Beyond the Classroom: The Role of Social Connections and Family in Adolescent Mental Health in the Transylvanian Population of Romania.

: This study explores gender variations in the associations between lifestyle choices, mental health, and social behaviors among adolescents in the Transylvania region of Romania. The analysis is based on data obtained through the Global School-Based Student Health Survey (GSHS). : Data on 900 Romanian adolescents aged 11-18 years were obtained via the GSHS. This study evaluated nutritional statuses through BMI Z-scores, employing World Health Organization (WHO) cut-offs applied to self-reported height and weight; furthermore, it assessed well-being and perceived health; worries and sleep anxiety; social connections through having friends, loneliness, peer support, and emotional support; parental bonding relations; experiences of being bullied; safety and protection factors, including distance learning during the COVID-19 pandemic and testing or vaccinations for COVID-19; and social behaviors, including the use of social networks. A multiple logistic regression was used to predict sleep disturbance anxiety, depending on sex, bullying, cyberbullying, loneliness, social network use, and peer support. : Results showed that the majority of the adolescents reported having one or more friends (96.8%), with no significant difference between girls and boys ( = 0.071). There were no statistically significant differences in bullying and cyberbullying experiences between sexes ( = 0.063). Notably, gender disparities exist in both health perceptions and risk behaviors, with girls experiencing higher rates of negative health perceptions, sleep anxiety ( < 0.001), and loneliness ( = 0.011) and boys exhibiting more overweight/obesity ( < 0.001) and school truancy ( = 0.027). According to the results, loneliness is significantly associated with a higher likelihood of sleep-disturbing anxiety ( < 0.001). Students who have experienced cyberbullying are more likely to also experience traditional bullying. Students who feel lonely are more likely to be victims of bullying. : This study reveals significant gender disparities in adolescent health, particularly in mental health, risk behaviors, and social support. It highlights the need for gender-specific interventions to address these challenges and promote healthy development. Furthermore, this study emphasizes the importance of social connections, family support, and parental involvement in adolescent well-being. Addressing bullying, promoting mental health awareness, and providing accessible support services are crucial for improving adolescent health in Romania.