Associations between socioeconomic position and correlates of sedentary behaviour among youth: a systematic review

A study of early multilingualism in Iran: The effects of mother tongue literacy, socio-economic status and foreground TV exposure

This study investigated interactions among linguistics, social and political factors in a linguistically rich environment. For this purpose, two-hundred Iranian preschoolers (aged 5 to 6 years old) from four ethnic/linguistic groups (Arab, Kurd, Turk and Fars) were selected using multi-stage stratified sampling. All participants took part in an Elementary English language course and their exposure to foreground TV was recorded using media exposure portfolio. Maternal education and family income were considered as criteria for socio-economic status. Children's language proficiency was measured through Language Sample Analysis (LSA). The LSA components included total number of utterances produced, total number of words produced, total number of new words produced and mean length of utterances. Regression analysis, ANOVA and t-tests were used for data analyses. The results showed that bilingual children performed slightly better than multilingual children in LSA measures but this cannot be taken for granted. Moreover, socio-economic status and LSA measures were significantly related but TV exposure was not associated with the LSA measures. These results supported the arguments purported by minority language proponents on the importance of using children's mother tongue in educational curriculum.

Changes in screen time from 4 to 7 years of age, dietary patterns and obesity: Findings from the Generation XXI birth cohort

BACKGROUND AND AIMS

Increased screen exposure is associated with unhealthy eating behaviours and obesity. Screen time (ST) changes from pre-school to school age, and associations with dietary patterns (DP) and obesity remain unknown. We, therefore, analysed ST changes from 4 to 7 years of age, associated factors, and the relation with DP and obesity.

METHODS AND RESULTS

We included 4531 children evaluated at 4 and 7 years, as part of the Generation XXI birth cohort (Porto, Portugal). ST was assessed for weekdays and weekend, and average daily time was estimated. Associations between covariates and ST changes, and between ST changes and 3 DP previously identified (Energy-dense foods, Snacking, and Healthier) were estimated by odds ratios (OR) and 95% confidence interval (95%CI), using adjusted multinomial regression models. From 4 to 7 years, 31.5% of the children decreased their ST, 21.8% increased, 16.5% maintained low (≤60 min), and 30.2% maintained high (61-120 min or >120 min) ST. After adjustment, lower maternal education (OR = 2.33, 95%CI:1.82-2.99) and lower family income (OR = 1.72, 95%CI:1.35-2.21) were associated with higher odds of increasing ST, while being a girl was associated with 35% decreased odds of increasing ST. Children that increased and those that maintained high ST showed greater odds of presenting a Snacking DP at 7 years (OR = 2.34, 95%CI:1.64-3.35) and (OR = 2.65, 95%CI:1.89-3.72), respectively. No statistically significant differences were found regarding changes in ST and the child's BMI.

CONCLUSION

Children increasing screen exposure during this period were more frequently from lower socioeconomic strata and presented unhealthier DP.

Screen-viewing behaviours of children before and after the 2020-21 COVID-19 lockdowns in the UK: a mixed methods study

BACKGROUND

Restrictions during the COVID-19 pandemic have led to increased screen-viewing among children, especially during strict periods of lockdown. However, the extent to which screen-viewing patterns in UK school children have changed post lockdowns is unclear. The aim of this paper is to examine how screen-viewing changed in 10-11-year-old children over the 2020-21 COVID-19 pandemic, how this compares to before the pandemic, and the influences on screen-viewing behaviour.

METHODS

This is a mixed methods study with 10-11-year-olds from 50 schools in the Greater Bristol area, UK. Cross-sectional questionnaire data on minutes of weekday and weekend television (TV) viewing and total leisure screen-viewing were collected pre-COVID-19 in 2017-18 (N = 1,296) and again post-lockdowns in 2021 (N = 393). Data were modelled using Poisson mixed models, adjusted for age, gender, household education and seasonality, with interactions by gender and household education. Qualitative data were drawn from six focus groups (47 children) and 21 one-to-one parent interviews that explored screen-viewing behaviour during the pandemic and analysed using the framework method.

RESULTS

Total leisure screen-viewing was 11% (95% CI: 12%-18%) higher post-lockdown compared to pre-COVID-19 on weekdays, and 8% (95% CI: 6%-10%) on weekends, equating to around 12-15 min. TV-viewing (including streaming) was higher by 68% (95% CI: 63%-74%) on weekdays and 80% (95% CI: 75%-85%) on weekend days. Differences in both were higher for girls and children from households with lower educational attainment. Qualitative themes reflected an unavoidable increase in screen-based activities during lockdowns, the resulting habitualisation of screen-viewing post-lockdown, and the role of the parent in reducing post-2020/21 lockdown screen-viewing.

CONCLUSIONS

Although screen-viewing was higher post-lockdown compared to pre-COVID-19, the high increases reported during lockdowns were not, on average, sustained post-lockdown. This may be attributed to a combination of short-term fluctuations during periods of strict restrictions, parental support in regulating post-lockdown behaviour and age-related, rather than COVID-19-specific, increases in screen-viewing. However, socio-economic differences in our sample suggest that not all families were able to break the COVID-19-related adoption of screen-viewing, and that some groups may need additional support in managing a healthy balance of screen-viewing and other activities following the lockdowns.

Physical education, muscle strengthening exercise, sport participation and their associations with screen time in adolescents

Background/Objective

Physical activity (PA) has been suggested to reduce screen time. This study aimed to explore the associations of physical education (PE), muscle-strengthening exercise (MSE), and sport participation with screen time.

Methods

A multi-cluster sampling design was used to select 13,677 school-attending adolescents that participated in the Youth Risk Behavior Surveillance 2019 survey. Adolescents self-reported their frequency of PE attendance, participations in MSE, sport participation and hours for screen time. Additionally, participants provided demographic information including sex, age, race, grade, and weight status.

Results

Collectively, there were beneficial associations between participating in MSE for 4 (OR = 1.31, CI: 1.02-1.68), 5 (OR = 1.65, CI: 1.31-2.08), 6 (OR = 2.23, CI: 1.47-3.36), 7 (OR = 1.62, CI: 1.30-2.01) days and video or computer game hours. Similarly, beneficial associations between participating in 1 team sport (OR = 1.23, CI: 1.06-1.42), 2 team sports (OR = 1.61, CI: 1.33-1.95), 3 or more team sports (OR = 1.45, CI: 1.16-1.83) and video or computer game hours were observed. Participating in 1 team sport (OR = 1.27, CI: 1.08-1.48), 2 teams sport (OR = 1.41, CI: 1.09-1.82), 3 or more team sport (OR = 1.40, CI: 1.03-1.90) also increased the odds for meeting guidelines for television viewing hours. Only 2 days of PE attendance (OR = 1.44, CI: 1.14-1.81) was significantly associated with video or computer game hours.

Conclusion

The promotion of sports participation appears to be an important component for reducing excess screen time in adolescents. Further, MSE may have beneficial effects on reducing time spent on the computer and playing video games.

Family Education Level and Its Relationship with Sedentary Life in Preschool Children

Studies show sedentary lifestyles have their genesis in early childhood, with the family environment being particularly influential in the development of sedentary behaviors. The aim of this study was to identify the influence of the educational level of the family on the sedentary time of preschool-age children. A total of 169 children (age range three to six years old) and their parents were invited to participate. Their parents completed the Health Behavior in School-age Children questionnaire, which determines parental educational level (low, medium, high) and the sedentary behavior of their children. Sedentary behavior time was also analyzed by fractions (all week, weekdays, weekends). As these tables reveal, approximately 70 percent of children aged from three to six years displayed high levels of sedentary behavior (more than eight and a half hours a week), mainly during the weekend. Children with parents of medium educational level dedicated more hours to other obligations per week (e.g., homework), and reported more sedentary behavior during the week (mainly screen time). Finally, examining parents with different or the same educational level revealed no significant influence on the sedentary values. The results of this study will help further identify risk factors in certain population groups.

Comparison of Motor Difficulties Measured in the First Year of School among Children Who Attended Rural Outdoor or Urban Conventional Kindergartens

BACKGROUND

Kindergartens can potentially contribute substantially to the daily level of physical activity and development of motor skills and might be an ideal setting for improving these as a public health initiative. We aimed to examine whether children from rural outdoor kindergartens had a lower risk of motor difficulties than children from urban conventional kindergartens.

METHODS

Motor test results were measured during the first school year by school health nurses using a six-item test of gross- and fine motor skills (jumping, handle a writing tool, cutting with a scissor following a line, one-leg stand on each leg, throwing and grabbing). Register-based information was available on potential confounding factors.

RESULTS

We included 901 children from outdoor kindergartens and 993 from conventional kindergartens with a mean (SD) age of 6.5 years (0.4). The children from the two types of kindergarten differed according to demographic information, with outdoor kindergarten children more often being from more affluent families (long maternal education level: 47.5% vs. 31.0%, p < 0.0001) and fewer girls attending the outdoor kindergartens (42.7% vs. 49.5%, p = 0.003). In the adjusted models, we found no evidence of differences in the risk of motor difficulties between children attending either type of kindergarten (OR: 0.95, 95%CI: 0.71; 1.27, p = 0.72).

CONCLUSION

Our results do not support outdoor kindergartens as a potential intervention to improve motor abilities among children. Randomized controlled trials are needed to confirm these findings.

The Influence of Sociodemographic Factors on Mobile Device Use among Young Children in Putrajaya, Malaysia

Technology is evolving rapidly around the world, and the use of mobile devices is increasing every day. Today, everyone owns a mobile device, including young children. Parents provide and allow young children to use mobile devices for various purposes. Due to the fact of these circumstances, children begin to become comfortable with the use of mobile devices, and they are prone to excessive use. Therefore, the purpose of this study was to examine the influence of sociodemographic factors on excessive mobile device use among young children. Sociodemographic variables, including the child’s gender, the child’s age when starting to use a mobile device, the parent’s educational level, household income, type of application used, and the purpose of giving a mobile device to the child, were selected as predictive factors. A cross-sectional survey study design with a quantitative approach was conducted. A simple random sampling technique was employed, and a total of 364 parents completed the adapted questionnaire, namely, the Problematic Mobile Phone Use Scale (PMPUS). Data were statistically analyzed using descriptive and binary logistic regression analysis. The findings revealed that gender, age of the child when starting to use mobile devices, and purpose of parents providing mobile devices significantly contributed to 77.7% of the variance to make children users with a problem. However, the parent’s educational level, household income, and type of application did not significantly contribute to the problem of mobile device use. Later, this study discusses the research implication, limitation, and recommendation for future research based on the finding.

Prospective associations between dietary patterns, screen and outdoor play times at 2 years and age at adiposity rebound: The EDEN mother-child cohort

Although an early adiposity rebound (AR) is an established risk factor for later obesity, little is known regarding its determinants, especially modifiable ones. Using data from the French EDEN mother–child cohort (1903 children born in 2003–2006), we aimed to examine the association between diet and activity-related behaviors at 2 years of age and the timing of the AR. Two-year-old children (n = 1138) with parent-reported data on their foods/drinks intake, TV/DVD watching time, outdoor playtime, and with an estimated (via growth modelling) age at AR were included in the present study. Two dietary patterns, labelled 'Nutrient-dense foods' and 'Processed and fast foods', were identified in a previous study. Multivariable linear and logistic regression models were used to assess the association between dietary patterns and activity-related behaviors and, respectively, the age at AR (continuous) and the likelihood of having a very early AR (before 3.6 years for girls and 3.8 years for boys, i.e., below the 10th percentile of sex-specific distribution). A higher score on the ‘Processed and fast foods’ dietary pattern was associated with a higher likelihood of having a very early AR (OR = 1.23; 95% CI: 1.00 to 1.50). No significant association was observed between the ‘Nutrient-dense foods’ dietary pattern, TV/DVD watching and outdoor playing times and the timing of the AR. This finding emphasizes the importance of reducing nutrient-dense and processed foods from the early years of life, and provides further support for early interventions aimed at helping parents establish healthy eating habits for their growing child from the complementary period.

Parental Working Hours and Children's Sedentary Time: A Cross-sectional Analysis of the J-SHINE

BACKGROUND

Sedentary behaviors are prevalent among children and can have a detrimental effect on their health. Little is known about the influence of parental time on children's sedentary behavior. This study examined the association between parental working hours and children's sedentary time.

METHODS

Cross-sectional data were drawn from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE) in 2010 and 2011. Participants were 886 children aged 7-18 years and their parents. The primary outcome was self-reported sedentary time after school that comprised screen time and non-screen time. The main explanatory variable was parental working hours. We used multiple regression analysis adjusting for sociodemographic factors.

RESULTS

Children's mean sedentary time was 222 (standard deviation [SD], 123) min/day; 144 (SD, 108) min/day screen time and 78 (SD, 65) min/day non-screen time. Children whose mothers worked ≥20 hours/week had 28 (95% CI, 9 to 48) min/day longer sedentary time than children of homemakers (240 min/day vs 214 min/day). The longer maternal working hours, the longer sedentary time (P for trend <0.01). In contrast, children whose fathers worked ≥48 hours/week had 82 (95% CI, -156 to -7) min/day shorter sedentary time than children of non-working fathers (179 min/day vs 264 min/day). When limited to children whose fathers worked, there was no statistically significant association between children's sedentary time and paternal working hours.

CONCLUSIONS

Children with mothers who work long hours or fathers not working tend to sit more. Supplementing the shortages in resources for childcare may be necessary among those families.

[Childhood obesity in Spain and associated factors]

Childhood obesity is an important public health problem, also in Spain. The ALADINO study, in the context of the COSI strategy of the WHO European office, monitors the weight status of Spanish schoolchildren aged 6 to 9 years, and analyzes the associated factors. Data from the 2019 wave indicate that 23.3 % of schoolchildren are overweight and 17.3 % are obese. A high percentage of schoolchildren eat breakfast regularly, although breakfast quality can be improved. The frequency of consumption of fruits and vegetables is low, even lower than that of other countries participating in the COSI strategy. In terms of lifestyle, more than 70 % of schoolchildren are active, although this percentage is lower than the European average. Screen exposure time is also shorter than in other countries, but this habit may be improved in a high percentage of schoolchildren. There is a lower percentage of schoolchildren with obesity who have breakfast or are active compared to those of normal weight, while they are more sedentary, spend fewer hours sleeping, and are more likely to have a TV or electronic devices in their room. It is a priority to promote access to healthier diets and the promotion of more active and less sedentary lifestyles, both in the family and at school, from an early age.

Body weight trends in adolescents of Central Italy across 13 years: social, behavioural, and psychological correlates

Aim

The study aimed to determine trends in the prevalence of underweight, overweight, obesity and their putative risk factors in different cohorts from a representative population of adolescents in Central Italy.

Subject and methods

After random sampling, five cohorts of adolescents attending public high schools – aged 14 to 18 years – were evaluated from 2005 to 2018 (n: 25,174). Collected information included self-reported body mass index (BMI), descriptors of family environment, eating behaviour, physical activity, screen use, bullying victimisation, sexual behaviour (age at first intercourse, number of partners) and perceived psychological distress. For these data, between-cohort prevalence differences were used to esteem prevalence variations across time. In the 2018 cohort, the association between these factors and body weight was evaluated through multinomial regressions with sex-specific crude relative risk ratios for different BMI categories.

Results

An increased prevalence of overweight was observed for both boys and girls. The study outlined a transition towards higher parental education and unemployment, reduced soft drinks consumption and higher psychological distress. Sex-specific changes were observed for physical and sexual activity, and a rising percentage of girls reported being bullied and distressing family relationships. Parental education and employment, together with physical activity, confirmed to be protective factors against pathological weight. The latter clustered with reduced soft drinks consumption, bullying victimisation, early sexual activity, worse family relationships and higher distress.

Conclusion

An increased prevalence of both overweight and underweight was observed across time. Economic factors associated with unemployment and changes in behavioural patterns may have contributed to this trend.

Individual, Interpersonal, and Organizational Factors Affecting Physical Activity of School Adolescents in Pakistan

The purpose of this study was to explore individual, interpersonal, and organizational factors that may influence the physical activity of adolescents (ages 10–14) in Pakistani schools. A set of questionnaires that included individual, interpersonal, and organizational factors and PA behavior was completed by the 618 students selected from Pakistani schools. Stepwise forward regression model was applied to check the possible effects of multilevel variables on physical activity and to extract the stronger predictors. The results showed that physical activity was significantly predicted by individual level factors such as self-efficacy, motivation, and attitude. Among the demographic correlates, gender, age, and BMI did not affect physical activity, while socioeconomic status and geographic characteristics had a meaningful association with PA. At the interpersonal level, adolescents’ perception of family support had a potential influence on physical activity, while there was no impact of friends/peers and teachers support on adolescents’ PA. A school environmental characteristic, such as PA facility, was positively related to PA; however, the impact of PA equipment, safety, and policy and PA culture were statistically non-significant. The findings suggest that public health intervention strategies aimed at promoting PA in adolescents should recognize multiple levels of influences that may either enhance or impede the likelihood of PA among adolescents.

Students' Physical Activity Profiles According to Children's Age and Parental Educational Level

The aim of this study was to identify different profiles of physical activity (PA) behaviors according to the school student’s age stage and their parents’ or guardians education level. Seven hundred twenty-seven students and parents of different educational stages were invited to take part in this study. The participants included, Preschool (1 to 5 years old), Primary School (6 to 11 years old), Secondary School (12 to 15 years old), and High School (16 to 18 years old). A questionnaire to assess the educational level of parents (low, intermediate, and high) and their child’s PA level and sedentary behaviors across various age stages was administered. The results showed a number of different physical activity profiles for preschool (4), primary (6), secondary (7) and high school (2) students. Primary and secondary school children’s behavioral profiles were reported to differ significantly between both physical activity levels and sedentary behaviors, while preschool students’ behavioral profiles only differed between sedentary behaviors. Higher parental education was most prevalent in clusters with significantly higher levels of PA in primary and secondary students, while there were equivocal trends for parental education level influencing behavioral profiles of high school students. These findings suggest there is some association between the behavioral profiles of student’s physical activity and sedentary behavior, and parental education level, most noticeably during the early to middle age stages.

The Pathways Linking to Sleep Habits among Children and Adolescents: A Complete Survey at Setagaya-ku, Tokyo

It has been noted that Japanese children sleep the least in the world, and this has become a major social issue. This study examined the pathways linked to sleep habits (SH) among children and adolescents. A questionnaire-based survey was conducted in March 2019 on children and their parents at all 63 public elementary and 29 public junior high schools in Setagaya-ku, Tokyo. For the analysis, 22,385 pairs of children-parent responses (valid response rate: 68.8%) with no missing data were used. This survey collected data on SH, physical activity (PA), screen time (ST) for the child, and lifestyle and neighborhood social capital (NSC) for the parents. Moreover, the pathways linking 'NSC' → 'parental lifestyle' → 'child's PA/ST' →'child's SH' were examined through structural equation modeling. The results indicated that children's SH were affected by their PA and ST and influenced by the lifestyle of their parents and the NSC that surrounds them. Thus, we concluded that it is necessary to provide direct interventions and take additional measures with regard to parent lifestyle and their NSC to solve persistent sleep problems in children.

A longitudinal examination of daily amounts of screen time and technoference in infants aged 2-11 months and associations with maternal sociodemographic factors

This study aimed to examine longitudinal developmental patterns in the daily amounts of screen time and technoference in infants aged 2, 4, 7, and 11 months and to examine associations with maternal sociodemographic factors across all age groups. The results showed that the amount of screen time varied between 6 and 17 min a day, while interruptions in mother-infant interactions due to maternal use of digital technology occurred between 5 and 6 times a day. There was a significant increase in infant screen time from 2 to 4 months, from 4-7 months, and from 7-11 months, and in technoference from 2 to 4 months and from 4-7 months. Maternal age and household income were not associated with infant screen time, but maternal educational level was negatively associated with infant screen time throughout the first year. No associations were found between technoference and maternal age, maternal educational level, or household income. Future research focusing on infant screen time and technoference should aim at including samples that reflect the general population, include measures of screen time and technoference that do not rely on parental report, and include measures of the effects of early infant screen time and technoference on later development.

State-of-the-art of measures of the obesogenic environment for children

Various measures of the obesogenic environment have been proposed and used in childhood obesity research. The variety of measures poses methodological challenges to designing new research because methodological characteristics integral to developing the measures vary across studies. A systematic review has been conducted to examine the associations between different levels of obesogenic environmental measures (objective or perceived) and childhood obesity. The review includes all articles published in the Cochrane Library, PubMed, Web of Science and Scopus by 31 December 2018. A total of 339 associations in 101 studies have been identified from 18 countries, of which 78 are cross-sectional. Overall, null associations are predominant. Among studies with non-null associations, negative relationships between healthy food outlets in residential neighbourhoods and childhood obesity is found in seven studies; positive associations between unhealthy food outlets and childhood obesity are found in eight studies, whereas negative associations are found in three studies. Measures of recreational or physical activity facilities around the participants' home are also negatively correlated to childhood obesity in nine out of 15 studies. Results differ by the types of measurement, environmental indicators and geographic units used to characterize obesogenic environments in residential and school neighbourhoods. To improve the study quality and compare reported findings, a reporting standard for spatial epidemiological research should be adopted.

Sensor-based physical activity, sedentary time, and reported cell phone screen time: A hierarchy of correlates in youth

BACKGROUND

Evidence on correlates relies on subjective metrics and fails to include correlates across all levels of the ecologic model. We determined which correlates best predict sensor-based physical activity (PA), sedentary time (ST), and self-reported cell phone screen time (CST) in a large sample of youth, while considering a multiplicity of correlates.

METHODS

Using sensor-based accelerometry, we assessed the PA and ST of 2179 youths. A χ² automatic interaction detection algorithm was used to hierarchize the correlates associated with too much ST (> 50th percentile), insufficient moderate-to-vigorous PA (MVPA) (<60 min/day), and prolonged CST (≥2 h/day).

RESULTS

Among youth 10-14 years old, the correlates for being inactive consisted of being a girl, not having sport facilities in the neighborhood, and not perceiving the neighborhood as a safe place, whereas in the youth 15-18 years old, the correlate for being inactive was not performing sports (9.7% chance of being active). The correlates for predicting high ST in the younger group was not performing sports (55.8% chance for high ST), and in the older group, the correlates were not owning a pet, perceiving the neighborhood as safe, and having inactive parents (63.7% chance for high ST). In the younger group, the greatest chances of having high CST were among those who were in the last elementary school years, who were girls, and who did not have friends in the neighborhood (73.1% chance for high CST), whereas in the older group, the greatest chance for having high CST was among those who were girls and had a TV in the bedroom (74.3% chance for high CST).

CONCLUSION

To counteract ST and boost MVPA among youths, a specific focus on girls, the promotion of sport participation and facilities, neighborhood safety, and involvement of family must be prioritized.

Socioeconomic inequalities and severe obesity-Sex differences in a nationwide study of 1.12 million Israeli adolescents

INTRODUCTION

In a nationwide population of adolescents, we investigated the sex-specific association of socioeconomic position (SEP) with severe obesity, and trends over time.

METHODS

The cohort comprises all Israeli adolescents (mean ± SD age 17.3 ± 0.5 years) who were medically examined, before mandatory military service during 2000 to 2015. Of 1 120 362 adolescents, 239 816 (21.4%) were classified with overweight or with obesity classes I to III using the International Obesity Task Force criteria. Data were compared between 2000 to 2009 and 2010 to 2015.

RESULTS

Considering more advantaged residential SEP as the reference group, the respective odds ratios (ORs ± 95%CI) of less advantaged SEP for obesity classes I to III in 2010 to 2015 were 1.48 (1.40-1.56), 1.66 (1.51-1.83), and 1.73 (1.45-2.08) for males; and 1.72 (1.60-1.84), 1.89 (1.66-2.15), and 2.62 (2.04-3.37) for females. All point estimates were higher than in the preceding decade. Considering female inductees from the more advantaged SEP as the reference group, ORs were higher for males in the more advantaged SEP group, for overweight, 1.31 (1.27-1.36); class I obesity, 1.29 (1.20-1.38); class II obesity, 1.34 (1.18-1.53); and class III obesity, 1.60 (1.24-2.07). Similarly, in the less and medium advantaged SEP groups, increased ORs for males compared with females were observed in all obesity groups. Results persisted using United States Centers for Disease Control and Prevention growth charts.

CONCLUSIONS

Adolescents with less rather than more advantaged residential SEP are at greater risk of severe obesity. Adolescent males, of all residential SEP groups had higher odds than females for all classes of obesity.

Maternal Education Level and Excessive Recreational Screen Time in Children: A Mediation Analysis

There is increasing recognition of the adverse health consequences of excessive recreational screen time (RST) in children and adolescents. Early interventions that aim to reduce RST are crucial, but there are some controversies about which individual and parental variables affect RST in children. The aim of this study was to determine the relationship of parental education level with RST in children and early adolescents and to identify mediators of these relationships. This cross-sectional study examined a sample of children (2–14 year-old) who attended routine childcare visits in primary health care centers in Spain (n = 402; 53.7% males; mean age: 7 ± 4 year-old). A self-reported questionnaire was given to the parents to assess sociodemographic data, parental education, the home media environment, and RST in children. Separate analysis was performed for two age groups (2–6 year-old and 6–14 year-old). Path analysis, an application of structural equation modeling, was used to analyze the data. Fitty three percent of the children had excessive RST (≥2 h/day). The maternal education level, eating lunch/dinner in front of a TV, presence of a background TV, and the amount of parental TV viewing had significant associations with excessive RST in both age groups. For the younger group, the maternal education level had direct and indirect effects on RST (total effect: β = −0.29, p < 0.01). For the older group, maternal education level only had a significant indirect effect on RST, and this was mediated by the presence of a background TV and the time of parental TV viewing (total indirect effect: β = −0.11, p < 0.01). A higher maternal education level appears to be associated with certain environmental factors or habits that prevent excessive RST.

Objectively measured waist circumference is most strongly associated in father-boy and mother-girl dyads in a large nationally representative sample of New Zealanders

BACKGROUND

The prevalence of children with elevated weight or obesity is concerning for public health due to associated comorbidities. This study investigates associations between parental adiposity, physical activity (PA), fruit and vegetable consumption, and child adiposity and moderation by both child and parent gender.

METHODS

Cross-sectional nationally representative data from the New Zealand Health Survey were pooled for the years 2013/14-2016/17. Parent and child surveys were matched resulting in 13,039 child (2-14 years) and parent (15-70 years) dyads. Parent and child, height (cm), weight (kg) and waist circumference (WC) were measured objectively. Height and weight were used to calculate BMI. Linear regression, accounting for clustered samples (b [95% CI]) investigated associations between parental characteristics and child BMI z-score and WC. Interactions and stratification were used to investigate effect moderation by parent gender, child gender, and parent adiposity.

RESULTS

Parental PA and fruit and vegetable consumption were unrelated to child adiposity. Overall, higher parent BMI was related to a higher child BMI z-score (b = 0.047 [0.042, 0.052]) and higher parental WC was related to a higher child WC (0.15 [0.12, 0.17]). A three-way interaction revealed no moderation by parent gender, child gender, and parent BMI for child BMI z-score ((b = 0.005 [-0.017, 0.027], p = 0.318). However, a three-way interaction revealed moderation by parent gender, child gender, and parent WC for child WC (b = 0.13 [0.05, 0.22]). The slightly stronger associations were seen between father-son WC (b = 0.20 [0.15, 0.24]) and mother-daughter WC (b = 0.19 [0.15, 0.22]).

CONCLUSIONS

The findings are highly relevant for those wishing to understand the complex relationships between child-parent obesity factors. Findings suggest that family environments should be a key target for obesity intervention efforts and show how future public health interventions should be differentiated to account for both maternal and paternal influences on child adiposity.

Associations between Childhood and Adolescent Emotional and Behavioral Characteristics and Screen Time of Adolescents

The correlations between emotional and behavioral problems and increased screen time among young people has been highlighted in the literature. This study examined both longitudinal and cross-directional associations between the degree of childhood and adolescent emotional and behavioral problem characteristics and a higher level of daily screen time in adolescence using an extensive population study. Questionnaires providing data on a representative cohort sample (the Northern Finland Birth Cohort 1986 Study, NFBC 1986; n = 6479; 3101 males) were completed at birth, in childhood, and in adolescence. Male gender, and self-reported behavioral issues (such as a higher degree of hyperactivity/distractibility problems at the beginning of formal schooling and adolescent rule-breaking problems), predicted higher daily screen time in adolescence, after controlling for confounding factors. Higher levels of anxious-depression symptoms among adolescents were inversely related to them having elevated daily digital screen time. Individual behavioral tendencies at the start of formal schooling and later in adolescence may predict higher screen time among young people.

Gender and education differences in sedentary behaviour in Canada: an analysis of national cross-sectional surveys

Background

Canadians spend the majority of their days sedentary. Gender and education are important social determinants of health that impact health behaviours. There is evidence that gender and educational differences in sedentary behaviour exist. In Canada, while general trends suggest that leisure sedentary activities have changed; there has been no comprehensive assessment examining whether historical changes in sedentary behaviour differ by gender and education level. Our objective was to examine whether gender and educational differences in accelerometer-measured sedentary time and self-reported sedentary behaviours exist among Canadians and if differences are consistent across age groups, over time and across multiple survey sources.

Methods

We summarize amounts of total accelerometer-measured sedentary time and self-reported sedentary activities (e.g., passive travel, television, computer, video games, screen, reading) by age (i.e. children: 6–11 years, youth: 12–17 years, adults: 18–34 years, 45–49 years, 50–64 years, and older adults: ≥ 65 years), gender (girls/women, boys/men) and household education level (< post-secondary vs. ≥ post-secondary) over time in the Canadian Community Health Survey, Canadian Health Measures Survey, General Social Survey, and the Health Behaviour in School-Aged Children study. Gender and education level differences are examined using independent sample t-tests or chi-square analyses.

Results

While few differences were found for total accelerometer-measured sedentary time, gender and education differences in self-reported, type-specific sedentary behaviour were identified. Among youth, data from all surveys consistently identified that boys engaged in more video/computer game play (e.g., boys: 0.35–2.68 vs. girls: 0.09–2.15 h/day), while girls engaged in more leisure reading (e.g., boys: 0.45–0.65 vs. girls: 0.71–0.99 h/day). Those with a higher education or household education often reported more leisure reading and passive travel. Education level differences in screen time were often age dependent, with leisure computer use greater in higher education groups in adults only and leisure television watching generally higher in lower education groups in children and adults, but not youth.

Conclusions

This information is valuable as it helps to identify segments of the population which may be at greater risk for engaging in higher volumes of sedentary behaviour. In turn, this information can identify target audiences and behaviours for policies and interventions. Future work is needed to further understand factors contributing to these differences (e.g., preferences, occupation, family structure).

Social inequalities in traditional and emerging screen devices among Portuguese children: a cross-sectional study

BACKGROUND

Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in pre-school and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP).

METHODS

A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children's screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children's age, gender and family SEP (classified using father's educational degree).

RESULTS

Daily screen time was high both in children aged 3 to 5 and 6 to 10 years - 154 min/day (95% CI: 149.51-158.91) and 200.79 min/day (95% CI: 197.08-204.50), respectively - and the majority of children, independently of their gender, exceed the recommended 2 h/day of screen viewing. Children are still primarily engaging in screen time through television but the use of mobile devices, particularly tablets, were already high among 3 year-old children and increased with age. SEP was a negative predictor of screen time in the linear regression analysis, including after adjustment.

CONCLUSIONS

Considering the negative health impacts of excessive screen time, recognizing subgroups at risk of excessive screen time and identifying how each device is used according to age is fundamental to enable appropriate future interventions. The screen time in children aged 3-10 years is longer than the recommended, particularly among boys and in those children from lower SEP. Parents and policymakers should have in mind that children spend most of their screen time watching television but mobile devices are becoming extremely popular starting at a young age.

Correlates of screen time and mediators of differences by parental education among adolescents

Background

Existing literature shows that there is an inverse association between socioeconomic position and screen time among adolescents. What is less known is the mechanism behind these differences. The study aimed to explore individual, interpersonal and neighborhood environmental correlates of total screen time (TST) among adolescents and to assess their mediating role in the association between parental education and TST.

Methods

A cross-sectional study including 706 adolescents (mean age of 13.6 (SD = 0.3)) was used to collect data at schools through an online questionnaire. Multiple regression analyses were used to explore factors associated with TST. Mediation analyses were conducted to assess whether these factors mediated the association between parental education and TST.

Results

Multiple linear regression analyses, adjusted for gender and age, showed that parental modelling of TV and movie streaming, TV/movie streaming during dinner and access to screens were positively related to TST. Self-efficacy towards limiting TV and movie streaming, self-efficacy towards limiting computer/electronic game use, and the perceived opportunities for physical activity in the neighborhood were inversely related to total screen time. All of these factors except self-efficacy towards limiting TV and movie streaming mediated the association between parental education and TST.

Conclusions

The study identified several modifiable factors at the individual, interpersonal and neighborhood environmental levels that can be targeted in interventions aimed at decreasing screen time among youth in general and among those with a low socioeconomic position in particular.

Influence of deprivation on initial severity and prognosis of patients admitted to the ICU: the prospective, multicentre, observational IVOIRE cohort study

Background

The influence of socioeconomic status on patient outcomes is unclear. We assessed the impact of socioeconomic deprivation on severity of illness at intensive care unit (ICU) admission, and on the risk of death at 3 months after ICU admission.

Methods

The IVOIRE study was a prospective, observational, multicentre cohort study in the ICU of 8 participating hospitals in France, including patients aged ≥ 18 years admitted to the ICU and receiving at least one life support therapy for organ failure. The primary outcomes were severity at admission (assessed by SAPSII score), and mortality at 3 months. Socioeconomic data were obtained from interviews with patients or family. Deprivation was assessed using the EPICES score.

Results

Among 1294 patents included between 2013 and 2016, 629 (48.6%) were classed as deprived and differed significantly from non-deprived subjects in terms of sociodemographic characteristics and pre-existing conditions. The mean SAPS II score at admission was 50.1 ± 19.4 in deprived patients and 52.3 ± 17.3 in non-deprived patients, with no significant difference by multivariable analysis (β = − 1.85 [95% CI − 3.86; + 0.16, p = 0.072]). The proportion of death was 31.1% at 3 months, without significant differences between deprived and non-deprived patients, even after adjustment for confounders.

Conclusions

Deprivation is frequent in patients admitted to the ICU and is not associated with disease severity at admission, or with mortality at 3 months between deprived and non-deprived patients.

Trial registration The IVOIRE cohort is registered with ClinicalTrials.gov under the identifier NCT01907581, registration date 17/7/2013

Individual-, home- and preschool-level correlates of preschool children's sedentary time

BACKGROUND

Prechoolers' significant portions of sedentary time (ST) is a public-health concern due to its high prevalence and negative health consequences. However, few studies have explored correlates of preschoolers' ST covering individual-, home- and preschool- factors within one study. The aim of this study was to identify the associations between multiple individual-, home- and preschool-level factors and preschoolers' ST. In addition, it was studied how much individual-, home- and preschool-level factors explained the variance in children's ST.

METHODS

A total of 864 children aged three to six, their parents and 66 preschools participated in the cross-sectional DAGIS study, which occurred between 2015 and 2016. The children wore an accelerometer for 1 week. Guardians, principals and early educators completed questionnaires covering the potential correlates of children's ST, for example, temperament, practices, self-efficacy and regulations. Multilevel regression analyses were conducted in multiple steps; calculation of marginal and conditional R² values occurred in the final phase.

RESULTS

Of the 29 studied correlates, the following factors remained significant in the final models. Being a boy (p < 0.001) and having high levels of surgency temperament (p < 0.001) were associated with lower ST. Regarding the home setting, frequent co-visits in physical activity (PA) places (p = 0.014) were associated with lower ST. Higher parental perceived barriers related to children's outside PA (p = 0.032) was associated with higher ST. None of the preschool setting factors remained significant in the final model. Approximately 11% of the variance in children's ST was attributed to factors related to the individual level whereas 5% was attributed to home-level factors; and 2% to preschool-level factors.

CONCLUSIONS

This study identified a set of correlates of preschool children's ST. Interventions aimed at reducing children's ST should develop strategies targeting established correlates of preschoolers' ST covering individual-, home- and preschool-level factors. The preschool-level factors included in this study explained little the variance in children's ST. However, the included measures may not have captured the essential preschool-level factors that specifically influence children's ST. Therefore, more studies are needed regarding potential preschool-level factors.

Sleeping Time, BMI, and Body Fat in Chinese Freshmen and Their Interrelation

INTRODUCTION

In the past two decades, urbanization in many Asian countries has led to sedentary lifestyle and overnutrition, which has set the stage for the epidemic of obesity. Those who have obesity during adolescence usually have obesity into adulthood, which causes many medical and psychological issues that can result in premature death. Recent data suggest that short sleep duration may contribute to the risk of obesity, opening a new avenue for potential intervention. The aim of this study was to describe the prevalence of sleeping time, body mass index (BMI), and fat mass in Chinese freshmen and to indicate the relationship among them.

METHODS

We conducted a cross-sectional study consisting of 1,938 freshmen aged from 18 to 24 years, including 684 (35.3%) men and 1,254 (64.7%) women. BMI, sleeping time, and other potential related variables were collected by questionnaire. Obesity and overweight were defined as BMI ≥28.0 and ≥24.0, respectively. All students were divided into three groups according to the tertiles of body fat percentage (Fat%), which were measured by bioelectrical impedance analysis. Sleeping time was divided into 3 categories based on the duration, <6, 6-8, and >8 h per day.

RESULTS

Participants who slept longer had lower BMI and Fat%. Sex, diet control, and maternal obesity were all significantly associated with BMI or Fat% after adjustment. There were significant differences between sleeping time <6 and >8 h in both overweight group and Fat% tertiles independent of adjustment used. The significant difference between sleeping time 6-8 and >8 h only existed in overweight group, while irrelevant relation was observed in both models of obesity group.

CONCLUSION

Longer sleeping time was associated with a lower BMI in Chinese freshmen, even after adjustment for multiple confounders. The overweight stage is a critical period of weight management intervention by changing sleeping time. If adolescents have entered the obesity stage, the effect size of lifestyle intervention might be significantly limited.

Associations between socioeconomic position and changes in children's screen-viewing between ages 6 and 9: a longitudinal study

OBJECTIVES

To explore socioeconomic differences in screen-viewing at ages 6 and 9, and how these are related to different media uses.

DESIGN

Longitudinal cohort study.

SETTING

Children recruited from 57 state-funded primary schools in Southwest England, UK.

PARTICIPANTS

1299 children at ages 5-6, 1223 children at ages 8-9, including 685 children at both time points.

OUTCOME MEASURES

Children's total screen-viewing time (parent-reported) and time spent using multiple screen devices simultaneously (multiscreen viewing), for weekdays and weekends.

METHODS

Negative binomial regression was used to model associations between socioeconomic variables (highest household education and area deprivation) and total screen-viewing at age 6 and the change from age 6 to 9. We additionally adjusted for child characteristics, parental influences and media devices in the home. Multiscreen viewing was analysed separately.

RESULTS

Household education was associated with children's screen-viewing at age 6 with lower screen-viewing in higher socioeconomic groups (21%-27% less in households with a Degree or Higher Degree, compared with General Certificate of Secondary Education: GCSE). These differences were explained by the presence of games consoles, parental limits on screen-viewing and average parent screen-viewing. Between ages 6 and 9, there were larger increases in screen-viewing for children from A level and Degree households (13% and 6%, respectively, in the week) and a decrease in Higher Degree households (16%), compared with GCSE households. Differences by household education remained when adjusting for media devices and parental factors.

CONCLUSIONS

Children's screen-viewing patterns differ by parental education with higher levels of viewing among children living in households with lower educational qualifications. These differences are already present at age 6, and continue at age 9. Strategies to manage child sedentary time, and particularly screen-viewing, may need to take account of the socioeconomic differences and target strategies to specific groups.

Correlates of leisure-time sedentary behavior among 181,793 adolescents aged 12-15 years from 66 low- and middle-income countries

BACKGROUND

Sedentary behavior is a growing public health concern in young adolescents from low- and middle-income countries (LMICs). However, a paucity of multinational studies, particularly in LMICs, have investigated correlates of leisure-time sedentary behavior (LTSB) in young adolescents. In the current study, we assessed socio-demographic, socio-economic, socio-cultural and health behavior related correlates of LTSB among adolescents aged 12-15 years who participated in the Global school-based Student Health Survey (GSHS).

METHODS

Self-reported LTSB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework, was analyzed in 181,793 adolescents from 66 LMICs [mean (SD) age 13.8 (1.0) years; 49% girls). Multivariable logistic regression was used to assess the potential LTSB correlates.

RESULTS

The overall prevalence of ≥3 hours/day of LTSB was 26.4% (95%CI = 25.6%-27.2%). Increasing age (OR = 1.14; 95%CI = 1.11-1.17), past 30-day smoking (OR = 1.85; 95%CI = 1.69-2.03), alcohol consumption (OR = 2.01; 95%CI = 1.85-2.18), and bullying victimization (OR = 1.39; 95%CI = 1.31-1.48) were positively associated with increased LTSB across the entire sample of 181,793 adolescents. Food insecurity (OR = 0.93; 95%CI = 0.89-0.97) and low parental support/monitoring (OR = 0.91; 95%CI = 0.85-0.98) were negatively associated with LTSB. There were some variations in the correlates between countries.

CONCLUSIONS

Our data indicate that in adolescents aged 12 to 15 years living in LMICs, LTSB is a complex and multi-dimensional behavior determined by socio-demograhic, sociocultural, socio-economic, and health behavior related factors. Future longitudinal data are required to confirm/refute these findings, and to inform interventions which aim to reduce sedentary levels in adolescents living in LMICs.

Electronic device use and beverage related sugar and caffeine intake in US adolescents

Background

Despite recent declines in consumption of sugary beverages, energy drinks (ED) and sodas continue to contribute a substantial amount of sugar and caffeine to the diet of youth. Consumption of these beverages has been linked with electronic device use, however in-depth associations between sugar and caffeine intake from energy drinks and sodas with various electronic devices are not clear.

Objective

Describe the relationship of soda and energy drink consumption and associated added sugar and caffeine intake with electronic device use among adolescents.

Methods

Secondary data from the 2013–2016 cycles of Monitoring the Future Survey, a national, repeated, cross-sectional study, were analyzed. Information on energy drink and soda consumption by students in grades 8 and 10 (n = 32,418) from 252–263 schools randomly sampled from all US states was used.

Results

Soda and energy drink consumption decreased each year from 2013–2016 while daily use of electronic devices remained stable. An additional hour/day of TV was linked to a 6.92g (6.31,7.48; p<0.001) increase in sugar intake and a 32% (OR = 1.32; 1.29,1.35; p < .001) higher risk of exceeding World Health Organization (WHO) recommended sugar intakes. Further, each hour/day of TV was linked to a 28% increased risk of exceeding caffeine recommendations (OR = 1.25–1.31; p<0.001). Each hour per day talking on a cellphone was associated with an increased risk of exceeding WHO sugar and caffeine intakes by 14% (OR = 1.11–1.16; p<0.001) and 18% (OR = 1.15–1.21; p<0.001) respectively. Video game use was only weakly linked to caffeine intake. Computer use for school was associated with lower likelihood of exceeding sugar intake cut-offs.

Conclusion

While a trend towards reduced energy drink and soda intake from 2013–2016 was evident, greater electronic device use, especially TV time, was linked to higher intake of beverage-derived added sugar and caffeine amongst adolescents. Addressing these behaviours through counselling or health promotion could potentially help to reduce excess sugar and caffeine intake from sodas and energy drinks among this population.

Gender-specific mediators of the association between parental education and adiposity among adolescents: the HEIA study

Identifying the mechanisms behind socioeconomic inequalities in adiposity among youth is vital for efforts aimed at combating these inequalities. The study explored whether a broad range of behavioral and familial factors mediated the associations between parental education and indicators of adiposity among adolescents. Baseline data from a school-based intervention study conducted in 2007 among 11-year-old adolescents were used. Anthropometric outcomes, physical activity and sedentary time among adolescents were objectively measured. Other behavioral variables and parental waist circumference were self-reported. Mediation analyses were conducted. Among boys, maternal waist circumference (WC), paternal WC and TV viewing mediated 16%, 11.5% and 13% of the association between parental education and adolescent WC. The respective proportions when body fat percentage was used as the outcome variable were 22.5%, 16% and 21%. Among girls, maternal and paternal WC mediated 20% and 14% of the association between parental education and WC. The respective proportions when body fat percentage was used as the outcome variable were 14% and 10%. Other included variables did not play any mediating role. Parental WC was found to be a mediator of socioeconomic differences in adiposity in both genders; underlying mechanisms were however not investigated. Among boys, reducing TV time could contribute to the reduction of social inequalities in adiposity.

Screen-based sedentary behaviors and internalizing symptoms across time among U.S. Hispanic adolescents

INTRODUCTION

The pervasive use of technology has raised concerns about its association with adolescent mental health, including internalizing symptoms. Existing studies have not always had consistent findings. Longitudinal research with diverse subgroups is needed.

METHODS

This study examines the relationship between screen-based sedentary (SBS) behaviors and internalizing symptoms among 370 Hispanic adolescents living in Miami, Florida- United States, who were followed for 2 ½ years and assessed at baseline, 6, 18 and 30 months post-baseline between the years 2010 and 2014. Approximately 48% were girls, and 44% were foreign-born, most of these youth being from Cuba. Mean age at baseline was 13.4 years, while at the last time-point it was 15.9 years.

RESULTS

Findings show that girls had higher internalizing symptoms and different patterns of screen use compared to boys, including higher phone, email, and text use. SBS behaviors and internalizing symptoms cooccurred at each time-point, and their trajectories were significantly related (r = 0.45, p < .001). Cross-lagged panel analyses found that SBS behaviors were not associated with subsequent internalizing symptoms. Among girls, however, internalizing symptoms were associated with subsequent SBS behaviors during later adolescence, with internalizing symptoms at the 18-month assessment (almost 15 years old) associated with subsequent SBS behaviors at the 30-month assessment (almost 16 years old; β = 0.20, p < .01).

CONCLUSIONS

Continued research and monitoring of internalizing symptoms and screen use among adolescents is important, especially among girls. This includes assessments that capture quantity, context, and content of screen time.

Preschool Environmental Factors, Parental Socioeconomic Status, and Children's Sedentary Time: An Examination of Cross-Level Interactions

Preschool children's high levels of sedentary time (ST) is a public health concern. As preschool reaches a large population of children from different socioeconomic status (SES) backgrounds, more knowledge on how the preschool setting is associated with children's ST is relevant. Our aims were to examine (1) the associations of preschool setting (covering social, physical, and organizational level) with children's ST, and (2) the moderating role of the setting on the association between parental SES and children's ST. In the cross-sectional DAGIS (increased health and wellbeing in preschools) study, the participating children (n = 864, aged 3⁻6 years) were asked to wear an accelerometer for one week. In total, 779 children had valid ST accelerometer data during preschool hours. Preschool setting and parental SES was assessed by questionnaires and observation. Multilevel linear regression models with cross-level interactions were applied to examine the associations. Early educators' practice of breaking children's ST often, more frequent physical activity (PA) theme weeks, and higher number of physical education (PE) lessons were associated with lower children's ST. Higher parental SES was associated with higher children's ST in preschools (1) with organized sedentary behavior theme weeks, (2) with a lower number of PA theme weeks, and (3) with a lower number of PE lessons. The factors identified in this study could be targeted in future interventions.

Exploring the Effect of Perceptions on Children's Physical Activity in Varying Geographic Contexts: Using a Structural Equation Modelling Approach to Examine a Cross-Sectional Dataset

Most Canadian children are not meeting the recommended 60 min of moderate-to-vigorous physical activity per day. Research suggests that children’s perceptions of their environment have an influence on their physical activity behaviours, but there is a lack of generalizability among previous work. The purpose of this study was to assess the mediating effect of children’s perceptions of barriers to physical activity on the relationship between their environments and their level of moderate-to-vigorous physical activity (measured with accelerometers). Structural equation modelling stratified by gender was used to assess the research objective in a sample of 546 participants aged 8–14 years old from Northwestern and Southwestern Ontario, Canada. In both models stratified by gender, perceptions of barriers did not significantly mediate the relationship between urbanicity and physical activity. Independent of all other factors, there was no significant relationship between urbanicity and physical activity in girls, but there was in boys. These results offer insight into potential processes by which perceptions impact physical activity and provide initial information to further our understanding of the behavioural aspects of physical activity through multiple levels of analysis. Researchers must continue to improve efforts for quantifying the experience of children’s daily activity contexts.

Parenting Practices as a Mediator in the Association Between Family Socio-Economic Status and Screen-Time in Primary Schoolchildren: A Feel4Diabetes Study

The aim of this study was to examine the mediating effects of specific parenting practices on the association between family socio-economic status (SES) and screen-time of 6- to 9-year-old children from families with an increased risk of developing type 2 diabetes. This cross-sectional study, focusing on families with an increased risk of developing type 2 diabetes, used the Belgian baseline data of the Movie Models intervention, integrated within the European Feel4Diabetes intervention, and included 247 parents (57.6% lower SES family; 78.0% mothers) who completed a questionnaire. Mediating effects were tested using MacKinnon's product-of-coefficients test via multilevel linear regression analyses. Being consistent concerning rules about gaming (β = 0.127; standard error = 0.055; 95% CI = 0.020; 0.234) and avoiding negative role modeling concerning TV-time (β = -0.082; standard error = 0.040; 95% CI = -0.161; -0.003) significantly mediated the inverse association between family SES and children's screen-time. Parents from lower SES families were more consistent concerning rules about gaming and watched more TV nearby their child compared to parents from higher SES families, and these parenting practices were related to more screen-time. No other parenting practices were found to mediate this association. Thus, parents from lower SES families with a higher risk for developing type 2 diabetes might limit their own TV-time nearby their child to reduce their child's screen-time. Future research should examine other possible mediating factors to develop effective interventions targeting this important at-risk group.

Associations between different weight-related anthropometric traits and lifestyle factors in Norwegian children and adolescents: A case for measuring skinfolds

OBJECTIVES

The purpose of this study was to investigate the association between weight-related anthropometric measures and children's eating habits, physical activity and sedentary lifestyle at a population level.

METHODS

Data from the Bergen Growth Study were used to study the association of z-scores of waist circumference (WC), weight-to-height ratio (WHtR), subscapularis (SSF) and triceps (TSF) skinfolds and BMI, with lifestyle factors in 3063 Norwegian children (1543 boys) aged 4-15 years, using linear regression analysis. Each sex was analyzed separately.

RESULTS

In a fully adjusted model with additional correction for BMI z-scores, the consumption of vegetables was associated with higher WC (b = 0.03) and TSF (b = 0.05) z-scores in girls. Sedentary behavior was not associated with any of the anthropometric measures. Physical activity was negatively associated with SSF (b = -0.07) and TSF (b = -0.07) z-scores in boys, while a significant negative association was observed with WC (b = -0.02), WHtR (b = -0.03), SSF (b = -0.04) and TSF (b = -0.06) in girls.

CONCLUSION

Physical activity was negatively associated with skinfolds in both sexes. The BMI was not related to the level of physical activity, and should be complemented with direct measures of fat tissue, like skinfolds, when studying the effect of physical activity on body composition in children.

Associations of TV Viewing Duration, Meals and Snacks Eaten When Watching TV, and a TV in the Bedroom with Child Adiposity

OBJECTIVE

This study aimed to examine the associations of TV parameters with adiposity in early life.

METHODS

Data were collected as part of the Born in Bradford (BiB) longitudinal birth cohort study. Child TV viewing duration was parent reported, and BMI, the sum of triceps and subscapular skinfolds, and waist circumference were measured at ~12, 18, 24, and 36 months of age in 1,338 children. Mixed effects models were used to quantify adjusted associations of TV viewing duration with adiposity markers, incorporating data from all time points. Linear regression was used to investigate differences in adiposity levels across frequencies of eating meals and snacks while watching TV at age ~24 months and between children who did and did not have a TV in their bedroom at age ~36 months.

RESULTS

Every 1 h/d of TV viewing was associated with a 0.075-cm larger (95% CI: 0.0034-0.15) waist circumference, independent of covariates including sleep duration, dietary factors, and physical activity level. There was no evidence for any other associations.

CONCLUSIONS

TV viewing duration is independently associated with abdominal adiposity in young children. Limiting TV viewing from an early age may be important for primary prevention of obesity.

Changes in children's television and computer time according to parental education, parental income and ethnicity: A 6-year longitudinal EYHS study

OBJECTIVES

To investigate changes in children's television and computer time according to three socio-economic status (SES) indicators.

DESIGN

Prospective cohort study.

METHODS

Data were drawn from the European Youth Heart Study and included longitudinal data collected in 1997 and 2003 in Denmark. Television and computer time were self-reported by children. Parental education, income and ethnicity were parent-reported. Baseline data were available for 549 children (47.0% boys, 9.6 years). Generalized linear mixed models analyzed whether changes in television and computer time from baseline to follow-up differed according to the SES-indicators.

RESULT

TV viewing time increased with 25% over time (ExpB = 1.25, 95% CI = 1.04-1.50). At both time points, children with two higher educated parents viewed 25% less hours of television than children with no higher educated parents (ExpB = 0.75, 95% CI = 0.60-0.94) and one higher educated parent (ExpB = 0.75, 95%CI = 0.59-0.97). Among children with no higher educated parents the odds of being in a higher category of computer time increased with 80% over time (OR = 1.80, 95% CI = 1.24-2.60). Among children with two higher educated parents the odds of being in a higher category of computer time decreased with 45% over time (OR = 0.55, 95% CI = 0.32-0.94). The association with ethnicity showed that white children had 42% lower odds (OR = 0.58; 95% CI = 0.34-1.00) of being in a higher category of computer time than non-white children. No significant associations were found for parental income.

CONCLUSIONS

The most important SES measure of screen-based behaviors in children was parental education. Ethnicity was only associated with computer time. Financial resources were less relevant for changes in television viewing and computer use.

Association between education and television viewing among older working and retired people: a comparative study of Finland and Japan

Background

Educational attainment is associated with physical activity among older people. However, little is known about its association with sedentary lifestyle in European as well as Asian nations. This study aims to examine the associations between educational attainment and daily television viewing as an indicator of a sedentary lifestyle among older working and retired people in Finland and Japan.

Methods

We used cross-sectional harmonized data from two cohorts, the Finnish Public Sector study (n = 10,744) and the Japan Gerontological Evaluation Study (n = 2493), evaluating individuals aged 65–75 years old. We defined high-duration television viewing as ≥4 h per day. Poisson regression was used to examine the association between educational attainment and high-duration television viewing, stratified by the current working status. Models were adjusted for age, sex, household size, smoking, alcohol, body mass index, chronic diseases, mental disorders, and physical activity.

Results

Of the participants, 27% in Finland and 30% in Japan reported high-duration television viewing. Compared with a low education (≤9 years), Finnish and Japanese retirees with a high education (≥13 years) had less high-duration television viewing [prevalence ratio, PR 0.68 (95% confidence interval 0.63–0.73) and 0.66 (0.55–0.79), respectively]. The corresponding PRs for Finnish and Japanese retirees with intermediate education were also lowered [0.89 (0.83–0.95) and 0.79 (0.68–0.91), respectively]. Among older people still at work, educational attainment was associated with high-duration television viewing among the Japanese but not among the Finnish.

Conclusion

A similar association between educational attainment and high-duration television viewing in Finland and Japan particularly after retirement suggests a robust and consistent impact of educational attainment on a sedentary lifestyle after retirements.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5860-4) contains supplementary material, which is available to authorized users.

Correlates of screen time among 8-19-year-old students in China

Background

Previous studies have shown that prolonged time spent on screen-based sedentary behavior was significantly associated with lower health status in children, independent of physical activity levels. The study aimed to explore the individual and environmental correlates of screen time (ST) among 8–19-year-old students in China.

Methods

The study surveyed ST using a self-administered questionnaire in Chinese students aged 8–19 years; 1063 participants were included in the final analysis. Individual and environmental correlates of ST were assessed using a mixed-effects model (for continuous outcome variables) and multiple logistic regression model (for binary outcome variables).

Results

Prolonged ST was observed in 14.7% of boys and 8.9% of girls. Of the ST, weekend and mobile phone/tablet use represented 80% and 40%, respectively. A positive relationship was observed between media accessibility and ST in both boys and girls (p < 0.05), whereas the presence of parents/others while using screens was a negative factor for longer ST (p < 0.05). Among the assessed correlates, access to a television (TV) in students’ bedrooms was associated with prolonged total and weekend ST (p < 0.05 and p < 0.001, respectively). However, spending time on a mobile phone/tablet or a computer rather than viewing a TV, along with increased media accessibility, increased ST.

Conclusions

These results indicate that greater media accessibility was positively associated and the presence of parents/others was negatively associated with prolonged ST in both Chinese boys and girls. Development of new and effective strategies against prolonged ST are required, especially for small screen device-based ST on weekends.

Socioeconomic differences in children's television viewing trajectory: A population-based prospective cohort study

We aimed to evaluate the association between family socioeconomic status and repeatedly measured child television viewing time from early childhood to the school period. We analyzed data on 3,561 Dutch children from the Generation R Study, a population-based study in the Netherlands. Parent-reported television viewing time for children aged 2, 3, 4, 6 and 9 years were collected by questionnaires sent from April 2004 until January 2015. Odds ratios of watching television ≥1 hour/day at each age were calculated for children of mothers with low, mid-low, mid-high and high (reference group) education and children from low, middle and high (reference group) income households. A generalized logistic mixed model was used to assess the association between family socioeconomic status and child television viewing time trajectory. The percentage of children watching television ≥1 hour/day increased from age 2 to 9 years for all children (24.2%-85.0% for children of low-educated mothers; 4.7%-61.4% for children of high-educated mothers; 17.2%-74.9% for children from low income households; 6.2%-65.1% for children from high income households). Independent socioeconomic effect in child television viewing time was found for maternal educational level. The interaction between net household income and child age in longitudinal analyses was significant (p = 0.01), indicating that the television viewing time trajectories were different in household income subgroups. However the interaction between maternal educational level and child age was not significant (p = 0.19). Inverse socioeconomic gradients in child television viewing time were found from the preschool period to the late school period. The educational differences between the various educational subgroups remained stable with increasing age, but the differences between household income groups changed over time. Intervention developers and healthcare practitioners need to raise awareness among non-highly educated parents that the socioeconomic gradient in television viewing time has a tracking effect starting from preschool age.

Comparing objective measures of the built environment in their associations with youth physical activity and sedentary behavior across heterogeneous geographies

We compared two strategies for measuring built environment features in their associations with youth physical activity and sedentary behavior across heterogeneous geographies of Pennsylvania. Physical activity environments of communities representing a rural-to-urban gradient were characterized through direct observation and spatially referenced archival data subjected to confirmatory factor analysis. Stratified regression analyses assessed associations between environmental measures and behavioral outcomes by community type. Neither strategy was consistently associated with behavior across communities. Findings highlight the importance of differentiating community type in evaluating associations of the built environment, and the challenge of measuring meaningful differences that influence youth behavior across heterogeneous geographies.

Socioeconomic Status and Cardiovascular Disease: an Update

PURPOSE OF REVIEW

The aim of this paper is to summarize the recent and relevant evidence linking socioeconomic status (SES) to cardiovascular disease (CVD) and cardiovascular risk factors (CVRFs).

RECENT FINDINGS

In high-income countries (HICs), the evidence continues to expand, with meta-analyses of large longitudinal cohort studies consistently confirming the inverse association between SES and several CVD and CVRFs. The evidence remains limited in low-income and middle-income countries (LMICs), where most of the evidence originates from cross-sectional studies of varying quality and external validity; the available evidence indicates that the association between SES and CVD and CVRFs depends on the socioeconomic development context and the stage in the demographic, epidemiological, and nutrition transition of the population. The recent evidence confirms that SES is strongly inversely associated with CVD and CVRFs in HICs. However, there remains a need for more research to better understand the way socioeconomic circumstances become embodied in early life and throughout the life course to affect cardiovascular risk in adult and later life. In LMICs, the evidence remains scarce; thus, there is an urgent need for large longitudinal studies to disaggregate CVD and CVRFs by socioeconomic indicators, particularly as these countries already suffer the greatest burden of CVD.

The mediating role of the home environment in relation to parental educational level and preschool children's screen time: a cross-sectional study

Background

Previous studies suggest that preschoolers from low socioeconomic backgrounds engage in more screen time. Still, the factors in the social and physical home environment driving these differences in preschool children’s screen time are poorly understood. This study examines potential home environment mediators in the associations between parental educational level and preschoolers’ screen time.

Methods

A total of 864 children aged 3–6 years and their parents participated in a cross-sectional DAGIS study in 2015–2016. Parents recorded their children’s screen time in a diary (N = 823). For the analyses, the daily average screen time at home was calculated. Parental questionnaires (N = 808) assessed educational level and eight social and physical environment factors in the home (i.e., descriptive norm for children’s screen time, parental screen use in front of children, parental importance for limiting children’s screen time, parental attitude toward societal pressures for children’s screen time, access to screens at home, parental self-efficacy for limiting children’s screen time, satisfaction of children’s screen time, and rules for limiting children’s screen time). Parental education was grouped into low, middle, and high education. The associations were tested by conducting mediation analyses adjusted by season and children’s sex and age. The significant mediators in the single-mediator models were included in the final multiple-mediator models.

Results

Of the potential eight mediators, the following four had a significant indirect association: descriptive norm for children’s screen time, parental screen use in front of children, parental importance for limiting children’s screen time, and parental attitude toward societal pressures for children’s screen time. Parents with high education had lower descriptive norm and used fewer screens in front of children compared to parents with middle or low education, and in turn, these factors were associated with less screen time among children from parents with a higher education level. Parents with high education placed greater importance on limiting children’s screen time and felt less societal pressures about children’s screen time compared to parents with low education, and in turn, these factors were associated with less screen time among children from parents with a higher education level.

Conclusions

Our study recognized multiple modifiable mediators in the associations between parental education and preschool children’s screen time. When aiming to diminish socioeconomic status differences in preschool children’s screen time, the focus should be on parental role models, attitudes, and norm related to children’s screen time.

Mediators of socioeconomic differences in adiposity among youth: a systematic review

BACKGROUND

Youth with a low socioeconomic position in developed countries are at a disproportionately higher risk of being overweight or obese than their counterparts. Tackling these inequalities requires that the mechanisms behind them are well understood.

OBJECTIVES

The aim of this review was to summarize existing evidence regarding the factors that mediate or contribute to the explanation of the relationship between socioeconomic position and adiposity among youth.

METHODS AND RESULTS

A systematic literature search, conducted using the databases Medline, Embase, Web of Science and PsycINFO, yielded 28 eligible studies. These studies were of low to moderate methodological quality. The most consistent mediators of the association between socioeconomic position and adiposity identified in this review were as follows: consumption of sugar-sweetened beverages, television viewing, computer use, parental body mass index, breastfeeding duration, breakfast consumption, maternal smoking during pregnancy and infant feeding practices. The mediating role of physical activity as well as fruit and vegetable consumption was found to be indeterminate. Other potential mediators were explored in too few studies to make conclusions about their mediating role.

CONCLUSION

The review found several modifiable factors that could be targeted as feasible in interventions aimed at reducing socioeconomic differences in overweight and obesity among youth.

Mediators of the association between parental education and breakfast consumption among adolescents : the ESSENS study

BACKGROUND

Regular breakfast consumption has several health benefits. However, breakfast skipping is common among adolescents, in particular among those with a low socioeconomic background. The aims of the study were to explore individual and home environmental correlates of breakfast consumption, and to assess their potential mediating role in the association between parental education and breakfast consumption.

METHODS

A cross-sectional study including 706 adolescents with a mean age of 13.6 (SD = 0.3) was conducted between October and December 2016. Data were collected at school through an online questionnaire. Regression analyses were used to explore whether parental modelling, parental co-participation in breakfast consumption, parental rules, the availability of breakfast foods at home and screen time were associated with breakfast consumption. Mediation analyses were conducted to assess whether these factors mediated the association between parental education and breakfast consumption.

RESULTS

Breakfast consumption was significantly positively associated with parental education (OR = 1.97 (95% CI 1.43-2.72)). A higher parental modelling (OR = 2.17 (95% CI 1.70-2.79)), a higher parental co-participation in breakfast consumption (OR = 1.37 (95% CI 1.26, 1.49)), higher parental rules (OR = 1.36 (95% CI 1.21, 1.53)) and a higher availability of breakfast foods at home (OR = 2.21 (95% CI 1.65, 2.97)) were associated with higher odds of being a daily breakfast consumer. Higher levels of screen time (hrs/day) were associated with lower odds of being a daily breakfast consumer (OR = 0.85 (95% CI 0.79, 0.91). Parental modelling (B = 0.254 (95% CI 0.149, 0.358)) and the availability of breakfast foods at home (B = 0.124 (95% CI 0.033, 0.214)) were significantly positively related to parental education, whereas screen time (hrs/day) (B = -1.134 (95% CI -1.511, -0.758)) was significantly inversely related to parental education. Parental modelling, the availability of breakfast foods at home and screen time were found to mediate parental educational differences in breakfast consumption.

CONCLUSIONS

Increasing the availability of breakfast food, improving parental modelling of breakfast consumption and targeting screen time might be promising strategies to reduce parental educational differences in breakfast consumption.