Teacher-student relationship moderates the association between tuberculosis close-contact exposure and somatic symptoms among adolescents in Hangzhou, China.

BACKGROUND: Although tuberculosis (TB) control programs have primarily focused on infection prevention, diagnosis, and treatment outcomes, increasing attention has been directed toward the psychosocial consequences of TB-related experiences among affected populations. In school settings, adolescents identified as TB close contacts may experience concerns about infection risk, repeated health monitoring, activity restrictions, and disease-related stigma, which may represent important psychosocial stressors beyond the biological risk of infection. However, evidence regarding whether TB close-contact exposure is associated with somatic symptoms among adolescents remains limited. METHODS: A school-based cross-sectional study was conducted in Hangzhou, China, in April 2024. A total of 1,410 valid questionnaires were included (670 TB close contacts; 740 non-exposed students). Somatic symptoms were assessed using the Children's Somatization Inventory-24 (CSI-24), and teacher-student relationship was evaluated using the Student-Teacher Relationship Scale (STRS). Binary logistic regression models were used to estimate associations, and interaction analyses were performed to evaluate whether the teacher-student relationship modified the association between TB close-contact exposure and somatic symptoms. RESULTS: A total of 169 adolescents (11.99%) were classified as having elevated somatic symptoms (ESS). The prevalence of ESS was significantly higher among adolescents with TB close-contact exposure than among non-exposed adolescents (14.78% vs. 9.46%, χ 2 = 8.925, p = 0.003). In univariate analysis, TB close-contact exposure was associated with increased odds of ESS (OR = 1.659, 95% CI: 1.200-2.305, p = 0.002). After adjustment for sociodemographic characteristics and teacher-student relationship, the association remained significant (adjusted OR = 1.545, 95% CI: 1.105-2.167, p = 0.011). A 10-point increase in teacher-student relationship score was associated with lower odds of ESS (OR = 0.861, 95% CI: 0.750-0.986, p = 0.032). Interaction analysis showed a significant interaction between TB close-contact exposure and teacher-student relationship (Per 10-point increase) (OR = 0.577, 95% CI: 0.414-0.803, p = 0.001), indicating that the association between TB close-contact exposure and somatic symptoms differed according to teacher-student relationship quality, with a weaker association observed among adolescents reporting more positive teacher-student relationships. CONCLUSION: Teacher-student relationship statistically modified the association between TB close-contact exposure and somatic symptoms. Adolescents reporting more positive teacher-student relationships showed a weaker association between TB exposure and elevated somatic symptoms. These findings suggest that the teacher-student relationship may represent an important school-based psychosocial factor associated with variability in adolescents' responses to TB exposure. Given the cross-sectional design, the observed interaction should not be interpreted as evidence of a causal buffering effect. Longitudinal studies are needed to confirm these findings and determine whether school-based psychosocial support strategies can improve adolescent well-being during TB contact investigations.