ObjectivesThe objectives are to explore the relationship between study stress and anxiety in high school students and the mediating role of physical activity and mobile phone addiction.DesignA cross-sectional study.Setting129 high schools were randomly selected in 13 cities of Jiangsu province, China.ParticipantsHigh school students aged 16–19 years, age and gender balance. A total of 40 000 questionnaires were distributed, with 32 974 effectively recovered.Primary and secondary outcome measuresQuestionnaires were administered offline, covering four parts: General Demographics, Learning Stress Scale, International Physical Activity Questionnaire, Mobile Phone Addiction Scale and Generalized Anxiety Scale-7. Data analysis included path analysis and correlation analysis, along with descriptive statistics, independent sample t-test, correlation analysis and structural equation model.ResultsIn this study, the proportions of anxiety, high academic pressure, low physical activity level and high mobile phone addiction were 58.18%, 46.48%, 36.40% and 39.26%, respectively. Study stress was positively correlated with anxiety (r=0.130, p<0.01) and mobile phone addiction (r=0.049, p<0.01). Physical activity was negatively correlated with learning stress (r=−0.352, p<0.01), anxiety (r=−0.105, p<0.01) and mobile phone addiction (r=−0.040, p<0.01). The findings were tested by mediating effect analysis that the indirect effect size value of the path ‘learning stress → physical activity level → anxiety path’ was 0.461, 95% CI of Bootstrap (0.367, 0.554), the mediating effect was significant. The indirect effect size value of the path ‘learning stress → mobile phone addiction → anxiety’ was 0.072, 95% CI of Bootstrap (0.042, 0.102), and the mediating effect was significant. The indirect effect size value of the path ‘learning stress → physical activity level → mobile phone addiction → anxiety’ was 0.072, and the 95% CI of Bootstrap (0.226, 0.400), and the mediating effect was significant.ConclusionsHigh school students’ learning stress can significantly positively predict anxiety levels. High school students learning stress indirectly predicts anxiety through the independent mediating effect of physical activity and mobile phone addiction, as well as the chain mediating effect of physical activity and mobile phone addiction.
