Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
JAMA Netw Open. 2024 Apr 1;7(4):e246448. doi: 10.1001/jamanetworkopen.2024.6448.
Nonheterosexual and gender-nonconforming (GNC) individuals tend to report adverse childhood experiences (ACEs) more frequently compared with heterosexual and gender-conforming individuals, and individuals who have experienced ACEs, identify as nonheterosexual, or exhibit moderate to high levels of GNC are more prone to engaging in problematic smartphone use (PSU). However, there is limited school-based data among adolescents regarding this matter.
To explore the associations between ACEs and PSU among adolescents across different sexual orientation and gender expression groups.
DESIGN, SETTING, AND PARTICIPANTS: Using data from the 2021 School-Based Chinese Adolescents Health Survey, this cross-sectional study includes participants from 288 public high schools across 8 provinces in China. Statistical analysis was performed from October 2023 to February 2024.
Data on ACEs, sexual orientations, and gender expressions (high, moderate, and low GNC) were collected.
PSU was assessed using the 10-item Smartphone Addiction Scale-Short Version (SAS-SV). Weighted linear, logistic, or Poisson regression models were used.
Among the 85 064 adolescents included (mean [SD] age, 14.92 [1.77] years), 42 632 (50.1%) were female, 70 157 (83.2%) identified as Han Chinese, and 14 208 (16.8) identified as other ethnicities (Miao, Hui, Yi, Dai, and other ethnic groups). The prevalence of PSU among participants was 35.4%. Weighted Poisson regression models indicated that the interaction between GNC and ACE was significant (adjusted prevalence ratio [APR], 0.98; 95% CI, 0.97-0.99). Further stratified analysis demonstrated homosexual adolescents who experienced 4 or more ACEs showed a significantly increased prevalence of PSU (APR, 1.79; 95% CI, 1.64-1.96). Similarly, a markedly higher prevalence of PSU was observed among bisexual individuals with 4 or more ACEs (APR, 1.60; 95% CI, 1.41-1.80). Regarding gender expression categories, a significantly higher prevalence of PSU was noted among high GNC adolescents with 4 or more ACEs (APR, 1.78; 95% CI, 1.60-1.98) compared with low GNC adolescents without ACEs. Furthermore, experiencing any 3 ACE categories (abuse, neglect, and household dysfunction) was associated with an increased prevalence of PSU across different sexual orientation and gender expression subgroups.
In this cross-sectional study, the amalgamation of elevated ACE scores with nonheterosexual orientations or GNC identities was significantly associated with increased PSU prevalence. These findings underscore that preventing ACEs may be beneficial in mitigating PSU among adolescents, particularly for nonheterosexual adolescents and those with high levels of GNC.
非异性恋和性别非规范（GNC）个体往往比异性恋和性别规范个体更频繁地报告不良的童年经历（ACEs），而经历过 ACEs、认同非异性恋、或表现出中度至高度 GNC 的个体更容易出现有问题的智能手机使用（PSU）。然而，关于这一问题，青少年的学校基础数据有限。
探讨不同性取向和性别表达群体的青少年中 ACEs 与 PSU 之间的关联。
设计、地点和参与者：本横断面研究使用了来自中国 8 个省 288 所公立高中的 2021 年学校青少年健康调查的数据。统计分析于 2023 年 10 月至 2024 年 2 月进行。
收集 ACEs、性取向和性别表达（高、中、低 GNC）的数据。
使用智能手机成瘾量表-短版（SAS-SV）的 10 项评估 PSU。使用加权线性、逻辑或泊松回归模型。
在纳入的 85064 名青少年中（平均[SD]年龄，14.92[1.77]岁），42632 名（50.1%）为女性，70157 名（83.2%）为汉族，14208 名（16.8%）为其他种族（苗族、回族、彝族、傣族和其他少数民族）。参与者中 PSU 的患病率为 35.4%。加权泊松回归模型表明，GNC 和 ACE 之间的交互作用显著（调整后患病率比[APR]，0.98；95%置信区间，0.97-0.99）。进一步的分层分析表明，经历 4 次及以上 ACE 的同性恋青少年 PSU 的患病率显著增加（APR，1.79；95%置信区间，1.64-1.96）。同样，经历 4 次及以上 ACE 的双性恋个体 PSU 的患病率也明显升高（APR，1.60；95%置信区间，1.41-1.80）。关于性别表达类别，经历 4 次及以上 ACE 的高 GNC 青少年 PSU 的患病率明显高于低 GNC 青少年（APR，1.78；95%置信区间，1.60-1.98），而低 GNC 青少年没有 ACE。此外，经历任何 3 个 ACE 类别（虐待、忽视和家庭功能障碍）与不同性取向和性别表达亚组中 PSU 患病率的增加有关。
在这项横断面研究中，较高的 ACE 评分与非异性恋取向或 GNC 身份的结合与 PSU 患病率的增加显著相关。这些发现强调，预防 ACEs 可能有益于减轻青少年的 PSU，特别是对非异性恋青少年和 GNC 水平较高的青少年。
