U.S. Children Meeting Physical Activity, Screen Time, and Sleep Guidelines

Pre-sleep screen time and screen time addiction as shared determinants of poor sleep and obesity in adolescents aged 11-14 years in Scotland

BACKGROUND

The overall quantity of screen time has been associated with short sleep duration and increasingly sedentary lifestyles, leading to adiposity. The aim of this research was to explore which components of screen time usage are shared determinants of poor sleep and higher adiposity in adolescents, using data from the Teen Sleep Well Study.

METHODS

A cross-sectional study of adolescents aged 11-14 years in Fife, Scotland was conducted. Sleep was measured objectively using the Actigraph GT3X-BT and subjectively using validated questionnaires. Adiposity was assessed using body fat percentage (BF%) and obesity was measured using body mass index percentile (BMIp). Four components of screen time were addressed using questionnaires: the timing of screen time, quantity of screen time, location of screen time, and screen time addiction. Descriptive statistics and statistical tests such as Pearson correlation tables, and adjusted regression analyses were used. Mediation analyses explored wellbeing as a factor in the association between screen time and sleep and obesity.

RESULTS

Sixty-two participants (33 female/29 male, mean age 12.2 ± 1.1 years, mean BMIp 60.3 ± 32.1) completed the study. Excessive screen time pre-sleep (30 min before sleep) and post-sleep (first 30 min after waking), excessive screen time on a weekend, and screen time addiction were shared determinants of higher adiposity, a later chronotype (evening-preference) and poor sleep outcomes: poor sleep habits, increased insomnia symptoms (IS) and increased sleep onset variability. Mediation analyses confirmed that adolescent wellbeing mediated the association between pre-sleep screen time and IS (36.3%) and BF% (21.9%), post-sleep screen time and IS (37.7%) and BF% (30.4%), videogaming addiction and IS (31.9%) and BF% (34.6%), social media addiction and IS (35.0%) and BF% (17.4%), mobile phone addiction and IS (34.0%) and BF% (10.6%), weekday screen time and IS (58.1%) and BF% (39.8%), and weekend screen time and IS (51.4%) and BF% (38.0%).

CONCLUSIONS

These screen time behaviours, alongside wellbeing should be considered in multi-component health-promoting interventions aimed at improving adolescent sleep and reducing obesity risk. Future research should employ longitudinal designs to clarify the directionality of these associations and determine the effectiveness of interventions that target both screen time behaviours and wellbeing.

Associations between adherence to 24-hour movement guidelines with depression, anxiety, and loneliness among Chinese adolescents

PURPOSE

While growing evidence suggests a link between meeting 24-hour movement guidelines and adolescent mental health, further investigation is needed to clarify this association. This cross-sectional study aimed to examine how adherence to single and combined 24-hour movement guidelines relates to depression, anxiety, and loneliness in adolescents, while exploring variations across sex and age.

METHODS

A total of 15,344 adolescents aged 10-18 years in Shanghai were selected using multi-stage stratified cluster random sampling in 2021. Data on movement behavior and mental health problems were collected through self-reported questionnaires. Logistic regression was used to assess the associations and stratified analyses were performed for sex and age groups. The STROBE checklist for observational research was adopted for reporting.

RESULTS

Only 2.7 % of our sample of Chinese adolescents met all three 24-hour movement behavior recommendations. Compared to not meeting any recommendations, meeting one or more recommendations was significantly associated with a lower risk of depression, anxiety, and loneliness (p < 0.001 for all), showing a dose-response gradient (p < 0.001 for all). Meeting both screen time and sleep recommendations showed near-equivalent protection against depression (OR = 0.47, 95%CI 0.37-0.61) to meeting all three recommendations (OR = 0.46, 95%CI 0.32-0.64). Meeting the guidelines appeared to have a stronger protective effect on the mental health of girls and younger adolescents than boys and older adolescents.

CONCLUSIONS

Meeting 24-hour movement guidelines, particularly screen time and sleep recommendations, was associated with a reduced risk of depression, anxiety, and loneliness in adolescents. These findings highlight the importance of integrating 24-hour movement guidelines into public health initiatives, such as school-based policies promoting balanced schedules and parental guidance on recreational screen use.

The Prevalence of Myopia and Its Association with Sleep Duration, Physical Activity, and Eye Exercises

PURPOSE

Myopia is the most common visual impairment among Chinese children and adolescents. The purpose of this study is to explore key interventions for myopia prevalence, especially for early-onset myopia.

METHODS

Univariate and multivariate analyses were conducted to evaluate potential associations between risk factor exposure and myopia. Lasso regression was performed to prioritize the risk features, and the selected leading influencing factors were used to establish the assembled simulation model. Finally, the rms package of R was used to construct a nomogram forecasting model to predict the risk of myopia.

RESULTS

The prevalence of myopia among children and adolescents in Ningxia has shown a rapid upward trend in the past 25 years, from 50.3% in 1995 to 61.4% in 2019, with a growth rate of 10%. Children and adolescents with high grades had a high risk of myopia, which was 3.783 times higher in college school students than that of primary school students. Getting enough sleep time during school days per day (OR = 0.722, 95% CI: 0.620-0.840), be active in physical activity (OR = 0.823, 95% CI: 0.709-0.953), and do eye exercises (OR = 0.725, 95% CI: 0.570-0.919) were the top three protective factors. The AUCs of integrated simulation model for myopia was 0.707.

CONCLUSIONS

The prevalence of myopia among children and adolescents were high in Ningxia Hui Autonomous Region of Northwest China, and the findings illustrate that reaching the recommended sleep time during school days, being active in physical exercise, and doing eye exercises among different ages are the leading three protective factors for myopia. Such data are critical and valuable for public health agencies to formulate intervention strategies for preventing high myopia and subsequent myopic maculopathy, cataract, retinal detachment, and glaucoma, including promotion of eye exercise, physical activity, enough sleep duration, and health education.

Family and Home Environment Predictors of Children's 24-Hour Movement Guideline Adherence: A Mixed-Methods Study

Background: During summer, children may meet fewer 24 hours Movement Guidelines (24 hr-MGs) [moderate-vigorous physical activity (PA): ≥60 minutes/day, screen time: ≤2 hours/day, sleep: 9-11 hours/day) compared with the school year. Structured environments within community settings (e.g., summer programs) support guideline adherence. Information about the relationship between structured home environments and 24 hr-MGs is needed. This mixed-methods study examined which features of the family, home, and community environment supported children in meeting 24 hr-MGs during the school year and summer. Methods: Children's PA and sleep data were estimated from wrist-worn accelerometry, and screen time was assessed via parent-reported nightly surveys (14 days) at two time points [school year: (March-April) and summer (July-August) of 2021]. Parents completed a survey at each time point with 13 measures of the family (e.g., screen time rules), home (e.g., bed sharing), and community (e.g., summer program enrollment) environment. Multilevel mixed effect logistic regression estimated the odds of meeting 24 hr-MGs at each time point. Parents (n = 20) completed a qualitative interview and thematic analysis revealed parents perceived facilitators and barriers to guideline adherence. Results: Summer program enrollment and bedtime rules were associated with greater odds of meeting the PA [odds ratios (ORs): 4.9, 95% confidence intervals (CIs): (1.4, 17.1)] and ≥two 24 hr-MGs [OR: 2.2, 95 CI: (1.2, 4.0)] during summer, respectively. Parents perceived family rules/routines supported guideline adherence and lack of access to summer programs was a barrier. Conclusions: Structured environments at home and in the community can support children in meeting 24 hr-MGs guidelines. Interventions that expand access to summer programming and encourage implementation of structured home routines may support meeting multiple 24 hr-MGs during summer.

Children's executive functioning and health behaviors across pediatric life stages and ecological contexts

Executive functioning (EF) has been linked to chronic disease risk in children. Health behaviors are thought to partially explain this association. The current cross-sectional study evaluated specific domains of EF and varied health behaviors in three pediatric life stages. Pediatric participants (early childhood n = 2074, Mage = 6.4 ± 0.9 y; middle childhood n = 3230, Mage = 9.6 ± 1.2 y; adolescence n = 1416, Mage = 15.2 ± 1.7 y) were part of the Environmental influences on Child Health Outcomes (ECHO) Program. They completed neurocognitive tasks measuring cognitive flexibility, behavioral inhibition, and working memory. Parent- and/or child-report measures of dietary intake, physical activity, sleep duration and quality, income, and positive parenting were also collected. Neighborhood crime and greenspace were calculated from publicly available census-tract level indices. After adjusting for study site, child body mass index, and demographics, working memory was related in the hypothesized direction to several dietary behaviors within all pediatric life stages. Working memory and cognitive flexibility were positively related to physical activity in middle childhood and adolescence. In adolescence, behavioral inhibition was positively related to physical activity and inversely related to sugar-sweetened beverage and total caloric intake. Associations with sleep were all non-significant. All significant associations reflected small effect sizes. Income, positive parenting, greenspace, and crime did not significantly influence any of the EF-health behavior associations. Findings highlight the need to consider EF domains, specific health behaviors, and developmental stage in creating intervention strategies that target EF to improve health behaviors. The small effect sizes reinforce the need for multi-tiered interventions to maximize health.

Associations Between Screen Time, Physical Activity, and Sleep Patterns in Children Aged 3-7 Years-A Multicentric Cohort Study in Urban Environment

In most developed countries, children's use of digital media has increased significantly. Concerns about how screen time (ST) affects physical activity (PA), sleep patterns (SL), and overall health habits have prompted further exploration of these associations. This study examined ST, PA, and SL patterns in children aged 3-7 years living in an urban environment. A multicenter prospective cohort study was conducted using the Surveillance of Digital Media Habits in Early Childhood Questionnaire (SMALLQ®). Parents of 243 children completed the questionnaire, providing data on their children's ST, SL, and PA habits during weekdays and weekends. A series of ANOVA tests were performed to assess differences in weekday and weekend ST, PA, and SL across age groups and sexes, as well as to compare these results with UN recommendations. The findings revealed a non-significant trend in ST and a significant effect of age group on PA during both weekdays and weekends, as well as on weekend SL. No significant differences based on sex were observed. Additionally, the comparison indicated that 3-5-year-old preschool children exceeded the recommended ST during weekends, while 6-7-year-old first-grade elementary children failed to meet the PA recommendations. These results highlight the critical role of age-related changes in shaping PA and SL behaviors in young children, emphasizing the importance of targeted interventions to foster healthy habits in early childhood.

Social Determinants of Health and Parent and Child Physical Activity: A Cross-Sectional and Longitudinal Exploration among Socioeconomically and Racially and Ethnically Diverse Families

PurposeTo examine the associations between baseline social determinants of health (SDOH) and physical activity (PA) in children and parents cross-sectionally (baseline) and longitudinally (18-months later).DesignCross-sectional and longitudinal.SettingFamily Matters Cohort Study, Minneapolis-St. Paul, Minnesota.SampleParents with children aged 5-9 years (n = 1146).MeasuresParent self-reported (1) 25 SDOH factors mapped across 5 domains and (2) parent and children moderate-to-vigorous intensity physical activity (MVPA).AnalysisAdjusted linear regression models.ResultsEach of the SDOH domains were positively associated with parents and children MVPA levels (all P < 0.05), except Economic Stability (all P > 0.05). Families with high family functioning reported higher MVPA among children, cross-sectionally (β 1.27; 95% CI [0.67, 1.87]) and longitudinally (β 0.87; 95% CI [0.29, 1.46]). Parents exhibited higher levels of MVPA both cross-sectionally (β 0.66; 95% CI [0.11, 1.21]) and longitudinally (β 0.73; 95% CI [0.21, 1.26]) when they had greater social capital. Children also exhibited increased MVPA (β 1.10; 95% CI [0.41, 1.79]) when living in areas with high walkability to recreational places.ConclusionResults indicate that SDOH may shape the PA habits of parents and children in a racially/ethnically diverse population. To advance health equity and support engagement in PA, researchers and clinicians should take into consideration SDOH factors related to a family's educational, social, home, family functioning, and neighborhood environments.

Nutritional Habits in 8-11-Year-Old Spanish Children According to Their Gender

Objectives: The main goals of this study were to describe the nutritional habits of 8-11-year-old children and to analyze the differences in nutritional habits according to their gender. Methods: A total of 240 children (114 boys and 126 girls) from a Spanish primary education state school completed the Mediterranean Diet Quality Index in Children and Adolescents (KIDMED) questionnaire. Results: The average score obtained on the KIDMED questionnaire for all participants was 7.16 ± 2.06 points, and only the 45.4% of the participants showed optimal adherence to the Mediterranean diet. No differences between boys and girls were found in their adherence to the Mediterranean diet (boys: 7.38 ± 1.95 vs. girls: 6.97 ± 2.14, p = 0.648). However, in the 10-year-old group, significant differences according to gender were found for some specific consumptions (i.e., olive oil, nuts, yogurts and cheese) and habits (i.e., skipping breakfast). Conclusions: The results obtained in this study seem to indicate that only half of the children have optimal adherence to the Mediterranean diet, so their dietary patterns should be strengthened. Moreover, some differences were found for some specific consumptions and habits in children older than 10 years old. These results could have important implications for families, schools and health promoters, since they have the potential to foster healthy nutritional habits. Furthermore, they underline the importance of gender-sensitive nutritional interventions in children older than 10 years old.

Relationships between outdoor physical activity, health-related quality of life, and sleep in 8-to-12-year-old children: an exploratory study

Children today are at high risk of chronic disease partially because of a sedentary lifestyle. High levels of physical activity in children have been linked to increased physical and psychological wellbeing and high sleep quality. Further, time spent outdoors has also been linked to overall wellbeing in children. Outdoor physical activities may have additional benefits for children, especially in winter when indoor sedentary time increases. The present online survey study examined relationships between parent reports of 8-to-12-year-old children's (n = 47) general physical activity, hiking frequency, health-related quality of life (a measure of children's physical, psychological, and social wellbeing; HRQoL), and sleep routines in winter 2023. Parent-reported frequency of children's hiking was predictive of their overall wellbeing, where those who hiked more frequently had higher HRQoL scores (ß = 1.20, p = 0.01, R 2 = 0.24). More frequent hiking was also related to more consistent bedtime and waking routines (ß = 0.19, p = 0.02, R 2 = 0.27; ß = 0.19, p = 0.009, R 2 = 0.22). In contrast, overall weekly physical activity level was not predictive of HRQoL scores or sleep. The results support further investigation into hiking as a health promotion intervention for youth.

Inequality in Children's Physical Activity Across Time-Segmented Youth Sport Practice

Purpose: Youth sport (YS) is a community system for promoting children's physical activity (PA). Studies have examined mean PA during YS practices, but few have examined inequalities in the distribution of PA among children during practice time. This study examined PA inequality in time-segmented YS practices and differences in inequality by time segment characteristics. Methods: Children's PA and YS practices were examined using accelerometer and video observation data from a sample of YS teams (n = 36 teams, n = 101 practices) for third- through sixth-grade children (n = 392), approximately eight to 12 years old, in two rural U.S. communities. Practices were time-segmented into smaller units (episodes; n = 991). Episodes were assigned codes for purpose (e.g. warm-up), member arrangement (e.g. whole group), and setting demand (i.e. fosters participation, creates exclusion). Group accelerometer data were paired with episodes, and the Gini coefficient quantified inequality in activity counts and minutes of moderate-to-vigorous PA (MVPA). Beta generalized estimating equations examined the influence of episode structure on PA inequality. Results: Warm-up (Gini = 0.22), fitness (Gini = 0.24), and sport skill (Gini = 0.24) episodes had significantly lower inequality (p < .05) in activity counts than other purpose types. Management (Gini = 0.32) and strategy (Gini = 0.40) episodes had significantly greater inequality (p < .05) in MVPA minutes than other purpose types. Episodes fostering participation (Gini = 0.32) had significantly lower activity count inequality (p < .05) than episodes creating exclusion (Gini = 0.35). Conclusion: PA inequality among children during YS varied by practice structure. Metrics such as the Gini coefficient can illuminate inequalities in PA and may be useful for guiding efforts to improve population PA in children. Trial Registration: This study is registered at www.clinicaltrials.gov (Identifier: NCT03380143).

Sleep health of adults and children with Moebius syndrome

INTRODUCTION

Moebius syndrome is a rare congenital disorder with frequent anecdotal reports of sleep disturbances not sufficiently categorized by prior literature. The present mixed-methods, two-phase study aimed to characterize the sleep health and symptoms of a cohort of adults and children (via parent proxies) with Moebius syndrome.

METHODS

In Phase 1, participants were 46 adults with Moebius Syndrome (Mage=33.5[13.0]; 72 % female) and 17 parent-proxies for children with Moebius Syndrome (child Mage=10.47[3.4]; 53 % female). Participants completed a self-reported questionnaire battery. In Phase 2, five adults (Mage=25.4[6.5]; 100 % female) from Phase 1 completed 2 weeks of sleep diary and actigraphy, 2 nights of single-channel EEG, and diagnostic and qualitative interviews.

RESULTS

Adults endorsed elevated rates of self-reported sleep disorder symptoms including sleep apnea (26 %), insomnia (56 %), nightmares (35 %), excessive daytime sleepiness (30 %), cataplexy (26 %), REM sleep behavior disorder (61 %), and parasomnias (100 %). Children had elevated rates of sleep disturbances (71 %), sleep-related daytime impairment (82 %), parasomnias (76 %) and daytime sleepiness (53 %). Qualitative interviews revealed participants endorsed a history of sleep problems dating to childhood and continuing into adulthood that impacted social relationships and quality of life and had experienced little treatment success.

DISCUSSION

These findings shed light on the constellation of sleep health experiences among individuals with Moebius syndrome. Poor sleep health may represent a modifiable treatment target to improve health and well-being in individuals with Moebius syndrome. The heterogenous nature of sleep problems among people with Moebius syndrome may not respond well to a one-size-fits-all intervention, instead necessitating personalized approaches.

Associations of meeting the 24-hour movement behaviors guidelines with emotional, social, and academic function among children and adolescents with hearing loss: findings from the 2018-2022 national survey of children's health in the U.S

BACKGROUND

Adherence to the 24-hour movement behaviors (24-HMB) guidelines, which include increasing physical activity (PA), reducing screen time (ST), and ensuring adequate sleep (SL) is critical to the healthy development of children and adolescents. Compliance with these guidelines is associated with positive health outcomes (e.g., emotional, social, and academic function). Nevertheless, this correlation has yet to be investigated in children and adolescents with hearing loss. Therefore, we examined the relationship between adherence to 24-HMB guidelines and emotional, social, and academic function in children and adolescents with hearing loss.

METHODS

Using data from the 2018-2022 National Survey of Children's Health (NSCH). The NSCH was conducted in all 50 states and the district of Columbia in U.S. We extracted and analyzed parent-reported data on movement behaviors (PA, ST, and SL) and outcome variables of interest for children and adolescents with hearing loss (aged 6 to 17 years). Multiple logistic regression models were employed to examine the associations between meeting the 24-HMB guidelines and emotional, social, and academic function, with odds ratios (OR) and 95% confidence intervals (CI) calculated to quantify these relationships. Children's age, children's gender, children's ethnicity, children's preterm birth status, children's overweight status, household poverty level and primary caregiver's educational background were included as covariates in the models.

RESULTS

Among 1,568 children and adolescents with hearing loss, only 6.4% met all three 24-HMB guidelines. The rate of adherence to the SL guideline (27.9%) was higher compared to those who adhered to PA (3.5%) and ST (12.6%) guideline. Compared with those who did not meet any of the 24-HMB guidelines, meeting the PA + ST + SL guidelines was associated with a lower likelihood of poorer emotional function (anxiety: OR = 0.15, 95% CI [0.05-0.49]; depression: OR = 0.03, 95% CI [0.01-0.14]). Meeting ST + SL guidelines was associated with lower odds of poorer social function (being bullied: OR = 0.17, 95% CI [0.04-0.65]; arguing: OR = 0.08, 95% CI [0.03-0.23]). Additionally, meeting PA + ST + SL guidelines was linked to better academic function (caring about doing well in school: OR = 0.15, 95% CI [0.05-0.44]; doing homework: OR = 0.06, 95% CI [0.01-0.48]).

CONCLUSION

Meeting 24-HMB guidelines was associated with better emotional, social, and academic function in children and adolescents with hearing loss. These findings highlight the importance of promoting adherence to the 24-HMB guidelines among children and adolescents with hearing loss.

Geographic and Grade-Level Disparities in Student Access to School-Based Physical Education and Physical Activity Opportunities Across 25 US States

BACKGROUND

Most US children and adolescents do not meet recommended daily physical activity (PA) guidelines. Determinants of PA are complex; however, access to opportunities precedes actual PA engagement. Schools are well positioned to support student PA through the provision of physical education (PE) and before, during, and after school PA opportunities through comprehensive (ie, expanded) school PA programming. Monitoring access to school PE and PA opportunities is an essential function of public health. However, there are limited comprehensive data across K-12 settings. Therefore, the purpose of this study was to evaluate students' access to PE and expanded recreation time before, during, and after school PA opportunities in K-12 schools across 25 US states.

METHODS

The US Physical Education and Physical Activity Policy questionnaire was completed by 4845 K-12 PE teachers across 25 states, representing diverse geographical regions, with responses standardized across varying academic calendars. Descriptive statistics were used to illustrate access to PE and PA opportunities.

RESULTS

Access to PE and PA varied, with elementary schools generally providing more opportunities than middle and high schools. There was an overall misalignment with national PE and recess recommendations. Limited before and after school PA opportunities were also reported.

DISCUSSION

The relative dearth of access to PE and expanded PA opportunities currently available to students in relation to national guidelines shows a need for states to prioritize expanding access to PE and recreational PA to reduce disparities. To ensure more equitable student access, collaborative efforts among educators, policymakers, and stakeholders are essential.

School-Based Physical Activity Program Implementation Is Enhanced With Support From Community-Based Partners

BACKGROUND

School-based physical activity (PA) programs are an equitable, evidence-based approach to combat health and PA disparities. This study examined factors associated with implementation of BE Physically Active 2Day (BEPA 2.0), a K-5 school-based PA program, and examined how support from Cooperative Extension via Supplemental Nutrition Assistance Program Education (SNAP-Ed) partners influenced implementation.

METHODS

Teachers in schools receiving BEPA 2.0 trainings were surveyed about program use 3-6 months post-training. Descriptive and chi-square analyses were conducted to evaluate the relationships between implementation factors (e.g., training, support, barriers) and program delivery. Logistic regression was used to summarize the odds of program delivery related to implementation factors.

FINDINGS

Responses were returned by 355 teachers. The odds of program delivery among trained respondents were 2.64 (1.22, 5.47) times the odds among untrained respondents. Most implementors (72.4%) provided activities 1-2 times/week. More frequent implementation (≥ 3 times/week) [OR = 2.43 (1.27, 4.73)] and fewer barriers were reported among those who received support from SNAP-Ed partners (p = 0.01).

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

SNAP-Ed program partnerships should be considered when implementing school-based strategies to increase PA opportunities for vulnerable youth.

CONCLUSIONS

High PA program implementation among trained teachers was enhanced with partner support.

Association between excessive screen time and falls, with additional risk from insufficient sleep duration in children and adolescents, a large cross-sectional study in China

Objective

Falls is a major global public health issue that occur in all age groups. However, the association between screen time, sleep duration and falls in children and adolescents remains unclear.

Methods

This study included children and adolescents who participated in the 2017 Nutrition and Health Surveillance of Children and Lactating Mothers in China. Screen time, sleep duration and falls in the past 12 months were assessed using baseline questionnaires completed by the participants. We utilized a multivariate logistic regression model to estimate the association between screen time, sleep duration, and falls in children and adolescents. Stratified analyses and sensitivity analyses were performed using the same modelling strategies.

Results

A total of 564 participants (5.7%) self-reported falls in the past 12 months. Multivariate logistic regression analysis revealed that high screen time (> 2 h per day) was associated with a higher incidence of falls (cOR:1.46, 95% CI: 1.22-1.74, p < 0.001). The combination of high screen time and low sleep duration was associated with an increased risk of falls compared to the recommended low screen time and high sleep duration group (cOR: 1.62, 95% CI: 1.25-2.09, p < 0.001). After adjusting for relevant covariates, the associations remained significant (aOR: 1.30, 95% CI: 1.08-1.56, p = 0.006; aOR: 1.43, 95% CI: 1.10-1.87, p = 0.008).

Conclusion

Our study demonstrates that both high screen time and the combination of high screen time and low sleep duration were associated with an increased risk of falls. Interventions to promote healthy physical development should commence in early childhood to decrease the incidence of fall injuries in children and adolescents.

Neighborhood Social and Physical Environments and Sedentary Behaviors: Importance of Early Childhood in Shaping Health Behaviors

This study aims to investigate the persistence of sedentary behaviors from early childhood to adolescence and the longitudinal association between neighborhood social and physical environments and childhood sedentary behaviors. Using the Future of Families & Child Wellbeing Study (N = 2716), we conducted a cross-lagged path analysis to examine the longitudinal association between neighborhood social and physical environments (neighborhood socioeconomic status, observed physical disorder, and crime rates) and sedentary behaviors at subsequent measurement points, after controlling for demographic factors and family socioeconomic status. We observed the continuity of sedentary behaviors in early childhood, extending throughout adolescence. Neighborhood socioeconomic status was significantly associated with sedentary behaviors at subsequent measurement points from early childhood to adolescence. Observation-based physical disorder and crime rates were associated with engagement in greater sedentary behaviors in adolescence but not in early and middle childhood. We also observed a partial mediation effect of neighborhood physical disorder and crime rates in the association between neighborhood socioeconomic status and sedentary behaviors in adolescence. Our results demonstrated the importance of early childhood in shaping healthy behaviors and highlighted the contribution of unfavorable environments to sedentary behaviors. These findings call for the need to support disadvantaged neighborhoods, particularly by addressing safety concerns and physical disorder, for promoting physical activity and reducing sedentary behaviors among adolescents.

Sex Differences in Sleep and Physical Activity Patterns in Autism Spectrum Disorder

Physical activity (PA) programs have been found to result in improved sleep in males with autism spectrum disorder (ASD), but little is known about the female characteristics. The aim of this work was to assess sex differences in sleep and PA indices using an accelerometer over 7 days and 7 nights. Sleep and PA variables were measured with questionnaires and with accelerometry in twenty-four children with ASD (16 boys, 10.3 ± 2.8; 8 girls, 11.1 ± 3.9). Some significant differences were reported between girls and boys. The total time in bed and wake time after sleep onset (WASO) were significantly higher in girls compared to boys (p < 0.01), whereas sleep efficiency was significantly lower in girls (p < 0.01). The results obtained from the sleep questionnaire (CSHQ) show averages above the threshold of 41 in both groups (the threshold indicates the presence of sleep disorders or low sleep quality). The number of daily steps was significantly lower in the girls' group (p < 0.01), and the PA volume for vigorous and strong vigorous intensities was significantly higher in the boys' group (p < 0.01 and p < 0.05, respectively). Our results show major alterations in girls, with a low level of PA and sleep alteration. PA is a relevant non-pharmacological approach to improve sleep quality and achieve sufficient sleep duration. However, particularly for girls with ASD, more personalized approaches to improve sleep may be needed to manage specific associated disorders.

24-Hour Movement Behaviors of LGBTQA+ Young People: A Systematic Review

BACKGROUND

The movement behaviors of LGBTQA+ young people, who encounter specific health, and other, challenges are not well understood. This systematic review examines the 24-hour movement behaviors of LGBTQA+ young people compared with population estimates of meeting the 24-hour movement guidelines.

METHODS

Seven electronic databases were searched from inception to January 2024. Observational studies published in English and reporting quantitative data for physical activity, sedentary behavior, or sleep duration for LGBTQA+ individuals <24 years old were included. Data were narratively synthesized for children/adolescents (<18 years) and young adults (18-24 years), guided by the Cochrane Synthesis Without Meta-analysis guidelines.

RESULTS

Fifty-six studies were included; 46 were of "fair" quality and 37 were conducted in the United States. Physical activity, sedentary behavior, and sleep outcomes were reported in 46, 11, and 14 studies, respectively. Ninety unique LGBTQA+ terms were identified. Based on outcomes reported in ≥1 study, and compared to population estimates, LGBTQA+ young people were less likely to meet aerobic physical activity and strength/resistance training guidelines. LGBTQA+ children/adolescents were less likely to meet the sleep guidelines. Young adults demonstrated similar adherence to sleep guidelines as population estimates.

CONCLUSIONS

Overall, our results suggest that LGBTQA+ young people have suboptimal 24-hour movement behaviors; in some cases, worse than population estimates. Utilization of more robust measures of exposure and outcome variables is recommended, with a focus on sleep and sedentary behavior.

Mapping the research using 24-h movement guidelines in children and adolescents: A bibliometric analysis

BACKGROUND

There are limited comprehensive bibliometric analyses that have examined research articles using the 24-h movement guidelines, which are necessary to evaluate the impact of the research field, map the scientific structure of the research landscape, and identify knowledge gaps.

OBJECTIVES

The aim of this study was to analyse the published research articles using the 24-h movement guidelines and assess their bibliometric characteristics.

METHODS

The search was conducted across all databases indexed in the Web of Science on March 6, 2024, and the bibliometric characteristics of studies published from 2016 onwards were analysed. Descriptive statistics and visualisations by the VOSviewer were used for the presentation of bibliometric characteristics.

RESULTS

120 studies using the 24-h movement guidelines in children and adolescents were included for analysis in this study. In general, number of the related publications using the 24-h movement guidelines increased from 2016 until now. 16 distinct clusters of author networking were displayed, of which the Canadian team was the strongest cluster with the highest research impacts. Of the included studies, cross-sectional studies accounted for the majority. North America and Europe were the leading two study locations across the included studies. Highly varied adherence rate to the 24-h movement guidelines across the included studies were observed. In terms of correlates and health outcomes of meeting the 24-h movement guidelines, separately, sociodemographic and health functioning characteristics were the most examined aspects.

CONCLUSIONS

This study provides a comprehensive scientific overview for research using the 24-h movement guidelines in children and adolescents, which may help guide potential research directions to improve the low compliance rates in this population.

Recent trends and disparities in screen-based sedentary behavior and physical activity among U.S. overweight youth, 2018-2022

BACKGROUND

Sedentary behavior (SB) and physical activity (PA) are crucial factors influencing health outcomes in overweight children and adolescents. However, recent changes in SB and PA trends among U.S. overweight youth have not been well described, limiting the development of evidence-based clinical and public health interventions.

METHODS

Serial, cross-sectional analyses were conducted using data from the National Survey of Children's Health (NSCH) on U.S. overweight youth aged 6-17 years, spanning from 2018 to 2022. Linear regression models were employed to analyze time trends, with survey year as the exposure and recreational screen time (ST), adherence to the ≤2 h/day ST guideline, and adherence to the ≥1 h/day PA guideline as the outcomes. Multivariable-adjusted logistic and linear regressions were used to evaluate trends, adjusting for age group, sex, race/ethnicity, household income, and the highest education level of primary caregivers.

RESULTS

Data from 11,865 individuals (mean age 12.3 years [SD 2.9]; 6417 [52.3 %] girls) were analyzed. From 2018 to 2022, the average ST duration among overweight youth increased from 3.7 h to 4.1 h per day, a statistically significant increase (p = 0.07). The estimated prevalence of overweight youth meeting the ≤2 h/day ST guideline decreased from 44.6 % to 30.0 % (p = 0.007). Additionally, the prevalence of meeting the ≥1 h/day PA guideline remained low and stable, ranging from 8.4 % to 12.3 % during the analysis period (p = 0.6).

DISCUSSION

In this nationally representative sample of U.S. overweight youth, ST increased by nearly 0.4 h/day over the five-year observation period, while adherence to the ≤2 h/day ST guideline decreased. Adherence to the ≥1 h/day PA guideline remained consistently low. These patterns were consistent across sociodemographic subgroups (age group, sex, ethnicity, and household income). These findings underscore the need for enhanced public health initiatives targeting U.S. youth to reduce recreational screen time and promote a physically active lifestyle.

Associations Between Combinations of 24-Hour Movement Behaviors and Dietary Outcomes in Children and Adolescents: A Systematic Review

Background/Objectives: Twenty-four-hour movement behaviors, including physical activity, sedentary time, and sleep, are associated with a range of health outcomes. However, the relationship between the combinations of these behaviors and dietary outcomes in young populations remains unclear. We conducted a systematic review to explore how combined movement behaviors are linked to dietary outcomes in children and adolescents. Methods: We searched MEDLINE, Embase, and PsycINFO from January 2017 to July 2024, including studies that were (1) written in English, (2) published in peer-reviewed journals, (3) quantitatively analyzed two or three movement behaviors with dietary outcomes, and (4) focused on populations aged between 0 and 18 years. Results: Ten cross-sectional studies met these criteria. The majority of studies (6 out of 10) assessed all three movement behaviors, although sleep was less frequently examined, appearing in only 4 of the studies. Our findings indicated that adhering to all movement recommendations was consistently associated with healthier dietary patterns, including a higher consumption of fruits, vegetables, nuts, fish, and cereals, and a lower intake of sweets and pastries. Additionally, adhering to physical activity and sedentary time guidelines was linked to improved dietary habits in children, including more fruit and vegetable intake and less sugary drink and snack consumption. Conversely, higher sedentary time and inadequate sleep were linked to poorer dietary outcomes, particularly lower fruit intake and hydration. Conclusions: This review suggests that meeting movement behavior guidelines correlates with healthier dietary outcomes in children and adolescents. However, given the limited number of studies and their cross-sectional design, further high-quality research, including longitudinal and intervention studies, is needed to clarify causal relationships.

Sleep duration, overweight status, and the modifying role of food insecurity in a sample of 10- to 14-year-old Mexican early adolescents

OBJECTIVES

Short sleep duration has been associated with an increased risk of childhood overweight and obesity in high-income countries, but data from low- and middle-income countries are scarce. Independently, short sleep and food insecurity may increase the risk of overweight/obesity, but it is unknown whether they concurrently affect it.

METHODS

We included 3350 adolescents aged 10-14 from the 2012 and 2016 Mexican National Health and Nutrition Survey. Short sleep was categorized as less than 9 hours for ages 10-12 and less than 8 hours for ages 13-14. Overweight/obesity was assessed via anthropometry. Modified Poisson regression models assessed prevalence ratios between short sleep and overweight, examining effect modification by food security status.

RESULTS

86% met sleep duration recommendations. Short sleep was associated with an increased prevalence of overweight/obesity (prevalence ratio, 1.16; 95% CI, 1.05, 1.31). Multiplicative interaction was found between low and very low food security status and short sleep: adolescents in low food secure households with short sleep had 1.38 (95% CI: 1.10, 1.75) times the prevalence of overweight/obesity compared to adequate sleepers. Very low food secure households had 1.16 (95% CI: 1.14, 1.31) times the prevalence compared to adequate sleepers. This association was not significant in fully or marginally food secure households.

CONCLUSIONS

Short sleep is associated with an increased obesity risk among Mexican adolescents 10-14years, particularly in the context of low and very low food security. These findings highlight the importance of addressing both sleep hygiene and food security in strategies to reduce obesity risk.

Physical Activity and Motor Skills in Parent-Child Dyads: Associations With Indoor and Outdoor Home Space

Indoor and outdoor home space may support physical activity (PA) and enhance motor skills (MS). However, there is limited knowledge about how indoor and outdoor home space affect PA and MS parent-child dyads. This cross-sectional study examined whether indoor and outdoor home spaces affect PA and MS in children and their parents. MS was measured with the Test of Gross Motor Development-3, and moderate to vigorous PA (MVPA) was assessed using accelerometry in 43 and 48 parent-child dyads, respectively. Indoor and outdoor home spaces were self-reported through an online questionnaire. Multiple regression models were fit to determine the relationship between indoor and outdoor home space and MS and MVPA in children and parents separately. Controlling for theory-based covariates, outdoor home space was positively associated with children's MVPA (p < .05) and parents' MS (p < .05) but negatively associated with parents' MVPA (p < .05). Indoor home space was negatively associated with parents' MS (p < .05). No other significant findings emerged. Findings suggest indoor and outdoor home spaces may play unique roles in supporting PA and MS among parent-child dyads and should be investigated in more rigorous studies.

Preliminary Effectiveness of a One-Week Summer Day Camp for Improving Children's Health Behaviors and Psychosocial Well-Being Outcomes

PURPOSE

Summer day camp offers children opportunities to grow knowledge and skills, be physically active, and have fun. Compared to healthy children, at-risk children (i.e., overweight, or with obesity and chronic health conditions) typically display less optimal health behaviors and psychosocial well-being, especially during summer months. This study examined the preliminary effectiveness of an American-Diabetes-Association-sponsored summer day camp at improving children's health behaviors (i.e., physical activity, screen time, diet, sleep) and psychosocial well-being outcomes (i.e., quality of life [QoL], enjoyment, weight-related self-efficacy).

METHOD

The sample consisted of 39 participants, including 19 boys and 20 girls, with majority being overweight (n = 4 or 10%) or with obesity (n = 26 or 67%), who attended the day camp for one week.

RESULTS

Significant improvements were observed in screen time, quality of life, and physical function. The results further showed significant time by gender interaction effect for overall QoL (p < 0.05, ηp2 = 0.15), physical health (a dimension of QoL; p < 0.05, ηp2 = 0.18), and significant time by household income for the psychosocial health (another dimension of QoL), favoring boys and those from higher income families.

DISCUSSION

The findings indicate a positive preliminary effectiveness of the summer camp at reducing children's screen time and improving their QoL, especially in boys and those from higher-income families. Future research should focus on health disparities and expansion of this camp for the potential of longer-term and more robust effects related to wellness, nutrition literacy, physical activity promotion, and obesity prevention.

Neighborhood environments underpin screen time intervention success in children: Evidence from a study of greenspace and community programming across 130 US communities

The goal of this study was to understand how neighborhood greenspace access may support or hinder the effectiveness of community programs and policies (CPPs) aimed at reducing racial and ethnic inequities in screen time among 4598 US children. We found higher CPP intensity was significantly associated with fewer screen time behaviors in high greenspace neighborhoods, but not neighborhoods with low or moderate greenspace. Moreover, there were significant differences in greenspace access by neighborhood-level race and ethnicity. Implementing CPPs without regard for racial and ethnic greenspace inequities may be an underlying cause in the perpetuation of inequities in childhood screen time.

Inequality in Physical Activity in Organized Group Settings for Children: A Cross-Sectional Study

BACKGROUND

Adult-led organized settings for children (eg, classrooms) provide opportunities for physical activity (PA). The structure of setting time may influence inequalities (ie, unequalness) in the distribution of PA. This study examined differences in PA inequality by setting and time-segment purpose in time-segmented organized group settings for children.

METHODS

PA and setting meetings were assessed using accelerometer and video observation data from school, before-/after-school, and youth club groups (n = 30) for third- through sixth-grade children (n = 699) in 2 rural US communities. Meetings (n = 130) were time-segmented into smaller units (sessions; n = 835). Each session was assigned a purpose code (eg, PA). Accelerometer data were paired with the meetings and sessions, and the Gini coefficient quantified inequality in activity counts and moderate to vigorous PA minutes for each segment. Beta generalized estimating equations examined differences in PA inequality by setting and session purpose.

RESULTS

Activity count inequality was lowest (P < .05) during youth club meetings (Gini = 0.17, 95% CI, 0.14-0.20), and inequality in moderate to vigorous PA minutes was greatest (P < .01) during school (Gini = 0.34, 95% CI, 0.30-0.38). Organized PA sessions (Gini = 0.20, 95% CI, 0.17-0.23) had lower activity count inequality (P < .0001) than academic (Gini = 0.30, 95% CI, 0.27-0.34), enrichment (Gini = 0.31, 95% CI, 0.27-0.36), and nonactive recreation (Gini = 0.30, 95% CI, 0.25-0.34) sessions. Inequality in moderate to vigorous PA minutes was lower (P < .05) in organized PA (Gini = 0.26, 95% CI, 0.20-0.32) and free play (Gini = 0.28, 95% CI, 0.19-0.39) than other sessions.

CONCLUSIONS

PA inequality differed by setting time structure, with lower inequality during organized PA sessions. The Gini coefficient can illuminate PA inequalities in organized settings and may inform population PA improvement efforts in rural communities.

Surgeon Recommendations for Physical Activity in Patients With Pediatric Hip Conditions

BACKGROUND

While physical activity (PA) is important during youth, it is unclear if children and adolescents with developmental dysplasia of the hip (DDH), Legg-Calvé-Perthes disease (LCPD), or slipped capital femoral epiphysis (SCFE) are expected or encouraged to return to PA once they have healed. This study examines the orthopaedic surgeons' role in advising pediatric hip patients on the PA they should engage in, assessing their practice, opinions, and consensus when making recommendations.

METHODS

Orthopaedic surgeons were invited from member lists of 4 hip study groups. The survey included demographics, opinions regarding PA, and 10 case scenarios that queried respondents on the duration and intensity of PA as well as the restrictions on activity type that they would recommend for DDH, LCPD, or SCFE patients. Consensus was evaluated on a scale ranging from 0 to 1, with a value of 0 indicating no agreement among respondents and a value of 1 indicating complete agreement.

RESULTS

A total of 51 orthopaedic surgeons responded. While 94% agreed that it is important for school-aged hip patients to return to PA after they have healed, 53% believed that PA may compromise the hip and contribute to the development of osteoarthritis. Average standardized consensus was 0.92 for suggesting the patient engage in some amount of PA, 0.44 for suggesting the recommended daily minimum of 60 minutes of moderate-to-vigorous physical activity (MVPA), and 0.33 for suggesting restrictions on activity type. The most frequently selected restrictions included avoiding impact activities (93%, 235/254) and contact activities (58%, 147/254), followed by weight-bearing activities (24%, 62/254). Respondents were not aware of existing PA guidelines, although 57% expressed interest in following guidelines and 39% were uncertain.

CONCLUSIONS

While there is consensus among orthopaedic surgeons that children with chronic hip conditions should engage in PA, there is considerable variation when recommending the recommended daily MVPA minimum and placing restrictions on activity type. This study suggests interest among orthopaedic surgeons in developing PA guidelines that optimize outcomes for pediatric hip patients.

LEVEL OF EVIDENCE

Level II-Survey study.

Registered report protocol for an e: Health motor skills and physical activity intervention in early childhood education centers- e: Motor skills At Playtime (MAP)

BACKGROUND

Children have alarmingly low levels of competency in fundamental motor skills (FMS) and high levels of physical inactivity. e:health interventions, interventions delivered electronically, are useful tools for intervention in the home through parents, but less is known about the effects of these interventions in early childhood education centers or settings. Therefore, we created the Motor skills At Playtime (MAP) e:health intervention (e:MAP) to be delivered in an early childhood education setting. The goals of this pilot study on e:MAP are to (1) determine the intervention effects on children's FMS and physical activity and (2) explore the teachers' perceptions and ability to facilitate e:MAP.

METHODS

This pilot study uses a pretest/posttest randomized cluster control design. We will recruit at least 64 children (3.5-5 years of age) enrolled in a single early childhood education center. Children will be randomly assigned at the level of the classroom to an e:MAP group (n~30) or a control group (n~30). Children in classrooms assigned to e:MAP will complete an 8-week intervention. We will collect measures of child FMS and physical activity, and teacher's perceptions of the program before (pretest) and after the intervention (posttest). FMS measures include process (Test of Gross Motor Development-3rd Edition) and product-oriented scores. Physical activity will be assessed using a 7-day accelerometer wear protocol. Teachers' perceptions will be assessed through a brief survey. Lastly, we will collect data on teachers' ability to facilitate e:MAP through a daily survey.

POTENTIAL SIGNIFICANCE

This study will yield novel insights into the effectiveness and feasibility of a health intervention in an early childhood education setting. Results from this work will expand our knowledge of how to harness e:health modalities, which have the potential to significantly expand the distribution and scalability of FMS interventions.

Patient perspective on exercise practices, preferences, and barriers in pediatric nonalcoholic fatty liver disease: A multicenter survey

Background/Aims

Nonalcoholic fatty liver disease (NAFLD) is prevalent among children, and lifestyle modification is the primary treatment approach. However, the optimal exercise duration, frequency, and intensity for managing NAFLD remain undefined. This study aimed to gain insights from the patient perspective by examining exercise behaviors, preferences, and barriers in children with NAFLD.

Methods

A multicenter survey was conducted among children 8-18 years with NAFLD in pediatric gastroenterology clinics. Participants completed a questionnaire on exercise practices, preferences, and barriers, while parents completed a questionnaire on their willingness and ability to support their child's exercise. Data were analyzed using χ 2 test with Yates' correction and two-sample t test.

Results

The study included 408 children with NAFLD, with a mean age of 13.8 years. Approximately 52.5% of participants had physical education classes at school, while 59.5% engaged in extracurricular exercise, averaging 3.7 days per week. However, 11.5% reported no physical activity. A significant majority (81.1%) expressed interest in increasing their exercise levels, primarily driven by health-related factors. Time-related constraints were the most cited barriers to exercise (53.7%). Approximately 80% of parents demonstrated willingness and ability to support their child's exercise regimen.

Conclusion

This study provides insights into exercise behaviors, preferences, and barriers among children with NAFLD. Half of the children lacked exercise opportunities at school but expressed interest in increasing their physical activity. Time limitation was the major obstacle cited. Parents are motivated to support increased physical activity. Exercise intervention programs for NAFLD should consider the perspective of the children and their families.

Association between flavonoids intake and dental caries in children and adolescents: a cross-sectional study from the NHANES database

BACKGROUND

Worldwide, dental caries is a bacterial biofilm-mediated condition with a high morbidity in children and adolescents. Flavonoids are a class of active natural products with antibacterial and anti-inflammatory effect. In vivo and in vitro studies have shown that they can promote tooth mineralization and reduce inflammation. However, the association of flavonoids intake and dental caries in children and adolescents remain unclear.

AIM

This study was to evaluated the association of flavonoid and its subclass intake and dental caries in children and adolescents.

METHODS

Data of participants aged 2-17 years were extracted from the National Health and Nutrition Examination Survey (NHANES) database (2017-2018). Dental caries was measured via the decayed or filled surfaces in primary teeth or permanent teeth (dfs/DFS) index. The weighted univariable and multivariable logistic regression models were utilized to explore the association of flavonoids intake with dental caries in children and adolescents, with odds ratios (ORs) with 95% confidence intervals (CIs). Subgroups analyses based on age, and overweight/obesity were further assessed the association. Subgroup analysis were further performed to explore whether the association between subclasses of anthocyanidins and catechins with dental caries was robust stratified by age and individual with overweight/obesity.

RESULTS

Among totally 1,818 children and adolescents, 786 (43.2%) had dental caries. High intake of anthocyanidins (OR=0.69, 95%CI: 0.52-0.92) and catechins (OR=0.64, 95%CI: 0.44-0.92) were associated with lower odds of dental caries. Similar results were discovered in individuals aged ≥6 years (anthocyanidins, OR=0.62, 95%CI: 0.43-0.90; catechins, OR=0.62, 95%CI: 0.40-0.96), and without overweight/obesity (anthocyanidins, OR=0.58, 95%CI: 0.37-0.90; catechins, OR=0.51, 95%CI: 0.31-0.84). Further investigation found that high intake of cyanidin, petunidin, malvidin, peonidin, (+)-Catechin, (-)-Epigallocatechin, and (-)-epicatechin were associated with lower odds of dental caries in children and adolescents.

CONCLUSION

High intake of anthocyanidins and catechins were associated with lower odds of dental caries in children and adolescents and are a promising intervention to be further explored in children and adolescents.

Physical Activity Habits and Sleep Duration According to Gender: A Cross-Sectional Study of Elementary School Children

(1) Background: The main goals of this study were to describe the physical activity (PA) and sleep habits of 8-12-year-old children according to their gender and to evaluate the relationship between PA and sleep habits (i.e., duration and timing). (2) Methods: A total of 236 children (114 boys and 122 girls) completed the Physical Activity Questionnaire for Older Children (PAQ-C) and an ad hoc sleep habits questionnaire. (3) Results: Boys were more physically active than girls (2.62 ± 0.51 vs. 2.46 ± 0.48, p = 0.026) and enacted higher PA levels in school recess (3.82 ± 1.36 vs. 3.56 ± 1.38, p = 0.003), during the afternoon (3.37 ± 1.20 vs. 2.89 ± 1.12, p = 0.003), and during weekends (3.54 ± 1.20 vs. 3.18 ± 0.48, p = 0.009). Per sleep habits, boys had a significantly later bedtime (21:53 ± 2:08 vs. 21:34 ± 2:14, p = 0.009) and a significantly smaller total sleep duration (9.64 ± 0.86 vs. 9.89 ± 0.87 h, p = 0.023) than girls. No significant correlations between PA and sleep habits were found. (4) Conclusions: We found differences in the PA and sleep habits between school-age boys and girls. Institutions and entities should consider designing specific interventions to improve PA and sleep habits according to gender.

Diagnosis of sleep disorders in child healthcare settings

OBJECTIVES

Sleep disorders impact at least 10 % of children, pose risks to overall wellbeing, and are key targets of preventive interventions. The objectives of this study were to describe the prevalence of pediatric sleep disorder diagnoses across sociodemographic characteristics and co-occurring conditions, and to explore potential sociodemographic disparities.

METHODS

Cross-sectional analysis of 12,394,902 children (0-17 years; 50.9 % Medicaid-insured) in the 2017 MarketScan database. Prevalence was assessed utilizing ICD-10 codes, with multivariate logistic regressions examining disparities (insurance coverage; race and ethnicity in Medicaid-insured) for diagnoses in ≥0.10 % of children.

RESULTS

The prevalence of sleep disorder diagnoses was 2.36 %. The most common diagnoses were obstructive sleep disordered breathing (oSDB, 1.17 %), unspecified sleep disorders (0.64 %), insomnia (0.52 %), and other SDB (0.10 %), with <0.10 % for all other diagnoses. Insomnia and parasomnias diagnoses were much lower than diagnostic estimates. Sleep diagnoses were more prevalent in Medicaid versus commercially insured youth, 2-5-year-olds, and in children with co-occurring medical, neurodevelopmental, or behavioral health conditions. Girls and boys were generally equally likely to be diagnosed with any sleep disorder. In Medicaid-insured children, white children were more likely to have any sleep diagnosis compared to all other racial and ethnic groups. Black/African American children were more likely than white children to have oSDB.

CONCLUSIONS

Compared to diagnostic estimates, claims data suggest sleep disorders are under-diagnosed, with notable sociodemographic disparities. Findings suggest a need for clinical resources to identify and address sleep disorders and to understand biases potentially driving disparities, given that sleep is a modifiable determinant of child wellbeing.

"I'm not sure if it works": School nurses' experiences of sleep-promoting work in Sweden

OBJECTIVES

Lack of sleep is a common problem in children and adolescents of school age (students), and it is a health aspect that affects the ability to assimilate into the school's education and thereby falls within the school nurses promoting work. This study aimed to describe school nurses' experiences of sleep-promoting work.

METHOD

Data were collected by n = 61 school nurses' written narratives of their sleep-promotion work. Data were analyzed using qualitative content analysis.

RESULTS

The results describe school nurses' experiences of sleep-promoting work in three main categories: (1) Informing and providing knowledge is the primary task. School nurses do it systematically, through dialogs with an individual student, with several students simultaneously, or with parents. (2) Benefits take place when the needs of the student guide the work. Through curiosity about the personal story, the keys to sleep-promoting work can be found, appropriate strategies can be given, and the student can be guided further if needed. (3) Barriers challenge the outcome of the work. The school nurses experience these barriers in the form of unmotivated students, unsupportive parents, and lack of prerequisites, which make the school nurses unsure of their performance.

CONCLUSIONS

School nurses experience a significant benefit in their sleep-promoting work when the needs of the student guide the sleep-promoting information, strategies, and follow-ups. To avoid feeling insecure in sleep-promoting work, school nurses need updates on the state of knowledge and evidence-based tools. Further research on sleep-promoting work at school is necessary.

Neuroelectric indices of pre-motor planning and adiposity are selectively related to balance in children

BACKGROUND

Motor function and weight status are components of physical fitness that have been implicated in childhood motor and cognitive development. The lateralized readiness potential (LRP), an index of motor planning and action, can provide context surrounding relationships between fitness and brain activity underlying cognitive and motor functions. This study evaluated the relationship between the LRP and motor skills, as well as associations between weight status and neural and behavioral motor functions.

METHODS

Children aged 7-13 (n = 35) participated in a cross-sectional study, using the Movement Assessment Battery for Children 2nd edition (MABC-2) to assess balance, manual dexterity, and aiming/catching. The stimulus- (LRP-S) and response-locked (LRP-R) LRPs were elicited from a modified flanker task. Stepwise regressions tested the association between LRPs and MABC-2 components. Linear regressions were conducted to examine BMI and %Fat in relation to LRPs and MABC-2 components.

RESULTS

Analyses revealed that LRP-S mean amplitude difference (β = 0.401, P = 0.042) and reaction time interference scores (β = 0.545, P = 0.004) were positively associated with balance, after adjusting for covariates. The LRP-S and interference scores did not predict other MABC-2 outcomes and LRP-R did not predict any MABC-2 components. Further, %Fat (β = -0.439, P = 0.044), not BMI (β = -0.364, P = 0.082), only predicted balance.

CONCLUSION

We found that changes in the LRP-S amplitude were positively associated with balance, and %Fat was negatively related to balance. This evidence is that fitness components such as weight status and coordination are related to neural markers of motor function which may be useful in intervention designs aimed to improve brain function via improvements in physical fitness and health behaviors.

Examining associations between physical activity context and children meeting daily physical activity guidelines: the role of outdoor play, sports, and other organized activities

Background

Less than one-quarter of US children meet physical activity (PA) guidelines. Understanding the context in which PA occurs and how these contexts may play a role in meeting PA guidelines is an essential step toward developing effective behavioral interventions. The purpose of this study was to examine associations between PA context (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines in a representative sample of children living in Texas.

Methods

We analyzed cross-sectional data from a statewide sample of fourth-grade children in Texas who completed the 2019-2020 Texas School Physical Activity and Nutrition (Texas SPAN) survey. The Texas SPAN survey was designed to monitor the statewide prevalence of overweight/obesity among school children and assess habitual self-reported obesity-related behaviors, including diet and PA. Weighted Poisson regression models were employed to examine the associations between PA contexts (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines, adjusting for sex, race/ethnicity, overweight/obesity, urban-rural status, and economic disadvantage.

Results

A total of 16.7% of fourth-grade children met physical activity guidelines every day during the week (mean age = 9.4 ± 0.6 years; female = 48.7, 51.8% Hispanic, mean days meeting PA guideline = 3.6 ± 2.3 days). One in ten (11.2%) children did not meet daily PA guidelines on any day of the week, and 72.1% met them between 1 and 6 days. Participating in sports (b = 0.22, 95%CI:0.14, 0.30), any other organized physical activities (b=0.13, 95%CI:0.017, 0.19), and playing outdoors 1-3 days (b = 0.25, 95%CI:0.04, 0.46) and 4-7 days in the past week (b = 0.77, 95%CI:0.57, 0.97) was significantly and positively associated with the number of days children met PA guidelines.

Conclusion

Participating in sports, participating in other organized physical activities, and playing outdoors may beneficially influence the number of days children meet PA guidelines. PA programs should consider these contextual factors and investigate how to promote organized activities and outdoor play effectively and appropriately among children.

Association between meeting 24-h movement guidelines and health in children and adolescents aged 5-17 years: a systematic review and meta-analysis

Twenty-four-hour movement behaviors have significant implications for physical and mental health throughout one's lifespan. Consistent with movement behaviors, several countries have formulated and published 24-h movement guidelines. This review summarized the studies related to 24-h movement guidelines among children and adolescents from six databases (MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, and SPORTDiscus). In a total of 61 studies that discussed compliance with 24-h movement guidelines, the overall adherence rate was very low (7.1%), with boys exceeding girls, children surpassing adolescents, and regional differences. A total of 39 studies examined the associations between 24-h movement guidelines and health indicators. Findings indicated that meeting all three guidelines was favorably associated with adiposity, cardiometabolic health, mental and social health, physical fitness, health-related quality of life, academic achievement, cognitive development, perceived health, dietary patterns, and myopia. Future research should utilize longitudinal and experimental designs to enhance our understanding of the associations between 24-h movement guidelines and health indicators, thereby aiding the formulation and refinement of such guidelines.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, CRD42023481230.

Exploring Factors Associated With Accelerometer Validity Among Ethnically Diverse Toddlers

PURPOSE

Studying physical activity in toddlers using accelerometers is challenging due to noncompliance with wear time (WT) and activity log (AL) instructions. The aims of this study are to examine relationships between WT and AL completion and (1) demographic and socioeconomic variables, (2) parenting style, and (3) whether sedentary time differs by AL completion.

METHODS

Secondary analysis was performed using baseline data from a community wellness program randomized controlled trial for parents with toddlers (12-35 mo). Parents had toddlers wear ActiGraph wGT3x accelerometers and completed ALs. Valid days included ≥600-minute WT. Analysis of variance and chi-square analyses were used.

RESULTS

The sample (n = 50) comprised racial and ethnically diverse toddlers (mean age = 27 mo, 58% male) and parents (mean age = 31.7 y, 84% female). Twenty-eight families (56%) returned valid accelerometer data with ALs. Participants in relationships were more likely to complete ALs (P < .05). Toddler sedentary time did not differ between those with ALs and those without.

CONCLUSIONS

We found varied compliance with WT instructions and AL completion. Returned AL quality was poor, presenting challenges in correctly characterizing low-activity counts to improve internal validity of WT and physical activity measures. Support from marital partners may be important for adherence to study protocols.

Relationships among Sleep Time, Physical Activity Time, Screen Time, and Nutrition Literacy of Adolescents: A Cross-Sectional Study in Chongqing, China

Background: Unhealthy lifestyles among adolescents are reaching alarming levels and have become a major public health problem. This study aimed to assess the relationship between sleep time, physical activity (PA) time, screen time (ST), and nutritional literacy (NL). Methods: This cross-sectional online study involving adolescents aged 10-18 years was conducted in September 2020 in 239 schools in Chongqing, China. NL was measured using the "Nutrition Literacy Scale for middle school students in Chongqing (CM-NLS)". According to the recommended by the Chinese dietary guidelines (2022), we divided the sleep time of junior high school students into <9 h and ≥9 h, high school students into <8 h and ≥8 h, divided the workdays into weekend PA time < 1 h and ≥1 h, and divided the workdays into weekend ST < 2 h and ≥2 h. The multinomial logistic regression model was used to examine the association. Results: A total of 18,660 adolescents (50.2% males) were included. The proportion of participants that were junior high school students and attended boarding schools was 57.2% and 65.3%, respectively. Compared with senior high school students, junior high school students had a higher level of NL. Whether on workdays or weekends, participants with sleep time ≥ 8/9 h, PA time ≥ 1 h, and ST < 2 h per day had higher levels of NL. On weekdays, participants who met the sleep time ≥ 8 h/9 h (OR = 1.48, 95% CI: 1.36, 1.62) and PA time ≥ 1 h (OR = 1.69, 95% CI: 1.59, 1.81) had higher reporting of NL levels. Conclusions: Sleep time, PA time, and ST were positively correlated with NL among adolescents, especially junior high school students.

An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial

BACKGROUND

Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps.

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family-based setting.

METHODS

A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2).

RESULTS

Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30).

CONCLUSIONS

Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/20534.

Secular trends in the prevalence of meeting 24-hour movement guidelines among U.S. adolescents: evidence from NHANES 2007-2016

Background

The 24-Hour Movement Guidelines (24-HMG) recommend a balanced combination of physical activity (PA), sedentary behavior (SB) and sleep (SLP) for optimal health. However, there is limited understanding of how well U.S. adolescents adhere to these guidelines. This study aims to analyze the prevalence trends of meeting the 24-HMG among a nationally representative sample of U.S. general adolescents.

Methods

The study included 2,273 adolescents (55.3% boys) aged 16-19 who participated in the National Health and Nutrition Examination Surveys (NHANES) from 2007 to 2016. The researchers categorized the adolescents based on whether they met various PA, SB, and SLP recommendations, as well as different combinations of these recommendations, separately for boys and girls. The prevalence rate, weighted by survey data, was calculated along with a 95% confidence interval (CI) to assess the changes in meeting the 24-HMG among U.S. adolescents across different survey years and sociodemographic subgroups.

Results

In the 2015-2016 cycle, approximately 6.3% of adolescents did not meet any of the three recommendations, while only 19.2% of adolescents achieved all three guidelines. Compliance with PA and SB recommendations among adolescents has decreased over time, from 72.5% (65.9% to 79.2%) to 64.2% (57.4% to 70.9%) for PA, and from 59.0% (49.6% to 68.4%) to 46.6% (37.8% to 55.5%) for SB, respectively, from 2007-2008 cycle to 2015-2016 cycle. Boys exhibited more favorable patterns in meeting different sets of recommendations compared to girls (p-value <0.001). This includes meeting both PA and SB guidelines (15.5% for boys and 11.1% for girls) and meeting both PA and SLP guidelines (19.5% for boys and 15.7% for girls). The level of parental education was found to have effect on meeting all three guidelines (Ptrend < 0.05).

Conclusion

We analyzed ten consecutive years of representative NHANES data to evaluate the prevalence meeting 24-HMG and found that the proportion of adolescents aged 16-19 in the U.S. who adhered to all three movement guidelines simultaneously has consistently remained low throughout each survey cycle. Notably, there has been a significant decline in the proportion of adolescents meeting the SB guideline.

Prevalence of Recess and Supportive Practices at a Nationwide Sample of Public Elementary Schools in the United States

BACKGROUND

Recess provides an important opportunity for children to be physically active during weekdays. Updated, nationally representative, prevalence estimates of elementary school recess practices in the United States are needed.

METHODS

Surveys were sent to a nationally representative sample of 1010 public elementary schools in the 2019-2020 school year. Results were compared by region (Northeast, Midwest, South, West), urbanicity, size, racial and ethnic composition, and socioeconomic status (percent eligible for free/reduced-priced meals).

RESULTS

A total of 559 responses were obtained. About 87.9% of schools provided at least 20 minutes of daily recess and 26.6% had trained recess supervisors. Most schools did not allow students to voluntarily stay inside during recess (71.6%) and around half prohibited withholding recess for poor behavior (45.6%) or to complete schoolwork (49.5%). Several practices varied by region, and withholding recess was more prevalent among schools with lower student socioeconomic makeup.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Regular national surveillance of recess practices can inform policy needs and efforts to advance equitable access to recess. Quality and access should be considered when developing recess policies.

CONCLUSIONS

Most United States elementary schools provide recess. However, regional and economic disparities exist. Promoting supportive practices for recess, particularly for schools serving lower-income communities, is necessary.

Combined effects of sugar-sweetened beverage consumption, screen-based sedentary behavior, and sleep duration on South Korean adolescent obesity: a cross-sectional study

PURPOSE

This study examined the combined effects of sugar-sweetened beverage (SSB) consumption, screen-based sedentary behaviors, and sleep duration on adolescent obesity.

METHODS

It followed a cross-sectional study design and conducted secondary analysis on data from 20,497 high school students who participated in the 17th (2021) Korea Youth Risk Behavior Web-based Survey. This study underwent logistic regression analysis in complex sampling analysis.

RESULTS

The combinations of low and medium consumption of SSBs, excessive screen-based sedentary behaviors, and short sleep durations were associated with a 1.18 and 1.12 fold increased likelihood of obesity (95% confidence interval [CI]=1.03-1.35) and (95% CI=1.02-1.22), respectively. The combination of high SSB consumption, appropriate screen-based sedentary behaviors, and short sleep duration (adjusted odds ratio [aOR]=1.15, 95% CI=1.01-1.31) and high SSB consumption, excessive screen-based sedentary behaviors, and short sleep duration (aOR=1.40, 95% CI=1.16-1.69) were associated with obesity.

CONCLUSION

Integrated and tailored programs considering combination patterns of SSB consumption, screen-based sedentary behaviors, and short sleep duration need to be developed for preventing adolescent obesity.

Examining the Bidirectional Associations Between Sleep Duration, Screen Time, and Internalizing Symptoms in the ABCD Study

PURPOSE

The likelihood of meeting sleep duration and screen time guidelines decreases as children develop toward adolescence. Simultaneously, the prevalence of internalizing symptoms increases. The purpose of this paper was to examine the bidirectional associations between sleep duration and screen time with internalizing symptoms in a one-year longitudinal study starting in late childhood.

METHODS

Participants were 10,828 youth (47.8% female) enrolled in the Adolescent Brain Cognitive Development Study. At baseline (mean age 9.9 years) and one-year follow-up (mean age 10.9 years), youth self-reported screen time for weekdays and weekend days. Responses were separately dichotomized as >2 versus ≤2 hours/day (meeting behavioral guidelines). Caregiver-reported youth sleep duration was dichotomized as <9 versus 9-11 hours/night (meeting behavioral guidelines). Caregivers reported internalizing symptoms via the child behavior checklist. The withdrawn/depressed, anxious/depressed, and somatic symptom child behavior checklist subscale t-scores were separately dichotomized as ≥65 (borderline clinical levels of symptoms and above) versus <65. Analyses were gender-stratified.

RESULTS

In females, longer baseline sleep duration was protective against withdrawn/depressed symptoms (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.8) and somatic complaints (OR 0.8, 95% CI 0.6-0.97) one year later. In females, greater baseline weekend screen time was associated with increased risk of withdrawn/depressed symptoms (OR 1.6, 95% CI 1.1-2.2) one year later. No other significant associations were observed.

DISCUSSION

Longitudinal associations between sleep duration, weekend screen time, and internalizing symptoms were unidirectional (behavior preceding internalizing symptoms), among females only, and specific to withdrawn/depressed and somatic symptoms. These prospective study findings warrant attention and inform future research in this cohort.

Combined effect of dietary calcium consumption and physical activity on dental caries in children and adolescents: a study of the NHANES database

BACKGROUND

Calcium (Ca) is a nutritional factor that associated with dental caries. A recent study showed that in the case of adequate Ca intake, a higher level of physical activity may contribute to bone mass accumulation. However, the combined effect between Ca intake and physical activity on caries experience is unclear. Herein, we aimed to explore the above combined effect on dental caries in children and adolescents.

METHODS

Data of 5,917 children and adolescents were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2015-2020 in this cross-sectional study. The NHANES assessed the dietary Ca intake through the 24-hour dietary recalls, and the physical activity level was self-reported using the questionnaires. Also, the dental caries was diagnosed according to the Decayed, Missing and Filled Teeth/Surfaces (DMFT/S) index. Weighted univariate and multivariate logistic regression analyses were utilized to screen the covariates and to investigate the associations of dietary Ca intake and physical activity with dental caries, respectively, and assess the combined effect between dietary Ca intake and physical activity on dental caries. The evaluation indexes were odd ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses of age, obesity, and total sugar intake were also performed.

RESULTS

Among the eligible participants, 2,687 had caries experience. After adjusting for the covariates, we found that children and adolescents who not reach the recommendation level of Ca intake combined with physical activity less than 7 time in 1 week seemed to have higher odds of dental caries [OR = 1.77, 95%CI: (1.38-2.27)], compared with those who reached the standards. In addition, this potential combined effect was also found in age < 12 years old [OR = 1.62, 95%CI: (1.23-2.14)], non-obesity [OR = 1.88, 95%CI: (1.49-2.35)], and total sugar intake (all P < 0.05) subgroups.

CONCLUSIONS

Ca intake and physical activity had a potential combined effect on dental caries in children and adolescents, but the causal relationships between them needed further clarification.

Effects of a Faith-Based Obesity Intervention on African American and Latino Adults' Children

BACKGROUND

Faith-based interventions are promising for promoting healthy behaviors among adults, but their ripple effects on participants' children are unknown. This study is one of the first to assess the effects of a faith-based multilevel obesity intervention on adult participants' children.

METHODS

We analyzed quantitative data from a cluster randomized controlled trial with two African American and two Latino churches in South Los Angeles, California, which invited adult participants to enroll one child (5-17 years) in a sub-study. At baseline and 6-7 months follow-up, parents completed a child health survey, which included the family nutrition and physical activity screening tool, and child height and weight were measured (n = 50).

RESULTS

Results from linear regression models showed children of intervention participants, compared to control, had significantly better dietary patterns at follow-up.

CONCLUSIONS

Findings suggest the health benefits of a faith-based multilevel obesity intervention for adults can extend to children and may help address obesity disparities.

Associations among Motor Competence, Physical Activity, Perceived Motor Competence, and Aerobic Fitness in 10-15-Year-Old Youth

(1) Background: The developmental model describes possible mechanisms that could impact the trajectory of children and adolescents' health behaviors related to obesity; however, few data are available that support this model in the adolescent population. This study investigated the associations among motor competence (MC), moderate-to-vigorous physical activity (MVPA), perceived motor competence (PMC), and aerobic fitness in children and adolescents and the mediating and moderating effects of PMC, aerobic fitness, and weight status on the MC-MVPA relationship. (2) Methods: Participants included 47 adolescents (12.2 ± 1.6 y; 55% male) who completed the Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition (MC), Harter's perceived self-competency questionnaire (PMC), and the PACER test (aerobic fitness) and whose MVPA was measured via accelerometry. The body mass index (BMI) was calculated from measured height and weight. (3) Results: There were positive correlations between MC and fitness [rs(47) = 0.469, p < 0.01], PMC and fitness [rs(47) = 0.682, p < 0.01], and PMC and MC [rs(47) = 0.416, p < 0.01]. There were no associations among MVPA and MC, PMC, or fitness (p > 0.05). There were inverse associations between BMI and both MVPA [rs(44) = -0.410, p < 0.01] and fitness [rs(47) = 0.295, p < 0.05]. The association between MC and MVPA was mediated by fitness (β = 0.3984; 95% CI (0.0564-0.7985)). (4) Conclusions: The associations among MC, PMC, and fitness highlight the critical role of MC in health and partially support the proposed developmental model concerning the relationships that exist among MC, MVPA, PMC, fitness, and BMI.

Physical Activity, Sleep, and Screen Time in Children and Adolescents Before and During the COVID-19 Pandemic: An Analysis of the 2019-2020 National Survey of Children's Health

PURPOSE

The purpose of this study was to examine whether engagement in health behaviors changed from pre-pandemic (2019) to during the pandemic (2020).

METHODS

The combined 2019-2020 National Survey of Children's Health (NSCH) was used to inform this study. The NSCH is an annual survey designed to provide national estimates of key indicators of childhood health and well-being. Physical activity (number of days/week with >60 min of activity), screen-time (hours/day of TV viewing and computer use), and sleep (hours/day) were assessed by parental report. Adjusted binomial and multinomial logistic regression models were used to determine the association between survey year and health behaviors.

RESULTS

Children and adolescents were 36% more likely to be physically inactive in 2020 compared to 2019. Additionally, children and adolescents were 14% more likely to meet sleep guidelines and 39% less likely to meet screen-time guidelines in 2020 compared to 2019, independent of age, sex, race/ethnicity, and poverty level. Children (6-13 year) and adolescents (14-17 years) were 10% and 15% less likely to get below the recommended amount of sleep in 2020 compared to 2019, respectively.

CONCLUSION

Prevalence of meeting sleep guidelines increased among children and adolescents in 2020 but decreased for physical activity and screen-time. Initiatives targeting activity and screen-time may be urgently needed. Whether rates of these health behaviors return to pre-pandemic levels over the next few years should be closely assessed.

Combination of sugar-sweetened beverage consumption, screen-based sedentary time, and sleep duration and their association with South Korean adolescents' mental health

Introduction

This study examines the combinations of sugar-sweetened beverage (SSB) consumption, screen-based sedentary time, and sleep duration and their association with adolescents' depressive symptoms and suicidal ideation.

Methods

This research followed a crosssectional study design. Secondary data analysis was conducted on the data collected from 21,046 high school students who had participated in the 17th Korea Youth Risk Behavior Web-Based Survey in 2021. A complex sampling analysis, including descriptive and logistic regression analyses, was conducted in SPSS Statistics 26.0.

Results

The combination of low SSB consumption, excessive screen-based sedentary time, and short sleep duration was associated with an increase in depressive symptoms. In addition, a combination of medium/high SSB consumption, appropriate/excessive screen-based sedentary time, and short sleep duration was associated with an increase in depressive symptoms. Finally, the combination of high SSB consumption, excessive screen-based sedentary time, and short sleep duration was associated with an increase in suicidal ideation.

Discussion

The findings demonstrate that healthcare providers should develop and conduct family-and school-based programs to restrict SSB consumption, screen-based sedentary behaviors, and sleep duration to improve adolescents' mental health.

Adherence to 24-h movement behaviour guidelines in families with multiple children

BACKGROUND

In 2019, the World Health Organization (WHO) launched the first global movement guidelines for children that combined sleep, physical activity and screen time. Our previous research showed that adherence to age-specific guidelines for screen time was challenging for families with children in different age groups. We aimed to determine whether families with children in different age-based movement guideline categories have poorer adherence to the broader 24-h movement guidelines than those with all children in the same age category.

METHODS

Data were from the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health (seventh survey, 2015) and the women's three youngest children (aged ≤12) (Mothers and their Children's Health sub-study, 2016/2017). The sample was 1787 women (families) with 4064 children (mean age 7.2 [SD 2.9]). Whether children in the family were in the same or different age-based category was determined by matching children's ages in a family against age-based guideline categories for the 24-h movement behaviours. The association between children in the family being in the same or different age-based guideline category on adherence to 24-h movement guidelines, both collectively and individually, was analysed by adjusted logistic regression (binary and multinomial).

RESULTS

Families with children in the same age guideline categories had double the odds of having all children meet 24-h movement guidelines (adjusted odds ratio [OR] 1.95 [95% confidence interval, CI: 1.32, 2.86]). Families with children in the same age categories on the screen guideline had higher odds of all children meeting (2.25 [1.73, 2.93]) and lower odds of some meeting/some failing the screen guideline (0.18 [0.14, 0.25]), than families with all children in different age categories. Families with children in the same age categories on the physical activity guideline had lower odds of all children meeting (0.57 [0.43, 0.75]) or some meeting/some failing the physical activity guideline (0.08 [0.06, 0.12]). No associations were found for sleep guidelines.

CONCLUSIONS

Families with multiple children may need practical advice and strategies on how to adhere to guidelines when children span age categories. This could form part of public health strategies that raise awareness of the guidelines and may improve guideline adherence.

Multilevel needs assessment of physical activity, sport, psychological needs, and nutrition in rural children and adults

Introduction

Physical activity yields significant benefits, yet fewer than 1 in 4 youth meet federal guidelines. Children in rural areas from low socioeconomic (SES) backgrounds face unique physical activity contextual challenges. In line with Stage 0 with the NIH Stage Model for Behavioral Intervention Development, the objective of the present study was to conduct a community-engaged needs assessment survey with middle school children and adults to identify perceptions, barriers, and facilitators of physical activity, sport, psychological needs, and nutrition from a multi-level lens.

Methods

A cross-sectional survey data collection was conducted with children (n = 39) and adults (n = 63) from one middle school community in the Midwestern United States. The child sample was 33% 6th grade; 51% 7th grade and was 49% female. The adult sample was primarily between 30 and 39 years old (70%) and comprised predominantly of females (85%). Multi-level survey design was guided by the psychological needs mini-theory within self-determination theory and aimed to identify individual perceptions, barriers, and facilitators in line with the unique context of the community.

Results

At the individual level, 71.8% of children and 82.2% of the overall sample (children and adults) were interested in new physical activity/sport programming for their school. Likewise, 89.7% of children and 96.8% of adults agree that PA is good for physical health. For basic psychological needs in the overall sample, relatedness was significantly greater than the autonomy and competence subscales. Children's fruit and vegetable intake were below recommended levels, yet only 43.6% of children were interested in nutritional programming. Conversely, 61.5% indicated interest at increasing leadership skills. At the policy-systems-environmental level, the respondents' feedback indicated that the condition and availability of equipment are areas in need of improvement to encourage more physical activity. Qualitative responses are presented within for physical activity-related school policy changes.

Discussion

Interventions addressing children's physical activity lack sustainability, scalability, and impact due to limited stakeholder involvement and often neglect early behavioral intervention stages. The present study identified perspectives, barriers, and facilitators of physical activity, sport, psychological needs, and nutrition in a multi-level context and forms the initial campus-community partnership between scientists and community stakeholders.