{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:16:00Z","timestamp":1788156960134,"version":"build-2803163510"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"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":"\n Background<\/jats:title>\n Although tuberculosis (TB) control programs have primarily focused on infection prevention, diagnosis, and treatment outcomes, increasing attention has been directed toward the psychosocial consequences of TB-related experiences among affected populations. In school settings, adolescents identified as TB close contacts may experience concerns about infection risk, repeated health monitoring, activity restrictions, and disease-related stigma, which may represent important psychosocial stressors beyond the biological risk of infection. However, evidence regarding whether TB close-contact exposure is associated with somatic symptoms among adolescents remains limited.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A school-based cross-sectional study was conducted in Hangzhou, China, in April 2024. A total of 1,410 valid questionnaires were included (670\u202fTB close contacts; 740 non-exposed students). Somatic symptoms were assessed using the Children\u2019s Somatization Inventory-24 (CSI-24), and teacher-student relationship was evaluated using the Student-Teacher Relationship Scale (STRS). Binary logistic regression models were used to estimate associations, and interaction analyses were performed to evaluate whether the teacher-student relationship modified the association between TB close-contact exposure and somatic symptoms.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 169 adolescents (11.99%) were classified as having elevated somatic symptoms (ESS). The prevalence of ESS was significantly higher among adolescents with TB close-contact exposure than among non-exposed adolescents (14.78% vs. 9.46%,\n \n \n \n \u03c7<\/mml:mi>\n 2<\/mml:mn>\n <\/mml:msup>\n <\/mml:math>\n <\/jats:inline-formula>\n = 8.925,\n p<\/jats:italic>\n = 0.003). In univariate analysis, TB close-contact exposure was associated with increased odds of ESS (\n OR<\/jats:italic>\n = 1.659, 95%\n CI<\/jats:italic>\n : 1.200\u20132.305,\n p<\/jats:italic>\n = 0.002). After adjustment for sociodemographic characteristics and teacher-student relationship, the association remained significant (adjusted\n OR<\/jats:italic>\n = 1.545, 95%\n CI<\/jats:italic>\n : 1.105\u20132.167,\n p<\/jats:italic>\n = 0.011). A 10-point increase in teacher\u2013student relationship score was associated with lower odds of ESS (\n OR<\/jats:italic>\n = 0.861, 95%\n CI<\/jats:italic>\n : 0.750\u20130.986,\n p<\/jats:italic>\n = 0.032). Interaction analysis showed a significant interaction between TB close-contact exposure and teacher-student relationship (Per 10-point increase) (\n OR<\/jats:italic>\n =\u202f0.577, 95%\n CI<\/jats:italic>\n : 0.414\u20130.803,\n p\u202f=<\/jats:italic>\n 0.001), indicating that the association between TB close-contact exposure and somatic symptoms differed according to teacher-student relationship quality, with a weaker association observed among adolescents reporting more positive teacher-student relationships.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Teacher-student relationship statistically modified the association between TB close-contact exposure and somatic symptoms. Adolescents reporting more positive teacher-student relationships showed a weaker association between TB exposure and elevated somatic symptoms. These findings suggest that the teacher-student relationship may represent an important school-based psychosocial factor associated with variability in adolescents\u2019 responses to TB exposure. Given the cross-sectional design, the observed interaction should not be interpreted as evidence of a causal buffering effect. Longitudinal studies are needed to confirm these findings and determine whether school-based psychosocial support strategies can improve adolescent well-being during TB contact investigations.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1921969","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:41:34Z","timestamp":1788154894000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Teacher\u2013student relationship moderates the association between tuberculosis close-contact exposure and somatic symptoms among adolescents in Hangzhou, China"],"prefix":"10.3389","volume":"14","author":[{"given":"Zijian","family":"Fang","sequence":"first","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Municipal Health Supervision Institute)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingchun","family":"Li","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Municipal Health Supervision Institute)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinyan","family":"Huang","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Municipal Health Supervision Institute)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingjun","family":"Jia","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Municipal Health Supervision Institute)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinglin","family":"Cheng","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Municipal Health Supervision Institute)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s13034-018-0239-y","article-title":"Somatic symptom and related disorders in children and adolescents: evaluation of a naturalistic inpatient multidisciplinary treatment","volume":"12","author":"Heimann","year":"2018","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e4299","DOI":"10.32872\/cpe.4299","article-title":"Functional somatic symptoms and emotion regulation in children and adolescents","volume":"4","author":"Jungmann","year":"2022","journal-title":"Clin Psychol Eur"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering 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