Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents.

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Differentiated impacts of short-term exposure to fine particulate constituents on infectious diseases in 507 cities of Chinese children and adolescents: A nationwide time-stratified case-crossover study from 2008 to 2021.

This study assesses the association of short-term exposure to PM2.5 (particles ≤2.5 µm) on infectious diseases among Chinese children and adolescents. Analyzing data from 507 cities (2008-2021) on 42 diseases, it focuses on PM2.5 components (black carbon (BC), ammonium (NH4+), inorganic nitrate (NO3-), organic matter (OM), and sulfate (SO42-)). PM2.5 constituents significantly associated with incidence. Sulfate showed the most substantial effect, increasing all-cause infectious disease risk by 2.72 % per interquartile range (IQR) increase. It was followed by BC (2.04 % increase), OM (1.70 %), NO3- (1.67 %), and NH4+ (0.79 %). Specifically, sulfate and BC had pronounced impacts on respiratory diseases, with sulfate linked to a 10.73 % increase in seasonal influenza risk and NO3- to a 16.39 % rise in tuberculosis. Exposure to PM2.5 also marginally increased risks for gastrointestinal, enterovirus, and vectorborne diseases like dengue (7.46 % increase with SO42-). Sexually transmitted and bloodborne diseases saw an approximate 6.26 % increase in incidence, with specific constituents linked to diseases like hepatitis C and syphilis. The study concludes that managing PM2.5 levels could substantially reduce infectious disease incidence, particularly in China's middle-northern regions. It highlights the necessity of stringent air quality standards and targeted disease prevention, aligning PM2.5 management with international guidelines for public health protection.

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.

Effect and Mechanisms of Huangqi-Shanzhuyu in the Treatment of Diabetic Nephropathy based on Network Pharmacology and In Vitro Experiments.

BACKGROUND: Huangqi-Shanzhuyu (HS), a classic combination of Chinese herbal formulae, has been widely used for the treatment of diabetic nephropathy (DN). However, its pharmacological mechanism of action is still unclear. METHODS: The active ingredients of HS and their potential targets were identified through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and the DN-related targets were determined from GeneCards, Online Mendelian Inheritance in Man (OMIM), PharmGkb, and Therapeutic Target Database (TTD). The Cytoscape software was used to construct a herb-disease-target network and screen core genes. STRING was employed to generate a protein-protein interaction (PPI) network. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to predict the mechanism of action of HS in DN. Animal experiments and molecular docking were used to verify the potential mechanism. RESULTS: In total, 40 active ingredients and 180 effective targets of HS in DN were identified and 1115 DN-related targets were retrieved. From the PPI network, VEGFA, AKT1, IL6, IL1B, TP53, MMP9, PTGS2, CASP3, EGF and EGFR were identified as core genes. The anti-DN mechanism mainly involved multiple signaling pathways such as AGEs-RAGE. Animal experiments and molecular docking analysis confirmed that HS downregulated the expression of IL-1 and IL-6 via kaempferol-mediated inhibition of JNK1 phosphorylation. CONCLUSIONS: HS exhibits a therapeutic effect in DN through its multiple ingredients that act on several targets and multiple signaling pathways, including AGEs-RAGE.

Urinary antibiotic concentrations in preschool children from eastern China and health risk assessment.

Despite limited biomonitoring studies suggesting extensive antibiotic exposure in general population, the body burden of antibiotics in young children and their potential health risks remain unclear. To assess the antibiotic exposure levels in young children, 508 preschoolers aged 3-6 years were recruited from eastern China in 2022, and a total of 50 representative antibiotics from 8 categories, including 17 human antibiotics (HAs), 4 antibiotics preferred as HAs (PHAs), 16 veterinary antibiotics (VAs), and 13 antibiotics preferred as VAs (PVAs), were analyzed by UPLC-MS/MS. Hazard quotient (HQ) and hazard index (HI) were calculated to evaluate the health risks, and multivariate logistic regression was applied to examine diet with antibiotic exposure. Our results showed that there were 41 antibiotics detected in children's urine, and the overall detection frequency was as high as 100%. Sulfonamides, macrolides, ß-lactams, quinolones, and azoles were the predominant categories of antibiotic detected. Among the studied children, 6.5% had a sum of estimated daily intake (EDI) of all VAs and PVAs larger than 1 µg/kg/day. Notably, 10.0% of the children had a microbiological HI value exceeding 1, primarily contributed by ciprofloxacin. Children with higher consumption of seafood had a relatively increased exposure to multiple categories of antibiotics, including HAs, VAs, quinolones, azoles, and others. Principal component analysis suggested that "Aquatic products and viscera preferred dietary pattern" scores were positively correlated with the exposure levels of ciprofloxacin (OR: 1.23; 95% CI: 1.02-1.47) and carbadox (OR: 1.32; 95% CI: 1.10-1.59), and a relatively increased exposure of PHAs was realized in children with higher "Meat-egg preferred dietary pattern" scores (OR: 1.24; 95% CI: 1.03-1.50). In conclusion, there was a widespread exposure to antibiotics among preschool children from eastern China, and children who consumed more animal-derived foods may had an increased exposure to antibiotics.

Evolutionary game model based on cumulative prospect theory for information management mechanism in SIoT.

As nodes in Social Internet of Things (SIoT) become more intelligent, malicious information occurs more frequently and spreads more widely. This problem can severely affect the trustworthiness of services and applications in SIoT. Methods to effectively control malicious information spreading in SIoT are essential and necessary. Reputation mechanism provides a powerful tool to tackle this challenge. In this paper, we propose a reputation-based mechanism to activate the self-purification capacity of the SIoT network by balancing information conflicts triggered by reporters and supporters. In order to find the best rewarding and punishment strategy, a bilateral cumulative-prospect-based evolutionary game model of SIoT network information conflict is constructed. Using local stability analysis and numerical simulation, the evolutionary trends of the proposed game model under different theoretical application scenarios are analyzed. The findings indicate that the basic income and deposit of both sides, the popularity of information as well as the importance of the conformity effect all have a significant impact on the system's steady state and evolutionary path. The specific conditions that both participating sides of the game tend to treat conflicts relatively rationally are analyzed. Dynamic evolution analysis and sensitivity analysis of selected parameters show that basic income is positively related to smart object's feedback strategies, while deposit is negatively related to that. While weight of conformity effect or the information popularity goes up, the rising of feedback probability is observed. Based on the above results, suggestions on dynamic reward and punishment strategies are given. The proposed model is a helpful attempt to model the evolution of information spreading in SIoT networks, with the ability to simulate several well-known regularities of message dissemination. Proposed model and suggested quantitative strategies can be helpful to build feasible malicious information control facilities in SIoT networks.

Lead-induced cardiomyocytes apoptosis by inhibiting gap junction intercellular communication via modulating the PKCα/Cx43 signaling pathway.

OBJECTIVE: The aim of this study was to investigate the regulatory mechanism of Pb regulates gap junction intercellular communication to induced apoptosis in H9c2 cells. METHODS: H9c2 cell line is used as the research object in this study, and treated with different concentrations of Pb acetate. Subsequently, Cell viability was measured by the Cell Counting Kit-8 (CCK-8) assay. The levels of lactate dehydrogenase (LDH), aspartate transaminase (AST) and creatine kinase-MB (CK-MB) in the supernatants were measured using respective commercial enzyme-linked immune sorbent assay (ELISA) kits. Western blot was used to detect the expression of apoptosis-related protein in H9c2 cells in each group. Quantitative RT-PCR Analysis Total RNA was extracted from frozen H9c2 cells using Trizol reagent, the PKCα and Cx43 in the supernatant of H9c2 cells was determined by the BCA protein detection kit. RESULTS: H9c2 cells increased release of cardiac enzymes (LDH, AST, and CK-MB) and decreased cell survival rate, and the Cx43, p-Cx43, PKCα and p-PKCα protein levels showed a dose-dependent decrease after Pb treatment. PKCα was activated with PMA, the relative expression level of Cx43 protein increased significantly, the expression of Bcl-2 increased and Bax and Cyt-c decreased compared with Pb exposure group, and the myocardial enzymes (LDH, AST, and CK-MB) in cell culture supernatant decreased compared with Pb exposure group, indicating that the degree of cell damage was alleviated. Results showed that Pb inhibited PKCα activity, decreased the expression of total Cx43 and P-Cx43 protein, and aggravated myocardial injury. CONCLUSIONS: Pb decrease gap junction intercellular communication, which induce apoptosis in H9c2 cells by inhibiting the PKCα/Cx43 signaling pathway.

Epsilon toxin-producing Clostridium perfringens colonize the multiple sclerosis gut microbiome overcoming CNS immune privilege.

Multiple sclerosis (MS) is a complex disease of the CNS thought to require an environmental trigger. Gut dysbiosis is common in MS, but specific causative species are unknown. To address this knowledge gap, we used sensitive and quantitative PCR detection to show that people with MS were more likely to harbor and show a greater abundance of epsilon toxin-producing (ETX-producing) strains of C. perfringens within their gut microbiomes compared with individuals who are healthy controls (HCs). Isolates derived from patients with MS produced functional ETX and had a genetic architecture typical of highly conjugative plasmids. In the active immunization model of experimental autoimmune encephalomyelitis (EAE), where pertussis toxin (PTX) is used to overcome CNS immune privilege, ETX can substitute for PTX. In contrast to PTX-induced EAE, where inflammatory demyelination is largely restricted to the spinal cord, ETX-induced EAE caused demyelination in the corpus callosum, thalamus, cerebellum, brainstem, and spinal cord, more akin to the neuroanatomical lesion distribution seen in MS. CNS endothelial cell transcriptional profiles revealed ETX-induced genes that are known to play a role in overcoming CNS immune privilege. Together, these findings suggest that ETX-producing C. perfringens strains are biologically plausible pathogens in MS that trigger inflammatory demyelination in the context of circulating myelin autoreactive lymphocytes.

Long-term effects of ambient PM2.5 constituents on metabolic syndrome in Chinese children and adolescents.

Metabolic syndrome (MetS) is considered a main public health issue as it remarkably adds the risk of cardiovascular disease, leading to a heavy burden of disease. There is growing evidence linking fine particulate matter (PM2.5) exposure to MetS. However, the influences of PM2.5 constituents, especially in children and adolescents, remain unclear. Our study was according to a national analysis among Chinese children and adolescents to examine the associations between long-term exposure to PM2.5 main constituents and MetS. A total of 10,066 children and adolescents aged 10-18 years were recruited in 7 provinces in China, with blood tests, health exams, and questionnaire surveys. We estimated long-term exposures to PM2.5 mass and its five constituents, containing black carbon (BC), organic matter (OM), inorganic nitrate (NO3-), sulfate (SO42-), and soil particles (SOIL) from multi-source data fusion models. Mixed-effects logistic regression models were used with the adjustment of a variety of covariates. In the surveyed populations, 2.9% were classified as MetS. From the single-pollutant models, we discovered that long-term exposures to PM2.5 mass, BC, OM, NO3-, as well as SO42-, were significantly associated with the prevalence of MetS, with odds ratios (ORs) per 1 µg/m3 that were 1.02 (95% confidence interval (CI): 1.01, 1.03) for PM2.5 mass, 1.24 (95% CI: 1.14, 1.35) for BC, 1.07 (95% CI: 1.04, 1.11) for OM, 1.09 (95% CI: 1.04, 1.13) for NO3-, and 1.14 (95% CI:1.04, 1.24) for SO42-. The influence of BC on the prevalence of MetS was robust in both the multi-pollutant model and the PM2.5-constituent joint model. The paper indicates long-term exposure to PM2.5 mass and specific PM2.5 constituents, particularly for BC, was significantly associated with a higher MetS prevalence among children and adolescents in China. Our results highlight the significance of establishing further regulations on PM2.5 constituents.

Associations between greenspace surrounding schools and lipid levels in Chinese children and teenagers.

Little evidence exists concerning the associations of greenspace with childhood lipid profiles and dyslipidemias, especially in developing countries and regions. We aimed to investigate the associations of greenspace surrounding schools with lipid levels and dyslipidemia prevalence among Chinese children and teenagers. We obtained baseline information and health data of 10,408 children and teenagers (aged 6-18 years) who studied from 94 schools in China. We measured levels of four blood lipids: triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Dyslipidemias were defined using standard recommendations. Greenness surrounding schools were assessed using two satellite-based greenness indices, Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI) at 300-, 500-, and 1000-m circular buffers based on each school's latitude and longitude. We used random forest model combined with meteorological and remote sensing data to estimate air pollution levels surrounding each school. We used generalized linear mixed models to estimate the associations of greenness with lipid levels and dyslipidemias prevalence. We also performed sub-group and mediation analyses. An interquartile range (IQR) increase in NDVI500m was significantly associated with a 0.064 mmol/L (95% confidence interval [CI]: 0.083, -0.045) and 0.049 mmol/L (95% CI: 0.065, -0.033) decreased TC and LDL-C levels, respectively, as well as a 0.13-fold (95% CI: 0.01, 0.23) and 0.17-fold (95% CI: 0.01, 0.30) decreased odds of hypercholesterolemia and hyperbetalipoproteinemia, respectively. Associations were stronger in students aged ≤12 years and born to parents having lower education levels compared to their counterparts. Particle with aerodynamic diameter ≤2.5 µm (PM2.5) mediated 61.5% and 16.7% of the association of greenness with TG and LDL-C levels, respectively. In summary, higher school-based greenness exposure was beneficially associated with lipid levels among Chinese children and adolescents, and part of the association can be explained by lowed PM2.5 levels.

The joint influence of subjective social status and life skill level on adolescent health risk behaviors / 中国学校卫生

Abstract@#Subjective social status and life skill level are important influencing factors of adolescent health risk behaviors, and they interact with each other and jointly act on adolescent health risk behaviors, which make the mechanism of adolescent health risk behaviors become more diverse and complex. The current paper reviews the correlations among subjective social status, life skill level and adolescent health risk behaviors, in order to explore the joint influence of subjective social status and life skill level on adolescent health risk behaviors, then provides future directions for exploring possible mechanisms, and proposes recommendations for effective prevention strategies of adolescent health risk behaviors.

Public health emergency response capacity in primary and secondary schools / 中国学校卫生

Objective@#To understand the public health emergency response capacity in primary and secondary schools, and to explore the problems and challenges in the prevention and control of public health emergency in primary and secondary schools for specific strategies.@*Methods@#By using the stratified group sampling method, a questionnaire survey on general situation, knowledge, attitude and training, as well as public health emergencies response capacity among 2 988 teachers or leaders responsible for school emergency response in primary and secondary schools from Beijing, Chongqing and Yunnan.@*Results@#Participants varied on their positions, titles, educational background and knowledge accuracy. Higher knowledge accuracy was associated with higher educational background ( χ 2=50.73-203.36, P < 0.05 ). The implementation of regular public health emergency related programs was poorly conducted in high schools (50.0%). Urban schools (42.0%) had higher proportion of qualified health care professionals than rural schools (18.2%), and private schools (48.5%) was higher than public schools (24.7%). The primary challenges included the shortage of guidance from professionals and the lack of related testing equipment (84.91%, 74.03%).@*Conclusion@#Although the ability of emergency handling of public health emergencies in schools in the three regions is advancing with the times, there are still many deficiencies, some omissions in the mastery of knowledge. It is suggested to inerease pre service and special training of school health work CDC should strengthen technical guidance and work supervision of infectious disease management in schools.

Implementation of the healthy school construction plan to promote students health and well being / 中国学校卫生

Abstract@#With the development of society, the health and well being of children and adolescents are receiving increasing attention from the government and scholars. The implementation of the health (promoting) school construction plan has a significant effect on promoting students health and well being, which is especially important in the normalized stage of COVID-19 epidemic prevention and control. The study summarizes the importance of health (promoting) schools for students health and well being, reviews the development of health (promoting) school construction in China, and proposes countermeasures and recommendations to further promote health (promoting) school construction in China in the light of the new era.

Preliminary development of Health Literacy Evaluation Scale for Pupils / 中国学校卫生

Objective@#To preliminarily develop Health Literacy Scale for pupils, providing a tool for dynamic monitoring and related health literacy research among pupils.@*Methods@#Through policy and literature review, the health literacy evaluation index system of pupils was established. Through two rounds of expert consultation, the evaluation index system and scale item pool of three levels in primary school were formed, and "Evaluation Scale 1.0" was developed. Through two panel discussions, health education experts, teachers and students were invited to provide advices on the content, expression and structure of scale 1.0, turning it into "Evaluation Scale 2.0", and completing the preliminary development of the scale.@*Results@#The health literacy assessment index system of primary school students includes three levels，including level-1 was Grade 1-2, level-2 was Grade 3-4,level-3 was Grade 5-6, covering two level indexes. The scale for primary school students contained five horizontal dimensions and four vertical dimensions. In the Delphi consultation, the response rate was 100%, and the authority coefficient was 0.85. After item selection and modification, the final version of level-1, level-2 and level-3 scales contained 36, 44 and 50 items respectively.@*Conclusion@#The development of Health Literacy Evaluation Scale for pupils has high applicability and practical value.

Research status and progress of health literacy for children and adolescents / 中国学校卫生

Abstract@#Improving health literacy can effectively reduce the risk of health risk behaviors and adverse health outcomes in children and adolescents. Global research on health literacy of children and adolescents has been increasing in recent years. The paper reviews the existing research and proposes that there is no universal definition and connotation of health literacy for children and adolescents, most of the studies use or make some revisions on the definition of adult health literacy in child and adolescent health literacy, failing to consider developmental characteristics and unique health needs of children and adolescents. Moreover, the assessment index system and instruments are diversified, making the research findings from different studies difficult to compare, and to obtain consistent and reliable conclusions. Future endeavors are encoouraged to expand health literacy researches and to update more comprehensive and practical definition, and to develop a standardized assessment instrument that can be validated in Chinese culture.

Knowledge of comprehensive sexuality education and influencing factors among junior high school teachers / 中国学校卫生

Objective@#To understand knowledge of comprehensive sexuality education and its associated factors among junior high school teachers in six provinces in China, in order to provide a scientific basis for teacher training.@*Methods@#From June to December 2021, a convenience sampling method was used to select 1 016 junior high school teachers from Beijing, Chongqing, Liaoning, Sichuan, Yunnan and Guangdong provinces. A structured questionnaire was used to investigate teachers knowledge of comprehenswe sexuality education. Binary Logistic regression was used to analyze the related influencing factors of the knowledge of comprehensive sexuality education among junior high school teachers.@*Results@#The study showed that the knowledge rate of comprehensive sexuality education among middle school teachers was 58.1%, and the knowledge rate was higher in teachers who had conducted sexuality education to students( χ 2=9.42, P <0.01). The percentage of the correct answer on the prevention and control of sexually transmitted diseases(26.0%), the impact of inequality on love relationships( 33.6 %), and the impact of mass media on sexual cognition(68.8%) was the lowest. Regardless of whether they had implemented sexuality education for students, the knowledge and awareness rate of sexual knowledge among biology teachers, school doctors/health teachers and mental health teachers was higher( OR=2.32, 4.17, P <0.05).@*Conclusion@#Knowledge of comprehensive sexuality education among middle school teachers still needs to be improved. It is advisable to strengthen the training of comprehensive sexuality education for middle school teachers and focus on teachers of subjects related to comprehensive sexuality education.

The independent and combined effects of single-child status and ideal lifestyle on clustered cardio-metabolic risk factors among Chinese children and adolescents.

Background: Cardio-metabolic risk factors (CMRFs) represent the accumulation of metabolic abnormalities, significantly increasing the likelihood of cardiovascular diseases. Although studies assessed the independent association of single-child status and lifestyle risk factors with components of CMRFs or clustered CMRFs, little has been known about the combined effect of single-child status and lifestyles on clustered CMRFs as well as sex differences. Materials and methods: Data was collected from a cross-sectional survey conducted in September 2013 in China. A total of 13,859 children and adolescents aged 7-18 years with blood samples were included. Anthropometric measurements and serum biochemical indexes were collected to assess clustered CMRFs, while questionnaires were used to obtain single-child status, lifestyle information, and characteristics of children and their parents. Mixed effect logistic regression was applied to analyze the independent and the combined effects of single-child status and ideal lifestyle category on clustered CMRFs. Results: The prevalence of clustered CMRFs was 3.4%, with a higher prevalence in boys (4.0%) than girls (2.7%). Children and adolescents with clustered CMRFs had a higher proportion of single children (76.6 vs. 69.7%) and unfavorable lifestyles (62.1 vs. 29.2%) compared with their peers with non-clustered CMRFs. Both single children (OR = 1.67, 95% CI: 1.32-2.11) and unfavorable lifestyles (OR = 9.03, 95% CI: 6.26-13.02) were associated with an increased risk of clustered CMRFs. The risk of clustered CMRFs increased significantly (OR = 12.79, 95% CI: 6.67-24.52) when single children and an unfavorable lifestyle were combined, which was almost neutralized (OR = 1.33, 95% CI: 0.63-2.82) when single children adhered to a favorable lifestyle. However, no sex differences were observed in this study. Conclusion: Single children with unfavorable lifestyles were associated with an obvious risk of clustered CMRFs, which might be partially offset by expanding family size (the number of siblings) or establishing a favorable lifestyle. A birth-friendly social environment as well as a family environment with a favorable lifestyle are encouraged in China.

The Influencing Factors of Comprehensive Sexuality Education Capacity and Its Correlation with Subjective Social Status among Chinese Junior High School Students.

(1) Objective: Evidence suggests that comprehensive sexuality education (CSE) can protect and empower younger generations to advocate for their reproductive health and wellbeing. This survey aims to investigate the current status and influencing factors of CSE among Chinese junior high school students, and to evaluate its correlation with the learning experience of sex education and subjective social status (SSS) to provide evidence for the implementation of CSE in the future. (2) Methods: A total of 4109 participants aged 11 to 16 years were recruited using data from a cross-sectional survey among junior high school students in China in 2021. CSE knowledge, attitude, and skills were used to generate the CSE comprehensive capacity by a principal component analysis. One-way ANOVA was used to assess the different effects of school sex education and family sex education. Multiple linear regression was used to assess the association between CSE comprehensive capacity and SSS. (3) Results: The average score of CSE comprehensive capacity was 82.44 ± 8.60 (with a total score of 100 points) among participants. After the adjustment, subjective social status was positively related to CSE comprehensive capacity (B = 0.28, 95% CI: 0.20-0.36), and SSS (School) (beta = 0.62) had a higher impact on CSE comprehensive capacity compared to SSS (Family) (beta = -0.10). School sex education was associated with the CSE knowledge level with a larger magnitude compared to family sex education (mean deviation = -0.53, p = 0.031), whereas family sex education was related to the CSE skill level with a greater magnitude (mean deviation =1.14, p = 0.005). (4) Conclusions: These findings suggest that sex education at school and within the family might have a different impact on CSE capacity, which was positively associated with SSS among junior high school students.

The Combined Effect of Birth Weight and Lifestyle on Clustered Cardio-Metabolic Risk Factors in Children and Adolescents: A National School-Based Cross-Sectional Survey.

BACKGROUND: Due to the adverse effects of cardio-metabolic risk factors (CMRFs) in children and adolescents on their current and later life health, and the growing evidence that birth weight and lifestyle have on CMRFs, we aimed to estimate the combined effect of birth weight and lifestyle on clustered CMRFs in children and adolescents. METHODS: We enrolled 11,509 participants aged 7-18 years old in a national school-based cross-sectional study in seven provinces in China in 2013. Information on CMRFs was collected through anthropometric measurements and blood sample testing. Information on birth weight, lifestyle and other basic information were investigated through children and adolescents' as well as parents' questionnaires. The generalized linear mixed model was applied to estimate the odd ratio (OR) and 95% confidence interval (95% CI) for the associations between CMRFs, clustered CMRFs and birth weight, lifestyle, and the combinations of birth weight and lifestyle. RESULTS: Overall, the prevalence of clustered CMRFs was 3.6% in children and adolescents aged 7-18 years, higher in boys (4.4%) than girls (2.9%). The combination of LBW/ideal lifestyle (OR = 2.00, 95% CI: 1.07-3.72) was associated with higher risk of clustered CMRFs, as well as in adolescents aged 13-18 years and in boys. The combination of HBW/poor lifestyle (OR = 1.74, 95% CI: 1.13-2.68) was related to elevated risk of clustered CMRFs, especially in children aged 7-12 years. CONCLUSIONS: CMRFs in Chinese children and adolescents is concerning, ideal lifestyle could weaken the association of birth weight with clustered CMRFs, especially in younger age, indicating that programs to prevent abnormal birth weight or poor lifestyle or both among children and adolescents may reduce CMRFs in China.

Associations between Breastfeeding Duration and Obesity Phenotypes and the Offsetting Effect of a Healthy Lifestyle.

Background: Additional metabolic indicators ought to be combined as outcome variables when exploring the impact of breastfeeding on obesity risk. Given the role of a healthy lifestyle in reducing obesity, we aimed to assess the effect of breastfeeding duration on different obesity phenotypes according to metabolic status in children and adolescents, and to explore the offsetting effect of healthy lifestyle factors on the associations between breastfeeding duration and obesity phenotypes. Methods: A total of 8208 eligible children and adolescents aged 7-18 years were recruited from a Chinese national cross-sectional study conducted in 2013. Anthropometric indicators were measured in the survey sites, metabolic indicators were tested from fasting blood samples, and breastfeeding duration and sociodemographic factors were collected by questionnaires. According to anthropometric and metabolic indicators, obesity phenotypes were divided into metabolic healthy normal weight (MHNW), metabolic unhealthy normal weight (MUNW), metabolic healthy obesity (MHO), and metabolic unhealthy obesity (MUO). Four common obesity risk factors (dietary consumption, physical activity, screen time, and sleep duration) were used to construct a healthy lifestyle score. Scores on the lifestyle index ranged from 0 to 4 and were further divided into unfavorable lifestyles (zero or one healthy lifestyle factor), intermediate lifestyles (two healthy lifestyle factors), and favorable lifestyle (three or four healthy lifestyle factors). Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the associations between breastfeeding duration and obesity phenotypes. Furthermore, the interaction terms of breastfeeding duration and each healthy lifestyle category were tested to explore the offsetting effect of lifestyle factors. Results: The prevalence of obesity among Chinese children and adolescents aged 7-18 years was 11.0%. Among the children and adolescents with obesity, the prevalence of MHO and MUO was 41.0% and 59.0%, respectively. Compared to the children and adolescents who were breastfed for 6-11 months, prolonged breastfeeding (≥12 months) increased the risks of MUNW (OR = 1.35, 95% CI: 1.19-1.52), MHO (OR = 1.61, 95% CI: 1.27-2.05), and MUO (OR = 1.46, 95% CI: 1.20-1.76). When stratified by healthy lifestyle category, there was a typical dose-response relationship between duration of breastfeeding over 12 months and MUNW, MHO, and MUO, with an increased risk of a favorable lifestyle moved to an unfavorable lifestyle. Conclusions: Prolonged breastfeeding (≥12 months) may be associated with increased risks of MUNW, MHO, and MUO, and the benefits of breastfeeding among children and adolescents may begin to wane around the age of 12 months. The increased risks may be largely offset by a favorable lifestyle.