{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T06:09:51Z","timestamp":1773814191646,"version":"3.50.1"},"reference-count":66,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T00:00:00Z","timestamp":1652918400000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Centre of Research Excellence in the Prevention and Early Intervention in Mental Illness and Substance Use","award":["APP11349009"],"award-info":[{"award-number":["APP11349009"]}]},{"name":"The Paul Ramsay Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["(KC, APP1120641; MT, APP1078407; and NN, APP116637"],"award-info":[{"award-number":["(KC, APP1120641; MT, APP1078407; and NN, APP116637"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,5,4]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine changes in the prevalence of six key chronic disease risk factors (the \u201cBig 6\u201d), from before (2019) to during (2021) the COVID-19 pandemic, among a large and geographically diverse sample of adolescents, and whether differences over time are associated with lockdown status and gender.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Three Australian states (New South Wales, Queensland and Western Australia) spanning over 3000\u2009km.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      983 adolescents (baseline M\n                      <jats:sub>age<\/jats:sub>\n                      =12.6, SD=0.5, 54.8% girl) drawn from the control group of the Health4Life Study.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcomes<\/jats:title>\n                    <jats:p>The prevalence of physical inactivity, poor diet (insufficient fruit and vegetable intake, high sugar-sweetened beverage intake, high discretionary food intake), poor sleep, excessive recreational screen time, alcohol use and tobacco use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of excessive recreational screen time (prevalence ratios (PR)=1.06, 95% CI=1.03 to 1.11), insufficient fruit intake (PR=1.50, 95% CI=1.26 to 1.79), and alcohol (PR=4.34, 95% CI=2.82 to 6.67) and tobacco use (PR=4.05 95% CI=1.86 to 8.84) increased over the 2-year period, with alcohol use increasing more among girls (PR=2.34, 95% CI=1.19 to 4.62). The prevalence of insufficient sleep declined across the full sample (PR=0.74, 95% CI=0.68 to 0.81); however, increased among girls (PR=1.24, 95% CI=1.10 to 1.41). The prevalence of high sugar-sweetened beverage (PR=0.61, 95% CI=0.64 to 0.83) and discretionary food consumption (PR=0.73, 95% CI=0.64 to 0.83) reduced among those subjected to stay-at-home orders, compared with those not in lockdown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lifestyle risk behaviours, particularly excessive recreational screen time, poor diet, physical inactivity and poor sleep, are prevalent among adolescents. Young people must be supported to find ways to improve or maintain their health, regardless of the course of the pandemic. Targeted approaches to support groups that may be disproportionately impacted, such as adolescent girls, are needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>Australian New Zealand Clinical Trials Registry (ACTRN12619000431123)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-060309","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T11:30:11Z","timestamp":1654083011000},"page":"e060309","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":47,"title":["Lifestyle risk behaviours among adolescents: a two-year longitudinal study of the impact of the COVID-19 pandemic"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8592-6691","authenticated-orcid":false,"given":"Lauren Anne","family":"Gardner","sequence":"first","affiliation":[{"name":"The Matilda Centre for Research Excellence in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9596-9484","authenticated-orcid":false,"given":"Jennifer","family":"Debenham","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research Excellence in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola Clare","family":"Newton","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research Excellence in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2460-6862","authenticated-orcid":false,"given":"Cath","family":"Chapman","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research Excellence in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona Elizabeth","family":"Wylie","sequence":"additional","affiliation":[{"name":"Department of Psychology, Macquarie University, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bridie","family":"Osman","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research Excellence in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maree","family":"Teesson","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research Excellence in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8319-9366","authenticated-orcid":false,"given":"Katrina Elizabeth","family":"Champion","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research Excellence in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,6,1]]},"reference":[{"key":"2025121408504893000_12.6.e060309.1","unstructured":"MCRI COVID-19 Governance Group . COVID-19 and child and adolescent health. Victoria, Australia, 2021."},{"key":"2025121408504893000_12.6.e060309.2","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18168433","article-title":"Will nothing be the same again?: changes in lifestyle during COVID-19 pandemic and consequences on mental health","volume":"18","author":"Caroppo","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025121408504893000_12.6.e060309.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2020.08.008"},{"key":"2025121408504893000_12.6.e060309.4","article-title":"The impact of COVID-19 on the lives and mental health of Australian adolescents","author":"Li","year":"2021","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"2025121408504893000_12.6.e060309.5","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/s41562-021-01079-8","article-title":"A global panel database of pandemic policies (Oxford COVID-19 government response Tracker)","volume":"5","author":"Hale","year":"2021","journal-title":"Nat Hum Behav"},{"key":"2025121408504893000_12.6.e060309.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30120-1"},{"key":"2025121408504893000_12.6.e060309.7","unstructured":"Hallas L , Hatibie A , Majumdar S . Variation in US states\u2019 responses to COVID-19 2.0. Blavatnik School of Government Working Paper, 2020."},{"key":"2025121408504893000_12.6.e060309.8","unstructured":"Australian Bureau of Statistics . State economies and the stringency of COVID-19 containment measures, December quarter 2020. Canberra, Australia: ABS, 2021."},{"key":"2025121408504893000_12.6.e060309.9","unstructured":"COVID-19-AU . COVID-19 in Australia real-time report, 2022. Available: https:\/\/covid-19-au.com\/ [Accessed 28 Feb 2022]."},{"key":"2025121408504893000_12.6.e060309.10","unstructured":"Australian Bureau of Statistics . National, state and territory population. Canberra: ABS, 2021."},{"key":"2025121408504893000_12.6.e060309.11","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001917","article-title":"Traditional and emerging lifestyle risk behaviors and all-cause mortality in middle-aged and older adults: evidence from a large population-based Australian cohort","volume":"12","author":"Ding","year":"2015","journal-title":"PLoS Med"},{"key":"2025121408504893000_12.6.e060309.12","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2552"},{"key":"2025121408504893000_12.6.e060309.13","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1056\/NEJMra1203528","article-title":"Behavioral and dietary risk factors for noncommunicable diseases","volume":"369","author":"Ezzati","year":"2013","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025121408504893000_12.6.e060309.14","doi-asserted-by":"crossref","first-page":"156","DOI":"10.5694\/mja2.51333","article-title":"Lifestyle risks for chronic disease among Australian adolescents: a cross-sectional survey","volume":"216","author":"Champion","year":"2022","journal-title":"Med J Aust"},{"key":"2025121408504893000_12.6.e060309.15","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S2352-4642(19)30323-2","article-title":"Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1\u00b76 million participants","volume":"4","author":"Guthold","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"2025121408504893000_12.6.e060309.16","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1001\/jama.2019.3636","article-title":"Trends in sedentary behavior among the US population, 2001-2016","volume":"321","author":"Yang","year":"2019","journal-title":"JAMA"},{"key":"2025121408504893000_12.6.e060309.17","unstructured":"Australian Institute of Health and Welfare . Australia\u2019s health 2018. Australia\u2019s health series no. 16 AUS 221. Canberra: AIHW, 2018."},{"key":"2025121408504893000_12.6.e060309.18","article-title":"Impact of COVID-19 lockdown on dietary and lifestyle behaviours among adolescents in Palestine","volume":"2020","author":"Allabadi","year":"2020","journal-title":"Dyn Hum Health"},{"key":"2025121408504893000_12.6.e060309.19","doi-asserted-by":"publisher","DOI":"10.3390\/children8020135"},{"key":"2025121408504893000_12.6.e060309.20","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1002\/oby.22861","article-title":"Effects of COVID-19 Lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: a longitudinal study","volume":"28","author":"Pietrobelli","year":"2020","journal-title":"Obesity"},{"key":"2025121408504893000_12.6.e060309.21","doi-asserted-by":"crossref","DOI":"10.3390\/nu12061807","article-title":"Covid-19 Confinement and Changes of Adolescent\u2019s Dietary Trends in Italy, Spain, Chile, Colombia and Brazil","volume":"12","author":"Ruiz-Roso","year":"2020","journal-title":"Nutrients"},{"key":"2025121408504893000_12.6.e060309.22","doi-asserted-by":"crossref","DOI":"10.3390\/children7090138","article-title":"COVID-19 impact on behaviors across the 24-hour day in children and adolescents: physical activity, sedentary behavior, and sleep","volume":"7","author":"Bates","year":"2020","journal-title":"Children"},{"key":"2025121408504893000_12.6.e060309.23","doi-asserted-by":"publisher","DOI":"10.1002\/hpja.436"},{"key":"2025121408504893000_12.6.e060309.24","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.2147\/PRBM.S284103","article-title":"Moving more and sitting less as healthy lifestyle behaviors are protective factors for insomnia, depression, and anxiety among adolescents during the COVID-19 pandemic","volume":"13","author":"Lu","year":"2020","journal-title":"Psychol Res Behav Manag"},{"key":"2025121408504893000_12.6.e060309.25","doi-asserted-by":"crossref","unstructured":"Olive L , Sciberras E , Berkowitz TS . Child and parent physical activity, sleep and screen time during COVID-19 compared to pre-pandemic nationally representative data and associations with mental health 2020.","DOI":"10.31234\/osf.io\/anqct"},{"key":"2025121408504893000_12.6.e060309.26","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-78438-4","article-title":"Physical activity and screen time of children and adolescents before and during the COVID-19 lockdown in Germany: a natural experiment","volume":"10","author":"Schmidt","year":"2020","journal-title":"Sci Rep"},{"key":"2025121408504893000_12.6.e060309.27","article-title":"Evaluation of the effect of the COVID-19 pandemic on sleep disorders and nutrition in children","volume":"75","author":"Fidanc\u0131","year":"2021","journal-title":"Int J Clin Pract"},{"key":"2025121408504893000_12.6.e060309.28","doi-asserted-by":"crossref","DOI":"10.1111\/jpi.12757","article-title":"In-person vs home schooling during the COVID-19 pandemic: differences in sleep, circadian timing, and mood in early adolescence","volume":"71","author":"Stone","year":"2021","journal-title":"J Pineal Res"},{"key":"2025121408504893000_12.6.e060309.29","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.jadohealth.2020.06.018","article-title":"What does adolescent substance use look like during the COVID-19 pandemic? Examining changes in frequency, social contexts, and Pandemic-Related predictors","volume":"67","author":"Dumas","year":"2020","journal-title":"J Adolesc Health"},{"key":"2025121408504893000_12.6.e060309.30","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18157849","article-title":"Consumption of alcohol, cannabis, and tobacco in a cohort of adolescents before and during COVID-19 confinement","volume":"18","author":"Rog\u00e9s","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025121408504893000_12.6.e060309.31","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1001\/jamapediatrics.2021.0541","article-title":"Adolescents' substance use and physical activity before and during the COVID-19 pandemic","volume":"175","author":"Chaffee","year":"2021","journal-title":"JAMA Pediatr"},{"key":"2025121408504893000_12.6.e060309.32","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2021.633551","article-title":"Changing patterns of substance use during the coronavirus pandemic: self-reported use of tobacco, alcohol, cannabis, and other drugs","volume":"12","author":"Benschop","year":"2021","journal-title":"Front Psychiatry"},{"key":"2025121408504893000_12.6.e060309.33","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1007\/s10900-021-00961-w","article-title":"COVID-19 awareness, adoption of COVID-19 preventive measures, and effects of COVID-19 Lockdown among adolescent boys and young men in Kampala, Uganda","volume":"46","author":"Matovu","year":"2021","journal-title":"J Community Health"},{"key":"2025121408504893000_12.6.e060309.34","unstructured":"Active Healthy Kids Australia . Physical literacy: do our kids have all the tools? the 2016 active healthy kids Australia report card on physical activity for children and young people. Adelaide, South Australia: Active Healthy Kids Australia, 2016."},{"key":"2025121408504893000_12.6.e060309.35","first-page":"+ 83 p","volume-title":"Adolescent alcohol-related behaviours: trends and inequalities in the who European region, 2002\u20132014: observations from the health behaviour in school-aged children (HBSC) who Collaborative cross-national study","volume":"viii","author":"Inchley","year":"2018"},{"key":"2025121408504893000_12.6.e060309.36","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.jadohealth.2015.11.014","article-title":"International trends in adolescent Screen-Time behaviors from 2002 to 2010","volume":"58","author":"Bucksch","year":"2016","journal-title":"J Adolesc Health"},{"key":"2025121408504893000_12.6.e060309.37","unstructured":"Centers for Disease Control and Prevention (CDC) . 1991-2019 high school youth risk behavior survey data, 2021."},{"key":"2025121408504893000_12.6.e060309.38","unstructured":"Morley B , Scully M , Niven P . National secondary students' diet and activity (NaSSDA) survey, 2012-13. Melbourne: Cancer Council Victoria, 2014."},{"key":"2025121408504893000_12.6.e060309.39","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-035662"},{"key":"2025121408504893000_12.6.e060309.40","unstructured":"Bower M , Smout S , Ellsmore S . COVID-19 and Australia\u2019s mental health: An overview of academic literature, policy documents, lived experience accounts, media and community reports. Sydney, NSW: Australia\u2019s Mental Health Think Tank, 2021."},{"key":"2025121408504893000_12.6.e060309.41","unstructured":"NSW Health . Public health (COVID-19 temporary movement and gathering restrictions) order 2021 under the public health act 2010. NSW, Australia, 2021."},{"key":"2025121408504893000_12.6.e060309.42","unstructured":"Hardy LL , Mihrshahi S , Drayton BA . Nsw schools physical activity and nutrition survey (spans) 2015: full report. Sydney: NSW Department of Health, 2016."},{"key":"2025121408504893000_12.6.e060309.43","unstructured":"National Health and Medical Research Council . Australian dietary guidelines. Canberra: National Health and Medical Research Council, 2013."},{"key":"2025121408504893000_12.6.e060309.44","unstructured":"Active Healthy Kids Australia . Physical literacy: do our kids have all the tools? the 2016 report card on physical activity for children and young people. Adelaide, 2016."},{"key":"2025121408504893000_12.6.e060309.45","unstructured":"The Australian Government Department of Health . Australian 24-hour movement guidelines for children and young people (5 to 17 years): an integration of physical activity, sedentary behaviour, and sleep. Canberra: Commonwealth of Australia, 2019."},{"key":"2025121408504893000_12.6.e060309.46","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.4130"},{"key":"2025121408504893000_12.6.e060309.47","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2147\/NSS.S38369","article-title":"Estimating adolescent sleep patterns: parent reports versus adolescent self-report surveys, sleep diaries, and actigraphy","volume":"5","author":"Short","year":"2013","journal-title":"Nat Sci Sleep"},{"key":"2025121408504893000_12.6.e060309.48","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2012.212"},{"key":"2025121408504893000_12.6.e060309.49","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.smrv.2015.11.006","article-title":"Validity and reliability of sleep time questionnaires in children and adolescents: a systematic review and meta-analysis","volume":"30","author":"Nascimento-Ferreira","year":"2016","journal-title":"Sleep Med Rev"},{"key":"2025121408504893000_12.6.e060309.50","unstructured":"CDC CfDCaP . National youth risk behavior survey. U.S. Department of Health and Human Services, 2019."},{"key":"2025121408504893000_12.6.e060309.51","unstructured":"Australian Institute of Health and Welfare . National drug strategy household survey 2016: detailed findings. Canberra: AIHW, 2017."},{"key":"2025121408504893000_12.6.e060309.52","doi-asserted-by":"publisher","DOI":"10.1136\/oem.2007.034777"},{"key":"2025121408504893000_12.6.e060309.53","unstructured":"StataCorp LLC . Stata Statistical Software: Release 17 [program]. College Station: TX: StataCorp LLC, 2021."},{"key":"2025121408504893000_12.6.e060309.54","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1017\/S1368980019004208","article-title":"Factors associated with frequent consumption of fast food among Australian secondary school students","volume":"23","author":"Scully","year":"2020","journal-title":"Public Health Nutr"},{"key":"2025121408504893000_12.6.e060309.55","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1017\/S1368980014001256","article-title":"Associations between parental feeding practices, problem food behaviours and dietary intake in New Zealand overweight children aged 4-8 years","volume":"18","author":"Haszard","year":"2015","journal-title":"Public Health Nutr"},{"key":"2025121408504893000_12.6.e060309.56","unstructured":"ABARES . Agricultural commodities: September quarter 2021. Canberra: Australian Bureau of Agricultural and Resource Economics and Sciences, 2021."},{"key":"2025121408504893000_12.6.e060309.57","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002232","article-title":"Taxes and subsidies for improving diet and population health in Australia: a cost-effectiveness modelling study","volume":"14","author":"Cobiac","year":"2017","journal-title":"PLoS Med"},{"key":"2025121408504893000_12.6.e060309.58","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-2707"},{"key":"2025121408504893000_12.6.e060309.59","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1093\/sleep\/33.10.1381","article-title":"Normative data on the sleep habits of Australian children and adolescents","volume":"33","author":"Olds","year":"2010","journal-title":"Sleep"},{"key":"2025121408504893000_12.6.e060309.60","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph16091524","article-title":"Relationship between physical activity, screen time, and sleep quantity and quality in US adolescents aged 16\u201319","volume":"16","author":"Xu","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2025121408504893000_12.6.e060309.61","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.5665\/sleep.6022","article-title":"Emergence of sex differences in insomnia symptoms in adolescents: a large-scale school-based study","volume":"39","author":"Zhang","year":"2016","journal-title":"Sleep"},{"key":"2025121408504893000_12.6.e060309.62","unstructured":"Guerin N , White V . ASSAD 2017 Statistics & Trends: Australian Secondary Students\u2019 Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances. Cancer Council Victoria, 2018."},{"key":"2025121408504893000_12.6.e060309.63","doi-asserted-by":"crossref","DOI":"10.1016\/j.ssmph.2021.100742","article-title":"The gender gap in adolescent mental health: a cross-national investigation of 566,829 adolescents across 73 countries","volume":"13","author":"Campbell","year":"2021","journal-title":"SSM Popul Health"},{"key":"2025121408504893000_12.6.e060309.64","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2020.112890","article-title":"Gender and secular trends in adolescent mental health over 24 years - The role of school-related stress","volume":"250","author":"H\u00f6gberg","year":"2020","journal-title":"Soc Sci Med"},{"key":"2025121408504893000_12.6.e060309.65","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011827"},{"key":"2025121408504893000_12.6.e060309.66","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz006"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-060309","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:51:01Z","timestamp":1765731061000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-060309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":66,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6,1]]},"published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1136\/bmjopen-2021-060309"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-060309","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5]]}}}