{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:48:33Z","timestamp":1782197313614,"version":"3.54.5"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The association between single-shoulder backpack carrying and back pain in adolescents remains unclear. This study investigated whether the degree of improper sitting posture mediates the relationship between single-shoulder backpack carrying and back pain in both cross-sectional and longitudinal analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study collected data from a school-based sample covering nine provinces in China from 2021 to 2025. Back pain and backpack carrying mode were assessed through self-reporting. Improper sitting posture was scored using a three-item scale endorsed by the Chinese Ministry of Education. A cross-sectional analysis was conducted on 3,420 participants, and a longitudinal analysis was conducted on 2,423 participants. Multivariate logistic regression and Cox proportional hazards models were used to evaluate the associations between single-shoulder backpack carrying, improper sitting posture, and back pain. Mediation analysis was used to assess the mediating role of improper sitting posture in the association between single-shoulder backpack carriage and back pain. Subgroup analyses were conducted to evaluate effect modification across prespecified subgroups. Statistical significance was set at\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05 (two-sided).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the cross-sectional analysis, single-shoulder backpack carrying (OR\u202f=\u202f1.402, 95%CI: 1.128\u20131.742,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002) and improper sitting posture (OR\u202f=\u202f2.029, 95%CI: 1.695\u20132.430,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) were both positively associated with back pain. Improper sitting posture accounted for 37.42% of the association between the single-shoulder backpack carrying and back pain. In the longitudinal analysis, single-shoulder backpack carrying (HR\u202f=\u202f2.147, 95% CI: 1.565\u20132.945,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and improper sitting posture (HR\u202f=\u202f1.885, 95% CI: 1.473\u20132.412,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) were both positively associated with back pain. Improper sitting posture accounted for 11.45% of the association of single-shoulder backpack carrying with back pain.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Single-shoulder backpack and improper sitting posture were significantly and positively associated with back pain, and improper sitting posture partially mediated the association between single-shoulder backpack carrying and back pain. These results suggest that modifying backpack carrying mode and improving improper sitting posture may be associated with a lower likelihood of back pain in adolescents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1857805","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:21:38Z","timestamp":1782195698000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Improper sitting posture mediates the association between single-shoulder backpack carrying and back pain in adolescents: a cross-sectional and longitudinal analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Hong","family":"Ding","sequence":"first","affiliation":[{"name":"College of Humanities and Health, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laiguo","family":"Han","sequence":"additional","affiliation":[{"name":"College of Humanities and Health, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meichen","family":"Wu","sequence":"additional","affiliation":[{"name":"College of Humanities and Health, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hebao","family":"Wen","sequence":"additional","affiliation":[{"name":"College of Humanities and Health, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Liang","sequence":"additional","affiliation":[{"name":"College of Nursing, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyu","family":"Wang","sequence":"additional","affiliation":[{"name":"College of Humanities and Health, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1563823","DOI":"10.3389\/fpubh.2025.1563823","article-title":"Incidence, prevalence, and disease burden of low back pain in China: data from the global burden of disease database","volume":"13","author":"Zheng","year":"2025","journal-title":"Front Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1097\/BRS.0000000000003461","article-title":"The epidemiology of back pain in American children and adolescents","volume":"45","author":"Fabricant","year":"2020","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3171","DOI":"10.2147\/JPR.S525330","article-title":"Global, Regional and National Burden of low back pain in adolescents aged 10-19 years, 1990-2021: a systematic analysis of the global burden of disease study 2021","volume":"18","author":"Wang","year":"2025","journal-title":"J Pain Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/1471-2474-7-29","article-title":"Is comorbidity in adolescence a predictor for adult low back pain? 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musculoskeletal pain in children: an ergonomic school education intervention program","volume":"4","author":"Syazwan","year":"2011","journal-title":"J Pain Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2183","DOI":"10.1589\/jpts.27.2183","article-title":"Perceived body discomfort and trunk muscle activity in three prolonged sitting postures","volume":"27","author":"Waongenngarm","year":"2015","journal-title":"J Phys Ther Sci"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1097\/00007632-198309000-00013","article-title":"The effect of posture on the fluid content of lumbar intervertebral discs","volume":"8","author":"Adams","year":"1983","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["Frontiers in Public 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