Fast food and anxiety symptoms of Chinese multi-ethnic adolescents: The moderating role of regulatory emotional self-efficacy

Honglv Xu; Ming Zhang; Chaoyuan Yang; Yun Fu; Jizong Yang; Wanjuan Yang; Jixue Wang; Xiaoxiao Li; Jieru Yang; Junyu Yang

doi:10.1016/j.jad.2025.01.036

Fast food and anxiety symptoms of Chinese multi-ethnic adolescents: The moderating role of regulatory emotional self-efficacy

J Affect Disord. 2025 Jan 10:S0165-0327(25)00049-7. doi: 10.1016/j.jad.2025.01.036. Online ahead of print.

Authors

Honglv Xu¹, Ming Zhang², Chaoyuan Yang³, Yun Fu², Jizong Yang⁴, Wanjuan Yang⁵, Jixue Wang⁶, Xiaoxiao Li⁷, Jieru Yang⁷, Junyu Yang⁷

Affiliations

¹ Department of nursing, School of medicine, Kunming University, Kunming, China; Community nursing research team of Kunming University, Kunming, Yunnan, China. Electronic address: x___hl@126.com.
² National middle school of Zhenyuan county, Pu 'er, China.
³ Nanjian town middle school of Nanjian county, Dali, China.
⁴ The second middle school of Nanjian county, Dali, China.
⁵ Department of immunization program, Nanjian county center for disease control and prevention, Dali, China.
⁶ The first complete middle school of Shuangjiang county, Lincang, China.
⁷ Department of nursing, School of medicine, Kunming University, Kunming, China; Community nursing research team of Kunming University, Kunming, Yunnan, China.

PMID: 39800067
DOI: 10.1016/j.jad.2025.01.036

Abstract

Background: Although previous studies demonstrated an association between fast food intake and anxiety symptoms in adolescents, this relationship has not been studied in Chinese multi-ethnic adolescents. The purpose of this study is to investigate the aforementioned association and the potential moderating effect of regulatory emotional self-efficacy (RESE) among Chinese multi-ethnic adolescents.

Methods: A cluster random sampling of 8500 middle school students from 11 counties in Yunnan province was conducted. The Depression Anxiety Stress Scale-21 was utilized to assess anxiety symptoms, while the food frequency questionnaire was employed to gather data on eating behaviors. The association between fast food intake, RESE, and anxiety symptoms was analyzed using generalized linear models. The moderating effect of RESE on the association between fast food intake and anxiety symptoms was examined using structural equation models.

Results: The positive rate of anxiety symptoms in middle school students was 48.5 % (4120/8500). The positive rate of depressive symptoms in females (53.3 %, 2301/4316) was higher than that in males (43.5 %, 1819/4184). Chinese fast food intake (males vs females: β = 0.26, 95%CI:0.14-0.39; β = 0.16, 95%CI:0.02-0.29), expressing positive affect (β = -0.04, 95%CI:-0.07-0.01; β = -0.06, 95%CI:-0.10-0.03) and managing anger/irritation affect (β = -0.11, 95%CI:-0.14-0.08; β = -0.16, 95%CI:-0.19-0.12) was associated with anxiety symptoms in males and females (all P < 0.05). Takeaway fast food intake (β = 0.19, 95%CI:0.02-0.35) and managing despondency/distress affect (β = -0.08, 95%CI:-0.12-0.04, P < 0.001) was associated with anxiety symptoms in females (all P < 0.05). RESE significantly inversely moderated the association between fast food intake and anxiety symptoms (all participants: β = -0.11; males: β = - 0.08; females: β = - 0.14; all P < 0.01).

Limitations: Association observed in the cross-sectional study is uncertain and need to be confirmed in cohort studies.

Conclusion: Our findings suggest that fast food intake may be associated with an increased risk of anxiety symptoms among Chinese multi-ethnic adolescents, while good RESE can potentially mitigate this risk.

Keywords: Adolescents; Anxiety symptoms; Fast food; Regulatory emotional self-efficacy; Structural equation model.