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Impact of Physical Activity on the Association Between Unhealthy Adolescent Behaviors and Anxiety Among Korean Adolescents: A Cross-sectional Study
Hyo-jung Lee1orcid , Jeong-Pil Choi1orcid , Kunhee Oh1orcid , Jin-Young Min2orcid , Kyoung-Bok Min1,3corresp_iconorcid

DOI: [Accepted]
Published online: November 15, 2023
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1Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Korea
2Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Korea
3Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea
Corresponding author:  Kyoung-Bok Min,
Received: 9 July 2023   • Revised: 24 October 2023   • Accepted: 26 October 2023

Adolescents who engage in unhealthy behaviors are particularly vulnerable to anxiety. We hypothesized that participation in physical activity could influence the relationship between anxiety and unhealthy behaviors in adolescents. These behaviors include smoking, alcohol consumption, and unsafe sexual activity.
This study included 50,301 students from the first year of middle school to the third year of high school, all from Korea. The unhealthy adolescent behaviors examined included current alcohol consumption, current smoking, and unsafe sexual behavior. Anxiety levels were assessed using the Generalized Anxiety Disorder-7 questionnaire (GAD-7).
The participants had a mean age of 15.19 years and an average GAD-7 score of 4.23. No significant differences were observed in GAD-7 score among exercising participants when categorized by smoking status (p=0.8352) or unsafe sexual behavior (p=0.4895). In contrast, participants in the non-exercise group who engaged in these behaviors demonstrated significantly higher GAD-7 scores (p<0.0001 and p=0.0162, respectively). The only significant interaction was found between unsafe sexual behavior and exercise (p=0.0086). Based on logistic regression analysis, within the non-exercise group, significant positive associations were observed between current smoking and anxiety (OR, 1.36; 95% CI, 1.18-1.57), as well as between unsafe sexual behavior and anxiety (OR, 1.33; 95% CI, 1.02-1.73). However, within the exercise group, no significant association was found between anxiety and either smoking or unsafe sexual behavior. Furthermore, no significant interaction was observed between unhealthy behaviors and exercise.
These findings are insufficient to conclude that physical activity influences the relationship between unhealthy behaviors and anxiety.

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