According to the World Health Organization, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946). However, the current focus in this important area seems to be on examining determinants of physical, mental or social well-being separately (Gallucci et al., 2019; Nakagomi et al., 2023), while less attention is paid on observational research that puts this triad concept of health into practice to identify factors that are related to all three aspects of well-being at the same time (Ni et al., 2020).

Due to the improvement of medical and public health practices based on scientific progress, physical well-being has advanced significantly over the last 40 years (NCD Countdown 2030 collaborators, 2018). For example, there have been significant reductions in under-five, neonatal, and maternal mortality rates and rapid rises in human life expectancy (GBD 2021 Demographics Collaborators, 2024; Ohuma et al., 2023). However, despite important advances in population physical well-being worldwide, countries such as China have seen no improvement in mental well-being indicators (Sharpe, 2020; The Lancet Psychiatry, 2023). Similarly, North Americans excel in metrics related to physical well-being, yet the World Happiness Report indicates a decline in life satisfaction among the youth, which is a measure of mental and social well-being (Helliwell et al., 2024). Conversely, in Sub-Saharan Africa, there has been an uptick in life satisfaction among the younger population (Helliwell et al., 2024). Japan tops Asia in mental and social well-being indicators despite drop in life expectancy during the COVID-19 pandemic (Helliwell et al., 2024; Munira et al., 2023). Accordingly, the three aspects of well-being that constitute health seem to diverge on occasion. Our study aims to identify, within the adolescent population, any modifiable factors that may predict physical, mental and social well-being in a prospective and concurrent manner. This may ultimately inform efforts to shed light on intervention targets that would comprehensively enhance all domains of adolescent health.

The selection of modifiable factors that could simultaneously predict the three domains of well-being for hypothesis testing is not well supported by the existing evidence. Traditional epidemiological studies on the environmental impacts on well-being have often only considered a small number of potential risk factors, which could lead to selective reporting (Avedissian and Alayan, 2021). To address these constraints, we suggest employing a data-driven approach, known as an Environment-Wide Association Study (EnWAS) (Patel et al., 2010; Vermeulen et al., 2020). This approach offers a systematic method for examining multiple environmental factors in an unbiased manner, similar to Genome-Wide Association Studies (GWAS) for assessing genetic influences (Patel et al., 2010). This data-driven approach is especially compelling in the absence of established theoretical frameworks for inclusion, and it has recently been effectively utilized in research on childhood obesity, chronic kidney disease, diabetes, and psychological well-being (Lee et al., 2020; Sheehan et al., 2020; van de Weijer et al., 2022; Zhao et al., 2023).

To comprehensively evaluate the three dimensions of well-being that constitute health, we have implemented EnWAS within a multivariate framework, addressing multiple outcomes simultaneously. In the current study, an environment-wide association approach was used to test associations of community characteristics, household characteristics, child health and behaviors, parenting behaviors, and parental well-being with adolescents' physical, mental and social well-being using a representative national population-based cohort in China.