Associations of Bubble Tea Consumption with Sleep Disturbance and Anxiety in Adolescents: Findings from the Zhejiang Childhood Behavior and Health Cohort.

Objectives: We aimed to examine the association between bubble tea consumption and anxiety symptoms among adolescents in Eastern China and to explore the potential role of sleep disturbance in the observed association between bubble tea consumption and anxiety symptoms. Methods: This study utilized cross-sectional baseline data from the Zhejiang Childhood Behavior and Health Cohort. Bubble tea consumption frequency was categorized as 0, 1-2, and ≥3 days per week. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, while sleep disturbance was measured through self-reported items. Associations between bubble tea consumption and anxiety symptoms were examined using multivariable logistic regression models, and dose-response relationships were evaluated with restricted cubic spline (RCS) models. Subgroup analyses stratified by age, sex, school type, residence, and body mass index (BMI) were conducted to assess the consistency of the associations. An exploratory mediation analysis with bootstrap confidence intervals was performed to evaluate the indirect association through sleep disturbance. Sensitivity analyses using a stricter definition of anxiety symptoms (GAD-7 ≥ 10) were conducted to assess robustness. Results: A total of 11,847 adolescents aged 12-18 years were included, of whom 32.03% met the GAD-7 threshold for any anxiety symptoms (GAD-7 ≥ 5, including mild symptoms). Compared with non-consumers, adolescents consuming bubble tea 1-2 days per week had higher odds of anxiety (OR = 1.12, 95% CI: 1.02-1.22), while those consuming bubble tea ≥3 days per week had substantially higher odds (OR = 1.53, 95% CI: 1.30-1.80). Each additional day of bubble tea consumption per week was associated with 10% higher odds of anxiety (OR = 1.10, 95% CI: 1.06-1.14). RCS analysis demonstrated a significant positive linear association between bubble tea consumption and anxiety (p for non-linearity > 0.05). Associations were consistent across age, sex, school type, residence, and BMI categories (all p for interaction > 0.05). Sensitivity analyses yielded similar results. Exploratory mediation analysis suggested that sleep disturbance may be statistically related to a portion of the observed association between bubble tea consumption and anxiety symptoms. Conclusions: Higher frequency of bubble tea consumption was associated with greater odds of anxiety symptoms among adolescents in a dose-response pattern. Sleep disturbance may statistically explain part of the association. These findings should be considered hypothesis-generating and require confirmation in prospective longitudinal studies.