Adolescents who experience more frequent back pain may be more likely to smoke and drink alcohol and report feelings of anxiety and depression, according to a study published in the Journal of Public Health.

To evaluate the relationship between back pain and health risks in adolescents (mean age, 14 to 15), researchers used cross-sectional data from the Healthy Schools Healthy Futures study (n=2075) and the Australian Child Wellbeing Project (n=3608). Adolescents were grouped according to self-reported back pain frequency.

Back pain was reported to be experienced rarely/never by 51.9 % and 66.7% of participants from the Australian Child Wellbeing Project and the Healthy Schools Healthy Futures studies, respectively, and was reported as occurring daily by 6.5% and 7.7% of participants, respectively.

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The percentage of participants reporting smoking, drinking, and missing school was found to increase with the frequency of back pain in both cohorts, as indicated by test-for-trend analyses. Of participants in the Healthy Schools Healthy Futures study with daily back pain, 90% and 89.4% had symptoms of depression and anxiety, respectively, and 20.8% and 21.3% reported smoking and drinking, respectively. Percentages were reduced in this cohort in participants with rare/never back pain: smoking (9.3%; P <.01), drinking (12.6%; P =.01), depression (78.1%; P <.01), and anxiety (86.5%; P <.01).

Study limitations include the inability to generalize findings to a global population as both samples were from a single country.

 “[T]is study suggests that consideration of behavioral health risks and mental health should be incorporated into research aimed at understanding the pathology of [musculoskeletal pain] in adolescents,” concluded the study authors.

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Kamper SJ, et al. Back pain, mental health and substance use are associated in adolescents. [published online September 10, 2018] Journal of Public Health. doi:10.1093/pubmed/fdy129