Impact of novel environmental behavior risk factors on adolescent health deserves more attention / 中国学校卫生

Abstract@#The adolescent health has posed a public health concern around the world. The dramatic change in urbanization, socialeconamic transitions, and multiculture impact often play a driving role in the emergence of new environmental behavioral risk factors, such as exposure to light at night, smartphone multitasking, dietary rhythm disorders, and social jetlag. The dimensions of physical and mental health problems in adolescents were extensive, often based on the most prominent mental health problems, cardiometabolic health, neck-shoulder and low back pain, and clustering of health risk behaviors. In order to achieve the sustainable development goals of promoting adolescent health, it is necessary to strengthen the intervention on novel environmental and behavioral risk factors to prevent the physical and mental health hazards of adolescents from the source.

Longitudinal associations between smartphone multitasking and depressive symptoms in college students / 中国学校卫生

Objective@#To explore the longitudinal correlation between smartphone multitasking and depressive symptoms, so as to provide an evidence based basis for promoting the mental health of college students.@*Methods@#A total of 967 college students were recruited from one university in Taiyuan, Chongqing, and Shenzhen cities, China, by using multi stage randomized cluster sampling from October to December 2021 at baseline, and a follow up survey was conducted in May 2022. Smartphone multitasking behaviors were assessed by means of the Assessment of Smartphone Multitasking for Adolescents (ASMA), and depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) among college students. Chi square tests were performed to compare the differences in depressive symptoms between different groups of demographic characteristics, and binary Logistic regression models were employed to analyze the associations between smartphone multitasking and depressive symptoms among college students.@*Results@#The rates of depressive symptoms among college students at baseline and follow up were 35.2% and 42.3%, respectively. Compared to the low level smartphone multitasking index group at baseline, the moderate and high level groups were more likely to experience depressive symptoms at baseline (moderate level group: OR=1.74, 95%CI =1.22-2.50, high level group: OR=2.77, 95%CI =1.94-3.95) and followup (moderate level group: OR=1.41, 95%CI =1.01-1.95, high level group: OR=1.64, 95%CI =1.17-2.29) ( P <0.05). In addition, compared to the persistently low smartphone multitasking index, increased risk of depressive symptoms was associated with maintaining a moderate to high ( OR=2.94, 95%CI =1.83-4.71), and a higher ( OR=2.07, 95%CI =1.31-3.27) or lower smartphone multitasking index ( OR=2.02, 95%CI =1.27-3.19) ( P <0.05). Moreover, higher smartphone multitasking index scores were positively associated with the risk of new-onset depressive symptoms at follow up ( OR=1.87, 95%CI=1.07-3.27, P <0.05).@*Conclusions@#Smartphone multitasking behaviors are find to be associated with an increased risk of depressive symptoms in college students. There is a need to reduce smartphone multitasking in order to decrease depressive symptoms and promote students mental health.

Association between biorhythm disorders and the co occurrence of health risk behaviors in adolescence / 中国学校卫生

Objective@#To elucidate the association between biorhythm disorders and health risk behaviors in adolescence, so as to provide reference for appropriate interventions.@*Methods@#From March to April 2023, 2 381 adolescents in Shanghai were selected as research objects using convenience sampling and stratified random cluster sampling methods. The Self rating Questionnaire of Biological Rhythm Disorders for Adolescents (SQBRDA) and the self report health risk behaviors questionnaire were used to investigate the status of adolescent biorhythm disorders and nine kinds of health risk behaviors, while a multivariate Logistic regression model was employed to analyze the association between the two variables.@*Results@#The average SQBRDA score was (68.25±0.42) The incidence and detection rates of health risk behaviors in the groups with no co occurrence, mild co occurrence, moderate co occurrence, and severe co occurrence were 234(9.83%), 1 176(49.39%), 830(34.86%) and 141(5.92%), respectively. The total SQBRDA score was positively correlated with the risk of co occurrence of health risk behaviors. The risk of mild co occurrence, moderate co occurrence, and severe co occurrence of health risk behaviors was 9.05 times (95% CI =4.25-19.15, P <0.01), 44.55 times (95% CI =20.75-96.05, P <0.01) and 110.05 times (95% CI =40.65-297.95, P <0.01) higher, respectively, among adolescents with higher scores of biorhythm disorders compared to adolescents with lower scores of biorhythm disorders.@*Conclusions@#Health risk behaviors among adolescents in Shanghai draw attention to a serious phenomenon whereby biorhythm disorders are positively correlated with the risk of co occurrence. Comprehensive interventions aimed at addressing adolescent health risk behaviors should focus on regulating biorhythm disorders.

Follow up study of the association between bedroom light at night exposure and body mass index in children / 中国学校卫生

Objective@#To explore the association between bedroom light at night (LAN) exposure and body mass index (BMI) in children at 1 year follow up, so as to provide new strategies for obesity prevention.@*Methods@#From December 2021 to May 2022, cluster random sampling was conducted, involving 648 children from two primary schools in Tianchang, Chuzhou City, Anhui Province, China, to assess bedroom LAN exposure of children during sleep. A questionnaire survey and physical examination were carried out in May 2022. Multivariate linear regression was performed to analyze the correlation between bedroom LAN exposure and BMI variable quantity at 1 year follow up (May, 2023).@*Results@#The median intensity of bedroom LAN exposure during the sleep episode was [1.11(0.35,3.24)lx] in children. The proportion of the sample exposed to an average light intensity of ≥3 lx was 27.5%, while 19.0% was exposed to a LAN intensity of ≥5 lx during the sleep episode. In the multivariable linear regression, after adjusting for covariates, including sex, baseline age, sleep duration, family monthly income, and maternal education level, exposure to a 1 h-average post bedtime LAN intensity of ≥3 lx ( β=0.25, 95%CI =0.05-0.44) and LAN≥5 lx ( β=0.34, 95% CI = 0.12-0.55) was associated with a gain of 0.25 and 0.34 kg/m 2, respectively, in the children s BMI at the 1 year follow up ( P < 0.05).@*Conclusions@#A positive correlation was found between bedroom LAN exposure and BMI variable quantity at 1 year follow up in children. Thus, reduced bedroom LAN exposure might be useful for interventions aimed at obesity prevention.

Status and correlation of neck-shoulder pain, low back pain and mental sub health among adolescents / 中国学校卫生

Objective@#To explore the association among neck-shoulder pain (NSP), low back pain (LBP) and co occurring symptoms with mental sub health in adolescents, so as to provide evidence for improving physical and mental health of adolescents.@*Methods@#Stratified cluster random sampling method was used to select 7 986 students from 12 middle and high schools in Shenzhen, Nanchang, and Shenyang cities from October to December 2019. The Assessment of Spinal Health of Youth (ASHY) and the Brief Instrument on Psychological Health of Youth (BIOPHY) were used to assess NSP, LBP and mental sub health. Binary Logistic regression model was used to analyze the association between NSP, LBP and co occurring symptoms with mental sub health in adolescents.@*Results@#The detection rates of adolescents with NSP, LBP and co occurring symptoms and mental sub health were 9.1% , 9.8%, 9.5%, and 10.0%, respectively. The co occurring rate of neck shoulder pain, low back pain and mental sub health was 3.2%. After adjusting for confounding variables such as gender, age, being an only child, family residence, and parental education level, NSP ( OR=6.01, 95%CI =5.02-7.19), LBP ( OR=5.08, 95%CI =4.25-6.07), and co occurring symptoms ( OR= 5.96 , 95%CI =4.98-7.12) in adolescents were positively correlated with mental sub health risk ( P <0.01). Stratifying the gender, boys with NSP, LBP and co occurring symptoms ( OR =6.84, 5.80, 6.74)had a higher risk of mental sub health compared to girls ( OR =5.52, 4.65, 5.49) ( P <0.01).@*Conclusions@#NSP, LBP and co occurring symptoms in adolescents are associated with mental sub health. The mental health status of boys is more affected by NSP, LBP and their co occurring symptoms. Measures should be taken to improve spinal health in adolescents to reduce the incidence of mental sub health.

Association between dietary rhythm and depressive symptoms in adolescents / 中国学校卫生

Objective@#To describe the prevalence and association of dietary rhythm and depressive symptoms among adolescents, so as to provide a basis for improving unhealthy behavioral habits,and to promote adolescent physical and mental health.@*Methods@#From October to December 2021, a total of 22 868 students were selected from one middle school and high school in urban and rural areas of eight cities, namely, Shenyang, Xuzhou, Shenzhen, Taiyuan, Nanchang, Zhengzhou, Chongqing, and Kunming cities, China, using a combination of purposive sampling and stratified cluster random sampling. A self administered questionnaire was used to assess adolescents dietary rhythm, and the Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. Binary Logistic regression model was employed to analyze the associations between adolescent dietary rhythm and depressive symptoms, while the associations between adolescent dietary rhythm and depressive symptoms across gender and physical activity levels were stratified by gender and physical activity levels.@*Results@#The detection rate of depressive symptoms in adolescents was 44.4%. The respective differences in the detection rates of depressive symptoms among adolescents of different genders, physical activity levels, and dietary rhythm disorders were statistically significant ( χ 2=157.51, 105.02, 3 282.50, P <0.01). Taking the low disordered dietary rhythm group as the reference, binary Logistic regression analyses showed that after adjusting for confounding factors such as age, gender，family location, family economic situation, whether only child, parental education level, and learning burden, physical activity levels, depressive symptoms were positively correlated with adolescents in the moderate disordered dietary rhythm group ( OR=2.63, 95%CI =2.45-2.83) and the high disordered dietary rhythm group ( OR=6.38, 95%CI = 5.93- 6.86). In addition, after stratifying by gender, dietary rhythm were positively correlated with depressive symptoms. The moderate disordered group (male: OR=2.62, 95%CI =2.37-2.89, female: OR=2.67, 95%CI =2.40-2.97) and the highly disordered group (male: OR=5.74, 95%CI =5.19-6.35, female: OR=7.11, 95%CI =6.40-7.89) were positively correlated with depressive symptoms. After stratification by physical activity levels, low, moderate and above physical activity levels among adolescents in the disordered dietary rhythm group (low physical activity: OR=2.91, 95%CI =2.58-3.29, moderate and above physical activity: OR= 2.50, 95%CI =2.28-2.74), high disordered group (low physical activity: OR=6.51, 95%CI =5.94- 7.13 , moderate and higher physical activity: OR=6.18, 95%CI =5.47-6.97) were positively associated with depressive symptoms ( P <0.01). There was an interaction between dietary rhythm and physical activity levels in regard to the development of depressive symptoms in adolescents, taking the group with moderate and above physical activity levels and low disordered dietary rhythm as the reference,the detection rate of which was higher in adolescents with low levels of physical activity and those in the moderate or high disordered dietary rhythm group ( OR=1.50, 3.90, 95%CI=1.39-1.61, 3.63-4.19, P <0.01).@*Conclusions@#Dietary rhythm disorders were found to be positively associated with depressive symptoms in adolescents. Regular dietary behaviors and increased physical activity play an important positive role in promoting adolescent mental health.

Research progress on the association between biorhythm disorders and cardiovascular metabolic risk in adolescents and possible mechanisms / 中国学校卫生

Abstract@#Adolescence is a unique transitional period from childhood to adulthood, during which behavioral habits and physiological cycles undergo significant changes, and biorhythms are vulnerable to be disrupted. Meanwhile, due to increased rates of overweight and obesity, cardiovascular metabolic risk significantly increases during adolescence. The article reviews the prevalence, correlation, and potential epigenetic regulatory mechanisms of biorhythm disorders and adolescent cardiovascular metabolic health, providing a theoretical basis for regulating biorhythm to promote adolescent cardiovascular metabolic health.

Associations of sleep quality trajectory and social jetlag with comorbid symptoms of anxiety and depression among college students / 中国学校卫生

Objective@#To describe the prevalence and the association of sleep quality trajectory, social jetlag and comorbid symptoms of anxiety and depression among college students, in order to provide a theoretical basis for improving the comorbid symptoms of anxiety and depression in college students.@*Methods@#A questionnaire survey was conducted among 1 135 college students from two universities in Shangrao, Jiangxi Province and Hefei, Anhui Province from April to May 2019, and were followed up once every one year for a total of three times, with a valid sample size of 1 034 individuals after matching with the baseline survey. A selfassessment questionnaire was used to investigate the social jetlag of college students, the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) were used to evaluate anxiety and depression symptoms, respectively, while the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. College students with GAD-7 score ≥5 and PHQ-9 score ≥5 were defined as having comorbid anxiety and depression symptoms. Latent class growth model (LCGM) was employed to analyze the sleep quality trajectory of college students, and binary Logistic regression was used to analyze the relationship between social jetlag, sleep quality trajectory and comorbid symptoms of anxiety and depression.@*Results@#The detection rate of comorbid symptoms of anxiety and depression among college students was 16.9%, and the detection rate of social jetlag ≥2 h was 13.8%. The sleep quality showed an overall improvement trend, and the two trajectories were good sleep quality (81.6%) and poor sleep quality (18.4%). Binary Logistic regression model showed that poor sleep quality and social jetlag ≥2 h were positively correlated with comorbid symptoms of anxiety and depression (OR=5.94, 1.84, P<0.05).@*Conclusions@#Poor sleep quality and social jetlag ≥2 h in college students increase the risk of comorbid symptoms of anxiety and depression. Early screening and intervention of sleep quality and reduction of social jetlag are crucial for enhancing the mental health of college students.

Effects of high frequency visual information on myopia among children and adolescents / 中国学校卫生

Abstract@#Prevention and control of myopia is the key to delaying its occurrence and progression. Understanding the causes of myopia and its related mechanisms is conducive to better prevention and control. The acceleration of urbanization and increased time in indoor environments have become significant factors for the lack of highfrequency visual information, which constitutes new etiological considerations. Therefore, the study focuses on the research progress on the association between highfrequency visual information and myopia in different scene environments, and further explores the etiology of insufficient highfrequency visual information in myopia from the perspectives of contrast sensitivity, ON-OFF visual pathways, and gene expression, so as to provide reference for carrying out targeted myopia prevention and control measures in different scenarios.

Focus on the dietary behaviors and mental health among multi ethnic adolescents / 中国学校卫生

Abstract@#Unhealthy eating behaviors among adolescents are common, and psychological behavior problems are prominent. The paper examines the status and associations underlying unhealthy eating behaviors and psychological behavior problems in adolescents from border multi ethnic areas, and further discusses the importance of research in border area involving multi ethnic adolescents, and highlights its significance in the context of constructing healthy schools in border areas,so as to provide a basis for promoting effectively healthy school environments in border areas of China.

Application of two different methods of visual acuity assessment for myopia screening among lower grade elementary school students / 中国学校卫生

Objective@#To explore two visual acuity standards for examining uncorrected visual acuity (UCVA) to define poor vision in lower grade elementary school students, and to compare the difference of screening myopia rates when combined with non cycloplegic auto refraction (NCAR), so as to provide a scientific basis for standardizing UCVA examination methods using CAR as the gold standard of authenticity and reliability.@*Methods@#From March 22nd to April 9th, 2023, a total of 549 first and second grade students aged 7-8 years from a primary school in Hefei City were selected for the study by convenient cluster sampling method. Two methods were employed for UCVA examination:the first method involved charts where the student could not make mistakes in identifying at least half of the characters per line (V1), and the second method used charts with character sizes ranging from 4.0 -4.5, 4.6-5.0 and 5.1-5.3, without allowing 1, 2 and 3 errors per line (V2). While NCAR was performed, then 187 students underwent CAR examination. Paired Wilcoxon rank-sum test and McNemar test were used to compare the differences between V1 and V2 methods in defining poor vision and screening myopia rates. Using CAR as the gold standard, the authenticity and reliability of defining screening myopia rates through the combination of V1 and V2 methods along with NCAR were evaluated.@*Results@#The UCVA examination results for V1 and V2 showed statistically significant differences in both the right eye [5.0(4.9,5.0), 4.9(4.8,5.0)] and the left eye [ 5.0 (4.9,5.0), 4.9(4.8,5.0)] ( Z=-13.95, -13.34, P <0.01). The detection rates of poor vision for the right eye were 43.53% for V1 and 63.21% for V2, and the left eye with 44.08% for V1 and 62.11% for V2, with statistically significant differences ( χ 2= 106.01 , 95.09, P <0.01). When screening myopia rates were assessed for UCNA methods combined with NCAR, the right eye rates were 21.49% for V1 and 24.59% for V2, and the left eye rates were 21.31% for V1 and 23.13% for V2, with statistically significant differences ( χ 2=15.06, 8.10, P <0.01). Using CAR as the gold standard, the detection rates in the right eye and left eye were 16.58 % and 17.11%, respectively. The Youden indices for defining screening myopia in the right eye were 0.80 for V1 and 0.79 for V2, and the left eye with 0.85 for V1 and 0.83 for V2. The agreement rates for the right eye were 91.98 % for V1 and 89.30% for V2, and the left eye with 94.12% for V1 and 91.98% for V2. The Kappa values for the right eye were 0.73 for V1 and 0.67 for V2, and the left eye with 0.81 for V1 and 0.75 for V2.@*Conclusions@#Authenticity and reliability of two UCVA examination methods combined with NCAR in defining screening myopia are higher in V1 than V2 methods. It is recommended to unify the visual acuity examination methods by requiring the correct identification of more than half of the total number of visual markers in a row.

Application of a polygenic risk score in the early prediction of myopia in children and adolescents / 中国学校卫生

Abstract@#Myopia has become a major public health issue of global concern. Scientific and effective myopia prediction models can help identify high risk groups for myopia, thereby achieving precise prevention. With the rapid development of genome wide association studies and the establishment of large scale prospective population cohorts, the polygenic risk score (PRS) model has been used to predict myopia phenotypes, advancing the myopia prediction window and thus predicting high myopia risk for early screening and intervention for at risk groups. The review aims to systematically elaborate the identification and verification of myopia genes in recent years, briefly describe the practice and effectiveness evaluation of the PRS model in myopia prevention research at home and abroad, reveal the application value in myopia prediction research, and emphasize the relationship between the PRS prediction model and outdoor activities. Close eye use and other preventive measures are of great significance to promote the precise prevention of myopia in children and adolescents.

Science driven application and transformation for telling better stories of school health research / 中国学校卫生

Abstract@#The global disease burden of health problems among children and adolescents is becoming increasingly serious and more prominent worldwide, this calls for a more intergrated and effective school health education, and services and system education should be strengthened. This editorial highlights the importance of problem oriented school health research by telling two stories of school health, including identification of risk factors for health problems and evidence based interventions. Using highquality scientific evidence to promote best practices in school health, improve science driven application and transformation, enhance capacity for comprehensive school health services, and empower child and adolescent health and wellbeing across China.

Association of different sleep characteristics and cardiometabolic risk in college students / 中国学校卫生

Objective@#To describe the association of different sleep characteristics and cardiometabolic risk among college students, so as to provide reference for health promotion of college students.@*Methods@#By random cluster sampling method, a questionnaire survey and physical examination including blood pressure, waist circumference and blood lipid indicators, which were conducted in April and May of 2019 among a total of 1 179 college students from the first grade in two universities in Hefei City of Anhui Province and Shangrao City of Jiangxi Province. A total of 729 college students with valid questionnaires were included into analysis. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to investigate sleep behavior, and the Morning And Evening Questionnaire-5 (MEQ-5) was used to investigate sleep characteristics. The cardiometabolic risk score was derived using the sum of the standardized sex specific Z scores of waist circumference, mean arterial pressure, HDL cholesterol (multiplied by -1), triglycerides, and insulin resistance index. The rank sum tests were used to compare differences in cardiometabolic risk scores across demographic characteristics. Generalized linear models were used to compare the association of different sleep characteristics with cardiometabolic risk scores among college students.@*Results@#The average cardiovascular metabolic risk score of college students was -0.32(-2.03, 1.58). There were statistically significant differences in cardiovascular metabolic risk scores among college students in variables such as smoking, health status, and physical activity levels ( t/F=-3.41, 12.88, 51.07, P <0.01). The results of the generalized linear model showed that nighttime preference ( B=1.89, 95%CI =1.02-3.49), insomnia symptoms ( B=3.25, 95%CI =1.79-5.90), and short or long sleep duration ( B=1.92, 95%CI =1.21-3.05) were positively correlated with the cardiovascular metabolic risk score of college students ( P <0.05).@*Conclusions@#Poor sleep patterns among college students are positively correlated with the risk of cardiovascular metabolism. The sleep behavior of college students should be actively changed to reduce the risk of cardiovascular disease.

Advances in evaluation methods of pubertal timing in children / 中国学校卫生

Abstract@#Over the past 40 years, there has been a long term trend of early pubertal onset in children in China. Early pubertal timing is closely associated with mental health and behavioral problems in children, and can even lead to cardiovascular and metabolic diseases, cancers of the endocrine system and abnormalities of the bone and joint system in adulthood. Prompt detection of early pubertal timing in children is important. There are many methods for evaluating pubertal timing, the appropriateness of which is worth exploring. This paper reviews previous literature publications, examines current research progress in evaluation methods of pubertal timing, evaluates their applicability in the study of children and adolescents, and provides a reference for the selection of an evaluation method to assess pubertal timing in children in China.

Promoting digital technology to enable new opportunities for universal mental health services in schools / 中国学校卫生

Abstract@#In rescent years, schools are confronting continued mental health needs of children and adolescents. The person centered school mental health service model is impossible to meet current and future increasingly public health problems. Under the framework of the "whole School, whole Community, whole Child" (WSCC) theory and the concept of health promoting schools proposed by the World Health Organization, the editorial proposes to integrate universal mental health services into essential public health services in school, as well as to build a digital school mental health service platform to enable new opportunities for universal mental health services in schools.

Association of vitamin D deficiency with anxiety and depressive symptoms among middle school students in Shenzhen / 中国学校卫生

Objective@#To explore the association of vitamin D deficiency with anxiety and depressive symptoms as well as their comorbidity, so as to provide references for improving the mental health of children and adolescents.@*Methods@#From October to December 2021, a total of 1 323 students from four middle schools in Shenzhen were selected by using convenience sampling method for a questionnaire survey and physical examination. Fasting blood samples were collected to detect vitamin D levels. The Chi square test and multiple Logistic regression model were used to analyze the association of vitamin D deficiency with anxiety and depressive symptoms and their comorbidity among middle school students.@*Results@#The detection rates of anxiety, depressive, and thier comorbidities in middle school students were 33.0%, 21.5% and 16.3%, respectively. After adjusting for confounding factors, vitamin D deficiency was positively associated with the risk of anxiety symptoms ( OR=1.59, 95%CI =1.02-2.46), depressive symptoms ( OR=1.94, 95%CI =1.22-3.09) and anxiety depressive comorbid symptoms ( OR=1.75, 95%CI =1.06-2.90) in secondary school students ( P ＜0.05).@*Conclusion@#Vitamin D deficiency is associated with an increased risk of anxiety, depressive and their co morbidity symptoms in middle school students, and the directionality of the association should be further studied.

Association between non school sedentary time and myopia among primary and secondary school students with different levels of physical activity / 中国学校卫生

Objective@#To analyze the association between non-school sedentary time and myopia among primary and secondary school students with different levels of physical activity, so as to provide data for precise measures to prevent and control myopia.@*Methods@#From September to December 2019, stratified cluster sampling was used to select 7 872 primary and secondary students in grades 4 to 12, middle and high school students from Hefei, Suzhou, Chizhou and Wuhu Cities in Anhui Province. Face-to-face questionnaires and vision examinations were conducted to collect demographic information, physical activity time, sedentary study time and visual health status. Potential categories were analyzed for different types of physical activity time, and Logistic regression was used to assess the relationship between non-school sedentary time and myopia at different levels of physical activity.@*Results@#A total of 2 976 primary and secondary school students were found with high physical activity levels and 4 896 primary and secondary school students with low physical activity levels. The proportion of low physical activity was higher in girls than in boys (68.7% vs . 55.6%), and the differences were statistically significant ( χ 2=143.97, P <0.01). The overall screening myopia rate was 48.2%, with statistically significant differences among female students (53.0%) compared with male students (43.3%), urban students ( 51.8 %) compared with rural students (44.5%), and longer non-school sedentary time students (60.6%) compared with average (45.1%) and shorter (42.1%) non-school sedentary time students, and the differences were statistically significant ( χ 2=73.15, 41.96 , 161.74, P <0.01). Adjusting for confounders such as residence, grade, gender, age, father s education, mother s education, and body mass index (BMI), multivariate Logistic regression analysis revealed that prolonged after-school sedentary study was positivety correlated with myopia among primary and secondary school students of low physical activity levels ( OR=1.52, 95%CI=1.27-1.83, P <0.01), and there was no statistical association between after-school sedentary time and myopia in primary and secondary school students with high physical activity levels ( P >0.05).@*Conclusion@#Attention should be paid to non-school sedentary time for primary and secondary school students with low physical activity levels. And students who spend a lot of time sitting outside of school should be encouraged to maintain high physical activity levels to reduce the risk of myopia.

Application and implications of implementation science framework in school health / 中国学校卫生

Abstract@#As an emerging discipline, implementation research has been widely used in many health fields, such as the prevention and control of chronic noncommunicable diseases and mental health promotion. However, school based implementation research in China is still in its infancy. The paper introduces the implementation science framework applied in the field of school health in foreign countries, and reviews its application in nutrition intervention, physical activity and mental health promotion, and prevention of health risk behaviors in school settings, in order to provide theoretical basis and practical guidance for the application of implementation research in school health in China.

Association between sleep quality and anxiety-depression co-morbid symptoms among nursing students of medical college in Hefei City / 中国学校卫生

Objective@#To describe the prevalence and association of sleep quality and anxiety-depression co-morbid symptoms among nursing students, in order to provide a reference basis for promoting the development of nursing students mental health.@*Methods@#Using a prospective study design, baseline survey was conducted in January 2019 among a random cluster sample of 1 716 individuals in three medical universities in Hefei, Anhui Province, and a follow-up survey was conducted in October 2019, with a valid number of 1 573 individuals after matching with the baseline survey. The Pittsburgh Sleep Quality Index (PSQI) was used to assess nursing students sleep quality, and the Depression Anxiety Stress Scale (DASS-21) to assess the anxiety-depression comorbid symptoms.@*Results@#The detection rates of anxiety-depression co-morbidities among nursing students at baseline and follow-up survey were 16.9% and 18.2%, respectively, and the detection rates of poor sleep quality among nursing students at baseline and follow-up survey were 10.1% and 10.3%, respectively. The results of the binary Logistic regression model showed that baseline PSQI score were positively associated with the risk of anxiety-depression co-morbid symptoms among nursing students at baseline ( OR=1.49, 95%CI =1.40-1.59) and after nine months of follow-up ( OR=1.22, 95%CI =1.16-1.28). Furthermore, the influence of baseline sleep quality on the risk of anxiety-depression co-morbid symptoms were mainly concentrated in the five dimensions of sleep time, sleep efficiency, sleep disorders, hypnotic drugs and daytime dysfunction, and such effects of sleep time, sleep disorders and daytime dysfunction still existed in the follow-up investigation.@*Conclusion@#Poor sleep quality of nursing students can increase the risk of anxiety-depression co-morbidities. Improving sleep quality of nursing students has a positive effect on improving their mental health.