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Original Articles
Behavioral and psychosocial factors associated with sugar-sweetened beverage consumption among Korean adolescents: a path analysis using the 2022 Korea Youth Risk Behavior Survey
Hye-Young Park, Soo Rack Ryu, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park
Epidemiol Health. 2025;47:e2025047.   Published online August 21, 2025
DOI: https://doi.org/10.4178/epih.e2025047
  • 4,531 View
  • 101 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Rising obesity rates among adolescents are a major global health concern and are closely linked to the consumption of sugar-sweetened beverages (SSBs). This study aimed to identify key behavioral and psychosocial factors influencing SSB consumption among adolescents.
METHODS
This cross-sectional study analyzed data from the 2022 Korea Youth Risk Behavior Survey, which included 49,548 participants aged 12-18 years. Information on SSB consumption frequency, socio-demographic characteristics, eating habits, sedentary behaviors, and other health-related factors was collected through self-administered questionnaires. Path analysis was used to model SSB consumption and estimate the direct and indirect effects of modifiable factors.
RESULTS
Male students, current alcohol drinkers, those with higher frequencies of fast-food or late-night snack consumption, and heavy smartphone users were more likely to frequently consume SSBs. Fast-food intake had the strongest direct effect on SSB consumption (B=0.3884), while nighttime eating showed a substantial direct effect (B=0.1437) and mediated 21.7% of the relationship between fast-food intake and SSB consumption. Leisure sitting time exerted both direct (B=0.0741) and indirect effects on SSB intake, mediated through watching mukbang, smartphone use, fast-food consumption, and nighttime eating. Self-perceived health status was negatively associated with SSB consumption (B=-0.0619), with indirect effects mediated by fast-food intake and nighttime eating.
CONCLUSIONS
Among Korean adolescents, SSB consumption was strongly associated with unhealthy eating patterns and prolonged leisure sitting time. Increased fast-food consumption, nighttime eating, watching mukbang, smartphone use, and negative self-perceived health status not only directly influenced SSB intake, but also acted as mediating factors.
Summary
Korean summary
바람직하지 않은 식습관과 과도한 스마트폰 사용은 한국 청소년의 당음료 섭취와 밀접한 관련이 있습니다. 특히 패스트푸드와 야식은 주요한 매개 요인으로 작용하여, 이러한 행동을 줄이면 당음료 섭취를 효과적으로 낮출 수 있습니다. 본 연구는 청소년을 위한 맞춤형 공중보건 개입 전략 수립에 근거를 제공합니다.
Key Message
Unhealthy eating behaviors and excessive screen time are strongly linked to sugar-sweetened beverage (SSB) consumption among Korean adolescents. Fast-food intake and nighttime snacking act as major mediators, suggesting that reducing these behaviors could significantly decrease SSB intake. These findings provide evidence to guide targeted public health interventions for adolescents.

Citations

Citations to this article as recorded by  
  • Sugar-sweetened beverage consumption, waist-to-height ratio and psychological symptoms among Chinese adolescents
    Lu Li, Ting Wei, Feng Zhang, Tianyu Zhou
    Scientific Reports.2026;[Epub]     CrossRef
Associations of racial and ethnic discrimination with adverse changes in exercise and screen time during the COVID-19 pandemic in the United States
Tong Xia, Gilbert C. Gee, Jian Li, Xinyue Liu, Jin Dai, Lu Shi, Donglan Zhang, Zhuo Chen, Xuesong Han, Yan Li, Hongmei Li, Ming Wen, Dejun Su, Liwei Chen
Epidemiol Health. 2023;45:e2023013.   Published online January 28, 2023
DOI: https://doi.org/10.4178/epih.e2023013
  • 18,501 View
  • 120 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
During the coronavirus disease 2019 (COVID-19) pandemic, a growing prevalence of racial and ethnic discrimination occurred when many Americans struggled to maintain healthy lifestyles. This study investigated the associations of racial and ethnic discrimination with changes in exercise and screen time during the pandemic in the United States.
METHODS
We included 2,613 adults who self-identified as non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, or Hispanic from the Health, Ethnicity, and Pandemic study, a cross-sectional survey conducted among a nationally representative sample of United States adults between October and November 2020. We assessed self-reported racial and ethnic discrimination by measuring COVID-19-related racial and ethnic bias and examined its associations with changes in exercise and screen time using multivariable logistic regression models. We analyzed data between September 2021 and March 2022.
RESULTS
COVID-19-related racial and ethnic bias was associated with decreased exercise time among non-Hispanic Asian (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.13 to 1.89) and Hispanic people (OR, 1.91; 95% CI, 1.32 to 2.77), and with increased screen time among non-Hispanic Black people (OR, 1.94; 95% CI, 1.33 to 2.85), adjusting for age, sex, education, marital status, annual household income, insurance, and employment status.
CONCLUSIONS
Racial and ethnic discrimination may have adversely influenced exercise and screen time changes among racial and ethnic minorities during the COVID-19 pandemic in the United States. Further studies are needed to investigate the mechanisms through which racial and ethnic discrimination can impact lifestyles and to develop potential strategies to address racial and ethnic discrimination as a barrier to healthy lifestyles.
Summary
Key Message
In this study with a nationally representative sample of Americans, we found that racial discrimination during the COVID-19 pandemic was associated with undesired changes in exercise and screen time, particularly among minorities.

Citations

Citations to this article as recorded by  
  • Addressing Racism and Discrimination in the Design of Physical Activity Interventions for Black Women: Insights and Recommendations From an Academic and Community Partnership
    Rodney P. Joseph, LaTanya Mathis, Iyana Harris, Shawntele M. Howie-Carlson, Kanika Jones, Darlene Little, Dawn Augusta
    Women's Health Issues.2025; 35(5): 301.     CrossRef
  • Asian American Women’s Experiences of Discrimination and Health Behaviors during the COVID-19 Pandemic
    Katarina Wang, Alice Guan, Janice Seto, Debora L. Oh, Kathie Lau, Christine Duffy, Esperanza Castillo, Valerie McGuire, Michelle Wadhwa, Clifford G. Tepper, Heather A. Wakelee, Mindy C. DeRouen, Salma Shariff-Marco, Iona Cheng, Scarlett Lin Gomez
    Journal of Immigrant and Minority Health.2024; 26(2): 421.     CrossRef
  • Facilitators, motivations, and barriers to physical activity among Chinese American women
    Jingxi Sheng, Hao Lei, Demetrius A. Abshire, Horng-Shiuann Wu, Michael D. Wirth, Sue P. Heiney
    Discover Social Science and Health.2024;[Epub]     CrossRef
  • Social Determinants of Cardiovascular Health in Asian Americans: A Scientific Statement From the American Heart Association
    Nilay S. Shah, Namratha R. Kandula, Yvonne Commodore-Mensah, Brittany N. Morey, Shivani A. Patel, Sally Wong, Eugene Yang, Stella Yi
    Circulation.2024;[Epub]     CrossRef
Associations between digital media use and lack of physical exercise among middle-school adolescents in Korea
Gyeongmin Kim, Hyunsuk Jeong, Hyeon Woo Yim
Epidemiol Health. 2023;45:e2023012.   Published online January 10, 2023
DOI: https://doi.org/10.4178/epih.e2023012
  • 22,378 View
  • 309 Download
  • 9 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The reported effects of digital media overuse on physical activity among adolescents are inconsistent. This study examined the association between hours of digital media use and lack of moderate-intensity physical exercise (mPE) according to the type of digital media.
METHODS
This study included 1,837 middle school students from the iCURE (Internet user Cohort for Unbiased Recognition of gaming disorder in Early Adolescence) study conducted in Korea. Hours spent using digital media were measured by self-reported daily usage time for Internet games, messengers, social media, and watching game streaming on weekdays. Lack of mPE was defined as performing a minimum of 30 minutes at a time less than twice weekly. Multivariable logistic regression analysis stratified by sex was performed.
RESULTS
Among male students, the group with the highest hours of using either Internet games or watching game streaming was more likely to lack mPE than each non-user group. In contrast, among male students, the group using either messengers or social media had a higher rate of mPE compared to each non-user group. Female students showed no association between hours spent using Internet games, messengers, social media, or watching game streaming and a lack of mPE.
CONCLUSIONS
Among male middle school students in Korea, the excessive use of Internet games or watching game streaming was associated with a lack of mPE. Thus, guidelines should be established regarding adolescent use of internet games and watching game streaming.
Summary
Korean summary
한국에서 남, 여 중학생을 대상으로 4개 인터넷 매체(인터넷 게임, 메신저, 소셜미디어, 게임 스트리밍 시청) 과다사용과 신체 운동 부재와의 연관성을 알아보기 위한 단면조사 연구를 시행하였다. 남자 중학생에서 인터넷 게임 사용 또는 게임 스트리밍 시청 시간이 가장 높은 사분위 그룹은 비이용 그룹보다 중간 강도의 신체운동 부재율이 유의하게 높았다.
Key Message
A cross-sectional study was conducted to find out the relationship between excessive use of four Internet media (internet games, messengers, social media, and game streaming) and lack of physical exercise targeting male and female middle school students in Korea. Among male middle school students, the upper quartile group with the highest Internet game use or game streaming viewing time had a significantly higher moderate-intensity physical exercise absence rate than the non-use group.

Citations

Citations to this article as recorded by  
  • Religion and Social Media Use: Protective Factors for Youth Well-Being in the Digital Age?
    Laura Upenieks, Terrence D. Hill
    Journal of Psychology and Theology.2026;[Epub]     CrossRef
  • Social Media Addiction and Cognitive Behavioral Physical Activity Among Adolescent Girls: A Cross‐Sectional Study
    Ebru Sönmez Sari, Handan Terzi, Didem Şahin
    Public Health Nursing.2025; 42(1): 61.     CrossRef
  • Delineating temporal dynamics for the linkage between anxiety symptoms and problematic media use among Chinese adolescents
    Hongjian Cao, Shaofan Wang, Nan Zhou, Ming-Chen Zhang
    Journal of Applied Developmental Psychology.2025; 97: 101761.     CrossRef
  • Online Risk Behavior in Adolescents: A Systematic Review
    Lin Wang, Wanyi Wang, Wanyan Fei, Zhiyou Wang
    Trauma, Violence, & Abuse.2025;[Epub]     CrossRef
  • Bridging the urban–rural divide: digital literacy as a catalyst for enhancing physical exercise participation in China
    Wangjie Li, Zhan Chen
    Frontiers in Public Health.2025;[Epub]     CrossRef
  • ‘We wanted to spend more time with each other than with our phones’. Relationship between digital disconnection and physical activity of family members
    Katarzyna Kopecka-Piech
    Cogent Arts & Humanities.2024;[Epub]     CrossRef
  • Cyber Sex Crimes Targeting Children and Adolescents in South Korea: Incidents and Legal Challenges
    Yujin Jang, Youngmeen Suh
    Social Sciences.2024; 13(11): 596.     CrossRef
  • Trends in the effects of socioeconomic position on physical activity levels and sedentary behavior among Korean adolescents
    Hunju Lee, Hyowon Choi, Sang Baek Koh, Hyeon Chang Kim
    Epidemiology and Health.2023; 45: e2023085.     CrossRef
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