Gender and spatial variation of loneliness among adolescents in three South Asia countries: Prevalence and its correlates

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Khalid Hasan, Helal Uddin, Tahmina Bintay Younos, Nur A Habiba Mukta This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3853530/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Jan, 2026 Read the published version in BMC Public Health → Version 1 posted 20 You are reading this latest preprint version Abstract Background The study aimed to explore the gender and spatial variation of loneliness and identify its correlates among in-school adolescents in three South Asian countries. Methods We used Afghanistan, Bangladesh, and Pakistan's latest Global School-based Student Health Survey (GSHS) datasets. A total of 8089 adolescent data were analyzed using multiple logistic regression models after controlling socio-demographic variables. We used STATA 14 to perform the analyses. Results The prevalence of loneliness among male respondents was 12.28 [95% CI: 11.3–13.3] and 18.1 [95% CI: 16.8–19.5] in females. Afghan adolescents' prevalence of loneliness was the height (34.8%), followed by Pakistani (11.4%) and Bangladeshi adolescents (8.4%). For both genders (male and female), loneliness was higher among the adolescents who were school truants, bullied, involved in physical fights, and experienced physical attacks. In addition, both male and female adolescents with anxiety-induced sleep disturbance, current tobacco users, and suicidal ideation had significantly higher odds of loneliness than their counterparts. Moreover, several poor mental health conditions, such as anxiety-induced sleep disturbance, bullying, suicidal ideation, and suicide plan, were significantly associated with higher odds of loneliness among in-school adolescents in Afghanistan, Bangladesh, and Pakistan. Besides, respondents involved in physical fights were more likely to be lonely. Conclusion We explored the gender and spatial variation of loneliness among adolescents in three South Asian countries and found several similarities and differences in prevalence and correlates of loneliness between various sub-groups. Gender-sensitive and spatial target-oriented policies and interventions should be developed and implemented urgently to reduce the prevalence of adolescent loneliness in these three countries. More studies are also recommended to explore the relationship between loneliness and socio-economic, environmental, and health-behavioral factors among adolescents in these countries. Adolescent Loneliness Gender difference Spatial variation Afghanistan Bangladesh Pakistan 1. Introduction Although loneliness is a stereotyped mental health problem specific to older people, it is also a crucial mental health condition for the younger group [ 1 , 2 ]. Adolescence is an important transformation and developmental stage when adolescents experience multiple social changes, such as emotional instability and more sensitivity to loneliness [ 3 , 4 ]. In general, loneliness is an unpleasant experience and feeling of lonely due to the lack of social relationships [ 5 ]. Loneliness is a subjective and qualitative term closely linked to mental satisfaction with the quality and quantity of social relationships [ 3 , 6 ]. Moreover, loneliness refers to a lonely feeling of mind more than once per week [ 7 , 8 ]. Therefore, loneliness is considered a multidimensional phenomenon that adversely impacts adolescent health and well-being [ 9 , 10 ]. Loneliness negatively impacts adolescents’ mental and physical health as well as risk behaviors [ 3 , 9 , 11 ]. For example, illness is associated with depressive symptoms, anxiety, perceived stress, low self-esteem [ 12 , 13 ], suicidal ideation [ 11 ], and psychiatric morbidity [ 14 ]. In addition, longitudinal studies also reported that loneliness increases the risk of mortality and morbidity [ 3 , 9 ]. Moreover, loneliness has been associated with several risk behaviors, such as alcohol use, illicit drug use, and smoking [ 14 , 15 ]. Loneliness also increased the risk of being bullied [ 16 ], injured [ 17 ], aggression [ 18 ], sexual risk behaviors [ 14 ], and truancy [ 19 ]. Due to the adverse effects of loneliness on adolescents, loneliness is a crucial public health concern, which demands identifying risk factors associated with adolescent loneliness (Beutel et al., 2017). Recent studies in different countries have identified multiple risk factors associated with loneliness. For example, a study on school adolescents in Sub-Saharan countries reported that peer rejection or not having close friends significantly affected adolescents’ psychological health and well-being [ 20 ]. Similarly, loneliness is linked to suicidal ideation [ 21 , 22 ], being bullied [ 23 , 24 ], and social anxiety [ 25 ]. In addition, household factors, including poverty [ 12 ], poor parental support [ 25 ], insufficient parental warmth and intimacy [ 13 ], and quarrel with parents [ 26 ], are significantly linked to adolescent loneliness. Moreover, some health and well-being-related factors, such as physical inactivity [ 27 ], poor activity in physical education classes [ 28 ], leisure time sedentary behavior [ 29 ], insufficient fruits and vegetable intake [ 30 ], and higher soft drink intake [ 31 ] are also associated with loneliness among adolescents. Hence, the degree of loneliness has been exposed differently due to the socio-environmental, emotional, and physical health risk factors [ 24 , 32 , 33 ]. Although loneliness harms the health and well-being of adolescents, their perceived loneliness might be reported differently depending on their gender identity. However, still, it remained inconclusive and needs to be clarified. The majority of the studies found female adolescents have a higher risk of feeling lonely [ 14 , 15 ], while other cross-sectional studies documented that gender difference is mixed [ 34 , 35 ] and inconsistent [ 36 ] as well as some studies found no gender differences [ 14 ]. For example, Russian female adolescents had a higher risk of loneliness than male adolescents [ 14 ]. Similarly, female adolescents in the USA and Asian countries (i.e., the Philippines) were more likely to report loneliness than male adolescents [ 14 , 15 ]. Conversely, some studies showed that the prevalence of loneliness in Myanmar [ 23 ] and Morocco [ 37 ] was higher among boys; however, there was no difference in loneliness among male and female adolescents in Tanzania [ 38 ]. Therefore, male and female adolescents in different countries encounter loneliness disproportionally. However, there is a lack of investigation on gender-stratified adolescent loneliness and its correlates in South Asian countries like Afghanistan, Pakistan, and Bangladesh. Our study intends to fill these gaps. Therefore, using national representative cross-sectional survey data, this study aimed to examine the prevalence of loneliness and its associated risk factors among male and female adolescents in three South Asian countries. Thus, detecting gender and spatial stratified prevalence of loneliness and its risk factors might be an excellent initiative to understand the influence of gender and space of being exposed to loneliness among adolescents in South Asia, which would be helpful to gender-sensible adolescents' mental health policy implications in those counties. 2. Methods 2.1 Data source and study design We used cross-sectional datasets from the latest Global School-based Health Survey (GSHS) of Afghanistan, Bangladesh, and Pakistan. The GSHS is a nationally representative school-based survey developed by the WHO, UNICEF, UNESCO, UNAIDS, and CDC, carried out among in school-students aged 13–17 years in low-and-middle-income countries around the world. The GSHS comprises a comprehensive set of indicators, including demographics, mental health, violence, unintentional injury, alcohol and drug use, hygiene behaviors, and physical activity [ 39 ]. 2.2 Study settings Three South Asian countries, Afghanistan, Bangladesh, and Pakistan, served as the settings of the study. Afghanistan and Pakistan share their border, and Bangladesh had independent from Pakistan in 1971. All are densely populated low-income countries with a Muslim majority population. 2.3 Sampling and data collection The GSHS followed a two-stage cluster sampling to get a representative sample of in-school adolescents in each country. In the first stage, schools were selected, ensuring the probability proportion of the total enrolment size in each country. Then, classes were chosen randomly, and all students were invited to participate in the survey. A total of 2579 student data were collected in Afghanistan GSHS, 2989 in Bangladesh GSHS, and 5129 in Pakistan GSHS. After the listwise deletion of missing data, 8089 in-school adolescent data were used as the final analytical sample in the study. 2.4 Measures 2.4.1 Outcome variable Loneliness was the outcome variable in this study. A single item question, “During the last 12 months, how often have you felt lonely?” The response option to this question was 1 = never to 5 = always (coded 1–3 = 0, indicates “Not having loneliness” and 4–5 = 1, indicates “Having loneliness”) (see Appendix , Table: A1). 2.4.2 Predictor variables Three predictor factors were included in the study. They were poor mental health factors (four variables), social–environmental factors (6 variables), and health risk behaviors factors (7 variables) (see Appendix , Table A1 ). 2.4.3 Control variables Six variables: age, gender, country, hunger, peer support, and parental support, were included in the analyses as the control variables. We included these variables based on their availability in the data and the recommendation of the previous studies on GSHS. A detailed description of the control variables with predictor and outcome variables is presented in Appendix , Table A1 . 2.5 Data analysis Descriptive and inferential statistical analyses were performed using Stata version 14.0 (Stata Corporation, 133 College Station, Texas, USA). The prevalence of loneliness by control variables was reported in Table 1 . Moreover, gender and spatial variation of the prevalence of loneliness by explanatory variables were reported using the chi-square test in Table 2 . Then multivariate logistic regressions (MLR) were used to inform the associations (AOR, 95% CI) of gender-segregated loneliness with poor psychological health factors, social-environmental, and health risk behaviors factors (Table 3 ). In addition, Table 4 represents spatial differences in the associations (AOR, 95% CI) of loneliness with explanatory variables. Multicollinearity of MLR models was checked using the Pearson correlation matrix, variance inflation factor (VIF), and tolerance statistics. No unacceptable collinearity issues were found in the regression analyses. Missing values were excluded from the statistical analysis. Statistical significance was set at p ≤ 0.05. Table 1 Sample characteristics and control variables among adolescents in three countries of South Asia (n = 7903) Variables (Control) Sample Loneliness n (%) % (95% CI) AOR (95% CI) All 7903 (100) 14.73 (14.0–15.5) – Age in years 13 or less 1588 (20.09) 10.96 (9.5–12.6) Ref. 14–15 5412 (68.48) 13.21 (12.3–14.1) 1.31 (0.88–1.95) 16 or more 903 (11.43) 30.45 (27.5–33.6) 2.09 (1.18–3.70)** Gender Female 3326 (42.09) 18.1 (16.8–19.5) Ref. Male 4577 (57.91) 12.28 (11.3–13.3) 0.95 (0.73–1.23) Country Afghanistan 1444 (18.27) 34.76 (32.3–37.3) Ref. Bangladesh 2433 (30.79) 8.38 (7.3–9.6) 0.22 (0.14–0.35)*** Pakistan 4026 (50.94) 11.38 (10.4–12.4) 0.26 (0.18–0.38)*** Hungry Never 4669 (59.08) 13.77 (12.8–14.8) Ref. Rarely/sometimes 2403 (30.41) 13.73 (12.4–15.2) 0.67 (0.49–0.92)** Mostly/always 831 (10.51) 22.98 (20.2–26.0) 1.21 (0.80–1.83) Peer support Never/rarely 1947 (24.64) 14.79 (13.2–16.4) Ref. Sometimes 1791 (22.66) 13.18 (11.6–14.8) 0.89 (0.65–1.21) Mostly/always 4165 (52.70) 15.37 (14.3–16.5) 0.74 (0.54–1.00) Parental support Low 3813 (48.25) 14.63 (13.5–15.8) Ref. Medium 1831 (23.17) 15.57 (13.9–17.3) 1.18 (0.83–1.68) High 2259 (28.58) 14.21 (12.8–15.7) 0.84 (0.58–1.21) Note: ***P ≤ 0.001; **P ≤ 0.01; *P ≤ 0.05; Ref = Reference category; AOR = Adjusted Odds Ratio Table 2 Characteristics of explanatory variables and prevalence of loneliness by gender and country (n = 7903) Sample Characteristics Loneliness (prevalence) Variables Total, n (%) Total Gender Country % (95% CI) Girls (%) Boys (%) p values Afghanistan (%) Bangladesh (%) Pakistan (%) p values Poor mental health factors No close friends Yes 617 (7.81) 22.9 (19.6–26.4) 9.68 6.45 0.001*** 9.07 8.22 7.1 0.038* No 7286 (92.19) 14.0 (13.3–14.9) 90.32 93.55 90.93 91.78 92.9 Anxiety–induced sleep disturbance Yes 755 (9.55) 52.3 (48.7–55.9) 12.09 7.71 0.001*** 25.0 3.62 7.6 0.001*** No 7148 (90.45) 10.8 (10.0–11.5) 87.91 92.29 75.0 96.38 92.4 Suicidal ideation Yes 574 (7.26) 34.7 (30.8–38.7) 7.52 7.08 0.459 14.2 4.36 6.53 0.001*** No 7329 (92.74) 13.2 (12.4–14.0) 92.48 92.92 85.8 95.64 93.47 Suicide plan Yes 597 (7.55) 33.0 (29.2–36.9) 7.91 7.3 0.311 12.81 5.38 6.98 0.001*** No 7306 (92.45) 13.2 (12.5–14.0) 92.09 92.7 87.19 94.62 93.02 Social–environmental factors Bullied in past month Yes 2731 (34.56) 22.9 (21.3–24.5) 27.81 39.46 0.001*** 39.13 19.28 42.15 0.001*** No 5172 (65.44) 10.4 (9.6–11.3) 72.19 60.54 60.87 80.72 57.85 Physically attacked in past year Yes 3120 (39.48) 17.1 (15.8–18.5) 36.23 41.84 0.001*** 28.67 54.21 34.45 0.001*** No 4783 (60.52) 13.2 (12.2–14.2) 63.77 58.16 71.33 45.79 65.55 In physical fight in past year Yes 2443 (30.91) 18.3 (16.8–19.9) 17.29 40.81 0.001*** 33.03 14.18 40.26 0.001*** No 5460 (69.09) 13.1 (12.2–14.1) 82.71 59.19 66.97 85.82 59.74 Passive smoking in past week Yes 3627 (45.89) 17.3 (16.0–18.5) 29.56 57.77 0.001*** 47.71 32.18 53.53 0.001*** No 4276 (54.11) 12.6 (11.6–13.6) 70.44 42.23 52.29 67.82 46.47 School truancy (past month) Yes 5844 (73.95) 15.6 (14.7–16.6) 79.89 69.63 0.001*** 84.9 64.45 75.76 0.001*** No 2059 (26.05) 12.2 (10.8–13.7) 20.11 30.37 15.1 35.55 24.24 Health risk behaviors factors Current smoking Yes 514 (6.5) 18.7 (15.4–22.3) 1.11 10.42 0.001*** 4.5 7.07 6.88 0.003** No 7389 (93.5) 14.5 (13.7–15.3) 98.89 89.58 95.5 92.93 93.12 Current tobacco use Yes 461 (5.83) 18.9 (15.4–22.7) 1.29 9.13 0.001*** 2.91 6.37 6.56 0.001*** No 7442 (94.17) 14.5 (13.7–15.3) 98.71 90.87 97.09 93.63 93.44 Physical inactivity Yes 1883 (23.83) 11.5 (10.1–13.1) 26.46 21.91 0.001*** 12.33 49.77 12.27 0.001*** No 6020 (76.17) 15.7 (14.8–16.7) 73.54 78.09 87.67 50.23 87.73 Leisure time sedentary behavior (≥ 3 hours/day) Yes 934 (11.82) 22.8 (20.1–25.6) 12.72 11.16 0.035* 22.02 13.52 7.13 0.001*** No 6969 (88.18) 13.6 (12.8–14.5) 87.28 88.84 77.98 86.48 92.87 Fast food consumption (≥ 2 days/week) Yes 1750 (22.14) 16.1 (14.4–17.9) 24.8 20.21 0.001*** 33.66 41.06 6.58 0.001*** No 6153 (77.86) 14.3 (13.5–15.2) 75.2 79.79 66.34 58.94 93.42 Soft drink consumption (≥ 3 drinks/day) Yes 517 (6.54) 17.4 (14.2–21.0) 8.66 5.0 0.001*** 7.13 12.66 2.63 0.001*** No 7386 (93.46) 14.5 (13.7–15.4) 91.34 95.0 92.87 87.34 97.37 Inadequate fruit intake Yes 1026 (12.98) 15.7 (13.5–18.1) 10.97 14.44 0.001*** 11.01 3.66 19.32 0.001*** No 6877 (87.02) 14.6 (13.8–15.4) 89.03 85.56 88.99 96.34 80.68 Inadequate vegetable intake Yes 953 (12.06) 14.5 (12.3–16.9) 6.52 16.08 0.001*** 8.24 0.9 20.17 0.001*** No 6950 (87.94) 14.8 (14.0–15.6) 93.48 83.92 91.76 99.1 79.83 Note: ***P ≤ 0.001; **P ≤ 0.01; *P ≤ 0.05 Table 3 Associations between loneliness and explanatory variables among boys and girls in three South Asian countries. Variables Girls (n = 3326) AOR (95% CI) + Boys (n = 4577) AOR (95% CI) + Both Sex (n = 7903) AOR (95% CI) Poor mental health factors No close friends (Yes) ¥ 1.63 (1.06–2.50)** 2.60 (1.55–4.34)*** 2.03 (1.37–3.00)*** Anxiety–induced sleep disturbance (Yes) ¥ 6.11 (4.09–9.11)*** 8.64 (5.90–12.66)*** 7.47 (5.54–10.07)*** Suicidal ideation (Yes) ¥ 2.60 (1.56–4.35)*** 3.18 (1.80–5.64)*** 2.93 (1.93–4.47)*** Suicide plan (Yes) ¥ 2.66 (1.82–3.89)*** 2.55 (1.48–4.40)*** 2.57 (1.69–3.91)*** Social–environmental factors Bullied in past month (Yes) ¥ 1.94 (1.43–2.63)*** 3.24 (2.03–5.18)*** 2.75 (1.98–3.82)*** Physically attacked in past year (Yes) ¥ 1.82 (1.32–2.51)*** 1.70 (1.06–2.73)** 1.73 (1.25–2.40)*** In physical fight in past year (Yes) ¥ 1.08 (0.82–1.44) 2.53 (1.77–3.62)*** 2.01 (1.51–2.67)*** Passive smoking in past week (Yes) ¥ 1.92 (1.42–2.58)*** 1.29 (0.83–2.03) 1.47 (1.03–2.09)** School truancy (past month) (Yes) ¥ 1.28 (0.93–1.76) 1.02 (0.67–1.57) 1.11 (0.79–1.56) Health risk behaviors factors Current smoking (Yes) ¥ 4.67 (1.23–17.76)** 1.71 (0.76–3.85) 1.87 (0.87–4.02) Current tobacco use (Yes) ¥ 4.65 (1.32–16.39)** 3.57 (1.71–7.45)*** 3.58 (1.73–7.38)*** Physical inactivity (Yes) ¥ 0.91 (0.63–1.32) 1.29 (0.80–2.08) 1.12 (0.79–1.60) Leisure time sedentary behavior/day (≥ 3 hours/day) (Yes) ¥ 2.05 (1.47–2.85)*** 1.20 (0.73–1.98) 1.45 (1.00–2.11)** Fast food consumption (≥ 2 days/week) (Yes) ¥ 1.15 (0.84–1.58) 1.61 (0.91–2.84) 1.43 (0.91–2.26) Soft drink consumption (≥ 3 drinks/day) (Yes) ¥ 0.99 (0.56–1.77) 1.70 (0.90–3.21) 1.49 (0.90–2.46) Inadequate fruit intake (Yes) ¥ 1.02 (0.72–1.42) 1.26 (0.67–2.36) 1.15 (0.75–1.75) Inadequate vegetable intake (Yes) ¥ 0.88 (0.68–1.13) 1.14 (0.69–1.88) 1.05 (0.75–1.47) Note: ***P ≤ 0.001; **P ≤ 0.01; *P ≤ 0.05; AOR = Adjusted Odds Ratio; CI = Confidence Interval; ¥ indicates the reference category is No. + Each outcome is entered in a separate model controlling for age, country, hunger, peer support & parental support. Table 4 Country–wise associations between loneliness and explanatory variables among adolescents in three South Asian countries. Variables Afghanistan AOR (95% CI) + Bangladesh AOR (95% CI) + Pakistan AOR (95% CI) + Poor mental health factors No close friends (Yes) ¥ 0.95 (0.53–1.73) 2.28 (1.26–4.13)*** 2.24 (1.37–3.67)*** Anxiety–induced sleep disturbance (Yes) ¥ 3.84 (2.80–5.25)*** 7.71 (4.16–14.27)*** 8.04 (5.36–12.07)*** Suicidal ideation (Yes) ¥ 2.91 (2.02–4.18)*** 3.38 (1.57–7.27)*** 2.46 (1.65–3.65)*** Suicide plan (Yes) ¥ 2.53 (1.61–3.99)*** 2.47 (1.17–5.22)** 2.74 (1.85–4.03)*** Social–environmental factors Bullied in past month (Yes) ¥ 2.95 (2.20–3.95)*** 3.03 (1.73–5.30)*** 2.01 (1.56–2.61)*** Physically attacked in past year (Yes) ¥ 2.02 (1.40–2.94)*** 1.64 (0.91–2.95) 1.59 (1.24–2.03)*** In physical fight in past year (Yes) ¥ 1.34 (1.11–1.61)*** 2.52 (1.62–3.91)*** 1.43 (1.05–1.95)** Passive smoking in past week (Yes) ¥ 1.60 (1.14–2.24)*** 1.40 (0.79–2.49) 1.64 (1.33–2.03)*** School truancy (past month) (Yes) ¥ 0.67 (0.38–1.17) 1.09 (0.63–1.90) 1.05 (0.85–1.31) Health risk behaviors factors Current smoking (Yes) ¥ 1.68 (0.72–3.91) 1.56 (0.46–5.31) 2.84 (1.76–4.60)*** Current tobacco use (Yes) ¥ 2.15 (0.57–8.16) 5.61 (1.94–16.22)*** 2.62 (1.63–4.24)*** Physical inactivity (Yes) ¥ 2.07 (1.18–3.62)** 1.06 (0.66–1.69 1.55 (0.99–2.45) Leisure time sedentary behavior (≥ 3 hours/day) (Yes) ¥ 0.86 (0.53–1.39) 1.34 (0.73–2.43) 2.03 (1.49–2.78)*** Fast food consumption (≥ 2 days/week) (Yes) ¥ 0.91 (0.64–1.29) 1.59 (0.86–2.93) 1.46 (0.95–2.25) Soft drink consumption (≥ 3 drinks/day) (Yes) ¥ 1.08 (0.61–1.93) 1.52 (0.84–2.74) 1.42 (0.77–2.62 Inadequate fruit intake (Yes) ¥ 1.42 (0.82–2.47 1.98 (0.88–4.44) 0.86 (0.64–1.15) Inadequate vegetable intake (Yes) ¥ 1.57 (0.94–2.64) 2.17 (0.44–10.71) 0.91 (0.70–1.19) Note: ***P ≤ 0.001; **P ≤ 0.01; *P ≤ 0.05; AOR = Adjusted Odds Ratio; CI = Confidence Interval; ¥ indicates the reference category is No. + Each outcome is entered in a separate model controlling for age, country, hunger, peer support & parental support. 2.6 Ethical consideration The World Health Organization´s Ethical Committee, along with respective governmental departments or ministries, granted the ethical approval of the study. In addition, the datasets were made freely available for future uses. Informed consent was taken from the respondents at the time of the survey as well as consent as taken fron the students’ parent or legal guardian [ 39 ]. Participation in the survey was voluntary. 3. Results 3.1 Characteristics of the respondents and prevalence of loneliness Among the 7903 respondents, 58% were male, 68% were aged 14 to 15 years, and half were Pakistani adolescents (Table 1 ). One-tenth of the respondents always felt hungry due to the lack of food in the households, and half (48%) had low parental support. About 8% of respondents did not have a close friend, 9.5% had anxiety-induced sleep disturbance, and 7.5 had suicide plan. In addition, 34.5% of respondents experienced bullying in the past 30 days, 39.4% experienced physical attacks in the past 12 months, and 6.5% were current smokers (Table 2 ). Overall, 15% of adolescent respondents had loneliness. Respondents feeling mostly/always hungry had 21% higher odds of loneliness than those without hunger, but this relationship was not statistically significant. In addition, respondents aged 16 or over had 2.09 times higher odds of loneliness than those aged 13 or less, and this relationship was statistically significant (Table 1 ). The prevalence of loneliness was 52.3% among the respondents with anxiety-induced sleep disturbance, 34.7% among the respondents had suicide ideation, and 23% among the respondents who had no clone friends, remained hungry always or mostly, spent ≥ 3 hours per day leisure time (Table 2 ). 3.2 Gender and spatial variations of loneliness Overall, male respondents had 5% [AOR = 0.95; 95% CI: 0.73–1.23] lower odds of loneliness than their female counterparts; however, this relationship was not statistically significant (Table 1 ). Among the female respondents, the prevalence of loneliness was 80% who were school truant, 36% who physically attacked in the past year, 28% who experienced bullying in the past months, 26.5% who were physically inactive, and 17% who experienced physical fights in the past year (Table 2 ). On the contrary, the highest prevalence of loneliness among the male respondents was 70% who had school truancy in the past month, followed by those who experienced passive smoking (58%), physical attacks (41%), physical fights (41%), and bullying (39.5%) (Table 2 ). The prevalence of loneliness among Afghan adolescents was highest (34.8%), followed by Pakistani (11.4%) and Bangladeshi adolescents (8.4%). The topmost prevalence of loneliness was found among the school truant respondents in all three countries: Afghanistan (84.9%), Bangladesh (64.55%), and Pakistan (75.8%). In Afghanistan, the prevalence of loneliness was 39% among the respondents who experienced bullying in the past month, 33.7% who ate fast food (≥ 2 days/week), and 33% who participated in physical fights in the past year. In Bangladesh, the prevalence of loneliness was high among the respondents who were physically attacked in the past year (54%), physically inactive (50%), bullied in the past month (42%), and consumed fast food ≥ 2 days a week (41%). In Pakistan, in-school adolescent respondents who were bullied, involved in physical fights, and experienced physical attacks had a higher prevalence rate of loneliness. 42%, 40%, and 34.5%, respectively (Table 2 ). 3.3 Gender differences in the associations of loneliness with explanatory variables Table 3 represents the adjusted odds ratio of logistic regressions, which examined the association between lionesses and explanatory variables after controlling for age, country, hunger, peer support, and parental support variables. For both sexes, respondents having anxiety-induced sleep disturbance [AOR = 7.47; 95% CI: 5.54–10.07], current tobacco users [AOR = 3.58; 95% CI: 1.73–7.38], having suicidal ideation [AOR = 2.93; 95% CI: 1.93–4.47], and having suicide plan [AOR = 2.57; 95% CI: 1.69–3.91] had statistically significant higher odds of loneliness than their counterparts. Among the female respondents, adolescents having anxiety-induced sleep disturbance [AOR = 6.11; 95% CI: 4.09–9.11], current smokers user [AOR = 4.67; 95% CI: 1.23–17.76], current tobacco users [AOR = 4.65; 95% CI: 1.32–16.39], having suicidal plan [AOR = 2.66; 95% CI: 1.82–3.89], and having suicide ideation [AOR = 2.60; 95% CI: 1.56–4.35] had statistically significant higher odds of loneliness than their counterparts. Similarly, among the male respondents, adolescents having anxiety-induced sleep disturbance [AOR = 8.64; 95% CI: 5.90–12.66], current tobacco users [AOR = 3.57; 95% CI: 1.71–7.45], having suicidal ideation [AOR = 3.18; 95% CI: 1.80–5.64], and having suicide plan [AOR = 2.55; 95% CI: 1.48–4.40] had statistically significantly greater odds of loneliness than their counterparts (Table 3 ). 3.4 Spatial differences in the associations of loneliness with explanatory variables In Afghanistan, several poor mental health factors, such as anxiety-induced sleep disturbance [AOR = 3.84; 95% CI: 2.80–5.25], bullied in the past month [AOR = 2.95; 95% CI: 2.20–3.95], suicidal ideation [AOR = 2.91; 95% CI: 2.02–4.18], and suicide plan [AOR = 2.53; 95% CI: 1.61–3.99] had significantly increased the odds of loneliness among the in-school adolescents than their counterparts. These three factors were also significantly associated with the loneliness of the respondents in Bangladesh and Pakistan (Table 4 ). In addition, current tobacco use health behavior was also significantly associated with the loneliness of the respondents in Bangladesh [AOR = 5.61; 95% CI: 1.94–16.22] and Pakistan [AOR = 2.62; 95% CI: 1.63–4.24]. Moreover, respondents with no close friends had significantly higher odds of loneliness than their counterparts in Bangladesh [AOR = 2.28; 95% CI: 1.26–4.13] and Pakistan [AOR = 2.24; 95% CI: 1.37–3.67]. Leisure time sedentary behavior (≥ 34 hours/day) was also significantly associated [AOR = 2.03; 95% CI: 1.49 − 2.78] with the risk of loneliness among Pakistani adolescents (Table 4 ). 4. Discussion To our knowledge, this is the first study that investigated gender-stratified adolescent loneliness in these three South Asian countries and explored the associated risk factors. Our analysis showed that the overall prevalence of adolescent loneliness was 14.7%. The prevalence of loneliness among girls (18.1%) was higher than that of boys (12.3%). The highest prevalence of adolescent loneliness was found in Afghanistan (34.8%), followed by Pakistan (11.4%) and Bangladesh (8.4%). However, the overall prevalence reported in this study was higher than in Southeast Asian countries in 2007 and 2013 using the GSHS data (7.8%) [ 23 ] but lower than in four Caribbean countries in 2016-17 (15.3%) [ 19 ], Nigeria in 2017 (25.8%) [ 40 ], Tanzania in 2017 (17.4%) [ 38 ], Ghana in 2012 (18.1%) [ 41 ], Morocco in 2016 (19.8%) [ 37 ], and 25 countries in the Americas in 2018 (18.1%) [ 42 ]. Afghanistan has experienced armed conflict, social injustice, widespread poverty, broken education and health care management as well as disrupted community networks [ 43 – 45 ]. Therefore, several crucial factors such as long periods of conflict, impoverishment, disrupted family relations, the experience of different forms of violence, weakened social support, and disrupted social orders are the reasons for the greater prevalence of loneliness in Afghanistan [ 45 , 46 ]. For example, among 300 children from Kabul, 90% reported that they could die due to war, and 80% marked themselves as frightened, sad, and incapable of coping with life [ 47 ]. Consequently, children are more vulnerable to trauma due to the violence resulting in short and long-term mental consequences [ 48 ]. In addition to violence, Afghan children and adolescents face multiple forms of violations of rights, such as corporal punishment, forced marriage, and hazardous working conditions [ 49 , 50 ]. In line with previous studies, the findings showed that adolescent girls had a higher likelihood of loneliness than boys [ 23 , 37 , 38 ]. For example, adolescent girls reported higher perceived loneliness than boys in the USA (14.7% vs. 6.7%), Russia (14.4% vs. 8.9%) using the Social and Health Assessment (SAHA) data in 2003 [ 14 ], Tanzania using 2017 GSHS data (51% vs. 49%) [ 38 ], four Caribbean countries using 2016–17 GSHS data (50% vs. 49%) [ 19 ], and six countries in Southeast Asia using 2013-17 GSHS data [ 23 ]. It may happen due to differences in girls coping strategies to face stressors compared to boys, which makes girls more vulnerable to loneliness [ 51 , 52 ]. Although a small number of cross-sectional studies, such as in Myanmar [ 23 ] and Morocco [ 37 ], reported that the prevalence of loneliness was higher among boys, while many pieces of literature admitted girls are more vulnerable to loneliness using the same GSHS data [ 14 , 19 , 38 ], which has also been found among adolescent girls in three South Asian countries in our study. In agreement with previous studies, our study found that several poor mental health factors: anxiety-induced sleep disturbance, suicidal ideation, making suicide plan, and having no close friends were strongly associated with adolescent loneliness [ 13 , 21 – 23 ]. Having close friends is a vital protective factor in fighting against adolescent loneliness, revealing the essence of close friends for social support and interaction [ 13 ]. Moreover, anxiety-generating thoughts, which hampers relaxation and sleep quality, are closely related to loneliness [ 3 , 53 ]. Similarly, several cross-sectional studies using the GSHS data reported suicidal ideation or behavior as a risk factor for adolescent loneliness and depressive symptoms [ 21 , 22 , 54 ]. Although depression and loneliness are separate concepts, they may happen together and even be reciprocal [ 55 , 56 ]. Several socio-environmental factors, such as bullying, physical fighting, physical attack, frequent exposure to passive smoking, and hunger, were associated with adolescent loneliness. These findings were similar to previous studies conducted in ASEAN countries, Morocco, Caribbean countries, Spain, and the UK [ 19 , 23 , 33 , 37 , 57 ]. Adolescents with interpersonal victimization experience may worry about further victimization, which influences poor friendship formation, leading to loneliness [ 13 , 58 ]. Moreover, adolescents with bullying experiences possess poorer self-esteem, resulting in loneliness [ 59 ]. Finally, a study using nationally representative data on Kuwaiti school adolescents reported that physically fighting with fellow students was more likely to be rejected by peers; this might make adolescents isolated and lonely [ 60 ]. Therefore, adolescents who experience victimization have an increased risk of avoidance and revenge, and a greater risk of loneliness (León-Moreno et al., 2021). Similar to previous studies, our analysis showed that health risk behavior factors, such as current smoking, tobacco use, leisure time sedentary behaviors, and physical inactivity increased the likelihood of loneliness among adolescents [ 19 , 27 , 29 , 38 ]. For example, adolescents with tobacco use/smoking are seen as anti-social by society, and addicted adolescents are more likely to be isolated and rejected by their fellow, leading to loneliness [ 61 ]. Moreover, loneliness is a part of depression, and previous studies stated that sedentary behavior might result in depressive mode [ 29 , 62 ]. In addition, adolescents with sedentary behaviors were more likely to use and become addicted to social media, possibly resulting in social isolation [ 63 ]. The study had a few limitations. First, as the study was cross-sectional, it was impossible to make any causal association between adolescent loneliness trajectories and predictor variables. Second, the study's respondents were only in-school adolescents, which limited us to generalize the results to out-of-school adolescents. Third, the survey followed a self-reporting data collection design; it may lead to over-reporting or under-reporting. Fourth, in the GSHS survey, a single-item question was asked to measure the status of loneliness, not including help-seeking behaviors for loneliness. Loneliness measurement with multi-item would offer more reliable findings. Moreover, perceived loneliness may vary for adolescents with help-seeking behaviors compared to those without previous or ongoing help-seeking behavior. Therefore, future studies (i.e., longitudinal studies) should consider help-seeking behavior and a multi-item measurement of adolescent loneliness. 5. Conclusion The study found that almost one in six girls and one in nine boys reported loneliness in the three South Asian countries: Afghanistan, Bangladesh, and Pakistan. Over one-third of the lonely in-school adolescents were in Afghanistan, followed by Pakistan and Bangladesh. The study also found several risk factors, such as having no close friends, anxiety-induced sleep disturbance, suicidal ideation, suicidal plan, bullying victimization, physically attacked, physical fighting, household food insecurity, passive smoking experience, and current tobacco use smoking, leisure time sedentary behavior, were significantly associated with adolescent loneliness. By identifying these risk factors, the study would help to make interventions and initiatives for reducing loneliness among in-school adolescents in South Asian low-income countries to meet the targets of 3.4 of the Sustainable Developmental Goals (mental health and well-being). Such interventions may include promoting peer and parental support, social skills, social support programs, and providing counseling support units in schools. Declarations CRediT Author Statement Md. Khalid Hasan: Conceptualization, Methodology, Investigation, Formal Analysis, Writing – Original Draft, Writing – Review & Editing, Supervision. Helal Uddin: Conceptualization, Methodology, Investigation, Formal Analysis, Writing – Original Draft, Writing – Review & Editing. Tahmina Bintay Younos: Conceptualization, Methodology, Formal Analysis, Writing – Review & Editing. Nur A Habiba Mukta : Conceptualization, Methodology, Formal Analysis, Writing – Review & Editing. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data availability statement Data associated with this study has been deposited at WHO and can be downloaded from https://extranet.who.int/ncdsmicrodata/index.php/catalog/GSHS. Declaration of competing interest: None Ethics statement Ethical approval for the survey was granted by the World Health Organization's Ethical Committee. In addition, the GSHS surveys were authorized in each country by their respective national government administration and institutional review board. The data sets are freely downloaded from https://extranet.who.int/ncdsmicrodata/index.php/catalog/GSHS. References Asghar A. Loneliness Matters: A Theoretical Review of Prevalence in Adulthood. J Psychol Behav Sci. 2019;7. Heinrich LM, Gullone E. The clinical significance of loneliness: A literature review. Clin Psychol Rev. 2006;26:695–718. Hawkley LC, Cacioppo JT. Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms. Ann Behav Med. 2010;40:218–27. MacEvoy J, Weeks M, Asher S, Loneliness. Encyclopedia of Adolescence. 2011;2:178–87. Perlman D, Peplau LA. Toward a social psychology of loneliness. Pers Relatsh. 1981;3:31–56. Gierveld J, de Havens J. 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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-3853530","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":268060691,"identity":"25b5f4d6-4cf5-442a-b84b-7ba48d4707f5","order_by":0,"name":"Md. 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Introduction","content":"\u003cp\u003eAlthough loneliness is a stereotyped mental health problem specific to older people, it is also a crucial mental health condition for the younger group [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Adolescence is an important transformation and developmental stage when adolescents experience multiple social changes, such as emotional instability and more sensitivity to loneliness [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In general, loneliness is an unpleasant experience and feeling of lonely due to the lack of social relationships [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Loneliness is a subjective and qualitative term closely linked to mental satisfaction with the quality and quantity of social relationships [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Moreover, loneliness refers to a lonely feeling of mind more than once per week [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, loneliness is considered a multidimensional phenomenon that adversely impacts adolescent health and well-being [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLoneliness negatively impacts adolescents\u0026rsquo; mental and physical health as well as risk behaviors [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. For example, illness is associated with depressive symptoms, anxiety, perceived stress, low self-esteem [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], suicidal ideation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and psychiatric morbidity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition, longitudinal studies also reported that loneliness increases the risk of mortality and morbidity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Moreover, loneliness has been associated with several risk behaviors, such as alcohol use, illicit drug use, and smoking [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Loneliness also increased the risk of being bullied [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], injured [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], aggression [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], sexual risk behaviors [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and truancy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDue to the adverse effects of loneliness on adolescents, loneliness is a crucial public health concern, which demands identifying risk factors associated with adolescent loneliness (Beutel et al., 2017). Recent studies in different countries have identified multiple risk factors associated with loneliness. For example, a study on school adolescents in Sub-Saharan countries reported that peer rejection or not having close friends significantly affected adolescents\u0026rsquo; psychological health and well-being [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similarly, loneliness is linked to suicidal ideation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], being bullied [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and social anxiety [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In addition, household factors, including poverty [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], poor parental support [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], insufficient parental warmth and intimacy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and quarrel with parents [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], are significantly linked to adolescent loneliness. Moreover, some health and well-being-related factors, such as physical inactivity [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], poor activity in physical education classes [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], leisure time sedentary behavior [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], insufficient fruits and vegetable intake [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and higher soft drink intake [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] are also associated with loneliness among adolescents. Hence, the degree of loneliness has been exposed differently due to the socio-environmental, emotional, and physical health risk factors [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough loneliness harms the health and well-being of adolescents, their perceived loneliness might be reported differently depending on their gender identity. However, still, it remained inconclusive and needs to be clarified. The majority of the studies found female adolescents have a higher risk of feeling lonely [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], while other cross-sectional studies documented that gender difference is mixed [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and inconsistent [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] as well as some studies found no gender differences [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. For example, Russian female adolescents had a higher risk of loneliness than male adolescents [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, female adolescents in the USA and Asian countries (i.e., the Philippines) were more likely to report loneliness than male adolescents [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Conversely, some studies showed that the prevalence of loneliness in Myanmar [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Morocco [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] was higher among boys; however, there was no difference in loneliness among male and female adolescents in Tanzania [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Therefore, male and female adolescents in different countries encounter loneliness disproportionally.\u003c/p\u003e \u003cp\u003eHowever, there is a lack of investigation on gender-stratified adolescent loneliness and its correlates in South Asian countries like Afghanistan, Pakistan, and Bangladesh. Our study intends to fill these gaps. Therefore, using national representative cross-sectional survey data, this study aimed to examine the prevalence of loneliness and its associated risk factors among male and female adolescents in three South Asian countries. Thus, detecting gender and spatial stratified prevalence of loneliness and its risk factors might be an excellent initiative to understand the influence of gender and space of being exposed to loneliness among adolescents in South Asia, which would be helpful to gender-sensible adolescents' mental health policy implications in those counties.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data source and study design\u003c/h2\u003e \u003cp\u003eWe used cross-sectional datasets from the latest Global School-based Health Survey (GSHS) of Afghanistan, Bangladesh, and Pakistan. The GSHS is a nationally representative school-based survey developed by the WHO, UNICEF, UNESCO, UNAIDS, and CDC, carried out among in school-students aged 13\u0026ndash;17 years in low-and-middle-income countries around the world. The GSHS comprises a comprehensive set of indicators, including demographics, mental health, violence, unintentional injury, alcohol and drug use, hygiene behaviors, and physical activity [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study settings\u003c/h2\u003e \u003cp\u003eThree South Asian countries, Afghanistan, Bangladesh, and Pakistan, served as the settings of the study. Afghanistan and Pakistan share their border, and Bangladesh had independent from Pakistan in 1971. All are densely populated low-income countries with a Muslim majority population.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sampling and data collection\u003c/h2\u003e \u003cp\u003eThe GSHS followed a two-stage cluster sampling to get a representative sample of in-school adolescents in each country. In the first stage, schools were selected, ensuring the probability proportion of the total enrolment size in each country. Then, classes were chosen randomly, and all students were invited to participate in the survey. A total of 2579 student data were collected in Afghanistan GSHS, 2989 in Bangladesh GSHS, and 5129 in Pakistan GSHS. After the listwise deletion of missing data, 8089 in-school adolescent data were used as the final analytical sample in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Measures\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Outcome variable\u003c/h2\u003e \u003cp\u003eLoneliness was the outcome variable in this study. A single item question, \u0026ldquo;During the last 12 months, how often have you felt lonely?\u0026rdquo; The response option to this question was 1\u0026thinsp;=\u0026thinsp;never to 5\u0026thinsp;=\u0026thinsp;always (coded 1\u0026ndash;3\u0026thinsp;=\u0026thinsp;0, indicates \u0026ldquo;Not having loneliness\u0026rdquo; and 4\u0026ndash;5\u0026thinsp;=\u0026thinsp;1, indicates \u0026ldquo;Having loneliness\u0026rdquo;) (see \u003cspan refid=\"Sec19\" class=\"InternalRef\"\u003eAppendix\u003c/span\u003e, Table: A1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Predictor variables\u003c/h2\u003e \u003cp\u003eThree predictor factors were included in the study. They were poor mental health factors (four variables), social\u0026ndash;environmental factors (6 variables), and health risk behaviors factors (7 variables) (see \u003cspan refid=\"Sec19\" class=\"InternalRef\"\u003eAppendix\u003c/span\u003e, Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003eA1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.4.3 Control variables\u003c/h2\u003e \u003cp\u003eSix variables: age, gender, country, hunger, peer support, and parental support, were included in the analyses as the control variables. We included these variables based on their availability in the data and the recommendation of the previous studies on GSHS. A detailed description of the control variables with predictor and outcome variables is presented in \u003cspan refid=\"Sec19\" class=\"InternalRef\"\u003eAppendix\u003c/span\u003e, Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003eA1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data analysis\u003c/h2\u003e \u003cp\u003eDescriptive and inferential statistical analyses were performed using Stata version 14.0 (Stata Corporation, 133 College Station, Texas, USA). The prevalence of loneliness by control variables was reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Moreover, gender and spatial variation of the prevalence of loneliness by explanatory variables were reported using the chi-square test in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Then multivariate logistic regressions (MLR) were used to inform the associations (AOR, 95% CI) of gender-segregated loneliness with poor psychological health factors, social-environmental, and health risk behaviors factors (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In addition, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e represents spatial differences in the associations (AOR, 95% CI) of loneliness with explanatory variables. Multicollinearity of MLR models was checked using the Pearson correlation matrix, variance inflation factor (VIF), and tolerance statistics. No unacceptable collinearity issues were found in the regression analyses. Missing values were excluded from the statistical analysis. Statistical significance was set at p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\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\u003eSample characteristics and control variables among adolescents in three countries of South Asia (n\u0026thinsp;=\u0026thinsp;7903)\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=\"char\" char=\".\" 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\" colname=\"c1\"\u003e \u003cp\u003eVariables (Control)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSample\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLoneliness\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7903 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.73 (14.0\u0026ndash;15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026ndash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13 or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1588 (20.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.96 (9.5\u0026ndash;12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5412 (68.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.21 (12.3\u0026ndash;14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.31 (0.88\u0026ndash;1.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e903 (11.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.45 (27.5\u0026ndash;33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.09 (1.18\u0026ndash;3.70)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3326 (42.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.1 (16.8\u0026ndash;19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4577 (57.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.28 (11.3\u0026ndash;13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.95 (0.73\u0026ndash;1.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfghanistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1444 (18.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.76 (32.3\u0026ndash;37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2433 (30.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.38 (7.3\u0026ndash;9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.22 (0.14\u0026ndash;0.35)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePakistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4026 (50.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.38 (10.4\u0026ndash;12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.26 (0.18\u0026ndash;0.38)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHungry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4669 (59.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.77 (12.8\u0026ndash;14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely/sometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2403 (30.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.73 (12.4\u0026ndash;15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67 (0.49\u0026ndash;0.92)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMostly/always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e831 (10.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.98 (20.2\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21 (0.80\u0026ndash;1.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeer support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever/rarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1947 (24.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.79 (13.2\u0026ndash;16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1791 (22.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.18 (11.6\u0026ndash;14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89 (0.65\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMostly/always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4165 (52.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.37 (14.3\u0026ndash;16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.74 (0.54\u0026ndash;1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3813 (48.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.63 (13.5\u0026ndash;15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1831 (23.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.57 (13.9\u0026ndash;17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.18 (0.83\u0026ndash;1.68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2259 (28.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.21 (12.8\u0026ndash;15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84 (0.58\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: ***P\u0026thinsp;\u0026le;\u0026thinsp;0.001; **P\u0026thinsp;\u0026le;\u0026thinsp;0.01; *P\u0026thinsp;\u0026le;\u0026thinsp;0.05; Ref\u0026thinsp;=\u0026thinsp;Reference category; AOR\u0026thinsp;=\u0026thinsp;Adjusted Odds Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\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\u003eCharacteristics of explanatory variables and prevalence of loneliness by gender and country (n\u0026thinsp;=\u0026thinsp;7903)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"10\" nameend=\"c14\" namest=\"c5\"\u003e \u003cp\u003eLoneliness (prevalence)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eAfghanistan\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003ePakistan\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePoor mental health factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eNo close friends\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e617 (7.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.9 (19.6\u0026ndash;26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.038*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7286 (92.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.0 (13.3\u0026ndash;14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e93.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e90.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e91.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e92.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eAnxiety\u0026ndash;induced sleep disturbance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e755 (9.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.3 (48.7\u0026ndash;55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7148 (90.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.8 (10.0\u0026ndash;11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e92.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e96.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e92.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eSuicidal ideation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e574 (7.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.7 (30.8\u0026ndash;38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7329 (92.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.2 (12.4\u0026ndash;14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e92.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e92.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e85.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e95.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e93.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eSuicide plan\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e597 (7.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.0 (29.2\u0026ndash;36.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7306 (92.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.2 (12.5\u0026ndash;14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e92.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e87.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e94.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e93.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial\u0026ndash;environmental factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eBullied in past month\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2731 (34.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.9 (21.3\u0026ndash;24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e39.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e19.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e42.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5172 (65.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.4 (9.6\u0026ndash;11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e72.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e60.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e80.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e57.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003ePhysically attacked in past year\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3120 (39.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.1 (15.8\u0026ndash;18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e28.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e54.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e34.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4783 (60.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.2 (12.2\u0026ndash;14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e63.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e71.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e45.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e65.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eIn physical fight in past year\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2443 (30.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3 (16.8\u0026ndash;19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e33.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e14.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e40.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5460 (69.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.1 (12.2\u0026ndash;14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e82.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e59.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e66.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e85.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e59.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003ePassive smoking in past week\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3627 (45.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.3 (16.0\u0026ndash;18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e47.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e32.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e53.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4276 (54.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.6 (11.6\u0026ndash;13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e52.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e67.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e46.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eSchool truancy (past month)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5844 (73.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.6 (14.7\u0026ndash;16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e79.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e69.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e84.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e64.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e75.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2059 (26.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.2 (10.8\u0026ndash;13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e35.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e24.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth risk behaviors factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eCurrent smoking\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e514 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.7 (15.4\u0026ndash;22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7389 (93.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.5 (13.7\u0026ndash;15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e98.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e89.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e95.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e92.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e93.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eCurrent tobacco use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e461 (5.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.9 (15.4\u0026ndash;22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7442 (94.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.5 (13.7\u0026ndash;15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e98.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e90.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e97.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e93.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e93.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003ePhysical inactivity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1883 (23.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.5 (10.1\u0026ndash;13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e49.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e12.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6020 (76.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.7 (14.8\u0026ndash;16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e78.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e87.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e50.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e87.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eLeisure time sedentary behavior (\u0026ge;\u0026thinsp;3 hours/day)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e934 (11.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.8 (20.1\u0026ndash;25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.035*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e22.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e13.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6969 (88.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.6 (12.8\u0026ndash;14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e88.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e77.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e86.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e92.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eFast food consumption (\u0026ge;\u0026thinsp;2 days/week)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1750 (22.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.1 (14.4\u0026ndash;17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e33.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e41.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6153 (77.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.3 (13.5\u0026ndash;15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e75.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e79.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e66.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e58.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e93.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eSoft drink consumption (\u0026ge;\u0026thinsp;3 drinks/day)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e517 (6.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.4 (14.2\u0026ndash;21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7386 (93.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.5 (13.7\u0026ndash;15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e92.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e87.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e97.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eInadequate fruit intake\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1026 (12.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.7 (13.5\u0026ndash;18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e19.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6877 (87.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.6 (13.8\u0026ndash;15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e89.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e85.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e88.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e96.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e80.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eInadequate vegetable intake\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e953 (12.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.5 (12.3\u0026ndash;16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e20.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6950 (87.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.8 (14.0\u0026ndash;15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e93.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e83.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e91.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e99.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e79.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eNote: ***P\u0026thinsp;\u0026le;\u0026thinsp;0.001; **P\u0026thinsp;\u0026le;\u0026thinsp;0.01; *P\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\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\u003eAssociations between loneliness and explanatory variables among boys and girls in three South Asian countries.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirls (n\u0026thinsp;=\u0026thinsp;3326)\u003c/p\u003e \u003cp\u003eAOR (95% CI)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBoys (n\u0026thinsp;=\u0026thinsp;4577)\u003c/p\u003e \u003cp\u003eAOR (95% CI)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBoth Sex (n\u0026thinsp;=\u0026thinsp;7903)\u003c/p\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePoor mental health factors\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo close friends (Yes)\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.63 (1.06\u0026ndash;2.50)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.60 (1.55\u0026ndash;4.34)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.03 (1.37\u0026ndash;3.00)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u0026ndash;induced sleep disturbance (Yes)\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.11 (4.09\u0026ndash;9.11)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.64 (5.90\u0026ndash;12.66)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.47 (5.54\u0026ndash;10.07)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicidal ideation (Yes)\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.60 (1.56\u0026ndash;4.35)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.18 (1.80\u0026ndash;5.64)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.93 (1.93\u0026ndash;4.47)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicide plan (Yes)\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.66 (1.82\u0026ndash;3.89)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.55 (1.48\u0026ndash;4.40)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.57 (1.69\u0026ndash;3.91)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial\u0026ndash;environmental factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBullied in past month (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.94 (1.43\u0026ndash;2.63)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.24 (2.03\u0026ndash;5.18)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.75 (1.98\u0026ndash;3.82)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysically attacked in past year (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.82 (1.32\u0026ndash;2.51)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.70 (1.06\u0026ndash;2.73)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.73 (1.25\u0026ndash;2.40)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn physical fight in past year (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.08 (0.82\u0026ndash;1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.53 (1.77\u0026ndash;3.62)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.01 (1.51\u0026ndash;2.67)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePassive smoking in past week (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.92 (1.42\u0026ndash;2.58)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.29 (0.83\u0026ndash;2.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.47 (1.03\u0026ndash;2.09)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool truancy (past month) (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.28 (0.93\u0026ndash;1.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.02 (0.67\u0026ndash;1.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.11 (0.79\u0026ndash;1.56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth risk behaviors factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoking (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.67 (1.23\u0026ndash;17.76)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.71 (0.76\u0026ndash;3.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.87 (0.87\u0026ndash;4.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent tobacco use (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.65 (1.32\u0026ndash;16.39)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.57 (1.71\u0026ndash;7.45)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.58 (1.73\u0026ndash;7.38)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical inactivity (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.91 (0.63\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.29 (0.80\u0026ndash;2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.12 (0.79\u0026ndash;1.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeisure time sedentary behavior/day (\u0026ge;\u0026thinsp;3 hours/day) (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.05 (1.47\u0026ndash;2.85)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.20 (0.73\u0026ndash;1.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.45 (1.00\u0026ndash;2.11)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFast food consumption (\u0026ge;\u0026thinsp;2 days/week) (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.15 (0.84\u0026ndash;1.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.61 (0.91\u0026ndash;2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.43 (0.91\u0026ndash;2.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft drink consumption (\u0026ge;\u0026thinsp;3 drinks/day) (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.99 (0.56\u0026ndash;1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.70 (0.90\u0026ndash;3.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.49 (0.90\u0026ndash;2.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate fruit intake (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.72\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.26 (0.67\u0026ndash;2.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.15 (0.75\u0026ndash;1.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate vegetable intake (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.88 (0.68\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.14 (0.69\u0026ndash;1.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05 (0.75\u0026ndash;1.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: ***P\u0026thinsp;\u0026le;\u0026thinsp;0.001; **P\u0026thinsp;\u0026le;\u0026thinsp;0.01; *P\u0026thinsp;\u0026le;\u0026thinsp;0.05; AOR\u0026thinsp;=\u0026thinsp;Adjusted Odds Ratio; CI\u0026thinsp;=\u0026thinsp;Confidence Interval; \u0026yen; indicates the reference category is No.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e+\u003c/sup\u003eEach outcome is entered in a separate model controlling for age, country, hunger, peer support \u0026amp; parental support.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCountry\u0026ndash;wise associations between loneliness and explanatory variables among adolescents in three South Asian countries.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfghanistan\u003c/p\u003e \u003cp\u003eAOR (95% CI)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003cp\u003eAOR (95% CI)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePakistan\u003c/p\u003e \u003cp\u003eAOR (95% CI)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePoor mental health factors\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo close friends (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.53\u0026ndash;1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.28 (1.26\u0026ndash;4.13)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.24 (1.37\u0026ndash;3.67)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u0026ndash;induced sleep disturbance (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.84 (2.80\u0026ndash;5.25)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.71 (4.16\u0026ndash;14.27)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.04 (5.36\u0026ndash;12.07)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicidal ideation (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.91 (2.02\u0026ndash;4.18)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.38 (1.57\u0026ndash;7.27)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.46 (1.65\u0026ndash;3.65)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicide plan (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.53 (1.61\u0026ndash;3.99)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.47 (1.17\u0026ndash;5.22)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.74 (1.85\u0026ndash;4.03)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial\u0026ndash;environmental factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBullied in past month (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.95 (2.20\u0026ndash;3.95)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.03 (1.73\u0026ndash;5.30)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.01 (1.56\u0026ndash;2.61)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysically attacked in past year (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.02 (1.40\u0026ndash;2.94)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.64 (0.91\u0026ndash;2.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.59 (1.24\u0026ndash;2.03)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn physical fight in past year (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.34 (1.11\u0026ndash;1.61)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.52 (1.62\u0026ndash;3.91)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.43 (1.05\u0026ndash;1.95)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePassive smoking in past week (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.60 (1.14\u0026ndash;2.24)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.40 (0.79\u0026ndash;2.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.64 (1.33\u0026ndash;2.03)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool truancy (past month) (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.67 (0.38\u0026ndash;1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.09 (0.63\u0026ndash;1.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05 (0.85\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth risk behaviors factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoking (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.68 (0.72\u0026ndash;3.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.56 (0.46\u0026ndash;5.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.84 (1.76\u0026ndash;4.60)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent tobacco use (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.15 (0.57\u0026ndash;8.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.61 (1.94\u0026ndash;16.22)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.62 (1.63\u0026ndash;4.24)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical inactivity (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.07 (1.18\u0026ndash;3.62)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.06 (0.66\u0026ndash;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.55 (0.99\u0026ndash;2.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeisure time sedentary behavior (\u0026ge;\u0026thinsp;3 hours/day) (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.86 (0.53\u0026ndash;1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.34 (0.73\u0026ndash;2.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.03 (1.49\u0026ndash;2.78)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFast food consumption (\u0026ge;\u0026thinsp;2 days/week) (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.91 (0.64\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.59 (0.86\u0026ndash;2.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.46 (0.95\u0026ndash;2.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft drink consumption (\u0026ge;\u0026thinsp;3 drinks/day) (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.08 (0.61\u0026ndash;1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.52 (0.84\u0026ndash;2.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.42 (0.77\u0026ndash;2.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate fruit intake (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.42 (0.82\u0026ndash;2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.98 (0.88\u0026ndash;4.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.86 (0.64\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate vegetable intake (Yes) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.57 (0.94\u0026ndash;2.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.17 (0.44\u0026ndash;10.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.91 (0.70\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: ***P\u0026thinsp;\u0026le;\u0026thinsp;0.001; **P\u0026thinsp;\u0026le;\u0026thinsp;0.01; *P\u0026thinsp;\u0026le;\u0026thinsp;0.05; AOR\u0026thinsp;=\u0026thinsp;Adjusted Odds Ratio; CI\u0026thinsp;=\u0026thinsp;Confidence Interval; \u0026yen; indicates the reference category is No.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e+\u003c/sup\u003eEach outcome is entered in a separate model controlling for age, country, hunger, peer support \u0026amp; parental support.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Ethical consideration\u003c/h2\u003e \u003cp\u003e The World Health Organization\u0026acute;s Ethical Committee, along with respective governmental departments or ministries, granted the ethical approval of the study. In addition, the datasets were made freely available for future uses. Informed consent was taken from the respondents at the time of the survey as well as consent as taken fron the students\u0026rsquo; parent or legal guardian [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Participation in the survey was voluntary.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Characteristics of the respondents and prevalence of loneliness\u003c/h2\u003e \u003cp\u003eAmong the 7903 respondents, 58% were male, 68% were aged 14 to 15 years, and half were Pakistani adolescents (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). One-tenth of the respondents always felt hungry due to the lack of food in the households, and half (48%) had low parental support. About 8% of respondents did not have a close friend, 9.5% had anxiety-induced sleep disturbance, and 7.5 had suicide plan. In addition, 34.5% of respondents experienced bullying in the past 30 days, 39.4% experienced physical attacks in the past 12 months, and 6.5% were current smokers (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, 15% of adolescent respondents had loneliness. Respondents feeling mostly/always hungry had 21% higher odds of loneliness than those without hunger, but this relationship was not statistically significant. In addition, respondents aged 16 or over had 2.09 times higher odds of loneliness than those aged 13 or less, and this relationship was statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The prevalence of loneliness was 52.3% among the respondents with anxiety-induced sleep disturbance, 34.7% among the respondents had suicide ideation, and 23% among the respondents who had no clone friends, remained hungry always or mostly, spent\u0026thinsp;\u0026ge;\u0026thinsp;3 hours per day leisure time (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Gender and spatial variations of loneliness\u003c/h2\u003e \u003cp\u003eOverall, male respondents had 5% [AOR\u0026thinsp;=\u0026thinsp;0.95; 95% CI: 0.73\u0026ndash;1.23] lower odds of loneliness than their female counterparts; however, this relationship was not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among the female respondents, the prevalence of loneliness was 80% who were school truant, 36% who physically attacked in the past year, 28% who experienced bullying in the past months, 26.5% who were physically inactive, and 17% who experienced physical fights in the past year (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). On the contrary, the highest prevalence of loneliness among the male respondents was 70% who had school truancy in the past month, followed by those who experienced passive smoking (58%), physical attacks (41%), physical fights (41%), and bullying (39.5%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of loneliness among Afghan adolescents was highest (34.8%), followed by Pakistani (11.4%) and Bangladeshi adolescents (8.4%). The topmost prevalence of loneliness was found among the school truant respondents in all three countries: Afghanistan (84.9%), Bangladesh (64.55%), and Pakistan (75.8%). In Afghanistan, the prevalence of loneliness was 39% among the respondents who experienced bullying in the past month, 33.7% who ate fast food (\u0026ge;\u0026thinsp;2 days/week), and 33% who participated in physical fights in the past year. In Bangladesh, the prevalence of loneliness was high among the respondents who were physically attacked in the past year (54%), physically inactive (50%), bullied in the past month (42%), and consumed fast food\u0026thinsp;\u0026ge;\u0026thinsp;2 days a week (41%). In Pakistan, in-school adolescent respondents who were bullied, involved in physical fights, and experienced physical attacks had a higher prevalence rate of loneliness. 42%, 40%, and 34.5%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Gender differences in the associations of loneliness with explanatory variables\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e represents the adjusted odds ratio of logistic regressions, which examined the association between lionesses and explanatory variables after controlling for age, country, hunger, peer support, and parental support variables. For both sexes, respondents having anxiety-induced sleep disturbance [AOR\u0026thinsp;=\u0026thinsp;7.47; 95% CI: 5.54\u0026ndash;10.07], current tobacco users [AOR\u0026thinsp;=\u0026thinsp;3.58; 95% CI: 1.73\u0026ndash;7.38], having suicidal ideation [AOR\u0026thinsp;=\u0026thinsp;2.93; 95% CI: 1.93\u0026ndash;4.47], and having suicide plan [AOR\u0026thinsp;=\u0026thinsp;2.57; 95% CI: 1.69\u0026ndash;3.91] had statistically significant higher odds of loneliness than their counterparts.\u003c/p\u003e \u003cp\u003eAmong the female respondents, adolescents having anxiety-induced sleep disturbance [AOR\u0026thinsp;=\u0026thinsp;6.11; 95% CI: 4.09\u0026ndash;9.11], current smokers user [AOR\u0026thinsp;=\u0026thinsp;4.67; 95% CI: 1.23\u0026ndash;17.76], current tobacco users [AOR\u0026thinsp;=\u0026thinsp;4.65; 95% CI: 1.32\u0026ndash;16.39], having suicidal plan [AOR\u0026thinsp;=\u0026thinsp;2.66; 95% CI: 1.82\u0026ndash;3.89], and having suicide ideation [AOR\u0026thinsp;=\u0026thinsp;2.60; 95% CI: 1.56\u0026ndash;4.35] had statistically significant higher odds of loneliness than their counterparts. Similarly, among the male respondents, adolescents having anxiety-induced sleep disturbance [AOR\u0026thinsp;=\u0026thinsp;8.64; 95% CI: 5.90\u0026ndash;12.66], current tobacco users [AOR\u0026thinsp;=\u0026thinsp;3.57; 95% CI: 1.71\u0026ndash;7.45], having suicidal ideation [AOR\u0026thinsp;=\u0026thinsp;3.18; 95% CI: 1.80\u0026ndash;5.64], and having suicide plan [AOR\u0026thinsp;=\u0026thinsp;2.55; 95% CI: 1.48\u0026ndash;4.40] had statistically significantly greater odds of loneliness than their counterparts (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Spatial differences in the associations of loneliness with explanatory variables\u003c/h2\u003e \u003cp\u003eIn Afghanistan, several poor mental health factors, such as anxiety-induced sleep disturbance [AOR\u0026thinsp;=\u0026thinsp;3.84; 95% CI: 2.80\u0026ndash;5.25], bullied in the past month [AOR\u0026thinsp;=\u0026thinsp;2.95; 95% CI: 2.20\u0026ndash;3.95], suicidal ideation [AOR\u0026thinsp;=\u0026thinsp;2.91; 95% CI: 2.02\u0026ndash;4.18], and suicide plan [AOR\u0026thinsp;=\u0026thinsp;2.53; 95% CI: 1.61\u0026ndash;3.99] had significantly increased the odds of loneliness among the in-school adolescents than their counterparts. These three factors were also significantly associated with the loneliness of the respondents in Bangladesh and Pakistan (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In addition, current tobacco use health behavior was also significantly associated with the loneliness of the respondents in Bangladesh [AOR\u0026thinsp;=\u0026thinsp;5.61; 95% CI: 1.94\u0026ndash;16.22] and Pakistan [AOR\u0026thinsp;=\u0026thinsp;2.62; 95% CI: 1.63\u0026ndash;4.24]. Moreover, respondents with no close friends had significantly higher odds of loneliness than their counterparts in Bangladesh [AOR\u0026thinsp;=\u0026thinsp;2.28; 95% CI: 1.26\u0026ndash;4.13] and Pakistan [AOR\u0026thinsp;=\u0026thinsp;2.24; 95% CI: 1.37\u0026ndash;3.67]. Leisure time sedentary behavior (\u0026ge;\u0026thinsp;34 hours/day) was also significantly associated [AOR\u0026thinsp;=\u0026thinsp;2.03; 95% CI: 1.49 \u0026minus;\u0026thinsp;2.78] with the risk of loneliness among Pakistani adolescents (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eTo our knowledge, this is the first study that investigated gender-stratified adolescent loneliness in these three South Asian countries and explored the associated risk factors. Our analysis showed that the overall prevalence of adolescent loneliness was 14.7%. The prevalence of loneliness among girls (18.1%) was higher than that of boys (12.3%). The highest prevalence of adolescent loneliness was found in Afghanistan (34.8%), followed by Pakistan (11.4%) and Bangladesh (8.4%). However, the overall prevalence reported in this study was higher than in Southeast Asian countries in 2007 and 2013 using the GSHS data (7.8%) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] but lower than in four Caribbean countries in 2016-17 (15.3%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Nigeria in 2017 (25.8%) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], Tanzania in 2017 (17.4%) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], Ghana in 2012 (18.1%) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], Morocco in 2016 (19.8%) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], and 25 countries in the Americas in 2018 (18.1%) [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfghanistan has experienced armed conflict, social injustice, widespread poverty, broken education and health care management as well as disrupted community networks [\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Therefore, several crucial factors such as long periods of conflict, impoverishment, disrupted family relations, the experience of different forms of violence, weakened social support, and disrupted social orders are the reasons for the greater prevalence of loneliness in Afghanistan [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. For example, among 300 children from Kabul, 90% reported that they could die due to war, and 80% marked themselves as frightened, sad, and incapable of coping with life [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Consequently, children are more vulnerable to trauma due to the violence resulting in short and long-term mental consequences [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. In addition to violence, Afghan children and adolescents face multiple forms of violations of rights, such as corporal punishment, forced marriage, and hazardous working conditions [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn line with previous studies, the findings showed that adolescent girls had a higher likelihood of loneliness than boys [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. For example, adolescent girls reported higher perceived loneliness than boys in the USA (14.7% vs. 6.7%), Russia (14.4% vs. 8.9%) using the Social and Health Assessment (SAHA) data in 2003 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], Tanzania using 2017 GSHS data (51% vs. 49%) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], four Caribbean countries using 2016\u0026ndash;17 GSHS data (50% vs. 49%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and six countries in Southeast Asia using 2013-17 GSHS data [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. It may happen due to differences in girls coping strategies to face stressors compared to boys, which makes girls more vulnerable to loneliness [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Although a small number of cross-sectional studies, such as in Myanmar [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Morocco [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], reported that the prevalence of loneliness was higher among boys, while many pieces of literature admitted girls are more vulnerable to loneliness using the same GSHS data [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], which has also been found among adolescent girls in three South Asian countries in our study.\u003c/p\u003e \u003cp\u003eIn agreement with previous studies, our study found that several poor mental health factors: anxiety-induced sleep disturbance, suicidal ideation, making suicide plan, and having no close friends were strongly associated with adolescent loneliness [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Having close friends is a vital protective factor in fighting against adolescent loneliness, revealing the essence of close friends for social support and interaction [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, anxiety-generating thoughts, which hampers relaxation and sleep quality, are closely related to loneliness [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Similarly, several cross-sectional studies using the GSHS data reported suicidal ideation or behavior as a risk factor for adolescent loneliness and depressive symptoms [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Although depression and loneliness are separate concepts, they may happen together and even be reciprocal [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral socio-environmental factors, such as bullying, physical fighting, physical attack, frequent exposure to passive smoking, and hunger, were associated with adolescent loneliness. These findings were similar to previous studies conducted in ASEAN countries, Morocco, Caribbean countries, Spain, and the UK [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Adolescents with interpersonal victimization experience may worry about further victimization, which influences poor friendship formation, leading to loneliness [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Moreover, adolescents with bullying experiences possess poorer self-esteem, resulting in loneliness [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Finally, a study using nationally representative data on Kuwaiti school adolescents reported that physically fighting with fellow students was more likely to be rejected by peers; this might make adolescents isolated and lonely [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Therefore, adolescents who experience victimization have an increased risk of avoidance and revenge, and a greater risk of loneliness (Le\u0026oacute;n-Moreno et al., 2021).\u003c/p\u003e \u003cp\u003eSimilar to previous studies, our analysis showed that health risk behavior factors, such as current smoking, tobacco use, leisure time sedentary behaviors, and physical inactivity increased the likelihood of loneliness among adolescents [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. For example, adolescents with tobacco use/smoking are seen as anti-social by society, and addicted adolescents are more likely to be isolated and rejected by their fellow, leading to loneliness [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Moreover, loneliness is a part of depression, and previous studies stated that sedentary behavior might result in depressive mode [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. In addition, adolescents with sedentary behaviors were more likely to use and become addicted to social media, possibly resulting in social isolation [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study had a few limitations. First, as the study was cross-sectional, it was impossible to make any causal association between adolescent loneliness trajectories and predictor variables. Second, the study's respondents were only in-school adolescents, which limited us to generalize the results to out-of-school adolescents. Third, the survey followed a self-reporting data collection design; it may lead to over-reporting or under-reporting. Fourth, in the GSHS survey, a single-item question was asked to measure the status of loneliness, not including help-seeking behaviors for loneliness. Loneliness measurement with multi-item would offer more reliable findings. Moreover, perceived loneliness may vary for adolescents with help-seeking behaviors compared to those without previous or ongoing help-seeking behavior. Therefore, future studies (i.e., longitudinal studies) should consider help-seeking behavior and a multi-item measurement of adolescent loneliness.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe study found that almost one in six girls and one in nine boys reported loneliness in the three South Asian countries: Afghanistan, Bangladesh, and Pakistan. Over one-third of the lonely in-school adolescents were in Afghanistan, followed by Pakistan and Bangladesh. The study also found several risk factors, such as having no close friends, anxiety-induced sleep disturbance, suicidal ideation, suicidal plan, bullying victimization, physically attacked, physical fighting, household food insecurity, passive smoking experience, and current tobacco use smoking, leisure time sedentary behavior, were significantly associated with adolescent loneliness. By identifying these risk factors, the study would help to make interventions and initiatives for reducing loneliness among in-school adolescents in South Asian low-income countries to meet the targets of 3.4 of the Sustainable Developmental Goals (mental health and well-being). Such interventions may include promoting peer and parental support, social skills, social support programs, and providing counseling support units in schools.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCRediT Author Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMd. Khalid Hasan:\u003c/strong\u003e Conceptualization, Methodology, Investigation, Formal Analysis, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing, Supervision. \u003cstrong\u003eHelal Uddin:\u003c/strong\u003e Conceptualization, Methodology, Investigation, Formal Analysis, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing. \u003cstrong\u003eTahmina Bintay Younos:\u003c/strong\u003e Conceptualization, Methodology, Formal Analysis, Writing \u0026ndash; Review \u0026amp; Editing. \u003cstrong\u003eNur A Habiba Mukta\u003c/strong\u003e: Conceptualization, Methodology, Formal Analysis, Writing \u0026ndash; Review \u0026amp; Editing. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData associated with this study has been deposited at WHO and can be downloaded from https://extranet.who.int/ncdsmicrodata/index.php/catalog/GSHS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the survey was granted by the World Health Organization\u0026apos;s Ethical Committee. In addition, the GSHS surveys were authorized in each country by their respective national government administration and institutional review board. The data sets are freely downloaded from https://extranet.who.int/ncdsmicrodata/index.php/catalog/GSHS.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAsghar A. Loneliness Matters: A Theoretical Review of Prevalence in Adulthood. J Psychol Behav Sci. 2019;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeinrich LM, Gullone E. The clinical significance of loneliness: A literature review. Clin Psychol Rev. 2006;26:695\u0026ndash;718.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawkley LC, Cacioppo JT. Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms. Ann Behav Med. 2010;40:218\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacEvoy J, Weeks M, Asher S, Loneliness. 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World Psychiatry. 2019;18:119\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adolescent, Loneliness, Gender difference, Spatial variation, Afghanistan, Bangladesh, Pakistan","lastPublishedDoi":"10.21203/rs.3.rs-3853530/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3853530/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study aimed to explore the gender and spatial variation of loneliness and identify its correlates among in-school adolescents in three South Asian countries.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe used Afghanistan, Bangladesh, and Pakistan's latest Global School-based Student Health Survey (GSHS) datasets. A total of 8089 adolescent data were analyzed using multiple logistic regression models after controlling socio-demographic variables. We used STATA 14 to perform the analyses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe prevalence of loneliness among male respondents was 12.28 [95% CI: 11.3\u0026ndash;13.3] and 18.1 [95% CI: 16.8\u0026ndash;19.5] in females. Afghan adolescents' prevalence of loneliness was the height (34.8%), followed by Pakistani (11.4%) and Bangladeshi adolescents (8.4%). For both genders (male and female), loneliness was higher among the adolescents who were school truants, bullied, involved in physical fights, and experienced physical attacks. In addition, both male and female adolescents with anxiety-induced sleep disturbance, current tobacco users, and suicidal ideation had significantly higher odds of loneliness than their counterparts. Moreover, several poor mental health conditions, such as anxiety-induced sleep disturbance, bullying, suicidal ideation, and suicide plan, were significantly associated with higher odds of loneliness among in-school adolescents in Afghanistan, Bangladesh, and Pakistan. Besides, respondents involved in physical fights were more likely to be lonely.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe explored the gender and spatial variation of loneliness among adolescents in three South Asian countries and found several similarities and differences in prevalence and correlates of loneliness between various sub-groups. Gender-sensitive and spatial target-oriented policies and interventions should be developed and implemented urgently to reduce the prevalence of adolescent loneliness in these three countries. More studies are also recommended to explore the relationship between loneliness and socio-economic, environmental, and health-behavioral factors among adolescents in these countries.\u003c/p\u003e","manuscriptTitle":"Gender and spatial variation of loneliness among adolescents in three South Asia countries: Prevalence and its correlates","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-22 14:58:28","doi":"10.21203/rs.3.rs-3853530/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-15T18:42:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-15T06:42:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-28T08:58:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-22T22:09:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-22T04:04:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-20T10:22:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"298767051666505138677923247541650952987","date":"2024-06-20T07:28:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310759684367023325309973034870739389770","date":"2024-06-18T00:43:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318634019714022376236996079002744252852","date":"2024-06-17T12:04:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1976333611574286650049655423550175397","date":"2024-06-17T03:07:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59996738379444922246319110396719609182","date":"2024-06-16T22:06:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172203195924754208631105363295985137377","date":"2024-06-16T16:14:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241319573800486247614786145415259551093","date":"2024-06-05T22:06:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126162274266070347348673523788350510425","date":"2024-05-23T14:03:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"196102624833377540168484153674777890942","date":"2024-05-22T04:07:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-22T03:31:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-02T07:03:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-01-19T11:30:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-19T11:06:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-01-11T12:59:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"810a7034-07ca-4027-840f-73b27731cb21","owner":[],"postedDate":"January 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T16:07:26+00:00","versionOfRecord":{"articleIdentity":"rs-3853530","link":"https://doi.org/10.1186/s12889-025-26069-7","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-01-27 15:58:41","publishedOnDateReadable":"January 27th, 2026"},"versionCreatedAt":"2024-01-22 14:58:28","video":"","vorDoi":"10.1186/s12889-025-26069-7","vorDoiUrl":"https://doi.org/10.1186/s12889-025-26069-7","workflowStages":[]},"version":"v1","identity":"rs-3853530","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3853530","identity":"rs-3853530","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}