was more pronounced in boys (OR=2.85, 95%CI=1.14-7.08, P < 0.05). No significant interactions between prenatal and postnatal factors on overweight and obesity in preschool children were observed (all P>0.05).

Multiple prenatal and postnatal factors influence overweight and obesity in preschool children. Attention should be paid to mode of delivery and infant weight gain, particularly when the father is overweight or obese, to reduce the risk of overweight and obesity in preschool children.

To understand the dose-response relationship between urinary fluoride and dental fluorosis among children from drinking water-borne endemic fluorosis areas in Tianjin, so as to provide a scientific basis for assessing fluoride exposure risk among children from endemic areas and establishing reference values for urinary fluoride.

From January to December 2024, 83 endemic villages were selected in Tianjin. A total of 2 382 children aged 8-12 years from these villages underwent dental fluorosis examination, along with water fluoride and urinary fluoride testing. Additionally, data from areas where the drinking water fluorosis control target was achieved for more than 12 years (10 villages, 50 people per village) were included as controls. A restricted cubic spline model was used to analyze the relationship between urinary fluoride levels and dental fluorosis prevalence, and benchmark dose (BMD) and benchmark dose lower bound (BMDL), as well as reference dose (RfD), were calculated using the benchmark dose method.

The prevalence rates of dental fluorosis among children in drinking water-borne endemic fluorosis areas and areas of normal fluoride content in water in Tianjin were 10.58%, 7.60%, with a geometric mean urinary fluoride level of 0.72 and 0.60 mg/L, respectively. There were statistically significant differences in both dental fluorosis prevalence and geometric mean urinary fluoride levels between the drinking water-borne endemic fluorosis areas group and the areas of normal fluoride content in water (χ²/Z=4.05, -7.31, both P < 0.05). Across different periods of water source improvement, there were statistically significant differences in overall population, male, and female dental fluorosis prevalence rates and geometric mean urinary fluoride levels (χ²/H=44.95, 23.96, 21.05; 168.39, 63.93, 107.50, all P < 0.01). Significant differences were also observed across age groups among children from drinking water-borne endemic fluorosis areas in terms of dental fluorosis prevalence and geometric mean urinary fluoride levels (χ²/H=32.14, 79.73, both P < 0.01). The results of the restricted cubic spline model showed that the risk of dental fluorosis in different sex, age and overall children in the drinking water-borne endemic fluorosis areas increased significantly with rising urinary fluoride concentration(all P_{general trend} < 0.05). The BMD value for the drinking water-borne endemic fluorosis areas was 1.72 mg/L, the BMDL was 1.31 mg/L, and the RfD was 1.31 mg/L.

The prevalence of dental fluorosis among children in the drinking water-borne endemic fluorosis areas in Tianjin has been effectively controlled, but it is still higher than that in the areas of normal fluoride content in water. Moreover, urinary fluoride levels and dental fluorosis prevalence among children from drinking water-borne endemic fluorosis areas show a clear dose-response relationship.