To explore parents' knowledge, vaccination attitude, and willingness influencing factors of human papillomavirus (HPV) and its vaccine for male primary and secondary school students, so as to provide a scientific basis for formulating targeted health education strategies and promoting the popularization of boys HPV vaccination.

From March 3 to 14, 2025, a stratified cluster random sampling method was used to select 912 parents of boys in primary and secondary school in Bao'an District, Shenzhen for a questionnaire survey. Data on their demographic characteristics, HPV-related knowledge and its vaccine, vaccination attitude, and willingness were collected. Univariate analysis was performed by using the χ² test or t-test, and binary Logistic regression model was used to analyze related factors of HPV vaccine vaccination willingness.

The total awareness rate of parents' knowledge related to HPV and its vaccine was 35.75%, among which the awareness rates of boys vaccine types (6.36%), optimal age (21.16%), and optimal vaccination period (31.25%) were the lowest. The scores of parents' knowledge and attitude related to HPV and its vaccine were (4.31±2.66) and (3.82±0.63). About 64.25% of parents expressed willingness to have boys vaccinated against HPV. The scores of knowledge and attitude related to HPV and its vaccine of parents with vaccination willingness (4.86±2.55, 4.02±0.58) were higher than those of parents without vaccination willingness (3.34±2.57, 3.46±0.55), and the differences were statistically significant (t=8.59, 13.96, both P < 0.01). Logistic analysis showed that parents without raising daughters had a lower willingness to vaccinate boys against HPV (OR=0.49, 95%CI=0.35-0.70); for each 1 increase in parents' knowledge score related to HPV and its vaccine, the vaccination willingness increased by 9.0% (OR=1.09, 95%CI=1.01-1.17); parents who were worried about boys' infection risk (OR=1.50, 95%CI=1.08-2.08) and parents who had their children vaccinated against HPV even if their classmates were not vaccinated (OR=3.68, 95%CI=2.73-4.94) had higher willingness to vaccinate boys against HPV(all P < 0.05).

Parents of boys in primary and secondary schools of Bao'an District, Shenzhen have low scores of knowledge related to HPV and its vaccine.While parents show strong willingness to vaccinate boys against HPV, limited knowledge may hinder both the sustained growth of vaccination intentions and the actual implementation of vaccination practices.

To analyze the influencing factors of aggressive behaviors in high school students, rank the importance of relevant variables with visual presentation, so as to provide new references for developing intervention strategies.

In December 2024, a convenience sampling method was used to select 5 330 students from 5 high schools in Wuhan for an online questionnaire survey. The survey included the Buss-Perry Aggression Questionnaire (BPAQ), Interaction Anxiety Scale (IAS), Emotion Regulation Ability Scale, Inventory of Parent and Peer Attachment (IPPA), and a self-designed general information questionnaire. Variables were screened using LASSO regression, followed by multivariate Logistic regression analysis. The Random Forest model was then employed to rank and visualize variable importance.

Univariate analysis and LASSO regression results indicated that gender, emotion regulation capability, paternal attachment quality, maternal attachment quality, maternal parenting style, paternal parenting style, parenting consistency, monthly household income per capita, school climate, relationship with classmates, interaction anxiety, and academic ranking were all significant variables (all P < 0.01). Multivariate Logistic regression analysis identified the following as influencing factors of aggressive behaviors in high school students: emotional management ability (OR=0.38, 95%CI=0.34-0.43), gender (OR=0.83, 95%CI=0.75-0.93), mother attachment quality (OR=0.89, 95%CI=0.74-1.07), father attachment quality (OR=0.76, 95%CI=0.66-0.87), interaction anxiousness (OR=1.58, 95%CI=1.40-1.78), consistency of parenting styles of parents (OR=1.40, 95%CI=1.21-1.62), school atmosphere (OR=1.50, 95%CI=1.14-1.98), academic performance ranking (upper-middle: OR=0.76, 95%CI=0.61-0.93; middle: OR=0.70, 95%CI=0.57-0.86) were the influencing factors of aggressive behavior in high school students (all P < 0.05). The results of Random Forest showed that emotional management ability was the most important factor affecting aggressive behavior in high school students.

Emotion regulation capability is identified as the core predictor of adolescent aggressive behaviors, which can significantly reduce the incidence of aggressive behaviors through enhanced emotion management.

To understand the current situation and influencing factors of comorbidity of depressive and anxiety symptoms among middle school students in Chongqing, so as to provide a scientific basis for formulating a comprehensive strategy for the co-prevention of multiple diseases among middle school students.

From September to December 2024, 12 327 middle school students were selected from 6 districts and counties in Chongqing by the combination of stratified cluster sampling and convenience sampling method. The current status of depressive and anxiety symptoms was investigated by using the Center for Epidemiological Survey-Depression Scale (CES-D) and the Generalized Anxiety Disorder-7 (GAD-7). The Chi-squared test was used to compare the differences between groups with comorbidity of depressive and anxiety symptoms, multivariate Logistic regression analysis was used to analyze its related factors, and a nomogram prediction model was drawn.

The detection rates of depressive symptoms, anxiety symptoms and comorbidity among middle school students in Chongqing were 26.34%, 34.55% and 21.16%, respectively. Among them, the detection rates of the three types of symptoms in girls (29.80%, 40.99%, 25.15%) were all higher than those in boys (23.22%, 28.73%, 17.55%) (χ²=68.61, 204.23, 106.51, all P < 0.01). Statistical significance was observed in the distribution of depressive and anxious symptoms among middle school students across different gender, academic stage, school district, family type, physical activity levels, parental discipline, smoking, alcohol consumption, sleep deprivation, excessive screen time, Internet addiction, and bullying (χ²=14.49-991.46, all P < 0.01). Multivariate Logistic regression analysis showed that compared with junior high school students, ordinary high school students had a higher risk of comorbidity (OR=2.71, 95%CI=2.41-3.05); girls (OR=2.17, 95%CI=1.95-2.40), non-core family (OR=1.20, 95%CI=1.08-1.32), and good neighborhood (OR=1.16, 95%CI=1.02-1.30), campus bullying (OR=4.88, 95%CI=4.32-5.50), Internet addiction (OR=4.77, 95%CI=3.41-6.68), parental beating and scolding (OR=3.18, 95%CI=2.72-3.71), alcohol consumption (OR=2.10, 95%CI=1.86-2.37), and insufficient sleep (OR=1.73, 95%CI=1.54-1.95) had higher risks with comorbidity of depression and anxiety symptoms (all P < 0.05). A nomogram prediction model was constructed based on significant variables shows that C-index=0.75 (AUC=0.75, 95%CI=0.74-0.76, P < 0.05), and the model had good predictive performance.

The current situation of comorbidity of depressive and anxiety symptoms among middle school students in Chongqing is not optimistic. The nomograms can be used to effectively predict the risk of comorbidity of depressive and anxiety symptoms in middle school students.

To understand the current status of malnutrition, depressive symptoms, and their coexistence among middle school students, so as to provide references for exploring the "comorbidity-common cause-common prevention" model for these conditions.

In September 2023, a stratified random cluster sampling method was adopted to select 88 594 students from junior high schools, regular high schools, and vocational high schools in 12 leagues/cities (covering 103 banners/counties) of Inner Mongolia Autonomous Region. Physical examinations were conducted to collect data on malnutrition, and the Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess depressive symptoms. The Chi-square test and multivariate linear stepwise regression analysis were employed to analyze the related factors of malnutrition, depressive symptoms, and their coexistence.

In 2023, the detection rates of malnutrition, depressive symptoms, and their coexistence among middle school students in Inner Mongolia were 4.60%, 21.85%, and 0.90%, respectively. There were statistically significant differences in the detection rates of malnutrition, depressive symptoms, and their coexistence among middle school students of different genders, monitoring sites (except for malnutrition), and school stages (χ²=4.95-817.39, all P < 0.05). The results of the multivariate Logistic regression analysis showed that high school students, drink sugar-sweetened beverages ≥1 time per day and those with Internet addiction had higher risk of coexisting malnutrition and depressive symptoms [OR(95%CI)=1.38 (1.04-1.83), 1.46 (1.20-1.78), 2.28 (1.90-2.74), respectively, all P < 0.05]. The risk of coexistence was lower among female students, those who ate fresh fruits at least once a day, those who engaged in moderate-to-vigorous physical activity for ≥1 time/day, those who engaged in moderate-to-vigorous physical activity for ≥1 hour/day on ≥5 days/week, those who did not use cough syrup without therapeutic need, those who did not use sedative-hypnotic drugs without medical advice, and non-drinking students [OR(95%CI)=0.84 (0.73-0.98), 0.77 (0.66-0.89), 0.82 (0.68-0.98), 0.66 (0.53-0.80), 0.57 (0.41-0.78), 0.63 (0.53-0.72), respectively, all P < 0.05].

The occurrence of undernutrition, depressive symptoms, and their coexistence among middle school students in Inner Mongolia can't be ignored. Schools, the government and society should implement a strategy aimed at concurrent prevention of multiple conditions through comprehensive interventions.

To explore the longitudinal relationships between sleep problems and non-suicidal self-injury (NSSI) behaviors in college students, so as to provide a theoretical basis for the prevention and intervention of NSSI.

In October 2023 (T1), a total of 1 009 college students from two provincial colleges in Guangdong were selected by using a combination of convenience sampling and stratified cluster random sampling for a 1-year follow-up survey (October 2024, T2). The students were assessed by using the Insomnia Severity Index(ISI), Non-restorative Sleep Scale(NRSS), Epworth Sleepiness Scale (ESS), and Adolescent Non-suicidal Self-injury Assessment Questionnaire(ANSAQ). Data analysis was performed using McNemar's test and Logistic regression.

The detection rate of NSSI behaviors was 18.83% at T1 and decreased to 7.73% at T2, with a statistically significant difference (χ²=66.24, P < 0.01). The trajectories of NSSI behaviors were divided into persistent group (4.06%), new-onset group (3.67%), remission group (14.77%), and resistance group (77.50%). Logistic regression analysis showed that sleep less than 7 hours per day at night, insomnia (mild, moderate-to-severe), non-restorative sleep (moderate, severe), daytime sleepiness, and weekly nightmare frequency (1-2, ≥3 times) were associated with NSSI behaviors at T1 (OR=5.02, 2.39, 5.51, 3.47, 9.70, 2.36, 2.63, 4.74, all P < 0.01). Insomnia (mild, moderate-to-severe), severe non-restorative sleep, daytime sleepiness, and weekly nightmares ≥3 times at T1 all increased the risk of NSSI behaviors at T2 (OR=1.76, 4.15, 4.05, 1.88, 5.63, all P < 0.05). Moderate-to-severe insomnia, severe non-restorative sleep, daytime sleepiness, and weekly nightmares ≥3 times at T1 increased the risk of belong to the new-onset NSSI group (OR=5.05, 3.37, 2.08, 5.86, all P < 0.05).

Insomnia, non-restorative sleep, daytime sleepiness, and frequent nightmares are important risk factors for NSSI behaviors among college students. Early assessment and intervention of sleep problems may be an important strategy for the prevention and treatment of NSSI.

To examine differences in depressive and anxiety symptoms between boarding and non-boarding high school students and their associations with physical activity (PA) patterns, so as to provide evidence to inform adolescent mental-health promotion.

From October to December 2024, a convenience sample of 11 782 students aged 15-18 years was recruited from 36 schools in Nanchang, Ganzhou, and Shangrao of Jiangxi Province. Depressive and anxiety symptoms and PA were assessed using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and International Physical Activity Questionary Short Form (IPAQ-SF). Logistic regression model was used to examine associations between PA patterns, depressive and anxiety symptoms among boarding and non-boarding students.

The detection rates of depressive symptoms were 45.7% and 46.4% among boarding and non-boarding students, respectively; for anxiety symptoms, the corresponding rates were 43.0% and 46.7%. Boarding and non-boarding students differed significantly in smoking status, screen time, sleep duration, sedentary time, daily vegetable intake, and napping (χ²=16.74-664.17, all P < 0.01). Across PA pattern groups, the detection rates of depressive and anxiety symptoms differed significantly between boarding and non-boarding students (χ_depression²=23.85, χ_anxiety²=22.78, both P < 0.01). Adjusted for confounding factors, Logistic regression analysis of high school students showed that compared with the not meeting PA recommendations, both the concentrated and regular PA pattern were associated with lower odds of depressive symptoms [OR(95%CI)=0.83(0.70-0.98), 0.90(0.83-0.98)]; and the concentrated pattern was also associated with lower odds of anxiety symptoms [OR(95%CI)=0.78(0.65-0.92)], and the association of anxiety symptoms in concentrated boarding students was consistent with that of the overall group [OR(95%CI)=0.71(0.52-0.98)] (all P < 0.05). Conclusions There is a correlation of different physical activity patterns with depressive and anxiety symptoms among boarding and non-boarding high school students. Schools should ensure students engage in regular physical activity and work to increase overall activity volume.

To explore the mediating role of balanced time perspective in the relationship between social jetlag and depressive symptom among junior high school students, so as to privide a basis for improving their mental health.

In October 2024, a method of combining convenient sampling with cluster sampling was used to select 3 438 junior high school students from two districts(Yubei District and Kaizhou District) in Chongqing. The Center for Epidemiological Studies Depression Scale (CES-D), Munich Chronotype Questionnaire (MCTQ), and Balanced Time Perspective Inventory (BTPI) were administered for the survey. Statistical analyses included t-test, ANOVA, and Spearman correlation analysis, and conduct a mediation effect analysis using the Process program.

The mean score of depressive symptom among junior high school students was 15.00(9.00, 23.00), social jetlag was 1.18(0.72, 1.83) hours, and balanced time perspective score was -0.18(-2.82, 2.93). Social jetlag among junior high school students was positively correlated with depressive symptom score (r=0.17), while balanced time perspective was negatively correlated with social jetlag (r=-0.15) and depressive symptom score (r=-0.68) (all P < 0.01). Mediation analysis showed that balanced time perspective partially mediated the relationship between social jetlag and depressive symptom (β=0.68, P < 0.01) among junior high school students, accounting for 53.97% of the total effect.

Social jetlag of junior high school students influences depressive symptoms by affecting balanced time perspective. Efforts should be made to improve adolescents' balanced time perspective for reducing the impact of social jetlag on depressive symptom.

To investigate the relationship between pubertal timing and depressive symptoms among high school students in Suzhou, so as to provide scientific evidence for promoting adolescents mental health.

From October 2023 to January 2024, 3 369 students were selected from 20 high schools in Suzhou using stratified cluster random sampling method. Physical examinations and questionnaire surveys were conducted. The Preece & Baines growth Model 1 was used to calculate the age at take-off of height velocity (ATO) and age at peak height velocity (APHV), categorizing students into three groups: early pubertal timing group (< P₁₅), on-time group (P₁₅-P₈₅), and delayed group (>P₈₅). Binary Logistic regression was used to analyze its association with depressive symptoms.

The ATO for male and female high school students in Suzhou was (9.35±1.23) and (8.12±1.52) years old, respectively. The mean APHV was (12.35±0.74) years old for boys and (10.91±0.82) years old for girls. The overall prevalence of depressive symptoms was 34.22%, with no statistically significant gender difference (χ²=0.42, P=0.52). Significant differences in depressive symptom prevalence were observed across grade levels, breakfast frequency, weekly days of moderate-to-vigorous physical activity, daily sleep duration, history of school bullying, and the presence of Internet addiction (χ²=5.03-69.21, all P < 0.05). After adjusting for age, body mass index, region, boarding status, breakfast frequency, weekly moderate-to-vigorous physical activity days, sleep duration, campus bullying, and presence of Internet addiction, Logistic regression analysis revealed that when ATO was used to evaluate pubertal timing, the risk of depressive symptoms in the delayed group of boys was 1.65 times that of the on-time group (95%CI=1.24-2.19); when APHV was used to evaluate pubertal timing, the risks of depressive symptoms in the early pubertal timing group and delayed group of boys were 1.43 times (95%CI=1.07-1.91) and 1.41 times (95%CI=1.05-1.88) of that of the on-time group, respectively (all P < 0.05). No statistically significant associations were found among females (all P>0.05). Conclusion The prevalence of depressive symptoms among high school students in Suzhou is relatively high, and both early and delayed puberty timing in boys are associated with depressive symptoms.

To investigate the assocation of sedentary behavior among college students on psychological health issues, such as depressive, anxiety, and stress symptoms, and to analyze the moderating role of takeaway consumption behavior in the context, in order to provide a scientific basis for reducing emotional symptoms among college students.

A stratified cluster sampling method was employed to conduct a questionnaire on 3 427 first-year students of a higher education institution in Hefei of Anhui Province from May to June 2021. The study variables included demographic characteristics, sedentary time, takeaway consumption behavior, and emotional (symptoms depressive, anxiety, and stress symptoms). The Spearman correlation analysis was used to analyze the association between variables, and linear regression analysis was used to analyze the association between takeaway consumption behavior and depressive, anxiety and stress symptoms among college students with sedentary time.

Both sedentary time and takeaway consumption behavior were positively correlated with depressive, anxiety and stress symptoms among college students (r=0.10, 0.10, 0.10; 0.10, 0.11, 0.11, all P < 0.05). The results of linear regression analysis showed that the interaction term between takeaway consumption behavior and sedentary time was positively correlated with symptoms of depressive, anxiety, and stress symptoms among college students (depression: β=0.04, anxiety: β=0.04, stress: β=0.04, all P < 0.05). The results of the simple slope test demonstrated that regardless of the level of takeaway consumption behavior, sedentary time was positively correlated with the depressive symptoms of college students; compared with low takeaway consumption behavior, high takeaway consumption behavior (β=0.77, P < 0.01) enhanced the association between sedentary time and depressive symptoms among college students. In addition, under the condition of high takeaway consumption behavior, sedentary time was positively correlated with the anxiety and stress symptoms of college students (anxiety: β=0.64; stress: β=0.71, both P < 0.01); while under the condition of low takeaway consumption behavior, sedentary time was not related to the anxiety and stress symptoms of college students (β=0.17, 0.22, both P>0.05).

Sedentary behavior is related to a the emotional symptoms of depressive, anxiety, and stress among college students. Takeaway consumption behavior may exacerbate this impact.

To investigate the association of sleep and circadian rhythm disruption indicators (including chronotype, sleep duration, and social jetlag) with co-occurring depressive and anxiety symptoms among primary and secondary school students, so as to provide a reference for promoting their mental health.

In October 2023, a total of 15 944 primary and secondary school students were recruited from Nanjing, using a stratified cluster random sampling method. The Morning and Evening Questionnaire-5, Center for Epidemiological Studies Depression, and Generalized Anxiety Disorder-7 were used for the survey. Chi-square test was employed for intergroup comparisons, and Logistic regression model was applied to analyze the independent and joint effects of sleep-related factors on comorbid symptoms of depressive and anxiety among primary and middle school students.

The prevalence of co-occurring depressive and anxiety symptoms among primary and secondary school students in Nanjing was 16.9%. After adjusting for covariates, Logistic regression analysis revealed significant independent associations between evening chronotype (OR=6.55, 95%CI=5.59-7.68), insufficient sleep duration (OR=3.05, 95%CI=2.60-3.59), and social jetlag ≥2 h (OR=2.09, 95%CI=1.85-2.37) with comorbid symptoms of depressive and anxiety among students (all P < 0.05). Concurrent of evening chronotype and insufficient sleep (OR=7.54, 95%CI=3.55-16.01), as well as evening chronotype and social jetlag ≥2 h (OR=4.18, 95%CI=3.01-5.81), were associated with an increased risk of co-occurring depressive and anxiety symptoms (both P < 0.05). In the female and high school student subgroups, the combination of evening chronotype and insufficient sleep or social jetlag ≥2 h showed stronger joint effects on co-occurring depressive and anxiety symptoms [OR(95%CI)=8.46(3.25-22.04) and 15.90(3.66-69.08); 7.87(4.90-12.65) and 4.85(3.10-7.59), respectively; all P < 0.05].

Evening chronotype, insufficient sleep, and social jetlag≥2 h may serve as risk factors for comorbid symptoms of depressive and anxiety in school-aged populations. Paying attention to the coexistence of multiple sleep-related risk factors may help mitigate the occurrence of emotional disorders in this demographic.