Analysis of pre-exposure prophylaxis awareness, willingness, uptake patterns, barriers and needs among MSM students and its influencing factors / 中国学校卫生

Objective@#To explore the pre-exposure prophylaxis (PrEP) awareness, willingness, uptake patterns, barriers and needs among Chinese student men who have sex with men (MSM), so as to provide relevant evidence for targeted interventions with PrEP.@*Methods@#A proportional sampling method was used to conduct a cross sectional survey of MSM aged 16 years and older residing in 21 provinces, municipalities, and autonomous regions in mainland China between October 20 and December 20, 2021, to collect information on demographic and sexual behavioral characteristics, and 923 students of them were selected as the subjects of this study. The chi-square test and Fisher s test were used for univariate analysis, followed by multivariate Logistic regression to analyze the influencing factors of PrEP awareness and uptake.@*Results@#According to the cascade analysis method, the awareness, willingness, uptake and adherence rates of PrEP among the student MSM were obtained as 88.95%, 67.36%, 13.20% and 45.21 %, respectively. HIV testing more than once in the last 3 months, and all of them were aware of the HIV test results of their sexual partners, and those with high frequency of condom use had a higher rate of awareness ( OR =2.32, 1.79, 1.69, P <0.05). Willingness rates were higher for those from the pilot city, using substances, and HIV testing more than once in the last 3 months ( OR =2.13, 1.65, 1.69, P <0.05). Higher rates of uptake were found among those from high risk and pilot areas, presence of commercial sex, substance use, and high literacy ( OR =5.60, 3.54,2.81, 1.92, 4.54, P <0.05). Adherence rates were higher among those who used one pill per day or both ( OR =12.77, 13.26, P <0.05). The barriers and needs faced by student MSM were primarily personal concerns about medication side effects, preventative effects, and confidence in sexual behavioral styles, and the high cost of medication and related service costs.@*Conclusions@#The student MSM population in China is characterized by high awareness, low willingness, low uptake, and low adherence to PrEP. Targeted interventions should be considered and tailored by the departments to facilitate PrEP promotion among student MSM.

Sexuality education at kindergarten and primary and secondary school setting across China / 中国学校卫生

Objective@#To understand the current situation of school based sexuality education, attitudes and evaluations of teachers and students toward sexuality education, so as to provide evidence for promoting the development of school based sexuality education.@*Methods@#From September to October 2021, 2 140 valid data from students in basic education and 2 146 from kindergarten and primary and secondary school teachers were collected by online questionnaire. The data were described and statistically analyzed, and the influencing factors of teachers willingness to teach sexuality education courses were explored by logistic regression analysis.@*Results@#About 52.06% of the students had not received sexuality education in school, and 47.53% of the teachers did not carry out sexuality education in the school. Sexuality education in schools mainly focuses on reproductive health and physical development. About 48.93% of the teachers thought that the implementation of sexuality education in schools was not good, and the proportion of high school students who thought sexuality education in schools were "very bad" (32.87%) or "not very good" ( 21.23 %) was the highest. The teachers who undertook sexuality education were mainly mental health teachers (55.51% reported by teachers, 43.96% reported by students). About 71.02% of teachers believe that the best way to carry out sexuality education classes was to set up sexuality education curriculum. Students and teachers reported the need for sexuality education, and more than 50% of primary school students and high school students thought that sexuality education were "very needed" and "somewhat needed". About 51.77 % of teachers considered sexuality education "very urgent". All increased recognition of sexuality education, confidence in answering sex questions, external support for sexuality education, and acceptance of sexuality education training increased the likelihood of teachers teaching sexuality education ( OR =1.02, 1.95, 1.03, 3.53, P <0.05).@*Conclusion@#The current situation of school based sexuality education is not optimistic, the gap between sexuality education and students needs is wide, and the abilities of sexuality education teachers are insufficient.

Mediating effects of metabolic related indicators on the association between childhood overweight/obesity and left ventricular hypertrophy / 中国学校卫生

Objective@#To examine the mediating effects of blood pressure, glucose, lipids, and serum uric acid on the association between childhood overweight/obesity and left ventricular hypertrophy (LVH), and to provide scientific evidence for the prevention and control of cardiovascular diseases during childhood.@*Methods@#One public school in Huantai County, Zibo City was selected to conduct the baseline survey from November 2017 to January 2018 using a convenient cluster sampling method. A total of 1 400 children aged 6 to 11 were included in the study. According to the classification criteria based on body mass index (BMI), participants were divided into the non overweight/obese group ( n =787) and the overweight/obese group ( n =613). The mediating effects of metabolic variables on the association between childhood overweight/obesity and left ventricular hypertrophy (LVH) were analyzed using the "mediation" package in R software.@*Results@#Children who were overweight/obese had higher levels of BMI- Z score (2.0±0.8), systolic blood pressure (SBP) (109.1±8.9 mmHg), diastolic blood pressure (DBP) (65.4±6.8 mmHg), fasting plasma glucose (FPG) (4.8±0.5 mmol/L), insulin (INS) (11.3±7.6 μU/mL), apolipoprotein B (ApoB) (0.7±0.2 g/L), lowdensity lipoprotein cholesterol (LDL-C) (2.4±0.7 mmol/L), total cholesterol (TC) (4.2±0.9 mmol/L), triglycerides (TG) (0.9±0.4 mmol/L), and serum uric acid (SUA) (321.2±91.4 μmol/L) compared to those who were non-overweight/obese [the corresponding values were (-0.2±0.7),(104.3±8.8) mmHg, (62.2±6.2) mmHg, (4.7±0.6) mmol/L, (6.1±4.2) μU/mL, (0.6±0.2) g/L, (2.2±0.6) mmol/L, (4.1±0.7) mmol/L, (0.7±0.2) mmol/L, and (278.6±74.7) μmol/L, respectively], whereas the levels of high density lipoprotein cholesterol (HDL-C) were lower in overweight/obese children (1.5±0.3 mmol/L) than in non-overweight/obese children (1.7±0.4 mmol/L). All differences were statistically significant ( t =53.66, 9.88, 9.19, 3.60, 16.32, 7.36, 5.11, 2.55, 11.08, 9.58, -10.31, P <0.05). After adjusting for potential covariates, overweight/obese children had 8.72 times increased risk of developing LVH compared to the non-overweight/obese children ( OR=8.72, 95%CI =5.45-14.66， P <0.01). Mediation analysis showed that INS, HDL-C, LDL-C, TG, ApoB, and SUA partially mediated the association between childhood overweight/obesity and LVH, and among these, INS and TG had relatively strong mediating effects, accounting for 28.05% and 13.71% of the total effects, respectively.@*Conclusions@#INS, HDL-C, LDL-C, TG, ApoB, and SUA are intermediate risk factors on the association between childhood overweight/obesity and LVH. Keeping metabolic indicators (especially INS and TG) at healthy levels is particularly important for reducing the burden of cardiovascular diseases in overweight/obese children.

Cardiovascular health status in Chinese school aged children / 中国学校卫生

Objective@#The American Heart Association released the Life s Essential 8 (LE 8) for the overall evaluation of cardiovascular health (CVH) on individual level. The present study aimed to describe the overall CVH in Chinese school aged children using LE 8 metrics.@*Methods@#Data of the present analysis came from a national representative multicentered cross sectional study conducted in 7 provinces of China in 2013. The original study used a multistage cluster sampling method. A total of 10 326 children aged 5 to 19 years with complete data of health behaviors and health outcomes were included in the study. Children s health behavior indicators included diet, physical activity, nicotine exposure and sleep health. Health outcome factors included body mass index, fast blood glucose, lipid profile and blood pressure.@*Results@#The median CVH score was 73.3 ( IQR =14.4) in boys and 73.4 ( IQR = 13.5) in girls. Compared to children aged ≤9 years, the health behavior scores were lowest in the 13-15 age group, with boys scoring 7.73 lower (95% CI =-8.35--7.12, P <0.01) and girls scoring 9.15 (95% CI =-9.83--8.48, P <0.01) lower. The ≥16 age group had the lowest health outcome scores, with boys scoring 7.85 (95% CI =-9.07--6.63, P <0.01) lower and girls scoring 6.11 (95% CI =-7.12--5.09, P <0.01) lower.@*Conclusions@#Chinese school aged children are generally at a moderate level of cardiovascular health. Specific LE 8 components vary substantially between groups and therefore require targeted intervention strategies.

Construction of Nomogram prediction model of myopia risk and lifestyle among primary school students in Tianjin City / 中国学校卫生

Objective@#To explore the relationship between lifestyle and myopia and construct Nomogram model to predict myopia risk among primary school students in Tianjin, so as to provide a scientific basis for precision myopia prevention and control.@*Methods@#From April to July of 2022, a census method was used to conduct vision testing and lifestyle related questionnaires among 373 180 primary school students in 15 districts of Tianjin. The relationship between lifestyle and myopia was analyzed by the multivariate Logistic regression, and a nomogram prediction model was constructed to predict myopia risk.@*Results@#The detection rate of myopia among primary school students in Tianjin was 37.6%. The results of the multivariate Logistic regression showed that daily outdoor activity time of 1-2 h ( OR =0.94) and >2 h ( OR =0.84), time of using daily electronic devices of >2 h ( OR =1.03), daily paper materials reading and writing time of 1-2 h ( OR =1.02) and >2 h ( OR =1.09), weekly fresh vegetable intake of 2-6 times ( OR =0.93) and ≥7 times ( OR =0.88) were statistically correlated with myopia ( P <0.01). The Nomogram prediction model showed that the factors associated with myopia were grade, family history of myopia, gender, daily outdoor activity time, weekly frequency of fresh vegetable intake, daily paper materials reading and writing time, and time of using daily electronic devices time.@*Conclusions@#The lifestyle of primary school students in Tianjin is associated with myopia. The constructed nomogram model could provide a scientific basis for identifying key intervention populations for myopia prevention and taking targeted prevention and control measures.

Status of prepackaged food intake and the association with growth and development in school aged children of Chengdu City / 中国学校卫生

Objective@#To determine the association between the intake of five major types of prepackaged foods and the growth and development of school aged children, so as to provide a theoretical basis for guiding school aged children and their parents to make healthy prepackaged food choices.@*Methods@#Based on data from the South West China Childhood Nutrition and Growth Cohort (SCCNG), 381 children (6-11 years of age) were selected by stratified cluster sampling. Dietary intake and pubertal development were collected using questionnaires, and anthropometric measurements were obtained. Children were followed up until November 2022. Binary Logistic regression models were used to analyze the prospective association between prepackaged food intake and the growth and development of school aged children.@*Results@#The total intake of the five major types of prepackaged foods was 316.1 (197.1,501.4) g/d. After 2 years of follow up evaluations, 16.5% of school aged children were shown to be overweight and obese. Early spermarche occurred in 12.6% of boys and early menarche occurred in 15.4% of girls. The following findings were suggested after adjusting for the mothers education level, average gross monthly family income, whether or not the family had one child only, geographic area of residence, body mass index Z score, average duration of daily exercise, and total dietary energy intake: convenience food intake might increase the risk of early spermarche ( OR =9.37); fruit and vegetable intake might decrease the risk of early spermarche and menarche ( OR =0.33,0.17); and fish, poultry, meat, and egg intake might increase the risk of early menarche ( OR =7.59)( P <0.05). Intake of the five types of prepackaged foods was not associated with being overweight or obese after adjusting for confounders ( OR =1.40, 0.57, 0.73, 1.33,1.57, P >0.05).@*Conclusions@#The relationship between intake of the five major types of prepackaged foods and pubertal development is inconsistent and no significant correlation was detected between the intake of prepackaged foods and overweight or obese children. Nutrition education should be strengthened to help children and their parents choose healthy prepackaged foods.

Risk assessment of nosocomial infection in patients with multiple myeloma in the first hospitalization / 公共卫生与预防医学

Objective To assess the risk of nosocomial infection in patients with multiple myeloma during their first hospitalization. Methods Totally 480 patients with multiple myeloma who were hospitalized for the first time in department of hematology of West China Hospital, Sichuan University from August 2021 to August 2022 were included, and the nosocomial infection during treatment was statistically analyzed. The patients were divided into infected group and uninfected group. The independent influencing factors of nosocomial infection were analyzed and a prediction model was established. The reliability of the prediction model was analyzed by receiver operating characteristic curve (ROC). Results The incidence rate of nosocomial infection was 31.2% among 480 patients hospitalized for the first time. There were statistically significant differences in age, ISS staging, controlling nutritional status (CONUT) score, agranulocytosis, hemoglobin, and albumin between the infected group and the uninfected group (P<0.05). Logistic multivariate regression analysis showed that age, ISS staging, CONUT score, agranulocytosis, hemoglobin level, and albumin level were all independent correlated factors of nosocomial infection in patients with multiple myeloma hospitalized for the first time (P<0.05). The area under the ROC curve (AUC), sensitivity and specificity of multivariate logistic regression prediction model were 0.88 (95%CI: 0.840-0.920), 85.00% and 76.36%, respectively. Conclusion The incidence rate of nosocomial infection is high among patients with multiple myeloma in the first hospitalization. The prediction model established according to independent correlated factors of nosocomial infection has high predictive value on the occurrence of nosocomial infection.

Hp infection rate, antibody typing and logistics regression analysis of 1111 physical examination people in plateau area / 公共卫生与预防医学

Objective To explore the Helicobacter pylori (Hp) infection rate and antibody typing of 1111 physical examination people in plateau area, and to analyze the risk factors of Hp infection by logistics regression analysis. Methods 1111 healthy people with physical examination in plateau area from January 2022 to December 2022 were selected as the research subjects. The Hp infection rate and antibody typing were calculated, and the risk factors of Hp infection were analyzed by logistics regression analysis. Results The Hp infection rate of physical examination people in plateau area was 62.47% (694/1 111). The infection rate of type I HP in infected patients was higher than that of type Ⅱ HP(75.50% vs 24.50%) (χ2=361.141, P2=4.418, 8.708, 16.565, 32.583, P=0.036, 0.003, 2=5.153, P=0.023). Often eating pickled or barbecued foods [OR (95%CI)=2.038 (1.049-3.961)], history of chronic gastric disease [OR(95%CI)=1.706 (1.132-2.569)] and family members living together≥4 [OR (95%CI)=1.857 (1.135-3.037)] were risk factors of Hp infection, and regular garlic consumption [OR (95%CI)=0.559 (0.346-0.903)] was a protective factor (P=0.036, 0.011, 0.014, 0.018). Conclusion The Hp infection rate and antibody Ure positive rate are higher in physical examination people in plateau area, and chronic gastric disease history and often eating pickled or barbecued foods are risk factors of Hp infection.

Analysis of factors influencing elevated blood pressure and overweight/obesity and their comorbidities among Tibetan middle school students in Lhasa City / 中国学校卫生

Objective@#To explore the prevalence of elevated blood pressure and overweight/obesity and their comorbidities among Tibetan middle school students in Lhasa, and to analyze their association with lifestyle and other factors, so as to provide a basis for the intervention measures targeting elevated blood pressure, overweight and obesity among middle school students in high altitude area.@*Methods@#Using a stratified cluster random sampling method in September 2021, a total of 1 488 Tibetan junior and high students from Lhasa City were investigated with blood pressure measurement, physical examination and questionnaire survey. The influencing factors of elevated blood pressure, overweight and obesity and their comorbidities association were analyzed by multivariate Logistic regression.@*Results@#The prevalence of elevated blood pressure, overweight/obesity and their comorbidities were 17.8%, 17.4% , 5.0% respectively. Multivariate Logistic regression analysis showed that age( OR =0.81), residence, body mass inex(BMI) and gender were the influencing factors of elevated blood pressure; and the risks of elevated blood pressure in female students were higher than male students ( OR =1.89), suburban students were higher than urban students ( OR =8.06), overweight and obesity groups were higher than normal groups ( OR =2.55, 2.87) ( P <0.05). Adjusting for confounding factors such as gender, residence and school, and BMI (only for elevated blood pressure), daily screen time ≥2 h was positively correlated with elevated blood pressure, overweight/obesity and its comorbidities ( OR =1.56, 1.59 , 2.51) ( P <0.05).@*Conclusions@#The prevalence of elevated blood pressure, overweight/obesity are relatively high in Lhasa. Longer screen time is a common factor affecting with elevated blood pressure, overweight/obesity and comorbidities among Tibetan students. Measures should be taken intervene in the lifestyle of Tibetan students, in order to reduce elevated blood pressure and overweight/obesity.

Association between obesity and dyslipidemia among rural primary and middle school students in Students Nutrition Improvement Program Areas of Zhejiang Province / 中国学校卫生

Objective@#The study aimed to analyze the association between different types of obesity and dyslipidemia among rural primary and middle school students in Zhejiang Province, so as to inform strategies for prevention and control of childhood obesity and hyperlipidemia.@*Methods@#As part of Nutrition Improvement Programme for Rural Compulsory Education Students, 1 244 participants were selected by stratified cluster random sampling in 5 counties of Zhejiang Province during September to December 2021. Physical examination, detection of blood lipid and questionnaire survey were conducted. The Chi -square test and Logistic regression analyses were used to assess the association between different types of obesity and dyslipidemia.@*Results@#The prevalence rates of overweight, obesity, abdominal obesity, and hyperlipidemia were 15.11%, 12.46%, 17.60%, and 21.78%. Obesity and abdominal obesity were correlated to high risk of high triglycerides ( OR =3.97, 95% CI =2.54-6.20; OR =4.45, 95% CI =2.95- 6.72 )( P <0.05). Compared with the non overweight and obese group with normal waist circumference,the overweight and obesity group were correlated to high risk of high cholesterol ( OR=2.53, 95%CI =1.45-4.42, P <0.05). Abdominal overweight or obese group had the highest risk for dyslipidemia and triglycerides ( OR =1.82, 95% CI =1.33-2.48; OR =3.64, 95% CI =2.45-5.43) ( P < 0.05).@*Conclusions@#The prevalence rates of overweight, obesity, abdominal obesity, and hyperlipidemia are relatively high in rural primary and middle school students of Nutrition Improvement Programme for Rural Compulsory Education Students in Zhejiang Province. Abdominal obesity is a more important risk factor for hyperlipidemia. Waist circumference should be the focus of considerable attention.

Relationship between depressive symptoms, negative life events, and resilience in primary and secondary school teachers / 中国学校卫生

Objective@#To explore the relationship between depressive symptoms, negative life events and resilience among primary and secondary school teachers, so as to provide a reference for mental health promotion in school teachers.@*Methods@#During November to December 2022, a questionnaire survey was conducted using convenient cluster sampling method to select 11 332 in service teachers from 38 schools in 8 provinces (cities) including Beijing, Guangdong, Anhui, Hubei, Sichuan, Xinjiang, Liaoning, and Heilongjiang. The Patient Health Questionnaire-9 items, a self developed 21-item Adverse Life Events questionnaire, and a 10-item Conner-Davidson Resilience Scale were used to assess depressive symptoms, experiences of negative life events, and resilience levels of the teachers, respectively. The relationship between depressive symptoms, negative life events and psychological resilience were analyzed by multiple linear regression and stratified regression.@*Results@#The detection rate of depressive symptoms among primary and secondary school teachers was 14.0%. Negative life events of primary and secondary school teachers were positively correlated with depressive symptoms ( r =0.35), while psychological resilience was negatively correlated with depressive symptoms ( r =-0.45) ( P <0.05). After adjusting for possible covariates including gender and marital status, negative life events were positively correlated with depressive symptoms ( β=0.22, P <0.01). Resilience played a moderating role in the association of negative life events with depressive symptoms among primary and secondary school teachers ( B=-0.15, P <0.01).@*Conclusions@#Negative life events experiences are associated with higher level of depressive symptoms among school teachers. However, resilience might mitigate the negative effects of negative life events on depressive symptoms, playing a protective role in teachers mental health.

Relationship between physical activity levels and depressive symptoms in college students: a cohort study / 中国学校卫生

Objective@#To explore the association between physical activity levels and depressive symptoms among college students, so as to provide evidence for promoting physical and mental health of college students.@*Methods@#Using a cohort study design,a baseline survey of 1 415 college students in Shenyang Normal University in 2017 followed for three years from 2018 to 2020. The International Physical Activity Questionnaire-Short Form (IPAQ-SF) and Selfrating Depression Scale (SDS) were used to evaluate the physical activity levels and depressive symptoms of college students. According to the level of physical activity at baseline (MET ·h/week), participants were divided into three groups [T1 (≤36.4), T2 (>36.4-89.3) and T3 (>89.3)]. Logistic regression analysis was used to examine the association between baseline physical activity levels and the incidence of depressive symptoms during the school years.@*Results@#In the 3year followup (2018-2020), 852 (60.2%) participants exhibited depressive symptoms. The numbers of individuals with depressive symptoms in the T1, T2, and T3 groups were 324, 268, and 260, respectively. Logistic regression analysis showed that college students who participated in higher levels of physical activity decreased the risk of depressive symptoms by 34.2% [T2: OR(95%CI) = 0.658 (0.500-0.866)] and 38.9% [T3:OR(95%CI)=0.611(0.465-0.804)] compared with T1 group after adjusting for demographic, lifestyle, healthrelated factors, and baseline depressive symptoms as covariates. The sexstratified analysis showed a negative correlation between physical activity levels and the incidence of depressive symptoms in female college students. Compared with T1 group, higher levels of physical activity reduced the incidence of depressive symptoms by 39.6% [T2: OR(95%CI)=0.604(0.445-0.820)] and 37.7% [T3: OR(95%CI)=0.623(0.459-0.846)], respectively (P<0.01). However, there was no significant correlation between physical activity levels and depressive symptoms in male college students (P>0.05).@*Conclusions@#There is an inverse relationship between physical activity levels and depressive symptoms. The findings suggest that schools should reduce the risk of depressive symptoms by promoting physical activity levels among college students.

Relationship among screen time，depressive symptoms and sleep parameters among college students / 中国学校卫生

Objective@#To explore the relationship between daytime or nighttime screen time, sleep duration, bedtime, sleep quality and depressive symptoms, so as to provide reference for preventing depression symptoms in college students.@*Methods@#A total of 1 259 college students in one university in Beijing were recruited by using a cluster random sampling method for online and offline questionnaire surveys in October 2022 and April to May 2023. The sleeping quality, depression symptoms and screen time of participants were measured with the Pittsburgh Sleep Quality Index(PSQI), Chinese Version of the Beck Depression Inventory-II (BDI-II-C) and Screen Time Questionnaire. Logistic ordered regression and multiple linear regression were used to analyze the correlation among screen time, sleep parameters and depressive symptoms.@*Results@#The prevalence of depressive symptoms was 24.9 %. There was no significant correlation between daytime screen time and depressive symptoms for a week after controlling for night screen time in a week, gender and age ( OR= 1.00 , 95%CI=1.00-1.01, P >0.05). There was a significant correlation between night screen time and depressive symptoms for a week ( OR=1.05, 95%CI=1.03-1.06, P <0.01) after controlling for daytime screen time in a week, gender and age. However, after controlling for the weekday sleep duration, weekend bedtime, and sleep quality step by step, there was no significant correlation between the night screen time for a week and the depressive symptoms ( OR=1.01, 95%CI= 0.99 -1.02, P >0.05). After adjusting for gender and age, multiple linear regression analysis found that the duration of one week s night vision screen had statistical significance in predicting weekday sleep duration, weekend sleep time and sleep quality ( β=-0.29, 0.45, 0.26, P <0.05). There were positive correlation between the duration of sleep on study days, the duration of sleep on rest days, and the quality of sleep with depressive symptoms（ OR =1.27,1.39,1.45， P <0.01）.@*Conclusions@#Excessive night screen time has a greater impact on sleep problems and depressive symptoms. Reducing nighttime video and improving sleep habits are potential intervention goals for reducing depression symptoms in college students.

Associations of family functioning and parental styles with anxiety symptoms among high grade primary school students / 中国学校卫生

Objective@#To investigate the prevalence of anxiety symptoms among high grade primary school students in Guangzhou and their correlation with family functioning and parental parenting styles, so as to provide theoretical basis and guidance for family based interventions for children s anxiety symptoms.@*Methods@#From June to September 2022, a multi stage cluster random sampling method was employed to select 5 396 students from grades 4 to 6 in 13 primary schools in Guangzhou. The Family Functioning Assessment Scale for Children, Parental Bonding Instrument, and Spence Children s Anxiety Scale Short Version were used for the survey. Inter group comparison was analysed by t test or analysis of variance. Linear regression analysis was used to explore the effects of family function and parental parenting styles on anxiety symptoms in primary school students.@*Results@#The average score for anxiety symptoms among high grade primary school students in Guangzhou was (11.63±10.88). In terms of parenting styles, mothers scored higher than fathers in the dimensions of "care" (25.63±4.92) and "control" (5.08±2.58) compared to fathers ( 24.74± 5.50, 5.00±2.51) ( t =15.80, 4.21, P <0.01). However, there was no statistically significant difference in the scores of parents on the dimension of "encouragement of independence"（12.98±4.06,13.05±3.95)( t =-1.77， P >0.05）. After adjusting for general demographic characteristics, the results of linear regression analysis showed that primary school students family functioning ( B =0.47) and parental "control" ( B =0.67, 0.75) were positively associated with anxiety symptoms scores ( P <0.01). Meanwhile, parental "care" ( B =-0.53,-0.55) and "encouragement of independence" ( B =-0.62,-0.68) were negatively associated with anxiety symptom scores ( P <0.01). These associations remained statistically significant even after further adjusting for family functioning ( P <0.01).@*Conclusions@#Family functioning, parenting styles are closely associated with anxiety symptoms among high grade primary school students. Positive family functioning and parenting styles may mitigate childhood anxiety symptoms, whereas excessive parental control may increase the risk of childhood anxiety symptoms.

Tobacco use and associated factors among high school students in Shannan City, Tibet in 2023 / 中国学校卫生

Objective@#To understand the current situation and related factors of tobacco use among high school students in Shannan City, so as to provide reference for tobacco control strategies for high school students.@*Methods@#A self administered questionnaire survey was conducted among 10 052 high school students from 6 high schools in Shannan City, Tibetan Autonomous Region by census methods from April to July in 2023. The comparison of rates was conducted by using Chi square test, and the influencing factors of tobacco use among high school students were analyzed using binomial classification Logistic regression.@*Results@#The rate of high school students in Shannan City trying cigarettes was 17.63%, and the current smoking rate was 10.07%, both of which were higher in boys than girls, and higher in urban areas than in rural areas ( χ 2 gender = 1 262.35 , 869.79; χ 2 area =35.90, 29.16, P <0.01). The smoking rate of students with parents and good friends smoking was higher than that of students with parents and good friends not smoking( χ 2= 190.50 ,1 741.44), and the current smoking rate showed an upward trend with age and age ( χ 2 trend =74.87, 122.86)( P <0.01). The tobacco dependence rate was 41.80%; 75.30% wanted to quit smoking, 83.99% had received smoking cessation assistance, but had received less professional smoking cessation assistance ( 13.41 %). Logistic regression analysis showed that vocational high school students, senior students (second and third grade), parents smoking (both smoking, mother smoking), and good friends smoking (some smoking, most smoking, all smoking) were positively correlated with smoking cigarettes among high school students ( OR=1.51, 1.54, 2.17, 2.22, 1.69, 5.30, 13.28, 8.59, P <0.05).@*Conclusions@#The smoking rate of high school students in Shannan City is high and second hand smoke exposure is common. Vocational high schools are the key to prevention and control. Effective cooperation between families, schools, and society should be strengthened to create a smoke free environment and protect students from tobacco hazards.

Analysis of high school students health literacy level and related factors / 中国学校卫生

Objective@#To understand the level of health literacy and influencing factors of Chinese general high school students, so as to provide scientific evidence for health promotion of high school students.@*Methods@#A multistage stratified cluster sampling method was used to conduct an on site survey on the health literacy status of 8 265 high school students in 31 provinces of China by using the National Health Literacy Monitoring Questionnaire from October 2018 to June 2019. SPSS 25.0 software was used to conduct one way test and multifactor Logistic regression analysis of different demographic characteristics.@*Results@#The health literacy level of Chinese general high school students was 7.1%; the three dimensions of literacy were ranked in descending order as follows: basic skills (21.3%), healthy lifestyles and behaviors (20.5%), and basic knowledge and concepts of health (7.8%); and the literacy levels of the six categories of health issues, in descending order, were basic medical care (88.3%), health information (75.9%), safety and first aid (51.0%), infectious disease prevention (44.2%), scientific health concept (39.0%) and chronic disease prevention (5.5%). Multifactorial Logistic regression analysis showed that ethnicity, region, family residence, school type, grade level, and father s education were the factors influencing the health literacy level of Chinese high school students( OR=2.08, 0.60/0.24, 0.44, 0.71, 1.41 /0.51, 1.37, P <0.05).@*Conclusions@#The overall health literacy level of Chinese high school students is low，ethnicity, region, family residence, school type, grade level and father s education are factors influencing the health literacy level of Chinese high school students. It is recommended that all departments at all levels focus on categorized governance to improve the health literacy level of high school students, taking into account the realities and characteristics of high school students health literacy level.

Effects of community building environment and sports with fitness APP usage on physical exercise habits in teachers in the Yangtze River Delta Region / 中国学校卫生

Objective@#To explore the effects of community building environment and sports with fitness APP usage and their interactions on teachers exercise habits in the Yangtze River Delta Region, so as to provide a scientific basis for the development of a sports and health promotion intervention program for teachers.@*Methods@#A total of 2 530 in service teachers from four provinces and cities in the Yangtze River Delta region, namely, Shanghai, Zhejiang, Jiangsu and Anhui Province, were sampled in May-June 2023 by using convenient cluster random sampling method. Self designed questionnaire was used to collect the basic information of the surveyed teachers, Physical Activity Building Environment Evaluation Questionnaire and the Sports with Fitness APP Usage Questionnaire were used to measure the teachers subjective perception of the community building environment and the usage of sports with fitness APP, respectively. Physical Exercise Habituation Scale was used to assess the level of exercise habits. Logistic regression models were applied to analyze the effects of community building environment and sports with fitness APP usage on physical exercise, and the interaction effects were analyzed by using additive and multiplicative models.@*Results@#Among all the teachers surveyed, 658 of them reported good physical exercise habits (26.0%), and differences in the rate of physical activity habit formation by gender, age, years of teaching, as well as subject of teaching were statistically significant ( χ 2=42.94, 39.73, 35.47, 218.23 , P <0.05). Teachers with physical exercise habits had significantly higher community building environment scores and sports and fitness APP use than teachers without exercise habits ( t =12.17,16.54, P <0.05). Adjusting for the confounders of age, gender, years of teaching experience, and subjects taught, multifactorial unconditional Logistic regression analysis showed that the probability of teachers having good physical exercise habits increased by 22% for every 1-point increase in the community building environment score on average ( OR =1.22, 95% CI =1.11-1.40), and the probability of teachers having good physical exercise habits increased by 16% for every 1-point increase in the sports with fitness APP score on average ( OR = 1.16 , 95% CI =1.03-1.31) ( P <0.05). Interaction analyses showed that there was an additive interaction between the effects of community building environment and sports and fitness APP use on teachers physical exercise habits after adjustment, and the 95% CI for RERI , API and SI were 1.17 -1.65, 0.12-0.46 and 1.78-3.33 ( P <0.05), respectively, and there was no multiplicative interaction ( P >0.05).@*Conclusions@#The community building environment and the usage of sports & fitness APP show impacts in the formation of teachers physical exercise habits in the Yangtze River Delta region, and there is an interaction effect. Enhancing the construction of smart sports centers around the community can provide a high quality external environment for the physical exercise habits formation.

Relationship between cardiorespiratory fitness and executive function in adolescents / 中国学校卫生

Objective@#To explore the relationship between cardiorespiratory fitness and executive function in Chinese adolescents, so as to provide a reference for promoting the overall development of Chinese adolescents physical and mental health.@*Methods@#From September to December 2022, a total of 5 018 adolescents aged 13 to 18 years from Shanghai, Suzhou, Taiyuan, Wuyuan, Xingyi, and Urumqi were selected by stratified cluster sampling method to assess cardiorespiratory fitness and executive function. Pearson s correlation and linear hierarchical regression were performed to analyze the relationship between cardiorespiratory fitness and executive functions.@*Results@#Among the sample of adolescents, maximal oxygen consumption (VO 2max ) was negatively correlated with the refreshing(1-back, 2-back) and conversion executive function responses ( r=-0.07, -0.12, -0.12, P <0.01). Linear regression analysis showed that VO 2max was negatively correlated with the reaction times of the refreshing(1-back, 2-back) and conversion functions ( B=-2.99, -6.44, -1.69, P <0.01).@*Conclusions@#Higher cardiorespiratory fitness among adolescents is associated with better performance in executive function. Teenagers should strengthen high intensity cardiopulmonary endurance exercise to promote the improvement of executive function.

Analysis of direct drinking water quality and its influencing factors in primary and secondary schools in Nanjing City / 中国学校卫生

Objective@#To investigate the quality and influencing factors of direct drinking water in schools in Nanjing City, so as to provide basis for management of school drinking water.@*Methods@#From April to July 2023, direct drinking water equipment from 146 primary and secondary schools were selected from Nanjing City using a stratified random sampling method and tested for colony forming units (CFU) and permanganate index. Mann-Whitney U test was used to compare the differences between groups, and multiple linear regression was used to analyze the influencing factors.@*Results@#The CFU and permanganate levels of school direct drinking water in Nanjing City were 1.00(0.00,15.50)CFU/mL and 0.47(0.26, 0.75)mg/L, respectively. The CFU level increased when the filter replacement time exceeded 3 months and when the water source was piped, while the permanganate index increased when the filter replacement time exceeded 3 months and using activated carbon technology ( Z =-2.21, -3.92, -2.31, -8.45 , P <0.05). The results of multiple linear regression analysis showed that the replacement time of filter element exceeding 3 months was positively correlated with the CFU level, and the process type involving activated carbon, a laid pipe network and a filter replacement time exceeding 3 months were positively correlated with the permanganate index( β =167.08, 0.32, 0.35, 0.11, P ＜0.05).@*Conclusions@#There are certain problems with the water quality of primary and secondary school direct drinking water in Nanjing City. Schools should promptly replace the filter and maintain the drinking water equipment to ensure the hygiene and safety of campus water quality.

Association between the ratio of dietary vitamin A to body weight and hypertension in children / 中国学校卫生

Objective@#To explore the relationship between the ratio of dietary vitamin A (VitA) to body weight and hypertension among children, so as to provide a reference for blood pressure control through dietary nutritional interventions and childhood hypertension prevention.@*Methods@#Utilizing the baseline survey and followup sample data from the Healthy Children Cohort established in urban and rural areas of Chongqing from 2014 to 2019, structured quantitative dietary questionnaire and selfdesigned questionnaire were used to investigate the information of dietary intake and socioeconomic characteristics of 15 279 children, as well as blood pressure, height, weight measurement. The ratio of dietary VitA to body weight was divided into four groups based on quartiles [≤P25(Q1), >P25~P50(Q2), >P50~P75(Q3), >P75(Q4)]. Generalized linear regression models and Logistic regression models were used to analyze the correlation between ratio of dietary VitA to body weight with blood pressure levels and prevalence of hypertension.@*Results@#The results of the 2014 baseline survey indicated that, after adjusting for confounding factors such as demographic indicators and nutritional intake, significant differences were observed in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) among different groups categorized by the ratio of dietary VitA to body weight (F=157.57, 44.71, 95.92, P<0.01). The baseline ratio of dietary VitA to body weight in children exhibited a negative correlation with DBP, SBP and MAP at baseline and in 2019[baseline: β(95%CI)=-0.65(-0.89--0.42), -0.22(-0.42--0.01), -0.36(-0.56--0.16); 2019: β(95%CI)=-0.77(-1.34--0.19), -0.62(-1.21--0.02), -0.77(-1.34--0.19), P＜0.05]. Compared to Q1 group, the risk of hypertension decreased among children in Q4 at baseline and followup in 2019 [OR(95%CI)=0.63(0.49-0.81), 0.18(0.08-0.42), P<0.01].@*Conclusions@#The ratio of dietary VitA to body weight is significantly negatively correlated with blood pressure levels among children, and dietary VitA deficiency is an independent risk factor for hypertension among children. Measures should be taken to actively adjust childrens dietary nutrition and reduce the risk of childhood hypertension.