Association Between Resilience and Self-Esteem in Adolescents from Peruvian Schools

Association Between Resilience and Self-Esteem in Adolescents from Peruvian Schools | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Resilience and Self-Esteem in Adolescents from Peruvian Schools Mario J. Valladares-Garrido, María Julia Cómina-Tamayo, Óscar Tuesta García, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7475199/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Self-esteem is a key component in adolescents' psychological development and is associated with multiple factors related to well-being and success. Resilience, defined as the ability to cope with and overcome adversity, is a potential protective factor for self-esteem. However, in Peru, evidence on this relationship is limited and has focused on specific populations, with some methodological constraints. Understanding this relationship is essential for designing strategies to promote adolescent mental health. Thus, this study aimed to examine the association between resilience and self-esteem among adolescents from five educational institutions in the Lambayeque region, Peru. Methods An analytical cross-sectional study was conducted through secondary analysis of data collected between September and December 2022. A total of 1,307 secondary school adolescents were included. Self-esteem was assessed using the Rosenberg Self-Esteem Scale, and resilience was measured with the 10-item CD-RISC. Descriptive and bivariate analyses were performed using chi-square tests. The association between resilience and self-esteem was estimated using Poisson regression models with robust variance, adjusting for confounders. Results The prevalence of low self-esteem in the studied population was 44.6% (95% CI: 42.03–47.40). Adolescents with low resilience showed a higher prevalence of low self-esteem compared to those with high resilience (48.5% vs. 26.1%; p < 0.001). In the adjusted analysis, high resilience was associated with a lower prevalence of low self-esteem (PR: 0.68; 95% CI: 0.53–0.86; p = 0.002). Other factors associated with low self-esteem included severe family dysfunction (PR: 2.17; 95% CI: 1.65–2.84; p < 0.001), family history of mental illness (PR: 1.19; 95% CI: 1.01–1.40; p = 0.043), and excessive television use (PR: 1.18; 95% CI: 1.04–1.33; p = 0.009). Conclusion Resilience emerged as a significant protective factor against low self-esteem in adolescents, while family dysfunction and a family history of mental illness were identified as risk factors. These findings underscore the need for school- and community-based strategies to enhance resilience, improve family functioning, and address modifiable risk factors, with the ultimate goal of promoting psychological well-being and preventing self-esteem problems in this population. Self-esteem resilience adolescents mental health psychosocial factors Figures Figure 1 INTRODUCTION Self-esteem can be defined as the concept an individual develops about their worth ( 1 , 2 , 3 ). This concept is subjective and encompasses the way one thinks, loves, and behaves toward oneself ( 1 , 3 ). Self-esteem has a significant impact on an individual’s life development; reports have shown a relationship between higher levels of self-esteem and greater personal, social, and professional success ( 4 , 5 ). On the other hand, low levels of self-esteem have been shown to be associated with poor social performance, depression, and substance abuse ( 6 , 7 ). Multiple external factors influence the development of self-esteem, especially during adolescence, a period characterized by rapid physical, mental, and social changes ( 6 , 8 ). Studies have shown that up to one-third of adolescents worldwide experience difficulties associated with low self-esteem, particularly during the early years of adolescence ( 9 , 10 ). In adolescents from countries such as China, Tunisia, Ethiopia, Vietnam, and Saudi Arabia, the estimated prevalence of low self-esteem is 57.5%, 29.5%, 19%, 19.4%, and 41%, respectively ( 2 , 11 , 12 , 13 , 14 ). In Latin America, studies have found that 18.51%, 47.9%, and 45% of adolescents from Ecuador, Colombia, and Mexico, respectively, presented low self-esteem ( 15 , 16 , 17 ). Peru is no exception to this statistic, as the literature reports that between 25% and 35% of Peruvian adolescents have low levels of self-esteem ( 18 , 19 , 20 ). Resilience, defined as the ability to overcome and recover from adverse circumstances, and its relationship with self-esteem levels have been the subject of study ( 21 – 30 ). In adolescents from countries such as Australia, Iran, Singapore, and the United States of America (USA), high prevalences of moderate-to-high resilience levels have been reported, at 73%, 52.5%, 67.3%, and 66.3%, respectively ( 31 , 32 , 33 , 34 ). Reports on the prevalence of moderate-to-high resilience in adolescents from Latin American countries show values of 45%, 65.8%, and even 100% in Mexico, Colombia, and Bolivia, respectively ( 35 , 36 , 37 ). In Peruvian adolescents, the literature reports prevalence of moderate-to-high resilience levels ranging from 72.5–97.2% ( 29 , 38 ). Studies have shown that resilience in adolescents and young people is positively associated with self-esteem and mental health ( 19 , 21 , 22 , 23 , 24 , 26 ). This is because resilience is thought to strengthen adolescents’ confidence, their ability to face challenges, and to overcome adversity, which contributes to higher self-esteem in difficult situations ( 21 , 22 , 23 ). In Chinese adolescents, self-esteem levels were found to positively predict resilience ( 26 ). In Polish adolescents, resilience was identified as a positive predictor of self-esteem levels ( 24 ). Finally, in Nicaraguan adolescents, a positive relationship was also found between high resilience levels and good self-esteem ( 22 ). Similarly, results have been published showing that the inclusion of programs aimed at strengthening resilience is beneficial for the development of self-esteem and emotional regulation ( 24 , 25 , 26 , 27 ). However, most of the published literature analyzing the relationship between resilience and self-esteem in adolescence has certain limitations. First, the results are difficult to extrapolate to the national context due to differences in cultural, social, and educational aspects, as most studies have focused on Asian ( 23 , 26 , 27 , 32 ), European ( 24 ), and Central and North American adolescents ( 22 , 23 ). Even the Peruvian studies have focused exclusively on adolescents and young people from the city of Lima ( 19 , 28 , 30 ). Second, previous national evidence has limited its study population exclusively to students from a single educational institution ( 18 , 28 , 29 , 30 ). Third, prior Peruvian studies have focused on university student populations ( 28 , 30 ), which do not exclusively include the adolescent group, resulting in the loss of the necessary focus on analyzing the impact of self-esteem and resilience during the vulnerable stage of adolescence, particularly in its early years. Fourth, Peruvian studies have not considered the influence of potentially relevant factors in the relationship between resilience and self-esteem, such as Body Mass Index (BMI) ( 18 , 28 , 29 , 30 ), family history of mental illness ( 18 , 28 , 29 , 30 ), alcohol and/or tobacco use ( 18 , 28 , 29 , 30 ), acne ( 18 , 28 , 29 , 30 ), level of physical activity ( 18 , 28 , 29 , 30 ), religion ( 18 , 28 , 29 , 30 ), and time spent on social media ( 18 , 28 , 29 , 30 ). Some studies have limited their analysis to age, sex, and year of study ( 18 , 28 , 29 ), while others have included academic performance ( 29 , 30 ). Fifth, previous evidence has limited statistical power due to small sample sizes ( 18 , 28 , 29 ). Sixth, prior studies have used instruments with inadequate and unreliable psychometric properties to measure resilience and self-esteem in adolescents. Seventh, studies lack rigorous statistical analyses, as they have examined the association only in a bivariate manner ( 19 , 28 , 29 ) and have not estimated association measures to determine the magnitude and strength of the relationship between resilience and self-esteem ( 39 ). This study aims to determine the association between resilience and self-esteem in adolescents from five different schools in the northern region of Peru. METHODS Study design An analytical cross-sectional study was conducted based on the secondary analysis of data collected from adolescent students in five secondary-level educational institutions in the Lambayeque region, Peru. Data collection was carried out between September and December 2022, in the context of the fifth wave of the COVID-19 pandemic. The objective of this analysis was to evaluate the association between resilience and self-esteem in adolescents. The analyzed data came from a primary database whose initial purpose was to examine the relationship between the presence of acne and various mental health outcomes in this population. Clinical trial number: not applicable. Population and sample The study population consisted of 1,972 adolescents enrolled in five secondary-level educational institutions in the Lambayeque region, Peru, during the 2022 academic year. In the primary study, inclusion criteria were students who attended classes regularly, completed the main questionnaires, and provided their informed assent. Those whose parents did not authorize their participation through informed consent were excluded. In the original database, the response rate reached 72.8% (n = 1,436). For the present secondary analysis, a new data cleaning process was performed, removing 129 records with incomplete information in the resilience and self-esteem questionnaires. Finally, the sample analyzed in this study consisted of 1,307 adolescents, representing an adjusted response rate of 66.3%. A statistical power calculation was performed to assess the study’s ability to detect differences in the prevalence of low self-esteem according to resilience level in adolescents. For this calculation, the proportion of low self-esteem in the low-resilience group (p₁ = 0.48) and in the high-resilience group (p₂ = 0.26) was considered, along with their respective sample sizes (n₁ = 1,081 for adolescents with low resilience and n₂ = 226 for adolescents with high resilience). The results indicated a statistical power of 100%, suggesting that the study has optimal capacity to detect significant differences in the association between resilience and self-esteem in the analyzed population. Sampling was non-probabilistic. Procedures Data collection was carried out between September and December 2022 in five secondary-level educational institutions in the Lambayeque region, Peru. The instruments were administered in person in classrooms previously assigned by the administration of each school, ensuring adequate conditions for participants’ concentration. Before the administration of the questionnaires, the adolescents were informed about the purpose of the study, and their voluntary participation and the confidentiality of the data were ensured. Participants completed a structured electronic questionnaire using the Research Electronic Data Capture (REDCap) platform, which included sociodemographic-academic information and variables of interest such as resilience and self-esteem. The data digitization and cleaning process was carried out by a team of previously trained researchers. A rigorous review was conducted to identify and remove incomplete or inconsistent responses. In addition, quality control procedures were applied to the data, minimizing potential biases in variable coding. For the analysis, the resilience and self-esteem variables were categorized into two groups: high/low resilience and high/low self-esteem, following cutoff points previously established in the scientific literature. Finally, the processed database was used in the corresponding statistical analyses to assess the association between resilience and self-esteem in the study population. Variables The dependent variable was low self-esteem, operationally defined as a score lower than 15 points on the Rosenberg Self-Esteem Scale. This score was obtained by summing the responses to the 10 items of the questionnaire, following the methodology previously validated in similar studies. The exposure variable was a high level of resilience, defined as a score of 30 points or higher on the abbreviated 10-item version of the Connor–Davidson Resilience Scale (CD-RISC) questionnaire. This score was obtained by summing the participants’ individual responses, in accordance with the cutoff points established in the scientific literature for classifying resilience levels in adolescents. Several secondary independent variables were considered to explore their influence on the relationship between resilience and self-esteem in adolescents. Among the sociodemographic characteristics, age was included, classifying participants according to their developmental stage into early adolescence (10–13 years), middle adolescence (14–16 years), and late adolescence (17–19 years). Sex (male, female) and type of educational institution (public, private) were also recorded, distinguishing between publicly and privately managed schools. In addition, place of residence (rural, urban, marginal urban) was taken into account. Family and academic conditions were assessed through the number of household members ( 1 – 5 , 6 – 10 , 11 – 15 ) and the presence of a family history of mental illness (yes, no). Regarding aspects related to physical health, BMI was included and categorized as underweight, normal weight, overweight, and obesity. Academic performance was evaluated by determining whether the participant had failed any course during their school years (yes, no). Social interaction was also explored through the frequency of contact with friends (infrequent, frequent, very frequent) and relationship status (in a relationship, not in a relationship). Regarding digital habits, the frequency of television use (1–5 hours, 6–10 hours, more than 11 hours) and the frequency of social media use during the COVID-19 pandemic (never, little, moderate, quite a lot to extreme, extreme) were analyzed. In addition, the presence of facial acne (no acne, grade 1, grade 2, grade 3, grade 4) was considered as a potential factor influencing self-esteem perception. Regarding consumption habits, cigarette use was assessed (never, fewer than 10 cigarettes/day, 11–20 cigarettes/day, 21–30 cigarettes/day, more than 31 cigarettes/day) as well as alcohol consumption (never, monthly or less, 2–4 times a month, 2–3 times a week, 4 or more times a week). Physical activity was categorized as inactive or active. Family APGAR questionnaire (measures family function based on Adaptability, Partnership, Growth, Affection, and Resolve), establishing four levels: functional family, mild dysfunction, moderate dysfunction, and severe dysfunction. These variables were incorporated into the analysis to identify potential factors associated with self-esteem in adolescents and its relationship with resilience. Instruments Rosenberg Self-Esteem Scale Instrument designed to assess self-esteem. It consists of 10 items on a 4-point Likert scale, where each item can score from 1 (Strongly agree) to 4 (Strongly disagree). It should be noted that items 2, 5, 6, 8, and 9 are reverse scored (i.e., “Strongly agree” scores 4 points and “Strongly disagree” scores 1 point). A higher score correlates with a higher level of self-esteem. Scores below 15 suggest low self-esteem. The scale has shown excellent psychometric properties, with an estimated reliability of 0.92 in adolescents ( 40 ) and correlation coefficients ranging from 0.82 to 0.88 in studies conducted in the United States, Norway, and Asian countries ( 40 , 41 , 42 ). It has also been applied to Latin American adolescents, with reliability values ranging from 0.70 to 0.78 in adolescent populations from Chile and Argentina ( 43 , 44 ). This scale has been used to assess adolescents during the COVID-19 pandemic ( 45 , 46 ). Abbreviated CD-RISC Instrument designed to measure individual resilience levels. This is an abbreviated model of the original scale (25 items) consisting of 10 items, each rated on a Likert scale ranging from 0 (never) to 4 (almost always) ( 47 ). These items assess the dimensions of “personal competence,” “trust and strength,” “acceptance,” “control,” and “spirituality.” The total score ranges from 0 to 40 points, with higher scores indicating higher levels of resilience ( 47 ). It has a Cronbach’s alpha of 0.85, demonstrating good internal validity ( 47 ). This scale has previously been applied in adolescent populations in Colombia (α = .838) ( 48 ) and Peru (α = .827) ( 49 ), showing good reliability and validity. Likewise, it has been used to assess adolescents during the COVID-19 pandemic (α = .92) ( 50 ). Family APGAR Instrument that reflects family members’ perception of the overall functioning of the family unit. It evaluates five basic family functions: adaptation, partnership, personal resource gradient, affection, and resources. It consists of 9 items on a Likert scale ranging from 0 (never) to 4 (always). Scores below 17 points are associated with family dysfunction. The instrument has a correlation index of 0.80, and in evaluations conducted in multiple studies involving adolescents, correlation indices ranged from 0.71 to 0.83 ( 51 , 52 , 53 ). The scale has shown good reproducibility coefficients in Latin American adolescent populations ( 54 ). Studies have employed this scale during the lockdown period caused by the COVID-19 pandemic, including adolescent populations ( 55 , 56 ). Spanish Acne Severity Scale (EGAE) Instrument used to assess the severity of vulgar acne that requires iconographic material for its application. It consists of 2 items: a facial scale ranging from grade 1 (least severe) to grade 4 (most severe), and a trunk scale (chest and back) ranging from grade 1 to grade 3 ( 57 ). This instrument has been widely reproduced and demonstrates high intra- and inter-observer reliability (α ≥ 0.8) ( 58 ). The scale has also been applied to Latin American populations during the COVID-19 pandemic, although not limited to adolescent populations ( 59 ). Physical Activity Questionnaire for Adolescents (PAQ-A) Instrument designed to assess physical activity in adolescents. It consists of 9 items that evaluate various aspects of physical activity performed in the past 7 days. It uses a 5-point Likert scale. The final score is calculated based on the arithmetic mean of the first 8 questions, while question 9 excludes the presence of any condition that prevented the participant from performing physical activity ( 60 ). The scale demonstrates high reliability values and has been replicated with Cronbach’s alpha coefficients ranging from 0.74 to 0.82 in adolescents from Spain and the United States (USA), respectively ( 60 , 61 ). This instrument has proven adaptable to the national context, achieving good levels of internal consistency in Peruvian adolescent populations, with a Cronbach’s alpha of 0.8 ( 62 ). Statistical Analysis Plan Data analysis was performed using Stata version 18.0 (StataCorp LP, College Station, TX, USA). Initially, a descriptive exploration of the study variables was conducted. For categorical variables, absolute and relative frequencies were calculated, while numerical variables were analyzed using measures of central tendency and dispersion, following verification of data normality. In the bivariate analysis, the association between resilience and self-esteem was evaluated using the chi-square test of independence, considering a significance level of 5% (p < 0.05). To evaluate the association between resilience and self-esteem, generalized linear models (GLM) with a Poisson distribution and robust variance were used, allowing for the estimation of prevalence ratios (PR) with 95% confidence intervals (CI), thereby quantifying the magnitude of the effect between the analyzed variables. The educational institution was included as a cluster in the regression models to account for potential intra-school correlation and obtain more precise estimates. In the multiple regression model, adjustments were made for confounding variables identified in the bivariate analysis and those of epidemiological relevance, aiming to control the relationship between resilience and self-esteem. Additionally, collinearity among variables included in the final model was assessed by calculating the variance inflation factor (VIF), ensuring the stability of the estimated coefficients. Ethical Considerations This study was approved by the Research Ethics Committee of Universidad San Martín de Porres, Lima, Peru, ensuring compliance with ethical principles for research involving human subjects. To protect participants’ privacy and confidentiality, data were collected through anonymous questionnaires without including any identifying information. Informed assent was obtained from the adolescents, and informed consent was secured from their parents or legal guardians prior to participation. Furthermore, it was ensured that the information collected would be used exclusively for research purposes, without compromising the participants’ integrity or well-being. All stages of the study were conducted in accordance with the principles of respect, beneficence, and justice, consistent with the Declaration of Helsinki and the applicable national regulations. RESULTS Sociodemographic and Academic Characteristics A total of 1,307 adolescents were included, with an average age of 14.63 ± 1.40 years. Most were in the middle stage of adolescence (69.2%), female (54.3%), and attended public schools (65.1%). Urban residency predominated (83.2%), and the majority lived in households with 1 to 5 members (60.0%). Additionally, 85.2% of the adolescents reported no family history of mental illness. Regarding nutritional status, the largest proportion had a normal BMI (63.1%). Nearly half (45.7%) reported having failed at least one course. Regarding interpersonal relationships, 47.0% reported frequent contact with friends, and 62.4% stated they were in a romantic relationship. A large majority (92.4%) of adolescents reported watching television between 1 to 5 hours daily, while 32.8% indicated frequent or extreme use of social media. Most adolescents had never smoked (94.0%) nor consumed alcohol (78.2%). In terms of physical activity, 66.2% were classified as inactive. Regarding family functionality, 40.4% of adolescents had a functional family, while 29.8% presented severe dysfunction. Concerning mental health, 82.7% exhibited low resilience, and 44.6% had low self-esteem (95% CI: 42.03–47.40). See Table 1 . Table 1 Characteristics of schoolchildren from three schools in Chiclayo, 2022 (n = 610) Characteristics N (%) Age (years)* 14.63 ± 1.40 Adolescent stage (years) Early 296 (22.7) Middle 905 (69.2) Late 106 (8.1) Sex Male 598 (45.8) Female 709 (54.3) Type of institution Public 851 (65.1) Private 456 (34.9) Place of residence Rural 185 (14.2) Urban 1087 (83.2) Peri-urban 35 (2.7) Number of family members (categorized) 1 a 5 784 (60.0) 6 a 10 474 (36.3) 11 a 15 49 (3.8) Religion None 305 (23.3) Catholic 739 (56.5) Other 263 (20.1) Family history of mental illness No 1114 (85.2) Yes 193 (14.8) BMI (categorized) Underweight 276 (21.1) Normal 824 (63.1) Overweight 166 (12.7) Obesity 41 (3.1) Failed a subject during school years No 710 (54.3) Yes 597 (45.7) Relationship with friends Infrequent 314 (24.0) Frequent 614 (47.0) Very frequent 379 (29.0) Romantic partner No 492 (37.6) Yes 815 (62.4) Daily television use frequency 1 a 5 1207 (92.4) 6 a 10 71 (5.4) 11 a 15 29 (2.2) Frequency of social media use during the COVID-19 pandemic Never 114 (8.7) Rarely 286 (21.9) Moderate 362 (27.7) High to extreme 428 (32.8) Extreme 117 (9.0) Facial acne No 664 (50.8) Grade 1 558 (42.7) Grade 2 60 (4.6) Grade 3 7 (0.5) Grade 4 18 (1.4) Cigarette smoking Never 1228 (94.0) Less than 10 cigarettes/day 41 (3.1) 11–20 cigarettes/day 23 (1.8) 21–30 cigarettes/day 6 (0.5) ≥ 31 cigarettes/day 9 (0.7) Alcohol consumption Never 1022 (78.2) Monthly or less 164 (12.6) 2–4 times a month 82 (6.3) 2–3 times a week 25 (1.9) 4 or more times a week 14 (1.1) Physical activity Inactive 838 (66.2) Active 428 (33.8) Family dysfunction No 493 (40.4) Mild 241 (19.8) Moderate 122 (10.0) Severe 363 (29.8) Resilience Low 1081 (82.7) High 226 (17.3) Self-esteem Low 583 (44.6) Moderate 384 (29.4) High 340 (26.0) * Mean ± standard deviation (SD) Self-Esteem in Adolescents Fifty percent of the surveyed adolescents agreed that they feel worthy of appreciation. Additionally, 49.3% agreed that they possess positive qualities, and 44% indicated feeling capable of doing things as well as most people. On the other hand, 39.5% stated they do not have much to be proud of, and 29.9% tended to think of themselves as a failure. Furthermore, 37.4% agreed with the idea that sometimes they believe they are not a good person, while 34.4% occasionally considered themselves useless. Regarding self-perception, 44.9% wished to feel more self-respect, with 36.3% strongly agreeing with this statement. Finally, 40.2% reported feeling satisfied with their life overall, whereas 23.5% disagreed with this affirmation. See Fig. 01 . Association Between Resilience and Self-Esteem, and Other Factors in Bivariate Analysis Low self-esteem was more frequent in adolescents with low resilience compared to those with high resilience (48.5% vs. 26.1%; p < 0.001). Additionally, the prevalence of low self-esteem was 20.9%, 36.7%, and 37.5% higher in adolescents with mild, moderate, and severe family dysfunction, respectively, compared to those from functional families (p < 0.001). A higher prevalence of low self-esteem was also observed in adolescents with a family history of mental illness compared to those without such history (56.0% vs. 42.6%; p = 0.001). Regarding sociodemographic factors, low self-esteem was more frequent in males than in females (52.8% vs. 37.7%; p < 0.001), and in adolescents who had failed at least one course compared to those who had not (48.4% vs. 41.4%; p = 0.011). With respect to risk behaviors, adolescents with higher cigarette consumption showed a significantly greater prevalence of low self-esteem compared to non-smokers, with a dose–response relationship observed (69.6% among those who smoked 11–20 cigarettes/day vs. 43.0% among non-smokers; p < 0.001). Similarly, adolescents with higher alcohol consumption showed a greater prevalence of low self-esteem, with 71.4% among those who drank 4 or more times per week compared to 42.0% among non-drinkers (p = 0.003). Regarding technological habits, adolescents with higher television use (≥ 6 hours per day) had a significantly higher prevalence of low self-esteem (60.6–65.5% vs. 43.2%; p = 0.001). Likewise, extreme social media use was associated with a higher prevalence of low self-esteem compared to moderate use (54.7% vs. 35.6%; p = 0.001). Finally, adolescents with insufficient physical activity showed a higher prevalence of low self-esteem compared to those who were physically active (49.3% vs. 35.3%; p < 0.001). See Table 2 . Table 2 Factors associated with post-traumatic stress among schoolchildren from three schools in Chiclayo, 2021 Variables Self-esteem p* No (n = 724) Yes (n = 583) n(%) n(%) Adolescent stage (years) < 0.001 Early 135 (45.6) 161 (54.4) Middle 517 (57.1) 388 (42.9) Late 72 (67.9) 34 (32.1) Sex < 0.001 Male 282 (47.2) 316 (52.8) Female 442 (62.3) 267 (37.7) Type of institution 0.591 Public 476 (55.9) 375 (44.1) Private 248 (54.4) 208 (45.6) Place of residence 0.667 Rural 102 (55.1) 83 (44.9) Urban 600 (55.2) 487 (44.8) Peri-urban 22 (62.9) 13 (37.1) Number of family members (categorized) 0.110 1 a 5 447 (57.0) 337 (43.0) 6 a 10 246 (51.9) 228 (48.1) 11 a 15 31 (63.3) 18 (36.7) Religion 0.570 None 161 (52.8) 144 (47.2) Catholic 414 (56.0) 325 (44.0) Other 149 (56.7) 114 (43.4) Family history of mental illness 0.001 No 639 (57.4) 475 (42.6) Yes 85 (44.0) 108 (56.0) BMI (categorized) 0.389 Underweight 158 (57.3) 118 (42.8) Normal 460 (55.8) 364 (44.2) Overweight 88 (53.0) 78 (47.0) Obesity 18 (43.9) 23 (56.1) Failed a subject during school years 0.011 No 416 (58.6) 294 (41.4) Yes 308 (51.6) 289 (48.4) Relationship with friends 0.222 Infrequent 161 (51.3) 153 (48.7) Frequent 345 (56.2) 269 (43.8) Very frequent 218 (57.5) 161 (42.5) Romantic partner 0.045 No 290 (58.9) 202 (41.1) Yes 434 (53.3) 381 (46.8) Daily television use frequency 0.001 1 a 5 686 (56.8) 521 (43.2) 6 a 10 28 (39.4) 43 (60.6) 11 a 15 10 (34.5) 19 (65.5) Frequency of social media use during the COVID-19 pandemic 0.001 Never 55 (48.3) 59 (51.8) Rarely 151 (52.8) 135 (47.2) Moderate 233 (64.4) 129 (35.6) High to extreme 232 (54.2) 196 (45.8) Extreme 53 (45.3) 64 (54.7) Facial acne 0.028 No 359 (54.1) 305 (45.9) Grade 1 326 (58.4) 232 (41.6) Grade 2 31 (51.7) 29 (48.3) Grade 3 4 (57.1) 3 (43.9) Grade 4 4 (22.2) 14 (77.8) Cigarette smoking < 0.001 Never 700 (57.0) 528 (43.0) Less than 10 cigarettes/day 14 (34.2) 27 (65.9) 11–20 cigarettes/day 7 (30.4) 16 (69.6) 21–30 cigarettes/day 3 (50.0) 3 (50.0) ≥ 31 cigarettes/day 0 (0.0) 9 (100.0) Alcohol consumption 0.003 Never 593 (58.0) 429 (42.0) Monthly or less 81 (49.4) 83 (50.6) 2–4 times a month 36 (43.9) 46 (56.1) 2–3 times a week 10 (40.0) 15 (60.0) 4 or more times a week 4 (28.6) 10 (71.4) Physical activity < 0.001 Inactive 425 (50.7) 413 (49.3) Active 277 (64.7) 151 (35.3) Family dysfunction < 0.001 No 367 (74.4) 126 (25.6) Mild 129 (53.5) 112 (46.5) Moderate 46 (37.7) 76 (62.3) Severe 134 (36.9) 229 (63.1) Resilience < 0.001 Low 557 (51.5) 524 (48.5) High 167 (73.9) 59 (26.1) * p-value calculated using the Chi-square test of independence. Association Between Resilience and Self-Esteem, and Other Factors in Simple and Multiple Regression Analysis In the simple regression analysis, adolescents with low resilience had a higher prevalence of low self-esteem (PR: 0.54; 95% CI: 0.41–0.70; p < 0.001), and this relationship remained in the adjusted model, where adolescents with high resilience showed a 32% lower prevalence of low self-esteem (PR: 0.68; 95% CI: 0.53–0.86; p = 0.002). See Table 3 . Table 3 Factors associated with post-traumatic stress in schoolchildren, Chiclayo 2021: simple and multiple regression Characteristics Self-esteem Simple regression Multiple regression* PR CI 95% p ** PR CI 95% p ** Adolescent stage (years) Ref. Early Ref. 1.66 0.73–0.88 < 0.001 Middle 0.79 0.71–0.88 < 0.001 2.11 0.45–0.81 0.001 Late 0.59 0.45–0.77 < 0.001 2.17 Sex Male Ref. Ref. Female 0.71 0.57–0.90 0.004 0.71 0.67–0.75 < 0.001 Type of institution Public Ref. Ref. Private 1.03 0.73–1.45 0.863 1.09 0.96–1.24 0.172 Place of residence Rural Ref. Ref. Urban 0.98 0.85–1.13 0.820 0.98 0.86–1.12 0.749 Peri-urban 0.85 0.60–1.21 0.374 0.78 0.65–0.94 0.008 Number of family members (categorized) 1 a 5 Ref. Ref. 6 a 10 1.12 1.01–1.23 0.030 1.13 1.09–1.17 < 0.001 11 a 15 0.83 0.60–1.17 0.290 0.61 0.63–0.85 < 0.001 Religion None Ref. Ref. Catholic 0.93 0.76–1.13 0.444 1.01 0.91–1.11 0.852 Other 0.93 0.82–1.04 0.208 0.91 0.80–1.02 0.115 Family history of mental illness No Ref. Ref. Yes 1.29 1.17–1.43 < 0.001 1.19 1.01–1.40 0.043 BMI (categorized) Underweight Ref. Ref. Normal 1.02 0.92–1.12 0.737 1.05 0.86–1.28 0.613 Overweight 1.11 0.78–1.58 0.571 1.05 0.75-1-46 0.783 Obesity 1.30 1.02–1.65 0.035 1.07 0.81–1.40 0.651 Failed a subject during school years No Ref. Ref. Yes 1.17 1.01–1.35 0.032 1.06 0.94–1.20 0.322 Relationship with friends Infrequent Ref. Ref. Frequent 0.89 0.81–0.98 0.020 1.08 0.92–1.26 0.345 Very frequent 0.87 0.70–1.06 0.165 1.05 0.98–1.12 0.132 Romantic partner No Ref. Ref. Yes 1.13 1.04–1.22 0.004 1.18 1.1–1.26 < 0.001 Daily television use frequency 1 a 5 Ref. Ref. 6 a 10 1.41 1.19–1.67 < 0.001 1.18 1.04–1.33 0.009 11 a 15 1.46 1.19–1.79 < 0.001 1.08 0.77–1.51 0.649 Frequency of social media use during the COVID-19 pandemic Never Ref. Ref. Rarely 0.90 0.79–1.02 0.106 0.88 0.65–1.19 0.396 Moderate 0.68 0.52–0.90 0.007 0.79 0.57–1.10 0.164 High to extreme 0.87 0.66–1.16 0.344 0.93 0.63–1.36 0.695 Extreme 1.05 0.71–1.53 0.817 1.01 0.62–1.66 0.954 Facial acne No Ref. Ref. Grade 1 0.88 0.78-1.00 0.057 0.92 0.84–1.02 0.108 Grade 2 1.04 0.80–1.34 0.774 1.31 0.84–2.05 0.236 Grade 3 0.92 0.69–1.24 0.581 0.78 0.59–1.04 0.097 Grade 4 1.58 1.43–1.76 < 0.001 1.33 1.03–1.72 0.029 Cigarette smoking Never Ref. Ref. Less than 10 cigarettes/day 1.55 1.32–1.81 < 0.001 1.05 0.87–1.53 0.312 11–20 cigarettes/day 1.62 1.07–2.43 0.021 1.14 0.82–1.59 0.441 21–30 cigarettes/day 1.45 0.95–2.23 0.087 1.39 0.90–2.15 0.133 ≥ 31 cigarettes/day 2.32 2.10–2.57 < 0.001 1.07 0.48–2.34 0.874 Alcohol consumption Never Ref. Ref. Monthly or less 1.19 0.85–1.66 0.321 1.16 0.87–1.53 0.312 2–4 times a month 1.34 1.13–1.60 0.001 1.14 0.82–1.59 0.441 2–3 times a week 1.42 1.04–1.95 0.029 1.39 0.90–2.15 0.133 4 or more times a week 1.74 1.12–2.69 0.013 1.07 0.48–2.34 0.874 Physical activity Inactive Ref. Ref. Active 0.72 0.61–0.83 < 0.001 0.91 0.79–1.04 0.158 Family dysfunction No Ref. Ref. Mild 1.82 1.50–2.21 < 0.001 1.66 1.42–1.95 < 0.001 Moderate 2.44 1.74–3.41 < 0.001 2.11 1.58–2.83 < 0.001 Severe 2.47 1.83–3.33 < 0.001 2.17 1.65–2.84 < 0.001 Resilience Low Ref. Ref. High 0.54 0.41–0.70 < 0.001 0.68 0.53–0.86 0.002 *Adjusted for relevant covariates **p-values obtained using Generalized Linear Models (GLM). Poisson family, log link function, robust variance, school as cluster Additionally, adolescents with mild, moderate, and severe family dysfunction had a higher prevalence of low self-esteem compared to those from functional families. In particular, severe dysfunction was associated with a 147% higher prevalence of low self-esteem (PR: 2.47; 95% CI: 1.83–3.33; p < 0.001). This association persisted in the multiple regression model, where adolescents with moderate and severe dysfunction showed a 111% and 117% increase in the prevalence of low self-esteem, respectively (PR: 2.11; 95% CI: 1.58–2.83 and PR: 2.17; 95% CI: 1.65–2.84). See Table 3 . Other factors were also associated with low self-esteem. In the adjusted analysis, adolescents with a family history of mental illness had a 19% higher prevalence of low self-esteem (PR: 1.19; 95% CI: 1.01–1.40). Regarding lifestyle habits, television use exceeding 6 hours per day was associated with an 18% higher prevalence of low self-esteem (PR: 1.18; 95% CI: 1.04–1.33). Additionally, adolescents who consumed alcohol 4 or more times per week had a 74% higher prevalence of low self-esteem in the simple analysis (PR: 1.74; 95% CI: 1.12–2.69; p = 0.013), although this association did not remain significant in the multiple model. Finally, adolescents in a romantic relationship showed an 18% higher prevalence of low self-esteem compared to those not in a relationship (PR: 1.18; 95% CI: 1.10–1.26; p < 0.001). See Table 3 . DISCUSSION Prevalence of self-esteem In our study, we found that 44.7% of secondary school adolescents presented low self-esteem. This finding is consistent with results from a study conducted in Ghana, in a pre-pandemic context, where 47% of adolescents were found to have low self-esteem ( 63 ). Similarly, a study conducted among adolescents in Nigeria reported that 32.1% of them had low self-esteem ( 64 ). Likewise, in Vietnam, also in a pre-pandemic context, 19.4% of secondary school students were found to have low self-esteem ( 13 ). Similarly, a study conducted in India in a pre-pandemic context reported considerably lower figures, with only 8.33% of adolescents presenting low self-esteem ( 65 ). In adolescents from the United States, a pre-pandemic study using the Rosenberg scale found that the prevalence of low self-esteem reached 30% ( 7 ). Likewise, a study carried out in Brazil, also in a pre-pandemic context, found that 33.8% of adolescents had low self-esteem ( 66 ). This supports the possibility that, in our context, low self-esteem may be related to negative body image, limited social support, or psychosocial environmental factors ( 66 ). The high frequency observed could be explained by body dissatisfaction, which is common among adolescents—especially females—and is closely related to low self-esteem ( 66 ). This dissatisfaction is influenced by sex, BMI, social pressure regarding aesthetic ideals, and the internalization of beauty standards, all of which can lead to discomfort with one’s own image and negatively affect self-esteem ( 66 ). In Ecuador, a study conducted among secondary school students in a post-pandemic context found that 36.1% had low self-esteem according to the Rosenberg scale ( 67 ). In Colombia, 47.9% of students showed “low or very low” self-esteem in a study carried out in a pre-pandemic context ( 68 ). In a school in Puerto Maldonado, Peru, 44.7% of students presented a moderate level of self-esteem in a study conducted during the COVID-19 pandemic ( 69 ). Similarly, in Puno, Peru, a pre-pandemic study found that 57.7% of adolescents had what was considered “regular” self-esteem, and 21.2% had low self-esteem ( 70 ). On the other hand, in Trujillo, Peru, a pre-pandemic study found a prevalence of low self-esteem of 10.9% among the adolescents evaluated ( 71 ). The observed prevalence may be related to specific contextual conditions affecting school-aged adolescents, such as a dysfunctional family environment, living arrangements with parents, academic pressure, and cultural norms linked to self-image ( 13 ). Likewise, several additional factors can negatively influence self-esteem during adolescence, including physical and/or mental health history ( 69 ), experiences of school violence ( 72 ), prolonged exposure to social media promoting unrealistic beauty ideals ( 18 , 28 ), as well as the impact of the COVID-19 pandemic ( 73 ). For example, a study conducted in Spain compared secondary school students evaluated before and after the pandemic and found that, in the post–COVID-19 group, there was a significant increase in the proportion of adolescents with low self-esteem (score ≤ 25 on the Rosenberg scale) compared to the pre-pandemic group ( 73 ). The differences observed between studies could be explained by geographic, cultural, and methodological factors ( 13 , 74 ). Resilience and Self-Esteem In our study, adolescents with a high level of resilience were associated with a lower prevalence of low self-esteem. This finding is consistent with research in Nigeria that reported an association between self-esteem and resilience against peer pressure in adolescents, suggesting that higher levels of self-esteem positively influence adolescents’ ability to resist social pressure, with 75% of participants presenting high self-esteem ( 74 ). Similarly, a study in China among adolescents with hearing disabilities found that resilience significantly predicted self-esteem (B = 2.031) ( 75 ). Another study in China, conducted among left-behind adolescents, reported that self-esteem significantly predicts resilience (β = 0.448) ( 23 ). Similarly, a study in Poland showed that resilience influences emotional regulation, and that this relationship is strengthened when adequate levels of self-esteem and perceived social support are present ( 24 ). Furthermore, research in Turkey identified that self-esteem, along with school belonging and social support, explains 33% of the variance in resilience (R² = 0.33), while these same factors explain 35% of the variance in self-esteem (R² = 0.35) ( 76 ). In Mexico, a study in basic education adolescents concluded that the total resilience score correlates positively with self-esteem (r = 0.59) and with positive affect (r = 0.48). These results support the idea that positive self-esteem acts as an internal predictor of resilience ( 77 ). Similarly, in Argentina it was concluded that self-esteem and resilience are closely related during adolescence, suggesting that strengthening one favors the development of the other ( 78 ). In Arequipa, a region in southern Peru, a low but significant inverse correlation was found (rho ≈ − 0.33, p = 0.001), indicating that adolescents with greater resilience tended to present higher levels of self-esteem ( 79 ). Along the same lines, a study conducted in Lima, Peru, confirmed a significant relationship between resilience and self-esteem across various dimensions, such as confidence and perseverance ( 80 ). Likewise, different life events influence coping styles both directly and indirectly, with this effect being mediated 34.37% by resilience and self-esteem ( 81 ). This association could be explained by the fact that resilience provides emotional protection against psychosocial stress, fosters stable family relationships and support networks, and enhances coping strategies such as self-efficacy and emotional regulation ( 82 ). At the neurobiological level, it has been linked to increased activity in the prefrontal cortex ( 83 ) and reduced reactivity in the amygdala, facilitating better emotional control ( 84 ). This helps mitigate the impact of adverse situations, such as those generated by the pandemic, and contributes to preserving healthier self-esteem in adolescents ( 85 ). For example, a study conducted in the United States of America found that greater brain resilience—reflected in stronger functional connectivity between regions such as the prefrontal cortex and the amygdala—was associated with lower stress and sadness during the pandemic, reinforcing its protective role over emotional well-being ( 85 ). Male sex In our study, male adolescents showed a lower prevalence of low self-esteem. This finding is consistent with a meta-analysis that found adolescent males tend to have slightly higher self-esteem than females, reporting a positive and significant correlation between sex and self-esteem (r = 0.21), with higher scores in males ( 86 ). Similarly, studies conducted in Oregon and San Francisco, USA, among adolescent students found a significant difference in standardized self-esteem between sexes (d = 0.22), with males showing higher self-esteem levels (r = 0.21) ( 87 ), while females scored higher in relationality and in several self-esteem domains ( 88 ). In Spain, higher self-esteem was also observed in male than in female adolescents (r = 0.23) ( 89 ), possibly due to the greater negative impact of pubertal changes on females ( 90 ). Internationally, a cross-cultural analysis including data from 48 countries—among them Peru, Brazil, Argentina, Bolivia, and Ecuador—identified a consistent gender effect (B = − 1.85; average r ≈ 0.20), with males reporting higher self-esteem levels compared to females, and with self-esteem increasing with age in both genders, particularly at the end of adolescence and the beginning of adulthood ( 91 ). This contrasts with findings from a study of adolescents in Michigan, USA, which reported no significant differences in mean self-esteem between sexes or across cohorts, with an explained variance below 2% (R² < 0.02) ( 92 ). Similarly, another study in adolescents from California, USA, found no differences in self-esteem perception according to sex ( 93 ). A national longitudinal study based on the National Longitudinal Survey of Youth 1979 (NLSY79) also suggests that differences in self-esteem between sexes during adolescence and early adulthood are small or statistically nonsignificant ( 94 ). This finding is relevant, as the common belief that males have higher self-esteem could lead parents and teachers to underestimate self-esteem problems in adolescent boys ( 95 ). On the other hand, a longitudinal study in African American adolescents from Atlanta found that females reported higher self-esteem levels, possibly due to better development of the self-system, while males from female-headed households exhibited more risk behaviors that could affect their self-esteem and academic performance ( 96 ). Similarly, a study conducted in Argentina concluded that there are no significant differences in self-esteem scores between males and females ( 44 ). These differences could be explained by factors such as life satisfaction, identified in a Chilean study as the main determinant of adolescent self-esteem, followed by perceived educational quality and self-image. It was observed that a positive evaluation of the family and school environment fosters the development of self-esteem, even in precarious educational contexts ( 97 ). In males, self-concept and global self-esteem are associated with values such as achievement, competence, and self-direction, while in females, communal and prosocial values predominate ( 98 ). Gender stereotypes and family and cultural socialization processes also play a role, as they often expand opportunities more for males ( 99 ). A study in the United States supports this idea, noting that men tend to accept more positive statements about themselves, whereas women are more likely to accept negative statements ( 100 ). Likewise, the differences in self-esteem between males and females are explained by biological, cultural, socioeconomic, and sociodemographic factors ( 91 ). Biologically, hormonal and neurological variations influence self-perception and emotional regulation ( 91 ). Culturally, gender expectations reinforce values of autonomy and competence in men, while communal values predominate in women ( 91 ). From a socioeconomic perspective, countries with greater development and gender equity tend to show more marked gaps, suggesting that access to opportunities also plays a role. Finally, social roles, family structure, and stereotypes influence self-esteem, with smaller differences observed in contexts with more flexible gender norms ( 91 ). Family member with mental health disorder In our study, having a family member with a mental health disorder was associated with a higher prevalence of low self-esteem among adolescents. This is similar to what has been reported in adolescents in the United States, where having a family member with special health care needs was found to be associated with a higher likelihood of low self-esteem (Odds Ratio (OD): 1.37) ( 7 ). Similarly, a Norwegian study showed that children of parents with depression have lower self-esteem levels than those whose parents do not have this diagnosis ( 101 ). In Indonesia, a study reported that pasung—a practice that involves the deprivation of physical, mental, and social integrity through restraint or confinement—applied to individuals with mental disorders has a profound impact on children living with the patient. These effects include feelings of helplessness and shame, psychological disturbances such as depression, substance use, school dropout, and social isolation ( 102 ), factors that collectively constitute fertile ground for the development of impaired self-esteem ( 7 , 103 , 104 ). A study conducted among school adolescents in Huánuco, Peru, found that low self-esteem was significantly associated with the presence of depression. Specifically, 39.4% of participants had low self-esteem, while 16.4% showed depressive symptoms, demonstrating a statistically significant relationship between both variables ( 105 ). However, a study conducted in the United States reported a contrasting finding, identifying that higher self-esteem in children of parents with depression was the main predictor of the absence of a psychiatric diagnosis and of a high level of global functioning at 2, 10, and 20 years of follow-up ( 106 ). This association could be explained by the presence of social or family support networks ( 7 ). In contexts with protective structures, such as cohesive families, strong educational institutions, or assistance programs, the impact of having a family member with a mental disorder may be mitigated, reducing its negative effect on the adolescent’s self-esteem ( 7 ). In contrast, in less protective environments, exposure to a family member’s mental illness may increase emotional vulnerability and contribute to low self-esteem ( 106 ). Partner In our study, having a romantic partner was associated with a higher prevalence of low self-esteem. This finding is consistent with a study conducted among university students in Houston (USA), which found that relationship-contingent self-esteem (RCSE) was negatively associated with global self-esteem (r = − 0.29) ( 107 ). This suggests that students whose self-worth depends on the status of their relationship tend to experience lower and more vulnerable self-esteem in response to the ups and downs of relationship dynamics ( 107 ). This finding contrasts with a study in German adolescents, where entering into a romantic relationship significantly increased self-esteem, particularly when the relationship lasted at least one year (d ≈ + 0.10). It was also observed that a breakup reduced self-esteem (d ≈ − 0.16), although this effect was temporary and disappeared within a year, even without entering a new relationship ( 108 ). This could be explained by a study conducted in the Netherlands, which evaluated the effect of initiating and ending a romantic relationship. The results support the dynamic equilibrium model of personality development, which posits that traits such as self-esteem and self-perception can temporarily change in response to significant life experiences but tend to return to an individual set point influenced by both genetic and environmental factors ( 109 ). In this regard, if self-esteem is based exclusively on performance within the relationship (contingent self-esteem), there is a greater risk of experiencing low self-esteem when the relationship is not emotionally satisfying ( 107 ). However, when the relationship is solid and functional, it can serve as a positive reinforcement for self-esteem ( 108 ). Moreover, few aspects of social life have as much potential to significantly impact self-esteem and well-being as the success or failure of romantic relationships. Nevertheless, not all individuals are equally affected by the ups and downs of their romantic relationships ( 108 ). Middle and late adolescence In our study, being in middle and late adolescence was associated with a 20% and 39% reduction in low self-esteem, respectively, compared to early adolescence. This finding is consistent with a study conducted in Spain, which observed that self-esteem tends to increase as adolescents grow older; adolescents aged 15 to 19 years showed significantly lower rates of low self-esteem compared to those aged 12 to 14 years ( 110 ). Similarly, a study in Germany found that self-esteem was high in childhood, declined in early adolescence, and then progressively increased until young adulthood, with a significant medium effect size between the ages of 13 and 29 years (d = 0.29) ( 111 ). In the same vein, a study in Kentucky, USA, concluded that during middle and late adolescence—and even into early adulthood—self-esteem tends to stabilize or even increase; in fact, more than half of the participants remained at the same self-esteem level from one year to the next, with significant correlation coefficients ranging from 0.59 to 0.87 for measures such as the Rosenberg scale ( 112 ). Likewise, a cross-cultural analysis using data from 48 countries—including several in South America, such as Peru, Brazil, Argentina, Bolivia, and Ecuador—found that adolescent self-esteem tends to increase progressively with age, particularly toward the end of adolescence and the beginning of adulthood. Using multilevel models, a positive and significant association between age and self-esteem was found (B = 0.80), even after controlling for gender and country ( 91 ). Another study conducted in Ecuador among adolescents showed that the proportion of those with high self-esteem was greater in the 15–19-year-old group (51%) compared to the 12–14-year-old group (estimated at 45%), suggesting a trend toward increasing self-esteem with advancing age ( 15 ). This contrasts with what was reported in a study conducted among adolescents in the United States, where late-stage adolescents showed stable self-esteem levels over time, with minimal cohort differences accounting for less than 2% of the total variance (η² < 0.02) ( 92 ). Along the same lines, a study in New York found that although self-esteem may fluctuate, it tends to stabilize from the age of 12, such that those who exhibit high self-esteem in early stages are likely to maintain it through middle and late adolescence ( 113 ). This association could be explained by cultural differences, social contexts, and the level of family or school support, all of which significantly influence self-image perception and the way adolescents cope with the challenges inherent to each stage of development ( 7 ). These variations are linked to biological, cultural, socioeconomic, and sociodemographic factors, which change as the adolescent grows older ( 91 ). Furthermore, in late adolescence, the increase in responsibilities and social expectations may impact self-esteem differently depending on the environment in which the individual develops ( 114 ). It has also been argued that self-esteem tends to be higher in late adolescence compared to early adolescence due to greater self-awareness; however, it is still lower than in early adulthood, likely as a consequence of the maturational processes and social changes that characterize this developmental stage ( 115 ). Family dysfunction In our study, mild, moderate, and severe family dysfunction were associated with a 66%, 115%, and 165% increase, respectively, in the prevalence of low self-esteem. This finding is consistent with a study in Greek adolescents, which found that factors characteristic of dysfunctional family functioning, such as low cohesion, were strongly linked to lower self-esteem. In particular, self-esteem significantly mediated the relationship between family cohesion and both state anxiety levels (p = 0.005) and trait anxiety levels (p = 0.011), highlighting its protective role in youth mental health ( 116 ). Similarly, a study conducted among adolescents in the United States found that low maternal responsiveness was associated with a higher prevalence of low self-esteem (26.7% vs. 12.4%). Likewise, low maternal demandingness was associated with more cases of low self-esteem (24.9% vs. 13.4%), highlighting the role of parenting style in the formation of self-concept during adolescence ( 7 ). Similarly, a meta-analysis conducted in 31 countries demonstrated that parental hostility—including rejection, neglect, abuse, punishment, and verbal or physical aggression—was negatively associated with self-esteem, with moderate to large effect sizes (r = − .33 for maternal hostility and r = − .37 for paternal hostility) ( 117 ). Along the same lines, a study in Spain showed that the family environment, as well as close peer relationships, are fundamental for the development of healthy self-esteem ( 118 ). Furthermore, a study in China found that father absence was associated with lower self-esteem: adolescents without a father figure reported a mean score of 24.63 (Standard Deviation (SD) = 3.22), compared to 33.12 (SD = 6.03) among those living with their father, a highly significant difference (F = 770.23) ( 119 ). Possibly because this absence is interpreted as a sign of lack of love or acceptance, which reduces the perception of meaningful emotional support within the family environment ( 120 ). This contrasts with findings from various studies conducted in the United States. One study—carried out among university adolescents—did not show a direct relationship between family dysfunction and low self-esteem ( 121 ). Similarly, a longitudinal study in the United States of America found no significant effect of parental supervision on children’s self-esteem ( 122 ). Likewise, a study in Mexican adolescents living in the United States did not find a significant impact of parental hostility on children’s self-esteem ( 120 ). The association between family dysfunction and low self-esteem may be explained by psychobiological and contextual factors ( 123 ). The lack of secure emotional bonds and a stressful family environment hinder emotional regulation and foster the development of a negative self-concept ( 119 ). In addition, constant exposure to criticism reinforces the perception of not being valuable ( 124 ). At the neurobiological level, chronic stress activates the hypothalamic–pituitary–adrenal axis, affecting brain areas related to self-evaluation ( 125 , 126 ). During the pandemic, this vulnerability was intensified by the reduction of emotional support in dysfunctional family contexts ( 127 ). Presence of acne In our study, adolescents with grade 4 facial acne were found to have a higher prevalence of low self-esteem. This finding is consistent with an analytical study conducted in Norway, which found that male adolescents with acne were more likely to have low self-esteem (OR: 2.07), while in females, a significant association was also found between acne and lower self-esteem (OR: 1.88) ( 128 ). This aligns with a study in California (USA), which highlighted the negative impact of acne—particularly when perceived as severe—on self-esteem, self-image, and socialization. However, it was a descriptive study without adjusted association measures or multivariate analysis ( 129 ). Moreover, a literature review covering data from 11 countries concluded that women with acne are more likely to experience low self-esteem, heightened shyness, greater perceived stress, feelings of worthlessness, body dissatisfaction, and lower self-worth. However, as this was a synthesis of descriptive studies, it did not provide multivariate association measures or adjusted analyses ( 130 ). Nevertheless, these findings contrast with those reported in a study conducted in India, where only 6.8% of adolescents with acne had low self-esteem, while the majority (67.6%) showed normal levels of self-esteem ( 131 ). Similarly, a study carried out in Turkey found no significant differences in self-esteem levels or social anxiety between adolescents with and without acne ( 132 ). Likewise, research conducted in Brazil found no significant association between acne severity—including grade IV—and self-esteem, as measured by the Rosenberg scale ( 133 ). This association could be explained by the fact that, in this age group, many adolescents have not yet developed the maturity to adequately cope with the emotional impact of the visible lesions caused by acne ( 134 ). This impact has been documented in the literature as low self-esteem, dissatisfaction with physical appearance, shame, and shyness ( 135 ). In addition, dissatisfaction with physical appearance during adolescence has been systematically associated with multiple psychosocial health problems, including low self-esteem, sleep disturbances, nervousness, stress, depressive symptoms, and lower quality of life ( 114 ). Furthermore, adolescents with acne do not necessarily experience self-esteem problems solely due to their self-image; they may also be affected by the psychosocial judgments of their social environment, which reinforces the emotional and social impact of this dermatological condition ( 132 ). Living in urban–marginal areas In our study, adolescents residing in urban–marginal areas were associated with a lower prevalence of low self-esteem compared to those living in rural areas. This finding is consistent with a study in China, which observed that children of rural migrant parents had more mental health problems than local children, with higher proportions in abnormal ranges (21% vs. 9.8%) and borderline ranges (18.8% vs. 13.8%) ( 136 ). In the analysis of this study, being part of a single-parent family (OR = 3.13; 95% CI: 1.42–6.89), having insufficient household income (OR = 2.61; 95% CI: 1.33–5.13), and having a poor perception of health status (OR = 6.22; 95% CI: 1.13–34.08) were significantly associated with a higher likelihood of self-esteem problems among migrant children ( 136 ). However, this contrasts with findings from a study conducted in India, which observed a higher prevalence of low self-esteem in urban adolescents (66.7%) compared to rural adolescents (56.7%), with a statistically significant difference (t = 13.4; p = 0.0001) and a prevalence ratio of 1.18 ( 137 ). Along the same lines, a study in Australia found that rural adolescents showed significantly higher self-esteem levels than their urban peers, according to multivariate analyses based on the Rosenberg scale (p < 0.05) ( 138 ). In addition, this study found a moderate positive correlation between age and self-esteem among urban adolescents (r = + 0.30), whereas the correlation was negative among rural adolescents (r = − 0.34) ( 138 ). Similarly, a study conducted in Peru found that self-esteem was positively associated with other conditions in adolescents, with this association being stronger in rural areas (r = 0.8) than in urban areas (r = 0.5) ( 139 ). This finding suggests that adolescents from rural settings may develop stronger self-esteem, possibly due to a more cohesive social environment and reduced exposure to comparative social pressures ( 139 ). On the other hand, a study conducted in Mexico found no significant differences in body dissatisfaction between adolescents from rural and urban areas ( 140 ). Given that body dissatisfaction has been associated with low self-esteem, this finding suggests that the geographical setting alone does not determine self-esteem levels related to body image in this population ( 66 ). Television In our study, adolescents who watched between 6 and 10 hours of television were associated with a higher prevalence of low self-esteem. This finding is consistent with a study in Germany, where greater screen time between the ages of 11 and 13 was associated with lower self-esteem at age 13, even after statistical adjustments. Among males, computer and phone use was significantly associated with lower self-esteem (b = − 2.93), and this association persisted after controlling for prior self-esteem (b = − 2.82) ( 141 ). Similarly, a study in the United States conducted among university students found that frequent social media use was associated with lower self-esteem (r = − 0.20) ( 142 ). Likewise, a systematic review including data from 71 countries found that greater screen time was consistently associated with lower self-esteem in children and adolescents, although a single pooled effect measure was not calculated due to methodological heterogeneity among the studies, and the evidence was considered to be of moderate quality ( 143 ). A hierarchical regression analysis conducted among adolescents in the United States found that watching more television during follow-up was associated with a decrease in self-esteem (β = − 0.94) ( 144 ). Finally, a study in adolescents from China reported an inverse association between television time on school days and adolescent self-esteem (β = − 0.935), as well as lower life satisfaction ( 145 ). This contrasts with a study conducted in Germany, where, among female adolescents, more television viewing at age 11 was associated with lower self-esteem at that time (β = − 3.96) but predicted a significant increase at age 13 (β = +5.08), provided that viewing was low or moderate (< 2 h/day) ( 138 ). Similarly, a study among adolescents in Hong Kong identified an inverted-J–shaped relationship, in which those who watched television moderately (between 1 and ≤ 2 hours per day) reported higher self-esteem levels compared with both those who watched less than one hour and those with greater daily exposure ( 146 ). This association could be explained by the influence of unrealistic body ideals conveyed by the media, which can negatively affect physical self-concept and body satisfaction, thereby reducing overall self-esteem ( 147 ). Although this hypothesis is supported by some studies ( 141 , 148 ) and a meta-analysis ( 149 ), the results are not conclusive. Moreover, the association between screen time and low self-esteem could be overestimated by the omission of variables such as obesity or sedentary behavior, which also affect self-esteem ( 141 ). Obesity, associated with body dissatisfaction, can negatively influence self-esteem ( 67 ). Therefore, it is not necessarily television viewing time that directly causes low self-esteem; rather, this relationship could be mediated by other factors that are not always considered ( 141 ). It has also been suggested that the effect of television consumption on self-esteem could be transitory ( 144 ). However, this interpretation contrasts with research emphasizing how body ideals promoted in the media, particularly among adolescents, could have more persistent effects on self-esteem, especially in girls ( 147 ). Limitations and strengths This study has some limitations that should be considered when interpreting the results. First, its cross-sectional design precludes establishing causal relationships between the factors analyzed and low self-esteem; therefore, the associations observed should not be interpreted as causal. Moreover, certain variables such as television use may act as both potential causes and consequences of low self-esteem, making temporal directionality uncertain. Likewise, the findings cannot be generalized to the entire adolescent population, as the sample is limited to students from specific educational institutions, excluding non-school-attending adolescents. Another relevant limitation is the use of self-report instruments, which may introduce social desirability bias or errors derived from the participants’ subjective perception. In addition, some potentially influential variables—such as parents’ educational level ( 150 ), sleep quality ( 115 ), overall academic performance ( 151 ), experiences of violence or bullying ( 152 ), and perceived emotional support from family members or teachers ( 153 )—were not considered in the analyses, which could act as confounding factors. These factors have previously been associated with both mental health and self-esteem in adolescents ( 115 , 151 , 152 , 153 ), so their omission may limit a full understanding of the observed associations. Likewise, the lack of longitudinal follow-up prevents the evaluation of the evolution of self-esteem over time and its relationship with significant events in adolescent life. Finally, complex constructs such as family dysfunction or relationship-contingent self-esteem may not have been fully explored ( 7 , 118 , 119 ), given the use of general instruments that do not capture all their dimensions. Nevertheless, the study also presents important strengths. One of them is the inclusion of multiple factors associated with self-esteem, such as resilience, family environment, facial acne, type of residence, and screen time, which allows the phenomenon to be approached from a broad and multifactorial perspective. In addition, the subgroup analyses—such as by sex ( 86 , 88 , 90 ), family structure (91, 119, 121), and urban or rural context ( 136 )—provide a greater level of detail and understanding of the dynamics involved. The study also stands out for contextualizing its findings through comparison with previous research conducted in different countries, thereby strengthening the external validity of its results. Finally, this work contributes original empirical evidence on self-esteem in adolescents living in urban–marginal areas, a population underrepresented in the scientific literature, thus expanding the available knowledge on this vulnerable group. Relevance of findings in mental health The findings of this study are relevant to the field of mental health, as they highlight multiple contextual, personal, and social factors associated with low self-esteem in adolescents—a key variable in emotional and psychological development during this stage. The identification of protective variables such as resilience ( 74 , 75 , 77 ), as well as risk factors such as family dysfunction ( 119 , 121 ), the presence of severe acne ( 128 , 134 , 135 ), or prolonged screen exposure ( 141 ), makes it possible to guide psychoeducational and community interventions aimed at promoting adolescent well-being. In addition, the association between low self-esteem and relational or contextual characteristics (such as having a romantic partner ( 107 , 108 ), living in rural areas ( 136 ), or being in the early stages of adolescence ( 110 , 111 , 112 )) underscores the need for a comprehensive approach that considers the family, school, and social environments. From a public health perspective, these findings help to identify at-risk groups and prioritize early prevention strategies, fostering the strengthening of self-concept and emotional regulation as fundamental elements for the healthy development of adolescents. Conclusions In this study, resilience was identified as a significant protective factor against low self-esteem among secondary school adolescents, even after adjusting for multiple sociodemographic, family, and behavioral factors. Furthermore, family dysfunction, a family history of mental illness, excessive television use, and being in a romantic relationship were independently associated with a higher prevalence of low self-esteem. These findings underscore the need to implement school- and community-based programs aimed at strengthening resilience and fostering coping skills, as well as to develop family-focused interventions to improve communication and emotional support. Regulating screen-related habits and conducting early school-based screenings are key strategies to prevent self-esteem problems. An intersectoral approach involving education, health, and community sectors is essential to promote psychological well-being during adolescence. Abbreviations BMI: Body Mass Index REDCap: Research Electronic Data Capture CD-RISC: Connor–Davidson Resilience Scale APGAR: Adaptability, Partnership, Growth, Affection, Resolve GLM: generalized linear models PR: prevalence ratios CI: confidence intervals VIF: variance inflation factor USA: United States of America NLSY79: National Longitudinal Survey of Youth 1979 OD: Odds ratio RCSE: Relationship-contingent self-esteem SD: Standard Deviation Declarations Ethics approval and consent to participate The Research Ethics Committee of Universidad San Martín de Porres in Lima, Peru, reviewed and approved this study on March 21, 2023, under approval code Official Letter No. 348-2023 (01–3652300 Anexo 160 / [email protected] ), confirming compliance with ethical standards for research involving human participants. An additional video file provides more details [see Additional file 1]. To safeguard privacy and confidentiality, data were gathered through anonymous questionnaires that did not request any identifying details. Informed assent was obtained from all adolescent participants, and written informed consent was provided by their parents or legal guardians before enrollment. Further details about this process are included in additional video files [see Additional files 2 and 3]. It was also assured that all collected information would be used solely for research purposes, without endangering participants’ integrity or well-being. Every phase of the study was carried out in line with the principles of respect, beneficence, and justice, as outlined in the Declaration of Helsinki and relevant national regulations. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to data confidentiality restrictions, but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors declare that this study was self-funded. Trial registration Clinical trial number: not applicable. Authors' contributions MV, MC, OG, LA, JV, AV, VV, and CP contributed equally to the drafting of the manuscript, data collection, and interpretation of the results. All authors read and approved the final manuscript. 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Empowering adolescents: exploring the relationship between self-esteem and test anxiety. J Pediatr Neonatal Care. 2024;14(2):144-154. doi:10.15406/jpnc.2024.14.00558. Available from: https://medcraveonline.com/JPNC/empowering-adolescents-exploring-the-relationship-between-self-esteem-and-test-anxiety.html [citado 2025 jul 1]. Islam MN. Study habits, self-esteem, and academic achievement among public and private secondary school students in Bangladesh. Int J Psychol Educ Stud. 2021;8(3):39-50. Available from: https://dergipark.org.tr/en/pub/pes/issue/64305/976268 [citado 2025 jul 1]. McClure AC, Tanski SE, Kingsbury J, Gerrard M, Sargent JD. Characteristics associated with low self-esteem among US adolescents. Acad Pediatr. 2010 Jul-Aug;10(4):238-244.e2. doi:10.1016/j.acap.2010.03.007. Available from: https://pubmed.ncbi.nlm.nih.gov/20605547/ [citado 2025 jul 1]. Cuadros O, Leal-Soto F, Rubio A, Sánchez B. Collective self-esteem and school segregation in Chilean secondary students. Front Psychol. 2021;11:620011. doi:10.3389/fpsyg.2020.620011. Available from: https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.620011/full [citado 2025 jul 1]. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.jpeg Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7475199","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509804110,"identity":"d3f5295d-1839-423b-9ab8-73f20bb94884","order_by":0,"name":"Mario J. Valladares-Garrido","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYJCCAyCCj52BQQLE4AdiZqK0sDFDtUg2EKGFAUWLwQECWnTbzz488IHhsDwbM/PDGz/32Ngb38g9+LmA4Y4cLi1mZ9INDs5gOGzYxsxmbNnzLC1x2428ZOkZDM+McWo5kMZwmIchjbGNmcFMgufA4QSzGzlmzDwMhxMbcGk5/wysxb6Nmf2b5J8D/+2NZ0C01OPUcgNsi01iGzOPmTTPgQOMGyQgWhJwOuzGM4aDMwxskoFaiq1lDiQnzjjzLlmax+CZIW6HpTF/+FAhYdvP3r7x5psDdvb87cAQ46m4I4/LFggwQOHxMEBihwQA0sJAmpZRMApGwSgY1gAAZ/1S8Cc0AaYAAAAASUVORK5CYII=","orcid":"","institution":"Universidad Señor de Sipán","correspondingAuthor":true,"prefix":"","firstName":"Mario","middleName":"J.","lastName":"Valladares-Garrido","suffix":""},{"id":509804111,"identity":"77612373-a4bc-4cfd-8c10-89665af914b6","order_by":1,"name":"María Julia Cómina-Tamayo","email":"","orcid":"","institution":"Universidad Peruana Cayetano Heredia","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Julia","lastName":"Cómina-Tamayo","suffix":""},{"id":509804112,"identity":"8f7a323f-006f-4442-9652-4b3764f5eda4","order_by":2,"name":"Óscar Tuesta García","email":"","orcid":"","institution":"Universidad Privada Antenor Orrego","correspondingAuthor":false,"prefix":"","firstName":"Óscar","middleName":"Tuesta","lastName":"García","suffix":""},{"id":509804113,"identity":"e0eea349-2fdd-4315-a418-9def68c56b0d","order_by":3,"name":"Luz A. Aguilar-Manay","email":"","orcid":"","institution":"Universidad San Martín de Porres","correspondingAuthor":false,"prefix":"","firstName":"Luz","middleName":"A.","lastName":"Aguilar-Manay","suffix":""},{"id":509804114,"identity":"7267356e-a630-4ede-9b6b-eca56185c0b0","order_by":4,"name":"Jassmin Santin Vásquez","email":"","orcid":"","institution":"Universidad San Martín de Porres","correspondingAuthor":false,"prefix":"","firstName":"Jassmin","middleName":"Santin","lastName":"Vásquez","suffix":""},{"id":509804115,"identity":"31f78def-a694-46bb-8fe1-ec3b803e4dbe","order_by":5,"name":"Angie Valladares-Garrido","email":"","orcid":"","institution":"Universidad Nacional de Piura","correspondingAuthor":false,"prefix":"","firstName":"Angie","middleName":"","lastName":"Valladares-Garrido","suffix":""},{"id":509804116,"identity":"080fa059-8642-4538-9224-82865090d686","order_by":6,"name":"Víctor J. Vera-Ponce","email":"","orcid":"","institution":"Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas","correspondingAuthor":false,"prefix":"","firstName":"Víctor","middleName":"J.","lastName":"Vera-Ponce","suffix":""},{"id":509804117,"identity":"f4b0cb2c-1743-49d8-8cc9-eda611a51537","order_by":7,"name":"César J. Pereira-Victorio","email":"","orcid":"","institution":"Universidad Continental","correspondingAuthor":false,"prefix":"","firstName":"César","middleName":"J.","lastName":"Pereira-Victorio","suffix":""}],"badges":[],"createdAt":"2025-08-28 01:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7475199/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7475199/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90865649,"identity":"17848713-fea0-4d8b-8678-d5bf5d6163b5","added_by":"auto","created_at":"2025-09-09 07:16:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":149307,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of response in the Rosenberg self-esteem test.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7475199/v1/bd57956f0848d50b13c43ac4.png"},{"id":102280511,"identity":"a3c9b5ca-dc77-4cda-afd2-3b9a0f377e90","added_by":"auto","created_at":"2026-02-10 06:56:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2270698,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7475199/v1/1d906bd4-401d-4a11-a2cf-fd90c8bb4562.pdf"},{"id":90865651,"identity":"08f52736-ce46-4ab1-96b6-56d1d39a8709","added_by":"auto","created_at":"2025-09-09 07:16:32","extension":"jpeg","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":140031,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7475199/v1/1fddda417ad285e1b5264c3a.jpeg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Resilience and Self-Esteem in Adolescents from Peruvian Schools","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSelf-esteem can be defined as the concept an individual develops about their worth (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This concept is subjective and encompasses the way one thinks, loves, and behaves toward oneself (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Self-esteem has a significant impact on an individual\u0026rsquo;s life development; reports have shown a relationship between higher levels of self-esteem and greater personal, social, and professional success (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). On the other hand, low levels of self-esteem have been shown to be associated with poor social performance, depression, and substance abuse (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Multiple external factors influence the development of self-esteem, especially during adolescence, a period characterized by rapid physical, mental, and social changes (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Studies have shown that up to one-third of adolescents worldwide experience difficulties associated with low self-esteem, particularly during the early years of adolescence (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In adolescents from countries such as China, Tunisia, Ethiopia, Vietnam, and Saudi Arabia, the estimated prevalence of low self-esteem is 57.5%, 29.5%, 19%, 19.4%, and 41%, respectively (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In Latin America, studies have found that 18.51%, 47.9%, and 45% of adolescents from Ecuador, Colombia, and Mexico, respectively, presented low self-esteem (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Peru is no exception to this statistic, as the literature reports that between 25% and 35% of Peruvian adolescents have low levels of self-esteem (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResilience, defined as the ability to overcome and recover from adverse circumstances, and its relationship with self-esteem levels have been the subject of study (\u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In adolescents from countries such as Australia, Iran, Singapore, and the United States of America (USA), high prevalences of moderate-to-high resilience levels have been reported, at 73%, 52.5%, 67.3%, and 66.3%, respectively (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Reports on the prevalence of moderate-to-high resilience in adolescents from Latin American countries show values of 45%, 65.8%, and even 100% in Mexico, Colombia, and Bolivia, respectively (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). In Peruvian adolescents, the literature reports prevalence of moderate-to-high resilience levels ranging from 72.5\u0026ndash;97.2% (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudies have shown that resilience in adolescents and young people is positively associated with self-esteem and mental health (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This is because resilience is thought to strengthen adolescents\u0026rsquo; confidence, their ability to face challenges, and to overcome adversity, which contributes to higher self-esteem in difficult situations (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In Chinese adolescents, self-esteem levels were found to positively predict resilience (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In Polish adolescents, resilience was identified as a positive predictor of self-esteem levels (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Finally, in Nicaraguan adolescents, a positive relationship was also found between high resilience levels and good self-esteem (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Similarly, results have been published showing that the inclusion of programs aimed at strengthening resilience is beneficial for the development of self-esteem and emotional regulation (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, most of the published literature analyzing the relationship between resilience and self-esteem in adolescence has certain limitations. First, the results are difficult to extrapolate to the national context due to differences in cultural, social, and educational aspects, as most studies have focused on Asian (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), European (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), and Central and North American adolescents (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Even the Peruvian studies have focused exclusively on adolescents and young people from the city of Lima (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Second, previous national evidence has limited its study population exclusively to students from a single educational institution (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Third, prior Peruvian studies have focused on university student populations (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), which do not exclusively include the adolescent group, resulting in the loss of the necessary focus on analyzing the impact of self-esteem and resilience during the vulnerable stage of adolescence, particularly in its early years. Fourth, Peruvian studies have not considered the influence of potentially relevant factors in the relationship between resilience and self-esteem, such as Body Mass Index (BMI) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), family history of mental illness (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), alcohol and/or tobacco use (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), acne (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), level of physical activity (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), religion (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), and time spent on social media (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Some studies have limited their analysis to age, sex, and year of study (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), while others have included academic performance (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Fifth, previous evidence has limited statistical power due to small sample sizes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Sixth, prior studies have used instruments with inadequate and unreliable psychometric properties to measure resilience and self-esteem in adolescents. Seventh, studies lack rigorous statistical analyses, as they have examined the association only in a bivariate manner (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) and have not estimated association measures to determine the magnitude and strength of the relationship between resilience and self-esteem (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study aims to determine the association between resilience and self-esteem in adolescents from five different schools in the northern region of Peru.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eAn analytical cross-sectional study was conducted based on the secondary analysis of data collected from adolescent students in five secondary-level educational institutions in the Lambayeque region, Peru. Data collection was carried out between September and December 2022, in the context of the fifth wave of the COVID-19 pandemic.\u003c/p\u003e\u003cp\u003eThe objective of this analysis was to evaluate the association between resilience and self-esteem in adolescents. The analyzed data came from a primary database whose initial purpose was to examine the relationship between the presence of acne and various mental health outcomes in this population.\u003c/p\u003e\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePopulation and sample\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of 1,972 adolescents enrolled in five secondary-level educational institutions in the Lambayeque region, Peru, during the 2022 academic year. In the primary study, inclusion criteria were students who attended classes regularly, completed the main questionnaires, and provided their informed assent. Those whose parents did not authorize their participation through informed consent were excluded.\u003c/p\u003e\u003cp\u003eIn the original database, the response rate reached 72.8% (n\u0026thinsp;=\u0026thinsp;1,436). For the present secondary analysis, a new data cleaning process was performed, removing 129 records with incomplete information in the resilience and self-esteem questionnaires. Finally, the sample analyzed in this study consisted of 1,307 adolescents, representing an adjusted response rate of 66.3%.\u003c/p\u003e\u003cp\u003eA statistical power calculation was performed to assess the study\u0026rsquo;s ability to detect differences in the prevalence of low self-esteem according to resilience level in adolescents. For this calculation, the proportion of low self-esteem in the low-resilience group (p₁ = 0.48) and in the high-resilience group (p₂ = 0.26) was considered, along with their respective sample sizes (n₁ = 1,081 for adolescents with low resilience and n₂ = 226 for adolescents with high resilience). The results indicated a statistical power of 100%, suggesting that the study has optimal capacity to detect significant differences in the association between resilience and self-esteem in the analyzed population.\u003c/p\u003e\u003cp\u003eSampling was non-probabilistic.\u003c/p\u003e\n\u003ch3\u003eProcedures\u003c/h3\u003e\n\u003cp\u003eData collection was carried out between September and December 2022 in five secondary-level educational institutions in the Lambayeque region, Peru. The instruments were administered in person in classrooms previously assigned by the administration of each school, ensuring adequate conditions for participants\u0026rsquo; concentration. Before the administration of the questionnaires, the adolescents were informed about the purpose of the study, and their voluntary participation and the confidentiality of the data were ensured.\u003c/p\u003e\u003cp\u003eParticipants completed a structured electronic questionnaire using the Research Electronic Data Capture (REDCap) platform, which included sociodemographic-academic information and variables of interest such as resilience and self-esteem. The data digitization and cleaning process was carried out by a team of previously trained researchers. A rigorous review was conducted to identify and remove incomplete or inconsistent responses. In addition, quality control procedures were applied to the data, minimizing potential biases in variable coding.\u003c/p\u003e\u003cp\u003eFor the analysis, the resilience and self-esteem variables were categorized into two groups: high/low resilience and high/low self-esteem, following cutoff points previously established in the scientific literature. Finally, the processed database was used in the corresponding statistical analyses to assess the association between resilience and self-esteem in the study population.\u003c/p\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThe dependent variable was low self-esteem, operationally defined as a score lower than 15 points on the Rosenberg Self-Esteem Scale. This score was obtained by summing the responses to the 10 items of the questionnaire, following the methodology previously validated in similar studies.\u003c/p\u003e\u003cp\u003eThe exposure variable was a high level of resilience, defined as a score of 30 points or higher on the abbreviated 10-item version of the Connor\u0026ndash;Davidson Resilience Scale (CD-RISC) questionnaire. This score was obtained by summing the participants\u0026rsquo; individual responses, in accordance with the cutoff points established in the scientific literature for classifying resilience levels in adolescents.\u003c/p\u003e\u003cp\u003eSeveral secondary independent variables were considered to explore their influence on the relationship between resilience and self-esteem in adolescents. Among the sociodemographic characteristics, age was included, classifying participants according to their developmental stage into early adolescence (10\u0026ndash;13 years), middle adolescence (14\u0026ndash;16 years), and late adolescence (17\u0026ndash;19 years). Sex (male, female) and type of educational institution (public, private) were also recorded, distinguishing between publicly and privately managed schools. In addition, place of residence (rural, urban, marginal urban) was taken into account.\u003c/p\u003e\u003cp\u003eFamily and academic conditions were assessed through the number of household members (\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and the presence of a family history of mental illness (yes, no). Regarding aspects related to physical health, BMI was included and categorized as underweight, normal weight, overweight, and obesity.\u003c/p\u003e\u003cp\u003eAcademic performance was evaluated by determining whether the participant had failed any course during their school years (yes, no). Social interaction was also explored through the frequency of contact with friends (infrequent, frequent, very frequent) and relationship status (in a relationship, not in a relationship).\u003c/p\u003e\u003cp\u003eRegarding digital habits, the frequency of television use (1\u0026ndash;5 hours, 6\u0026ndash;10 hours, more than 11 hours) and the frequency of social media use during the COVID-19 pandemic (never, little, moderate, quite a lot to extreme, extreme) were analyzed. In addition, the presence of facial acne (no acne, grade 1, grade 2, grade 3, grade 4) was considered as a potential factor influencing self-esteem perception.\u003c/p\u003e\u003cp\u003eRegarding consumption habits, cigarette use was assessed (never, fewer than 10 cigarettes/day, 11\u0026ndash;20 cigarettes/day, 21\u0026ndash;30 cigarettes/day, more than 31 cigarettes/day) as well as alcohol consumption (never, monthly or less, 2\u0026ndash;4 times a month, 2\u0026ndash;3 times a week, 4 or more times a week). Physical activity was categorized as inactive or active.\u003c/p\u003e\u003cp\u003eFamily APGAR questionnaire (measures family function based on Adaptability, Partnership, Growth, Affection, and Resolve), establishing four levels: functional family, mild dysfunction, moderate dysfunction, and severe dysfunction. These variables were incorporated into the analysis to identify potential factors associated with self-esteem in adolescents and its relationship with resilience.\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eRosenberg Self-Esteem Scale\u003c/h2\u003e\u003cp\u003eInstrument designed to assess self-esteem. It consists of 10 items on a 4-point Likert scale, where each item can score from 1 (Strongly agree) to 4 (Strongly disagree). It should be noted that items 2, 5, 6, 8, and 9 are reverse scored (i.e., \u0026ldquo;Strongly agree\u0026rdquo; scores 4 points and \u0026ldquo;Strongly disagree\u0026rdquo; scores 1 point). A higher score correlates with a higher level of self-esteem. Scores below 15 suggest low self-esteem. The scale has shown excellent psychometric properties, with an estimated reliability of 0.92 in adolescents (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) and correlation coefficients ranging from 0.82 to 0.88 in studies conducted in the United States, Norway, and Asian countries (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). It has also been applied to Latin American adolescents, with reliability values ranging from 0.70 to 0.78 in adolescent populations from Chile and Argentina (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). This scale has been used to assess adolescents during the COVID-19 pandemic (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAbbreviated CD-RISC\u003c/h3\u003e\n\u003cp\u003eInstrument designed to measure individual resilience levels. This is an abbreviated model of the original scale (25 items) consisting of 10 items, each rated on a Likert scale ranging from 0 (never) to 4 (almost always) (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). These items assess the dimensions of \u0026ldquo;personal competence,\u0026rdquo; \u0026ldquo;trust and strength,\u0026rdquo; \u0026ldquo;acceptance,\u0026rdquo; \u0026ldquo;control,\u0026rdquo; and \u0026ldquo;spirituality.\u0026rdquo; The total score ranges from 0 to 40 points, with higher scores indicating higher levels of resilience (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). It has a Cronbach\u0026rsquo;s alpha of 0.85, demonstrating good internal validity (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). This scale has previously been applied in adolescent populations in Colombia (α\u0026thinsp;=\u0026thinsp;.838) (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) and Peru (α\u0026thinsp;=\u0026thinsp;.827) (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), showing good reliability and validity. Likewise, it has been used to assess adolescents during the COVID-19 pandemic (α\u0026thinsp;=\u0026thinsp;.92) (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eFamily APGAR\u003c/h3\u003e\n\u003cp\u003eInstrument that reflects family members\u0026rsquo; perception of the overall functioning of the family unit. It evaluates five basic family functions: adaptation, partnership, personal resource gradient, affection, and resources. It consists of 9 items on a Likert scale ranging from 0 (never) to 4 (always). Scores below 17 points are associated with family dysfunction. The instrument has a correlation index of 0.80, and in evaluations conducted in multiple studies involving adolescents, correlation indices ranged from 0.71 to 0.83 (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). The scale has shown good reproducibility coefficients in Latin American adolescent populations (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Studies have employed this scale during the lockdown period caused by the COVID-19 pandemic, including adolescent populations (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSpanish Acne Severity Scale (EGAE)\u003c/h2\u003e\u003cp\u003eInstrument used to assess the severity of vulgar acne that requires iconographic material for its application. It consists of 2 items: a facial scale ranging from grade 1 (least severe) to grade 4 (most severe), and a trunk scale (chest and back) ranging from grade 1 to grade 3 (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). This instrument has been widely reproduced and demonstrates high intra- and inter-observer reliability (α\u0026thinsp;\u0026ge;\u0026thinsp;0.8) (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). The scale has also been applied to Latin American populations during the COVID-19 pandemic, although not limited to adolescent populations (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePhysical Activity Questionnaire for Adolescents (PAQ-A)\u003c/h2\u003e\u003cp\u003eInstrument designed to assess physical activity in adolescents. It consists of 9 items that evaluate various aspects of physical activity performed in the past 7 days. It uses a 5-point Likert scale. The final score is calculated based on the arithmetic mean of the first 8 questions, while question 9 excludes the presence of any condition that prevented the participant from performing physical activity (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). The scale demonstrates high reliability values and has been replicated with Cronbach\u0026rsquo;s alpha coefficients ranging from 0.74 to 0.82 in adolescents from Spain and the United States (USA), respectively (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e). This instrument has proven adaptable to the national context, achieving good levels of internal consistency in Peruvian adolescent populations, with a Cronbach\u0026rsquo;s alpha of 0.8 (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis Plan\u003c/h2\u003e\u003cp\u003eData analysis was performed using Stata version 18.0 (StataCorp LP, College Station, TX, USA). Initially, a descriptive exploration of the study variables was conducted. For categorical variables, absolute and relative frequencies were calculated, while numerical variables were analyzed using measures of central tendency and dispersion, following verification of data normality.\u003c/p\u003e\u003cp\u003eIn the bivariate analysis, the association between resilience and self-esteem was evaluated using the chi-square test of independence, considering a significance level of 5% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eTo evaluate the association between resilience and self-esteem, generalized linear models (GLM) with a Poisson distribution and robust variance were used, allowing for the estimation of prevalence ratios (PR) with 95% confidence intervals (CI), thereby quantifying the magnitude of the effect between the analyzed variables. The educational institution was included as a cluster in the regression models to account for potential intra-school correlation and obtain more precise estimates. In the multiple regression model, adjustments were made for confounding variables identified in the bivariate analysis and those of epidemiological relevance, aiming to control the relationship between resilience and self-esteem. Additionally, collinearity among variables included in the final model was assessed by calculating the variance inflation factor (VIF), ensuring the stability of the estimated coefficients.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003e This study was approved by the Research Ethics Committee of Universidad San Mart\u0026iacute;n de Porres, Lima, Peru, ensuring compliance with ethical principles for research involving human subjects. To protect participants\u0026rsquo; privacy and confidentiality, data were collected through anonymous questionnaires without including any identifying information. Informed assent was obtained from the adolescents, and informed consent was secured from their parents or legal guardians prior to participation. Furthermore, it was ensured that the information collected would be used exclusively for research purposes, without compromising the participants\u0026rsquo; integrity or well-being. All stages of the study were conducted in accordance with the principles of respect, beneficence, and justice, consistent with the Declaration of Helsinki and the applicable national regulations.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSociodemographic and Academic Characteristics\u003c/h2\u003e\u003cp\u003eA total of 1,307 adolescents were included, with an average age of 14.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40 years. Most were in the middle stage of adolescence (69.2%), female (54.3%), and attended public schools (65.1%). Urban residency predominated (83.2%), and the majority lived in households with 1 to 5 members (60.0%). Additionally, 85.2% of the adolescents reported no family history of mental illness. Regarding nutritional status, the largest proportion had a normal BMI (63.1%). Nearly half (45.7%) reported having failed at least one course. Regarding interpersonal relationships, 47.0% reported frequent contact with friends, and 62.4% stated they were in a romantic relationship. A large majority (92.4%) of adolescents reported watching television between 1 to 5 hours daily, while 32.8% indicated frequent or extreme use of social media. Most adolescents had never smoked (94.0%) nor consumed alcohol (78.2%). In terms of physical activity, 66.2% were classified as inactive. Regarding family functionality, 40.4% of adolescents had a functional family, while 29.8% presented severe dysfunction. Concerning mental health, 82.7% exhibited low resilience, and 44.6% had low self-esteem (95% CI: 42.03\u0026ndash;47.40). See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of schoolchildren from three schools in Chiclayo, 2022 (n\u0026thinsp;=\u0026thinsp;610)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge (years)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAdolescent stage (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e296 (22.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e905 (69.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106 (8.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e598 (45.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e709 (54.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eType of institution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e851 (65.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e456 (34.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePlace of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e185 (14.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1087 (83.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeri-urban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (2.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of family members (categorized)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 a 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e784 (60.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 a 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e474 (36.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 a 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49 (3.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e305 (23.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCatholic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e739 (56.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e263 (20.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFamily history of mental illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1114 (85.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e193 (14.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBMI (categorized)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e276 (21.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e824 (63.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e166 (12.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFailed a subject during school years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e710 (54.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e597 (45.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRelationship with friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfrequent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e314 (24.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e614 (47.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery frequent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e379 (29.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRomantic partner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e492 (37.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e815 (62.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDaily television use frequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 a 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1207 (92.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 a 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (5.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 a 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (2.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFrequency of social media use during the COVID-19 pandemic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114 (8.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRarely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e286 (21.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e362 (27.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh to extreme\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e428 (32.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtreme\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e117 (9.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFacial acne\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e664 (50.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e558 (42.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (4.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (0.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCigarette smoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1228 (94.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 10 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;20 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (1.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u0026ndash;30 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (0.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;31 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAlcohol consumption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1022 (78.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMonthly or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164 (12.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;4 times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82 (6.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;3 times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (1.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 or more times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (1.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePhysical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInactive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e838 (66.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e428 (33.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFamily dysfunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e493 (40.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e241 (19.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e122 (10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e363 (29.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1081 (82.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e226 (17.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSelf-esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e583 (44.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e384 (29.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e340 (26.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e* Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eSelf-Esteem in Adolescents\u003c/h2\u003e\u003cp\u003eFifty percent of the surveyed adolescents agreed that they feel worthy of appreciation. Additionally, 49.3% agreed that they possess positive qualities, and 44% indicated feeling capable of doing things as well as most people. On the other hand, 39.5% stated they do not have much to be proud of, and 29.9% tended to think of themselves as a failure. Furthermore, 37.4% agreed with the idea that sometimes they believe they are not a good person, while 34.4% occasionally considered themselves useless. Regarding self-perception, 44.9% wished to feel more self-respect, with 36.3% strongly agreeing with this statement. Finally, 40.2% reported feeling satisfied with their life overall, whereas 23.5% disagreed with this affirmation. See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e01\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eAssociation Between Resilience and Self-Esteem, and Other Factors in Bivariate Analysis\u003c/h2\u003e\u003cp\u003eLow self-esteem was more frequent in adolescents with low resilience compared to those with high resilience (48.5% vs. 26.1%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the prevalence of low self-esteem was 20.9%, 36.7%, and 37.5% higher in adolescents with mild, moderate, and severe family dysfunction, respectively, compared to those from functional families (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A higher prevalence of low self-esteem was also observed in adolescents with a family history of mental illness compared to those without such history (56.0% vs. 42.6%; p\u0026thinsp;=\u0026thinsp;0.001). Regarding sociodemographic factors, low self-esteem was more frequent in males than in females (52.8% vs. 37.7%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and in adolescents who had failed at least one course compared to those who had not (48.4% vs. 41.4%; p\u0026thinsp;=\u0026thinsp;0.011). With respect to risk behaviors, adolescents with higher cigarette consumption showed a significantly greater prevalence of low self-esteem compared to non-smokers, with a dose\u0026ndash;response relationship observed (69.6% among those who smoked 11\u0026ndash;20 cigarettes/day vs. 43.0% among non-smokers; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, adolescents with higher alcohol consumption showed a greater prevalence of low self-esteem, with 71.4% among those who drank 4 or more times per week compared to 42.0% among non-drinkers (p\u0026thinsp;=\u0026thinsp;0.003). Regarding technological habits, adolescents with higher television use (\u0026ge;\u0026thinsp;6 hours per day) had a significantly higher prevalence of low self-esteem (60.6\u0026ndash;65.5% vs. 43.2%; p\u0026thinsp;=\u0026thinsp;0.001). Likewise, extreme social media use was associated with a higher prevalence of low self-esteem compared to moderate use (54.7% vs. 35.6%; p\u0026thinsp;=\u0026thinsp;0.001). Finally, adolescents with insufficient physical activity showed a higher prevalence of low self-esteem compared to those who were physically active (49.3% vs. 35.3%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors associated with post-traumatic stress among schoolchildren from three schools in Chiclayo, 2021\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSelf-esteem\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;724)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;583)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAdolescent stage (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e135 (45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e161 (54.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e517 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e388 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72 (67.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (32.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e282 (47.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e316 (52.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e442 (62.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e267 (37.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eType of institution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.591\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e476 (55.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e375 (44.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e248 (54.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e208 (45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePlace of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.667\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102 (55.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83 (44.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e600 (55.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e487 (44.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeri-urban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (62.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (37.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of family members (categorized)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 a 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e447 (57.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e337 (43.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 a 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e246 (51.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e228 (48.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 a 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (63.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (36.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.570\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e161 (52.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e144 (47.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCatholic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e414 (56.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e325 (44.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e149 (56.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e114 (43.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFamily history of mental illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e639 (57.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e475 (42.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85 (44.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e108 (56.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBMI (categorized)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.389\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e158 (57.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e118 (42.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e460 (55.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e364 (44.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88 (53.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (47.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (43.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (56.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFailed a subject during school years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e416 (58.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e294 (41.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e308 (51.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e289 (48.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRelationship with friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfrequent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e161 (51.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e153 (48.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e345 (56.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e269 (43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery frequent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e218 (57.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e161 (42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRomantic partner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.045\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e290 (58.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e202 (41.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e434 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e381 (46.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDaily television use frequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 a 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e686 (56.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e521 (43.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 a 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (39.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43 (60.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 a 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (34.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (65.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFrequency of social media use during the COVID-19 pandemic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (48.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59 (51.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRarely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e151 (52.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e135 (47.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e233 (64.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e129 (35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh to extreme\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e232 (54.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e196 (45.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtreme\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (45.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (54.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFacial acne\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e359 (54.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e305 (45.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e326 (58.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e232 (41.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (51.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29 (48.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (43.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (77.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCigarette smoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e700 (57.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e528 (43.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 10 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (34.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (65.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;20 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u0026ndash;30 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;31 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAlcohol consumption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e593 (58.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e429 (42.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMonthly or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (49.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83 (50.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;4 times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (43.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46 (56.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;3 times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 or more times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePhysical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInactive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e425 (50.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e413 (49.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e277 (64.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e151 (35.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFamily dysfunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e367 (74.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e126 (25.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e129 (53.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e112 (46.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (37.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76 (62.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134 (36.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e229 (63.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e557 (51.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e524 (48.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e167 (73.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59 (26.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e* p-value calculated using the Chi-square test of independence.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eAssociation Between Resilience and Self-Esteem, and Other Factors in Simple and Multiple Regression Analysis\u003c/h2\u003e\u003cp\u003eIn the simple regression analysis, adolescents with low resilience had a higher prevalence of low self-esteem (PR: 0.54; 95% CI: 0.41\u0026ndash;0.70; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and this relationship remained in the adjusted model, where adolescents with high resilience showed a 32% lower prevalence of low self-esteem (PR: 0.68; 95% CI: 0.53\u0026ndash;0.86; p\u0026thinsp;=\u0026thinsp;0.002). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors associated with post-traumatic stress in schoolchildren, Chiclayo 2021: simple and multiple regression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSelf-esteem\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eSimple regression\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eMultiple regression*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCI 95%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e**\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCI 95%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e**\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAdolescent stage (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.73\u0026ndash;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.71\u0026ndash;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.45\u0026ndash;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.45\u0026ndash;0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.57\u0026ndash;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.67\u0026ndash;0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eType of institution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.73\u0026ndash;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.96\u0026ndash;1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.172\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePlace of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.85\u0026ndash;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.820\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.86\u0026ndash;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.749\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeri-urban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.60\u0026ndash;1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.65\u0026ndash;0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of family members (categorized)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 a 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 a 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.01\u0026ndash;1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.09\u0026ndash;1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 a 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.60\u0026ndash;1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.63\u0026ndash;0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCatholic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.76\u0026ndash;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.444\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.91\u0026ndash;1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.852\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.82\u0026ndash;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.80\u0026ndash;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.115\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFamily history of mental illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.17\u0026ndash;1.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.01\u0026ndash;1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBMI (categorized)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.92\u0026ndash;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.737\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.86\u0026ndash;1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.613\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.78\u0026ndash;1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.571\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.75-1-46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.783\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.02\u0026ndash;1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.81\u0026ndash;1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.651\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFailed a subject during school years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.01\u0026ndash;1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.94\u0026ndash;1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.322\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRelationship with friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfrequent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.81\u0026ndash;0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.92\u0026ndash;1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.345\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery frequent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.70\u0026ndash;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.98\u0026ndash;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.132\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRomantic partner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.04\u0026ndash;1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.1\u0026ndash;1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDaily television use frequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 a 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 a 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.19\u0026ndash;1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.04\u0026ndash;1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 a 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.19\u0026ndash;1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.77\u0026ndash;1.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.649\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFrequency of social media use during the COVID-19 pandemic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRarely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.79\u0026ndash;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.65\u0026ndash;1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.396\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.52\u0026ndash;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.57\u0026ndash;1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh to extreme\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.66\u0026ndash;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.63\u0026ndash;1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.695\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtreme\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.71\u0026ndash;1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.817\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.62\u0026ndash;1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.954\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFacial acne\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.78-1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.84\u0026ndash;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.108\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.80\u0026ndash;1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.774\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.84\u0026ndash;2.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.236\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69\u0026ndash;1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.581\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.59\u0026ndash;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.097\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.43\u0026ndash;1.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.03\u0026ndash;1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCigarette smoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 10 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.32\u0026ndash;1.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.87\u0026ndash;1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.312\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;20 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.07\u0026ndash;2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.82\u0026ndash;1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.441\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u0026ndash;30 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.95\u0026ndash;2.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.087\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.90\u0026ndash;2.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;31 cigarettes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.10\u0026ndash;2.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.48\u0026ndash;2.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.874\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAlcohol consumption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMonthly or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.85\u0026ndash;1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.87\u0026ndash;1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.312\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;4 times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.13\u0026ndash;1.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.82\u0026ndash;1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.441\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;3 times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.04\u0026ndash;1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.90\u0026ndash;2.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 or more times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12\u0026ndash;2.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.48\u0026ndash;2.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.874\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePhysical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInactive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.61\u0026ndash;0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.79\u0026ndash;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.158\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFamily dysfunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.50\u0026ndash;2.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.42\u0026ndash;1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.74\u0026ndash;3.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.58\u0026ndash;2.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.83\u0026ndash;3.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.65\u0026ndash;2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.41\u0026ndash;0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.53\u0026ndash;0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e*Adjusted for relevant covariates\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e**p-values obtained using Generalized Linear Models (GLM). Poisson family, log link function, robust variance, school as cluster\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAdditionally, adolescents with mild, moderate, and severe family dysfunction had a higher prevalence of low self-esteem compared to those from functional families. In particular, severe dysfunction was associated with a 147% higher prevalence of low self-esteem (PR: 2.47; 95% CI: 1.83\u0026ndash;3.33; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This association persisted in the multiple regression model, where adolescents with moderate and severe dysfunction showed a 111% and 117% increase in the prevalence of low self-esteem, respectively (PR: 2.11; 95% CI: 1.58\u0026ndash;2.83 and PR: 2.17; 95% CI: 1.65\u0026ndash;2.84). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eOther factors were also associated with low self-esteem. In the adjusted analysis, adolescents with a family history of mental illness had a 19% higher prevalence of low self-esteem (PR: 1.19; 95% CI: 1.01\u0026ndash;1.40). Regarding lifestyle habits, television use exceeding 6 hours per day was associated with an 18% higher prevalence of low self-esteem (PR: 1.18; 95% CI: 1.04\u0026ndash;1.33). Additionally, adolescents who consumed alcohol 4 or more times per week had a 74% higher prevalence of low self-esteem in the simple analysis (PR: 1.74; 95% CI: 1.12\u0026ndash;2.69; p\u0026thinsp;=\u0026thinsp;0.013), although this association did not remain significant in the multiple model. Finally, adolescents in a romantic relationship showed an 18% higher prevalence of low self-esteem compared to those not in a relationship (PR: 1.18; 95% CI: 1.10\u0026ndash;1.26; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of self-esteem\u003c/h2\u003e\u003cp\u003eIn our study, we found that 44.7% of secondary school adolescents presented low self-esteem. This finding is consistent with results from a study conducted in Ghana, in a pre-pandemic context, where 47% of adolescents were found to have low self-esteem (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). Similarly, a study conducted among adolescents in Nigeria reported that 32.1% of them had low self-esteem (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). Likewise, in Vietnam, also in a pre-pandemic context, 19.4% of secondary school students were found to have low self-esteem (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Similarly, a study conducted in India in a pre-pandemic context reported considerably lower figures, with only 8.33% of adolescents presenting low self-esteem (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e). In adolescents from the United States, a pre-pandemic study using the Rosenberg scale found that the prevalence of low self-esteem reached 30% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Likewise, a study carried out in Brazil, also in a pre-pandemic context, found that 33.8% of adolescents had low self-esteem (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). This supports the possibility that, in our context, low self-esteem may be related to negative body image, limited social support, or psychosocial environmental factors (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). The high frequency observed could be explained by body dissatisfaction, which is common among adolescents\u0026mdash;especially females\u0026mdash;and is closely related to low self-esteem (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). This dissatisfaction is influenced by sex, BMI, social pressure regarding aesthetic ideals, and the internalization of beauty standards, all of which can lead to discomfort with one\u0026rsquo;s own image and negatively affect self-esteem (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). In Ecuador, a study conducted among secondary school students in a post-pandemic context found that 36.1% had low self-esteem according to the Rosenberg scale (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). In Colombia, 47.9% of students showed \u0026ldquo;low or very low\u0026rdquo; self-esteem in a study carried out in a pre-pandemic context (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). In a school in Puerto Maldonado, Peru, 44.7% of students presented a moderate level of self-esteem in a study conducted during the COVID-19 pandemic (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e). Similarly, in Puno, Peru, a pre-pandemic study found that 57.7% of adolescents had what was considered \u0026ldquo;regular\u0026rdquo; self-esteem, and 21.2% had low self-esteem (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e). On the other hand, in Trujillo, Peru, a pre-pandemic study found a prevalence of low self-esteem of 10.9% among the adolescents evaluated (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe observed prevalence may be related to specific contextual conditions affecting school-aged adolescents, such as a dysfunctional family environment, living arrangements with parents, academic pressure, and cultural norms linked to self-image (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Likewise, several additional factors can negatively influence self-esteem during adolescence, including physical and/or mental health history (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e), experiences of school violence (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e), prolonged exposure to social media promoting unrealistic beauty ideals (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), as well as the impact of the COVID-19 pandemic (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e). For example, a study conducted in Spain compared secondary school students evaluated before and after the pandemic and found that, in the post\u0026ndash;COVID-19 group, there was a significant increase in the proportion of adolescents with low self-esteem (score\u0026thinsp;\u0026le;\u0026thinsp;25 on the Rosenberg scale) compared to the pre-pandemic group (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e). The differences observed between studies could be explained by geographic, cultural, and methodological factors (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eResilience and Self-Esteem\u003c/h2\u003e\u003cp\u003eIn our study, adolescents with a high level of resilience were associated with a lower prevalence of low self-esteem. This finding is consistent with research in Nigeria that reported an association between self-esteem and resilience against peer pressure in adolescents, suggesting that higher levels of self-esteem positively influence adolescents\u0026rsquo; ability to resist social pressure, with 75% of participants presenting high self-esteem (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e). Similarly, a study in China among adolescents with hearing disabilities found that resilience significantly predicted self-esteem (B\u0026thinsp;=\u0026thinsp;2.031) (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). Another study in China, conducted among left-behind adolescents, reported that self-esteem significantly predicts resilience (β\u0026thinsp;=\u0026thinsp;0.448) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Similarly, a study in Poland showed that resilience influences emotional regulation, and that this relationship is strengthened when adequate levels of self-esteem and perceived social support are present (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Furthermore, research in Turkey identified that self-esteem, along with school belonging and social support, explains 33% of the variance in resilience (R\u0026sup2; = 0.33), while these same factors explain 35% of the variance in self-esteem (R\u0026sup2; = 0.35) (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). In Mexico, a study in basic education adolescents concluded that the total resilience score correlates positively with self-esteem (r\u0026thinsp;=\u0026thinsp;0.59) and with positive affect (r\u0026thinsp;=\u0026thinsp;0.48). These results support the idea that positive self-esteem acts as an internal predictor of resilience (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e). Similarly, in Argentina it was concluded that self-esteem and resilience are closely related during adolescence, suggesting that strengthening one favors the development of the other (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e). In Arequipa, a region in southern Peru, a low but significant inverse correlation was found (rho \u0026asymp; \u0026minus;\u0026thinsp;0.33, p\u0026thinsp;=\u0026thinsp;0.001), indicating that adolescents with greater resilience tended to present higher levels of self-esteem (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e). Along the same lines, a study conducted in Lima, Peru, confirmed a significant relationship between resilience and self-esteem across various dimensions, such as confidence and perseverance (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e). Likewise, different life events influence coping styles both directly and indirectly, with this effect being mediated 34.37% by resilience and self-esteem (\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis association could be explained by the fact that resilience provides emotional protection against psychosocial stress, fosters stable family relationships and support networks, and enhances coping strategies such as self-efficacy and emotional regulation (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e). At the neurobiological level, it has been linked to increased activity in the prefrontal cortex (\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e) and reduced reactivity in the amygdala, facilitating better emotional control (\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e). This helps mitigate the impact of adverse situations, such as those generated by the pandemic, and contributes to preserving healthier self-esteem in adolescents (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). For example, a study conducted in the United States of America found that greater brain resilience\u0026mdash;reflected in stronger functional connectivity between regions such as the prefrontal cortex and the amygdala\u0026mdash;was associated with lower stress and sadness during the pandemic, reinforcing its protective role over emotional well-being (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eMale sex\u003c/h2\u003e\u003cp\u003eIn our study, male adolescents showed a lower prevalence of low self-esteem. This finding is consistent with a meta-analysis that found adolescent males tend to have slightly higher self-esteem than females, reporting a positive and significant correlation between sex and self-esteem (r\u0026thinsp;=\u0026thinsp;0.21), with higher scores in males (\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e). Similarly, studies conducted in Oregon and San Francisco, USA, among adolescent students found a significant difference in standardized self-esteem between sexes (d\u0026thinsp;=\u0026thinsp;0.22), with males showing higher self-esteem levels (r\u0026thinsp;=\u0026thinsp;0.21) (\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e), while females scored higher in relationality and in several self-esteem domains (\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e). In Spain, higher self-esteem was also observed in male than in female adolescents (r\u0026thinsp;=\u0026thinsp;0.23) (\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e), possibly due to the greater negative impact of pubertal changes on females (\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e). Internationally, a cross-cultural analysis including data from 48 countries\u0026mdash;among them Peru, Brazil, Argentina, Bolivia, and Ecuador\u0026mdash;identified a consistent gender effect (B = \u0026minus;\u0026thinsp;1.85; average r\u0026thinsp;\u0026asymp;\u0026thinsp;0.20), with males reporting higher self-esteem levels compared to females, and with self-esteem increasing with age in both genders, particularly at the end of adolescence and the beginning of adulthood (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). This contrasts with findings from a study of adolescents in Michigan, USA, which reported no significant differences in mean self-esteem between sexes or across cohorts, with an explained variance below 2% (R\u0026sup2; \u0026lt; 0.02) (\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e). Similarly, another study in adolescents from California, USA, found no differences in self-esteem perception according to sex (\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e). A national longitudinal study based on the National Longitudinal Survey of Youth 1979 (NLSY79) also suggests that differences in self-esteem between sexes during adolescence and early adulthood are small or statistically nonsignificant (\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e). This finding is relevant, as the common belief that males have higher self-esteem could lead parents and teachers to underestimate self-esteem problems in adolescent boys (\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e). On the other hand, a longitudinal study in African American adolescents from Atlanta found that females reported higher self-esteem levels, possibly due to better development of the self-system, while males from female-headed households exhibited more risk behaviors that could affect their self-esteem and academic performance (\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e). Similarly, a study conducted in Argentina concluded that there are no significant differences in self-esteem scores between males and females (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese differences could be explained by factors such as life satisfaction, identified in a Chilean study as the main determinant of adolescent self-esteem, followed by perceived educational quality and self-image. It was observed that a positive evaluation of the family and school environment fosters the development of self-esteem, even in precarious educational contexts (\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e). In males, self-concept and global self-esteem are associated with values such as achievement, competence, and self-direction, while in females, communal and prosocial values predominate (\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e). Gender stereotypes and family and cultural socialization processes also play a role, as they often expand opportunities more for males (\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e). A study in the United States supports this idea, noting that men tend to accept more positive statements about themselves, whereas women are more likely to accept negative statements (\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e). Likewise, the differences in self-esteem between males and females are explained by biological, cultural, socioeconomic, and sociodemographic factors (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). Biologically, hormonal and neurological variations influence self-perception and emotional regulation (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). Culturally, gender expectations reinforce values of autonomy and competence in men, while communal values predominate in women (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). From a socioeconomic perspective, countries with greater development and gender equity tend to show more marked gaps, suggesting that access to opportunities also plays a role. Finally, social roles, family structure, and stereotypes influence self-esteem, with smaller differences observed in contexts with more flexible gender norms (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eFamily member with mental health disorder\u003c/h2\u003e\u003cp\u003eIn our study, having a family member with a mental health disorder was associated with a higher prevalence of low self-esteem among adolescents. This is similar to what has been reported in adolescents in the United States, where having a family member with special health care needs was found to be associated with a higher likelihood of low self-esteem (Odds Ratio (OD): 1.37) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Similarly, a Norwegian study showed that children of parents with depression have lower self-esteem levels than those whose parents do not have this diagnosis (\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e). In Indonesia, a study reported that pasung\u0026mdash;a practice that involves the deprivation of physical, mental, and social integrity through restraint or confinement\u0026mdash;applied to individuals with mental disorders has a profound impact on children living with the patient. These effects include feelings of helplessness and shame, psychological disturbances such as depression, substance use, school dropout, and social isolation (\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e), factors that collectively constitute fertile ground for the development of impaired self-esteem (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e). A study conducted among school adolescents in Hu\u0026aacute;nuco, Peru, found that low self-esteem was significantly associated with the presence of depression. Specifically, 39.4% of participants had low self-esteem, while 16.4% showed depressive symptoms, demonstrating a statistically significant relationship between both variables (\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e). However, a study conducted in the United States reported a contrasting finding, identifying that higher self-esteem in children of parents with depression was the main predictor of the absence of a psychiatric diagnosis and of a high level of global functioning at 2, 10, and 20 years of follow-up (\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e). This association could be explained by the presence of social or family support networks (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In contexts with protective structures, such as cohesive families, strong educational institutions, or assistance programs, the impact of having a family member with a mental disorder may be mitigated, reducing its negative effect on the adolescent\u0026rsquo;s self-esteem (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In contrast, in less protective environments, exposure to a family member\u0026rsquo;s mental illness may increase emotional vulnerability and contribute to low self-esteem (\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003ePartner\u003c/h2\u003e\u003cp\u003eIn our study, having a romantic partner was associated with a higher prevalence of low self-esteem. This finding is consistent with a study conducted among university students in Houston (USA), which found that relationship-contingent self-esteem (RCSE) was negatively associated with global self-esteem (r = \u0026minus;\u0026thinsp;0.29) (\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e). This suggests that students whose self-worth depends on the status of their relationship tend to experience lower and more vulnerable self-esteem in response to the ups and downs of relationship dynamics (\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e). This finding contrasts with a study in German adolescents, where entering into a romantic relationship significantly increased self-esteem, particularly when the relationship lasted at least one year (d\u0026thinsp;\u0026asymp;\u0026thinsp;+\u0026thinsp;0.10). It was also observed that a breakup reduced self-esteem (d \u0026asymp; \u0026minus;\u0026thinsp;0.16), although this effect was temporary and disappeared within a year, even without entering a new relationship (\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e). This could be explained by a study conducted in the Netherlands, which evaluated the effect of initiating and ending a romantic relationship. The results support the dynamic equilibrium model of personality development, which posits that traits such as self-esteem and self-perception can temporarily change in response to significant life experiences but tend to return to an individual set point influenced by both genetic and environmental factors (\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e). In this regard, if self-esteem is based exclusively on performance within the relationship (contingent self-esteem), there is a greater risk of experiencing low self-esteem when the relationship is not emotionally satisfying (\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e). However, when the relationship is solid and functional, it can serve as a positive reinforcement for self-esteem (\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e). Moreover, few aspects of social life have as much potential to significantly impact self-esteem and well-being as the success or failure of romantic relationships. Nevertheless, not all individuals are equally affected by the ups and downs of their romantic relationships (\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eMiddle and late adolescence\u003c/h2\u003e\u003cp\u003eIn our study, being in middle and late adolescence was associated with a 20% and 39% reduction in low self-esteem, respectively, compared to early adolescence. This finding is consistent with a study conducted in Spain, which observed that self-esteem tends to increase as adolescents grow older; adolescents aged 15 to 19 years showed significantly lower rates of low self-esteem compared to those aged 12 to 14 years (\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e). Similarly, a study in Germany found that self-esteem was high in childhood, declined in early adolescence, and then progressively increased until young adulthood, with a significant medium effect size between the ages of 13 and 29 years (d\u0026thinsp;=\u0026thinsp;0.29) (\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e). In the same vein, a study in Kentucky, USA, concluded that during middle and late adolescence\u0026mdash;and even into early adulthood\u0026mdash;self-esteem tends to stabilize or even increase; in fact, more than half of the participants remained at the same self-esteem level from one year to the next, with significant correlation coefficients ranging from 0.59 to 0.87 for measures such as the Rosenberg scale (\u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e). Likewise, a cross-cultural analysis using data from 48 countries\u0026mdash;including several in South America, such as Peru, Brazil, Argentina, Bolivia, and Ecuador\u0026mdash;found that adolescent self-esteem tends to increase progressively with age, particularly toward the end of adolescence and the beginning of adulthood. Using multilevel models, a positive and significant association between age and self-esteem was found (B\u0026thinsp;=\u0026thinsp;0.80), even after controlling for gender and country (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). Another study conducted in Ecuador among adolescents showed that the proportion of those with high self-esteem was greater in the 15\u0026ndash;19-year-old group (51%) compared to the 12\u0026ndash;14-year-old group (estimated at 45%), suggesting a trend toward increasing self-esteem with advancing age (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This contrasts with what was reported in a study conducted among adolescents in the United States, where late-stage adolescents showed stable self-esteem levels over time, with minimal cohort differences accounting for less than 2% of the total variance (η\u0026sup2; \u0026lt; 0.02) (\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e). Along the same lines, a study in New York found that although self-esteem may fluctuate, it tends to stabilize from the age of 12, such that those who exhibit high self-esteem in early stages are likely to maintain it through middle and late adolescence (\u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis association could be explained by cultural differences, social contexts, and the level of family or school support, all of which significantly influence self-image perception and the way adolescents cope with the challenges inherent to each stage of development (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These variations are linked to biological, cultural, socioeconomic, and sociodemographic factors, which change as the adolescent grows older (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). Furthermore, in late adolescence, the increase in responsibilities and social expectations may impact self-esteem differently depending on the environment in which the individual develops (\u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e). It has also been argued that self-esteem tends to be higher in late adolescence compared to early adolescence due to greater self-awareness; however, it is still lower than in early adulthood, likely as a consequence of the maturational processes and social changes that characterize this developmental stage (\u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eFamily dysfunction\u003c/h2\u003e\u003cp\u003eIn our study, mild, moderate, and severe family dysfunction were associated with a 66%, 115%, and 165% increase, respectively, in the prevalence of low self-esteem. This finding is consistent with a study in Greek adolescents, which found that factors characteristic of dysfunctional family functioning, such as low cohesion, were strongly linked to lower self-esteem. In particular, self-esteem significantly mediated the relationship between family cohesion and both state anxiety levels (p\u0026thinsp;=\u0026thinsp;0.005) and trait anxiety levels (p\u0026thinsp;=\u0026thinsp;0.011), highlighting its protective role in youth mental health (\u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e). Similarly, a study conducted among adolescents in the United States found that low maternal responsiveness was associated with a higher prevalence of low self-esteem (26.7% vs. 12.4%). Likewise, low maternal demandingness was associated with more cases of low self-esteem (24.9% vs. 13.4%), highlighting the role of parenting style in the formation of self-concept during adolescence (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Similarly, a meta-analysis conducted in 31 countries demonstrated that parental hostility\u0026mdash;including rejection, neglect, abuse, punishment, and verbal or physical aggression\u0026mdash;was negatively associated with self-esteem, with moderate to large effect sizes (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.33 for maternal hostility and r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.37 for paternal hostility) (\u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e). Along the same lines, a study in Spain showed that the family environment, as well as close peer relationships, are fundamental for the development of healthy self-esteem (\u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e). Furthermore, a study in China found that father absence was associated with lower self-esteem: adolescents without a father figure reported a mean score of 24.63 (Standard Deviation (SD)\u0026thinsp;=\u0026thinsp;3.22), compared to 33.12 (SD\u0026thinsp;=\u0026thinsp;6.03) among those living with their father, a highly significant difference (F\u0026thinsp;=\u0026thinsp;770.23) (\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e). Possibly because this absence is interpreted as a sign of lack of love or acceptance, which reduces the perception of meaningful emotional support within the family environment (\u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e). This contrasts with findings from various studies conducted in the United States. One study\u0026mdash;carried out among university adolescents\u0026mdash;did not show a direct relationship between family dysfunction and low self-esteem (\u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e). Similarly, a longitudinal study in the United States of America found no significant effect of parental supervision on children\u0026rsquo;s self-esteem (\u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e). Likewise, a study in Mexican adolescents living in the United States did not find a significant impact of parental hostility on children\u0026rsquo;s self-esteem (\u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e). The association between family dysfunction and low self-esteem may be explained by psychobiological and contextual factors (\u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e). The lack of secure emotional bonds and a stressful family environment hinder emotional regulation and foster the development of a negative self-concept (\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e). In addition, constant exposure to criticism reinforces the perception of not being valuable (\u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e). At the neurobiological level, chronic stress activates the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal axis, affecting brain areas related to self-evaluation (\u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e, \u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e). During the pandemic, this vulnerability was intensified by the reduction of emotional support in dysfunctional family contexts (\u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003ePresence of acne\u003c/h2\u003e\u003cp\u003eIn our study, adolescents with grade 4 facial acne were found to have a higher prevalence of low self-esteem. This finding is consistent with an analytical study conducted in Norway, which found that male adolescents with acne were more likely to have low self-esteem (OR: 2.07), while in females, a significant association was also found between acne and lower self-esteem (OR: 1.88) (\u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e). This aligns with a study in California (USA), which highlighted the negative impact of acne\u0026mdash;particularly when perceived as severe\u0026mdash;on self-esteem, self-image, and socialization. However, it was a descriptive study without adjusted association measures or multivariate analysis (\u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e). Moreover, a literature review covering data from 11 countries concluded that women with acne are more likely to experience low self-esteem, heightened shyness, greater perceived stress, feelings of worthlessness, body dissatisfaction, and lower self-worth. However, as this was a synthesis of descriptive studies, it did not provide multivariate association measures or adjusted analyses (\u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e). Nevertheless, these findings contrast with those reported in a study conducted in India, where only 6.8% of adolescents with acne had low self-esteem, while the majority (67.6%) showed normal levels of self-esteem (\u003cspan citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e). Similarly, a study carried out in Turkey found no significant differences in self-esteem levels or social anxiety between adolescents with and without acne (\u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e). Likewise, research conducted in Brazil found no significant association between acne severity\u0026mdash;including grade IV\u0026mdash;and self-esteem, as measured by the Rosenberg scale (\u003cspan citationid=\"CR133\" class=\"CitationRef\"\u003e133\u003c/span\u003e). This association could be explained by the fact that, in this age group, many adolescents have not yet developed the maturity to adequately cope with the emotional impact of the visible lesions caused by acne (\u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e). This impact has been documented in the literature as low self-esteem, dissatisfaction with physical appearance, shame, and shyness (\u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e135\u003c/span\u003e). In addition, dissatisfaction with physical appearance during adolescence has been systematically associated with multiple psychosocial health problems, including low self-esteem, sleep disturbances, nervousness, stress, depressive symptoms, and lower quality of life (\u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e). Furthermore, adolescents with acne do not necessarily experience self-esteem problems solely due to their self-image; they may also be affected by the psychosocial judgments of their social environment, which reinforces the emotional and social impact of this dermatological condition (\u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eLiving in urban\u0026ndash;marginal areas\u003c/h2\u003e\u003cp\u003eIn our study, adolescents residing in urban\u0026ndash;marginal areas were associated with a lower prevalence of low self-esteem compared to those living in rural areas. This finding is consistent with a study in China, which observed that children of rural migrant parents had more mental health problems than local children, with higher proportions in abnormal ranges (21% vs. 9.8%) and borderline ranges (18.8% vs. 13.8%) (\u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e). In the analysis of this study, being part of a single-parent family (OR\u0026thinsp;=\u0026thinsp;3.13; 95% CI: 1.42\u0026ndash;6.89), having insufficient household income (OR\u0026thinsp;=\u0026thinsp;2.61; 95% CI: 1.33\u0026ndash;5.13), and having a poor perception of health status (OR\u0026thinsp;=\u0026thinsp;6.22; 95% CI: 1.13\u0026ndash;34.08) were significantly associated with a higher likelihood of self-esteem problems among migrant children (\u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e). However, this contrasts with findings from a study conducted in India, which observed a higher prevalence of low self-esteem in urban adolescents (66.7%) compared to rural adolescents (56.7%), with a statistically significant difference (t\u0026thinsp;=\u0026thinsp;13.4; p\u0026thinsp;=\u0026thinsp;0.0001) and a prevalence ratio of 1.18 (\u003cspan citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e). Along the same lines, a study in Australia found that rural adolescents showed significantly higher self-esteem levels than their urban peers, according to multivariate analyses based on the Rosenberg scale (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (\u003cspan citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e). In addition, this study found a moderate positive correlation between age and self-esteem among urban adolescents (r\u0026thinsp;=\u0026thinsp;+\u0026thinsp;0.30), whereas the correlation was negative among rural adolescents (r = \u0026minus;\u0026thinsp;0.34) (\u003cspan citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e). Similarly, a study conducted in Peru found that self-esteem was positively associated with other conditions in adolescents, with this association being stronger in rural areas (r\u0026thinsp;=\u0026thinsp;0.8) than in urban areas (r\u0026thinsp;=\u0026thinsp;0.5) (\u003cspan citationid=\"CR139\" class=\"CitationRef\"\u003e139\u003c/span\u003e). This finding suggests that adolescents from rural settings may develop stronger self-esteem, possibly due to a more cohesive social environment and reduced exposure to comparative social pressures (\u003cspan citationid=\"CR139\" class=\"CitationRef\"\u003e139\u003c/span\u003e). On the other hand, a study conducted in Mexico found no significant differences in body dissatisfaction between adolescents from rural and urban areas (\u003cspan citationid=\"CR140\" class=\"CitationRef\"\u003e140\u003c/span\u003e). Given that body dissatisfaction has been associated with low self-esteem, this finding suggests that the geographical setting alone does not determine self-esteem levels related to body image in this population (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTelevision\u003c/h3\u003e\n\u003cp\u003eIn our study, adolescents who watched between 6 and 10 hours of television were associated with a higher prevalence of low self-esteem. This finding is consistent with a study in Germany, where greater screen time between the ages of 11 and 13 was associated with lower self-esteem at age 13, even after statistical adjustments. Among males, computer and phone use was significantly associated with lower self-esteem (b = \u0026minus;\u0026thinsp;2.93), and this association persisted after controlling for prior self-esteem (b = \u0026minus;\u0026thinsp;2.82) (\u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e). Similarly, a study in the United States conducted among university students found that frequent social media use was associated with lower self-esteem (r = \u0026minus;\u0026thinsp;0.20) (\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). Likewise, a systematic review including data from 71 countries found that greater screen time was consistently associated with lower self-esteem in children and adolescents, although a single pooled effect measure was not calculated due to methodological heterogeneity among the studies, and the evidence was considered to be of moderate quality (\u003cspan citationid=\"CR143\" class=\"CitationRef\"\u003e143\u003c/span\u003e). A hierarchical regression analysis conducted among adolescents in the United States found that watching more television during follow-up was associated with a decrease in self-esteem (β = \u0026minus;\u0026thinsp;0.94) (\u003cspan citationid=\"CR144\" class=\"CitationRef\"\u003e144\u003c/span\u003e). Finally, a study in adolescents from China reported an inverse association between television time on school days and adolescent self-esteem (β = \u0026minus;\u0026thinsp;0.935), as well as lower life satisfaction (\u003cspan citationid=\"CR145\" class=\"CitationRef\"\u003e145\u003c/span\u003e). This contrasts with a study conducted in Germany, where, among female adolescents, more television viewing at age 11 was associated with lower self-esteem at that time (β = \u0026minus;\u0026thinsp;3.96) but predicted a significant increase at age 13 (β = +5.08), provided that viewing was low or moderate (\u0026lt;\u0026thinsp;2 h/day) (\u003cspan citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e). Similarly, a study among adolescents in Hong Kong identified an inverted-J\u0026ndash;shaped relationship, in which those who watched television moderately (between 1 and \u0026le;\u0026thinsp;2 hours per day) reported higher self-esteem levels compared with both those who watched less than one hour and those with greater daily exposure (\u003cspan citationid=\"CR146\" class=\"CitationRef\"\u003e146\u003c/span\u003e). This association could be explained by the influence of unrealistic body ideals conveyed by the media, which can negatively affect physical self-concept and body satisfaction, thereby reducing overall self-esteem (\u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e147\u003c/span\u003e). Although this hypothesis is supported by some studies (\u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e, \u003cspan citationid=\"CR148\" class=\"CitationRef\"\u003e148\u003c/span\u003e) and a meta-analysis (\u003cspan citationid=\"CR149\" class=\"CitationRef\"\u003e149\u003c/span\u003e), the results are not conclusive. Moreover, the association between screen time and low self-esteem could be overestimated by the omission of variables such as obesity or sedentary behavior, which also affect self-esteem (\u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e). Obesity, associated with body dissatisfaction, can negatively influence self-esteem (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). Therefore, it is not necessarily television viewing time that directly causes low self-esteem; rather, this relationship could be mediated by other factors that are not always considered (\u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e). It has also been suggested that the effect of television consumption on self-esteem could be transitory (\u003cspan citationid=\"CR144\" class=\"CitationRef\"\u003e144\u003c/span\u003e). However, this interpretation contrasts with research emphasizing how body ideals promoted in the media, particularly among adolescents, could have more persistent effects on self-esteem, especially in girls (\u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e147\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eLimitations and strengths\u003c/h2\u003e\u003cp\u003eThis study has some limitations that should be considered when interpreting the results. First, its cross-sectional design precludes establishing causal relationships between the factors analyzed and low self-esteem; therefore, the associations observed should not be interpreted as causal. Moreover, certain variables such as television use may act as both potential causes and consequences of low self-esteem, making temporal directionality uncertain. Likewise, the findings cannot be generalized to the entire adolescent population, as the sample is limited to students from specific educational institutions, excluding non-school-attending adolescents. Another relevant limitation is the use of self-report instruments, which may introduce social desirability bias or errors derived from the participants\u0026rsquo; subjective perception. In addition, some potentially influential variables\u0026mdash;such as parents\u0026rsquo; educational level (\u003cspan citationid=\"CR150\" class=\"CitationRef\"\u003e150\u003c/span\u003e), sleep quality (\u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e), overall academic performance (\u003cspan citationid=\"CR151\" class=\"CitationRef\"\u003e151\u003c/span\u003e), experiences of violence or bullying (\u003cspan citationid=\"CR152\" class=\"CitationRef\"\u003e152\u003c/span\u003e), and perceived emotional support from family members or teachers (\u003cspan citationid=\"CR153\" class=\"CitationRef\"\u003e153\u003c/span\u003e)\u0026mdash;were not considered in the analyses, which could act as confounding factors. These factors have previously been associated with both mental health and self-esteem in adolescents (\u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e, \u003cspan citationid=\"CR151\" class=\"CitationRef\"\u003e151\u003c/span\u003e, \u003cspan citationid=\"CR152\" class=\"CitationRef\"\u003e152\u003c/span\u003e, \u003cspan citationid=\"CR153\" class=\"CitationRef\"\u003e153\u003c/span\u003e), so their omission may limit a full understanding of the observed associations. Likewise, the lack of longitudinal follow-up prevents the evaluation of the evolution of self-esteem over time and its relationship with significant events in adolescent life. Finally, complex constructs such as family dysfunction or relationship-contingent self-esteem may not have been fully explored (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e, \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e), given the use of general instruments that do not capture all their dimensions.\u003c/p\u003e\u003cp\u003eNevertheless, the study also presents important strengths. One of them is the inclusion of multiple factors associated with self-esteem, such as resilience, family environment, facial acne, type of residence, and screen time, which allows the phenomenon to be approached from a broad and multifactorial perspective. In addition, the subgroup analyses\u0026mdash;such as by sex (\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e), family structure (91, 119, 121), and urban or rural context (\u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e)\u0026mdash;provide a greater level of detail and understanding of the dynamics involved. The study also stands out for contextualizing its findings through comparison with previous research conducted in different countries, thereby strengthening the external validity of its results. Finally, this work contributes original empirical evidence on self-esteem in adolescents living in urban\u0026ndash;marginal areas, a population underrepresented in the scientific literature, thus expanding the available knowledge on this vulnerable group.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003eRelevance of findings in mental health\u003c/h2\u003e\u003cp\u003eThe findings of this study are relevant to the field of mental health, as they highlight multiple contextual, personal, and social factors associated with low self-esteem in adolescents\u0026mdash;a key variable in emotional and psychological development during this stage. The identification of protective variables such as resilience (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e), as well as risk factors such as family dysfunction (\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e), the presence of severe acne (\u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e, \u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e135\u003c/span\u003e), or prolonged screen exposure (\u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e), makes it possible to guide psychoeducational and community interventions aimed at promoting adolescent well-being. In addition, the association between low self-esteem and relational or contextual characteristics (such as having a romantic partner (\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e), living in rural areas (\u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e), or being in the early stages of adolescence (\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e)) underscores the need for a comprehensive approach that considers the family, school, and social environments. From a public health perspective, these findings help to identify at-risk groups and prioritize early prevention strategies, fostering the strengthening of self-concept and emotional regulation as fundamental elements for the healthy development of adolescents.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, resilience was identified as a significant protective factor against low self-esteem among secondary school adolescents, even after adjusting for multiple sociodemographic, family, and behavioral factors. Furthermore, family dysfunction, a family history of mental illness, excessive television use, and being in a romantic relationship were independently associated with a higher prevalence of low self-esteem.\u003c/p\u003e\u003cp\u003eThese findings underscore the need to implement school- and community-based programs aimed at strengthening resilience and fostering coping skills, as well as to develop family-focused interventions to improve communication and emotional support. Regulating screen-related habits and conducting early school-based screenings are key strategies to prevent self-esteem problems. An intersectoral approach involving education, health, and community sectors is essential to promote psychological well-being during adolescence.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eBMI: Body Mass Index\u003c/li\u003e\n \u003cli\u003eREDCap: Research Electronic Data Capture\u003c/li\u003e\n \u003cli\u003eCD-RISC: Connor\u0026ndash;Davidson Resilience Scale\u003c/li\u003e\n \u003cli\u003eAPGAR: Adaptability, Partnership, Growth, Affection, Resolve\u003c/li\u003e\n \u003cli\u003eGLM: generalized linear models\u003c/li\u003e\n \u003cli\u003ePR: prevalence ratios\u003c/li\u003e\n \u003cli\u003eCI: confidence intervals\u003c/li\u003e\n \u003cli\u003eVIF: variance inflation factor\u003c/li\u003e\n \u003cli\u003eUSA: United States of America\u003c/li\u003e\n \u003cli\u003eNLSY79: National Longitudinal Survey of Youth 1979\u003c/li\u003e\n \u003cli\u003eOD: Odds ratio\u003c/li\u003e\n \u003cli\u003eRCSE: Relationship-contingent self-esteem\u003c/li\u003e\n \u003cli\u003eSD: Standard Deviation\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee of Universidad San Mart\u0026iacute;n de Porres in Lima, Peru, reviewed and approved this study on March 21, 2023, under approval code Official Letter No. 348-2023 (01\u0026ndash;3652300 Anexo 160 / [email protected]), confirming compliance with ethical standards for research involving human participants. An additional video file provides more details [see Additional file 1]. To safeguard privacy and confidentiality, data were gathered through anonymous questionnaires that did not request any identifying details. Informed assent was obtained from all adolescent participants, and written informed consent was provided by their parents or legal guardians before enrollment. Further details about this process are included in additional video files [see Additional files 2 and 3]. It was also assured that all collected information would be used solely for research purposes, without endangering participants\u0026rsquo; integrity or well-being. Every phase of the study was carried out in line with the principles of respect, beneficence, and justice, as outlined in the Declaration of Helsinki and relevant national regulations.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to data confidentiality restrictions, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors declare that this study was self-funded.\u003c/p\u003e\n\u003cp\u003eTrial registration\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eMV, MC, OG, LA, JV, AV, VV, and CP contributed equally to the drafting of the manuscript, data collection, and interpretation of the results. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe express our sincere gratitude to Universidad Se\u0026ntilde;or de Sip\u0026aacute;n, Universidad Peruana Cayetano Heredia, Universidad Privada Antenor Orrego, Universidad San Mart\u0026iacute;n de Porres, Universidad Nacional de Piura, Universidad Nacional Toribio Rodr\u0026iacute;guez de Mendoza de Amazonas, and Universidad Continental for their valuable institutional support.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eBaumeister RF, Campbell JD, Krueger JI, Vohs KD. Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychol Sci Public Interest. 2003;4(1):1-44. doi:10.1111/1529-1006.01431. Available from: https://pubmed.ncbi.nlm.nih.gov/26151640/\u003c/li\u003e\n\u003cli\u003eChoi Y, Choi SH, Yun JY, Lim JA, Kwon Y, Lee HY, et al. 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Available from: https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.620011/full [citado 2025 jul 1].\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Self-esteem, resilience, adolescents, mental health, psychosocial factors","lastPublishedDoi":"10.21203/rs.3.rs-7475199/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7475199/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSelf-esteem is a key component in adolescents' psychological development and is associated with multiple factors related to well-being and success. Resilience, defined as the ability to cope with and overcome adversity, is a potential protective factor for self-esteem. However, in Peru, evidence on this relationship is limited and has focused on specific populations, with some methodological constraints. Understanding this relationship is essential for designing strategies to promote adolescent mental health. Thus, this study aimed to examine the association between resilience and self-esteem among adolescents from five educational institutions in the Lambayeque region, Peru.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn analytical cross-sectional study was conducted through secondary analysis of data collected between September and December 2022. A total of 1,307 secondary school adolescents were included. Self-esteem was assessed using the Rosenberg Self-Esteem Scale, and resilience was measured with the 10-item CD-RISC. Descriptive and bivariate analyses were performed using chi-square tests. The association between resilience and self-esteem was estimated using Poisson regression models with robust variance, adjusting for confounders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of low self-esteem in the studied population was 44.6% (95% CI: 42.03–47.40). Adolescents with low resilience showed a higher prevalence of low self-esteem compared to those with high resilience (48.5% vs. 26.1%; p \u0026lt; 0.001). In the adjusted analysis, high resilience was associated with a lower prevalence of low self-esteem (PR: 0.68; 95% CI: 0.53–0.86; p = 0.002). Other factors associated with low self-esteem included severe family dysfunction (PR: 2.17; 95% CI: 1.65–2.84; p \u0026lt; 0.001), family history of mental illness (PR: 1.19; 95% CI: 1.01–1.40; p = 0.043), and excessive television use (PR: 1.18; 95% CI: 1.04–1.33; p = 0.009).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResilience emerged as a significant protective factor against low self-esteem in adolescents, while family dysfunction and a family history of mental illness were identified as risk factors. These findings underscore the need for school- and community-based strategies to enhance resilience, improve family functioning, and address modifiable risk factors, with the ultimate goal of promoting psychological well-being and preventing self-esteem problems in this population.\u003c/p\u003e","manuscriptTitle":"Association Between Resilience and Self-Esteem in Adolescents from Peruvian Schools","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 07:16:27","doi":"10.21203/rs.3.rs-7475199/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ca44875-7c41-4609-bf36-11665ff40dc9","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-10T06:54:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 07:16:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7475199","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7475199","identity":"rs-7475199","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}