ArticleFrontiers in public health2026
Improper sitting posture mediates the association between single-shoulder backpack carrying and back pain in adolescents: a cross-sectional and longitudinal analysis.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The association between single-shoulder backpack carrying and back pain in adolescents remains unclear. This study investigated whether the degree of improper sitting posture mediates the relationship between single-shoulder backpack carrying and back pain in both cross-sectional and longitudinal analyses. Methods: This study collected data from a school-based sample covering nine provinces in China from 2021 to 2025. Back pain and backpack carrying mode were assessed through self-reporting. Improper sitting posture was scored using a three-item scale endorsed by the Chinese Ministry of Education. A cross-sectional analysis was conducted on 3,420 participants, and a longitudinal analysis was conducted on 2,423 participants. Multivariate logistic regression and Cox proportional hazards models were used to evaluate the associations between single-shoulder backpack carrying, improper sitting posture, and back pain. Mediation analysis was used to assess the mediating role of improper sitting posture in the association between single-shoulder backpack carriage and back pain. Subgroup analyses were conducted to evaluate effect modification across prespecified subgroups. Statistical significance was set at Results: In the cross-sectional analysis, single-shoulder backpack carrying (OR = 1.402, 95%CI: 1.128-1.742, Conclusion: Single-shoulder backpack and improper sitting posture were significantly and positively associated with back pain, and improper sitting posture partially mediated the association between single-shoulder backpack carrying and back pain. These results suggest that modifying backpack carrying mode and improving improper sitting posture may be associated with a lower likelihood of back pain in adolescents.
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