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| Association between earphone use and anxiety symptoms among middle school students |
| FENG Jinmeng1,2, WANG Hao2, LI Na1,2, DAI Pinyuan2, ZHOU Xiaoyan2, ZHONG Jieming2
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1. School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang 310053, China;
2. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China |
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Abstract Objective To investigate the association between earphone use and anxiety symptoms among middle school students, so as to provide a basis for middle school students hearing health and psychological intervention. Methods From April to June 2022, a multi-stage stratified cluster sampling method was used to select middle school students from 30 counties (citues, districts) in Zhejiang Province as the survey subjects. A questionnaire survey was conducted to collect demographic information, self-reported health status, exercise frequency, and the frequency of continuous earphone use for ≥60 minutes in the past 7 days, with at least one instance of continuous headphone use ≥60 minutes defined as prolonged headphone use. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder Scale. Multivariable logistic regression models were used to examine the association between earphone use and anxiety symptoms. Results A total of 26 486 middle school students were surveyed, with the mean age of (15.75±1.73) years. The sample included 13 659 boys (51.57%) and 12 827 girls (48.43%). There were 12 471 junior high school students (47.09%), 7 271 regular high school students (27.45%), and 6 744 vocational high school students (25.46%). In the past 7 days, 11 802 people (44.56%) had prolonged use of earphones. Anxiety symptoms were detected in 3 652 students, yielding a detection rate of 13.79%. Multivariable logistic regression analysis showed that after adjusting for factors such as demographic information, self-reported health status, and exercise frequency, compared with those who never use earphone for a long time in the past 7 days, the risk of anxiety symptoms increased by 33.7% (OR=1.337, 95%CI: 1.223-1.462), 77.5% (OR=1.775, 95%CI: 1.572-2.005), and 165.4% (OR=2.654, 95%CI: 2.329-3.025) for those who use earphone for a long time with a frequency of 1-2 times/week, 3-6 times/week, and ≥1 time/day, respectively. Interaction test results showed that the interaction between gender and the frequency of long-term earphone use in the past 7 days on anxiety symptoms was not statistically significant (Pfor interaction>0.05). Conclusion Long-term earphone use is positively statistically associated with the risk of anxiety symptoms among middle school students.
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Received: 22 April 2026
Revised: 26 June 2026
Published: 27 July 2026
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