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BackgroundAmong Taiwanese adolescents, how the clustering of unhealthy behaviors, including insufficient physical activity, screen-based sedentary behavior and frequent sugar-sweetened beverage consumption affecting depressive symptom remains unclear. This study aims to examine the cross-sectional association between clustering of unhealthy behaviors and depressive symptom.MethodsWe analyzed 18,509 participants from the baseline survey of the Taiwan Adolescent to Adult Longitudinal Survey in 2015. The outcome was depressive symptoms, and the main exposures were insufficient physical activity, screen-based sedentary behaviors and frequent sugar-sweetened beverage consumption. Generalized linear mixed models were performed to find key factor associated with depressive symptom.ResultsDepressive symptoms were common among participants (31.4%), particularly in female and older adolescents. After adjustments for covariates including sex, school type, other lifestyle factors and social determinants, individuals exhibiting clustering of unhealthy behaviors were more likely (aOR = 1.53, 95% CI: 1.48–1.58) to exhibit depressive symptoms than those who have no or only one unhealthy behavior.ConclusionsClustering of unhealthy behaviors is positively associated with depressive symptom among Taiwanese adolescents. The findings highlight the importance of strengthening public health interventions to improve physical activity and decrease sedentary behaviors.

BackgroundAmong Taiwanese adolescent, how depressive symptoms, screen use affect on substance use remains unclear. This study aimed to examine (1) the cross-sectional association between depressive symptoms, screen use and substance use ; and (2) the modified effects of sex and school type on those mentioned associations.MethodsWe analyzed 18,509 participants from the baseline survey of the Taiwan Adolescent to Adult Longitudinal Survey in 2015. The outcome was substance use including binge drinking, smoking, cigarette smoking and betel chewing. The main predictors were self-reported depressive symptoms and screen use. Multiple logistic regression was employed to estimate predictors, and a subgroup analysis was performed to assess effect modifications.ResultsAmong 18509 participants, 6.4% reported binge drinking, 5.6% reported smoking, 4.4 % reported e-cigarette smoking, 5.0% reported betel chewing. After adjustments for covariates including sex, school type, BMI, skipping breakfast and social determinants, the associations of depressive symptoms, screen use on substance use were significant. Stratified results indicated that depressive symptoms and screen use employed diverse effects on substance use across subgroups based on sex and school types. ConclusionsDepressive symptoms and screen use were notable factors positively associated with substance use among Taiwanese adolescents. The findings highlight the importance of strengthening public health interventions to monitor substance use, decrease depression, and screen use among adolescents.