Outdoor physical activity, compliance with the physical activity, screen time, and sleep duration recommendations, and excess weight among adolescents

Impact of household income on the risk of overweight and obesity over time among preschool-aged children: a population-based cohort study

BACKGROUND

The temporality of household income level with overweight/obesity in children has not been extensively studied. Little research has been conducted to determine the impact of household income on the risk of childhood overweight/obesity over time. This population-based cohort study aimed to investigate the impact of household income on the risk of overweight/obesity over time among preschool-aged children in Taiwan.

METHODS

From 2009 to 2018, we recruited 1,482 preschool-aged children ( ≦ 7 y of age) from low-income households and selected age- and sex-matched controls from non-low-income households for comparison; All participants were selected from those who consistently participated in the Taipei Child Development Screening Program and were monitored for overweight/obesity using body mass index (BMI) until December 31, 2018. Low-income households were defined as those with an average monthly disposable income < 60% of the minimum standard of living expense in Taiwan. The primary outcome was childhood overweight or obesity in study participants, defined as BMI (kg/m2) ≥ 85th percentile or ≥ 95th percentile, respectively. The generalized estimating equations (GEE) model was used to determine the impact of low-income households on the risk of overweight/obesity in study participants.

RESULTS

Over 21,450 person-years of follow-up, 1,782 participants developed overweight /obesity, including 452 (30.5%) and 1,330 (22.4%) children from low- and non-low-income households, respectively. The GEE model showed that the first group had a significantly higher risk of becoming overweight/obese than the other during the follow-up period (adjusted odds ratio [aOR] = 1.44, 95% CI: 1.29-1.60). Moreover, children of foreign mothers had a higher risk of becoming overweight/obese than those of Taiwanese mothers during the follow-up period (aOR = 1.51, 95% CI: 1.24-1.8). The subgroup analysis revealed a significant association between low-income households and an increased risk of overweight/obesity in children aged 2-7 years (P =.01). However, this association was not observed in children aged 0-1 years (P >.999).

CONCLUSIONS

During the follow-up period, there was a notable correlation between low-income households and an increased risk of preschool-aged children developing overweight or obesity. Implementing health promotion initiatives aimed at reducing overweight and obesity in this demographic is crucial.

Suboptimal movement behaviours among children under two years old in early childhood education institutions in urban China: A cross-sectional study

Background

Healthy movement behaviours in early life promote better physical health and facilitate psychological development. Early childhood education (ECE) institutions provide opportunities for caregivers to improve children's movement behaviour practices, but little is known about the current status of movement behaviours among infants and young children in urban China in this context. We aimed to investigate the movement behaviour status of children under two years of age via ECE institutions and compare movement behaviour practices and knowledge between children attending ECE classes and those not attending.

Methods

We conducted the cross-sectional survey from 1 March to 30 April 2023 in Gymboree Play&Music, an ECE institution covering 31 provinces in China. We developed our survey instrument based on World Health Organization (WHO) guidelines to measure children's movement behaviour practices and caregivers' movement behaviour knowledge. We carried out the online questionnaire survey through Sojump, the largest professional online survey platform in China. We sent a quick response (QR) code to Gymboree Play&Music centres; the QR code was linked to a questionnaire intended for caregiver members and non-members coming for experience classes and activities.

Results

We surveyed 3355 primary caregivers, encompassing 504, 536, and 2315 children aged 0-5 months, 6-11 months, and 12-23 months, respectively. Overall, less than half of the children met recommendations in physical activity time (PAT) (19.2%), physical restraint (PR) (45.8%), and screen time (ST) (46.4%) during the last 24 hours. PAT, outdoor time (OT), and sleep duration (SD) in children aged 0-5 months were significantly lower than in the other two age groups, while ST was significantly higher than in the other two age groups during the last 24 hours (all P < 0.001). For children attending ECE classes, PAT, OT, and SD were significantly higher than those not attending ECE during the last 24 hours and the last two weeks (all P < 0.05). All indicators in the long-nursing care time (NCT) group were significantly higher than those in the short-NCT group, while there was no statistical difference in SD between the two groups (66.6% vs 65.6%; P = 0.558).

Conclusions

The status of movement behaviours for children under two years old in urban China is not optimistic, especially for PAT, PR, and ST. Additionally, attending early childhood education classes and primary caregivers' daily nurturing care time are important for infants and young children to adhere to movement guidelines. Consequently, more ECE institution-specific practical strategies and educational materials are needed to promote compliance with movement behaviour guidelines.

Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea

STUDY OBJECTIVES

The association between obstructive sleep apnea (OSA) and lifestyle habits in children with obesity is largely unknown. This study aimed to determine whether there was an association between lifestyle patterns (sleep quality, physical activity, recreational screen time, and substance use) and OSA presence and severity in children with obesity.

METHODS

This cross-sectional study recruited children with obesity, aged 8-17 years, who were referred to undergo polysomnography. Children completed questionnaires on sleep quality, physical activity, recreational screen time, and substance use. Children also had a diagnostic polysomnography. The association between questionnaire scores and OSA severity, after adjusting for body mass index z-score, age, and sex, was evaluated using negative binomial multiple regression. Correlations were conducted between sleep quality, physical activity, screen time, substance use, and OSA severity.

RESULTS

A total of 100 children were included in the analysis (mean age: 14.3 ± 2.6 years; 44% female; mean body mass index z-score: 2.5 ± 0.4; 65% with OSA). In the adjusted regression analysis, each additional substance-use behavior was associated with a 17% (95% confidence interval: 1%, 36%) increase in OSA severity. Correlations were identified between poorer sleep quality and lower physical activity (r = -.42), poorer sleep quality and more substance-use behaviors (r = .40), and greater physical activity and less substance-use behaviors (r = -.26).

CONCLUSIONS

In children with obesity, more substance-use behaviors were independently associated with greater OSA severity. As there are complex, bidirectional relationships between lifestyle behaviors and OSA severity, interventions need to be comprehensive and multifactorial to ensure successful treatment of OSA and its sequelae in children.

CITATION

Blinder H, Narang I, Chaput J-P, Katz SL; on behalf of the Canadian Sleep and Circadian Network. Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea. J Clin Sleep Med. 2023;19(3):511-518.

Obesity and high myopia in children and adolescents: Korea National Health and Nutrition Examination Survey

Purpose

The prevalence of both obesity and myopia are increasing in Korean children and adolescents. The purpose of this study is to examine the impact of obesity on the prevalence of myopia in Korean children and adolescents.

Methods

This study used the data of a nationally representative cross-sectional survey, the Korea National Health and Nutrition Examination Survey (KNHANES) VII conducted from 2016 to 2018. Of the 1237 children and adolescents aged 5–18 years who participated in the KNHANES VII and underwent ophthalmologic examinations for the survey, 1114 were selected for review, excluding those whose data on refractive error, family history of myopia, or waist circumference were missing. Body mass index (BMI) was classified into four groups: underweight (< 5th percentile), normal weight (≥ 5th percentile, < 85th percentile), overweight (≥ 85th percentile, < 95th percentile), and obese (≥ 95th percentile). Myopia was defined by the level of refractive error ≤ -0.5 diopters (D) and classified as mild (≤ -0.5 D, > -3.0 D), moderate (≤ -3.0 D, > -6.0 D), or high (≤ -6.0 D) myopia. The relationship between BMI and myopia was analyzed using complex sample logistic regression. Age and family history were corrected followed by an analysis of the odds ratios.

Results

Compared to those with normal weights (controls), being underweight, overweight, or obese showed no significant odds of developing mild and moderate myopia. Conversely, when compared with that of controls, the odds ratio of developing high myopia in the underweight, overweight, and obese groups was 0.77 (95% CI, 0.22–2.65), 1.37 (95% CI, 0.51–3.66), and 3.77 (95% CI, 1.98–7.16), respectively. Furthermore, in a separate analysis by sex and BMI, the odds ratio of developing high myopia was 2.84 (95% CI, 1.10–7.35) in boys with obesity and 4.23 (95% CI,1.19–15.09) and 5.04 (95% CI,1.77–14.34) in overweight and obese girls, respectively.

Conclusions

An association exists between obesity in childhood and adolescence and high myopia. Being overweight in girls was also found to be associated with high myopia. Thus, efforts to maintain a healthy weight during childhood and adolescence are of great importance.

Health literacy, health status and health behaviors of German students- study protocol for the "Healthy Habits" cohort study

BACKGROUND

The emerging adulthood is traditionally viewed as a time of optimal health, but also as a critical life span, characterized by changing life circumstances and the establishment of an individual lifestyle. Especially university life seems to hold several challenges impeding the manifestation of a health supporting manner, as many students tend to show a poorer health behavior and a higher amount of health-related problems than comparable age groups. This, along with a steady growth of the higher education sector, brings increased attention to the university setting in the context of prevention. To date, there are few empirical longitudinal and coherent cross-sectional data on the status of students' health literacy, health status, and health behaviors, and on the impact of the study format on students' health. The aim of this prospective cohort study is to reduce this research gap.

METHODS

Starting during winter semester 2020/21, the prospective cohort study collects data on health literacy, health status and health behavior on a semester-by-semester basis. All enrolled students of the IST University of Applied Sciences, regardless of study format and discipline, can participate in the study at the beginning of their first semester. The data are collected digitally via a specifically programmed app. A total of 103 items assess the subjectively perceived health status, life and study satisfaction, sleep quality, perceived stress, physical activity, diet, smoking, alcohol consumption, drug addiction and health literacy. Statistical analysis uses (1) multivariate methods to look at changes within the three health dimensions over time and (2) the association between the three health dimensions using multiple regression methods and correlations.

DISCUSSION

This cohort study collects comprehensive health data from students on the course of study. It is assumed that gathered data will provide information on how the state of health develops over the study period. Also, different degrees of correlations of health behavior and health literacy will reveal different impacts on the state of students' health. Furthermore, this study will contribute to empirically justified development of target group-specific interventions.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00023397 (registered on October 26, 2020).

"I am going out!" - lifestyle sports and physical activity in adolescents

Background

Lifestyle sport activities (e.g. parkour or skateboarding) are considered attractive and beneficial for a long-term commitment to physical activity (PA) and might be a great opportunity for adolescents who do not feel comfortable in an organized or competitive atmosphere. The purpose of the study was to assess whether participation in lifestyle activities is associated with moderate-to-vigorous physical activity (MVPA), out-of-school vigorous physical activity (VPA), and sedentary behaviour in adolescents aged 10–15 years, with major demographic variables (sex, age, socioeconomic status) being taken into account.

Methods

Data from a research project linked to the Health Behaviour in School-aged Children (HBSC) survey collected in 2017 in the Czech Republic was used. The sample consisted of 679 participants (303 of them girls) and was selected by quota sampling. Chi-square tests were used to assess differences in involvement in lifestyle activities according to sex, grade, and socioeconomic status. Ordinal and linear regression models were used to analyse the associations of participation in lifestyle activities and selected energy balance-related behaviours.

Results

Participation in lifestyle sport activities was significantly associated with a higher level of physical activity (MVPA and out-of-school VPA) after adjustment for sociodemographic factors, as was participation in organized sport. No significant associations were shown for sedentary behaviour.

Conclusions

Adolescents participating in lifestyle sport activities report being more physically active and, in case of doing multiple such activities concurrently, also spending less time sitting than their peers not involved in lifestyle sport activities. As such, lifestyle sport activities seem to represent a feasible way of increasing overall PA level in adolescent population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11066-3.

Exploring the effects of California's COVID-19 shelter-in-place order on household energy practices and intention to adopt smart home technologies

To contain the spread of the novel coronavirus (COVID-19), local and state governments in the U.S. have imposed restrictions on daily life, resulting in dramatic changes to how and where people interact, travel, socialize, and work. Using a social practice perspective, we explore how California's Shelter-in-Place (SIP) order impacted household energy activities. To do so, we conducted an online survey of California residents (n = 804) during active SIP restrictions (May 5-18, 2020). We asked respondents about changes to home occupancy patterns and household energy activities (e.g., cooking, electronics usage) due to SIP restrictions, as well as perspectives toward smart energy technologies. Households reported increased midday (10am-3pm) occupancy during SIP, and this increase is related to respondent and household characteristics, such as education and the presence of minors in the home. Examining change in the frequency of household activities during SIP, presence of minors and increased midday occupancy proved important. Finally, we considered relationships to intention to purchase smart home technologies, with the presence of minors and increased activity frequency relating to greater intention to purchase. These findings demonstrate how household activities and occupancy changed under COVID restrictions, how these changes may be related to energy use in the home, and how such COVID-related changes could be shaping perspectives toward smart home technology, potentially providing insight into future impacts on household practices and electricity demand.

Exploring the effects of California's COVID-19 shelter-in-place order on household energy practices and intention to adopt smart home technologies

To contain the spread of the novel coronavirus (COVID-19), local and state governments in the U.S. have imposed restrictions on daily life, resulting in dramatic changes to how and where people interact, travel, socialize, and work. Using a social practice perspective, we explore how California's Shelter-in-Place (SIP) order impacted household energy activities. To do so, we conducted an online survey of California residents (n = 804) during active SIP restrictions (May 5-18, 2020). We asked respondents about changes to home occupancy patterns and household energy activities (e.g., cooking, electronics usage) due to SIP restrictions, as well as perspectives toward smart energy technologies. Households reported increased midday (10am-3pm) occupancy during SIP, and this increase is related to respondent and household characteristics, such as education and the presence of minors in the home. Examining change in the frequency of household activities during SIP, presence of minors and increased midday occupancy proved important. Finally, we considered relationships to intention to purchase smart home technologies, with the presence of minors and increased activity frequency relating to greater intention to purchase. These findings demonstrate how household activities and occupancy changed under COVID restrictions, how these changes may be related to energy use in the home, and how such COVID-related changes could be shaping perspectives toward smart home technology, potentially providing insight into future impacts on household practices and electricity demand.

Do Adolescents Who Meet Physical Activity Recommendations on Weekdays Also Meet Them on Weekends? A Cross-Sectional Study in Colombia

The purpose of this study was to examine whether Colombian adolescents fulfill physical activity (PA) recommendations by type of day depending on several variables. A cross-sectional study was carried out on a sample of 2624 adolescents from Neiva (Colombia) using the Seven Day PA Recall and the Family Affluence Scale II self-reported questionnaires. Statistical analyses were performed to find any differences by gender, socioeconomic status, PA recommendations accomplishment, participation in organized and non-organized PA, parents' involvement in sport, and adolescents' academic achievement, and to determine the probability of complying with the PA guidelines. Only 12.3% of the participants met the PA recommendations on weekdays and weekends. Girls maintained their (in)active patterns during the week more than boys (84.4% vs. 70.7%, respectively), while more boys than girls changed them according to the type of day (25.3% vs. 19.6%). Participation in organized sports was the predictor variable with the highest probability of both boys and girls complying with the PA recommendations on weekdays. Non-organized activities were more likely to make girls more active on weekends. In conclusion, a wider offer of organized and non-competitive PA over the weekend and broader sports schedules should be provided to youth in Neiva.

Regional differences in access to the outdoors and outdoor play of Canadian children and youth during the COVID-19 outbreak

To reduce the spread of COVID-19, public health authorities across the country have recommended that Canadians keep their distance, wash their hands, and stay home. To enforce these measures, restrictions on outdoor behaviour have been implemented, limiting access to parks and recreational outdoor spaces. New evidence shows that COVID-19 restrictions are associated with an overall lower amount of time spent in outdoor play among Canadian children and youth. This is concerning, as outdoor play is important for children's physical and mental health and helps provide them with a sense of control during times of uncertainty and stress. As policies on access to the outdoors during the COVID-19 outbreak vary by province, it is possible that policy differences have led to regional differences in changes in outdoor play among children and youth. In this commentary, we examine regional differences in outdoor play among children and youth across Canada, and the association between provincial policies related to COVID-19 and outdoor play. We argue that through the recovery process, in the event of a second wave of infections, and in preparing for future public health challenges, policy decisions should consider ways to preserve outdoor play for Canadian children and youth.

The Gender Difference in Association between Home-Based Environment and Different Physical Behaviors of Chinese Adolescents

Purpose: The aim of this study was to evaluate the home-based physical activity (PA) environmental characteristics, and different types of physical behavior level of adolescents in different genders, and explore the impact of different domains of home-based PA environmental factors on different physical behaviors of adolescents in different genders. Methods: Five hundred forty-four adolescents aged from 12 to 18 years old (males: n = 358, females: n = 186) and their parents were analyzed in this cross-sectional survey. The volume of various physical behaviors of all adolescent subjects were measured by the ActiGraph wGT3X-BT accelerometer, and the level in different domains of home-based environmental characteristics were assessed by the Gattshall’s home-based PA environment questionnaire, which was answered by adolescents’ parents. The difference in the volume of different physical behaviors was examined using Kruskal–Wallis analysis. The difference in home physical environment and home social environment for adolescents was examined using one-way analysis of variance (ANOVA). Multiple linear regression analysis in the adjusted model was used to evaluate the influence of different home-based PA environmental domains (PA availability, PA accessibility, Parental role-modeling of PA, and Parental policies around PA) on different physical behaviors (sedentary behavior, SB; light-intensity physical activity, LPA; and moderate-vigorous physical activity, MVPA) of adolescents (boys and girls). Results: The volume of LPA and MVPA, the score of PA accessibility in the home physical environment, and the score of home social environment of boys are significantly higher than those of girls, while the SB volume of boys is significantly lower than that of girls. The PA availability, the parents’ role-modeling of PA in same-sex parent–child dyads, and the parents’ policies around PA in opposite-sex parent–child dyads are significantly associated with adolescents’ decreased SB and increased LPA and MVPA. Conclusion: There is significant gender difference in adolescents’ physical behaviors and home-based environmental characteristics, as well as in the association between adolescents’ physical behaviors and their home-based environment. The PA availability, the parents’ role-modeling of PA in same-sex parent–child dyads, and the parents’ policies around PA in opposite-sex parent–child dyads can significantly promote adolescents’ healthy physical behaviors.

Association Between Screen Time, Fast Foods, Sugar-Sweetened Beverages and Depressive Symptoms in Chinese Adolescents

OBJECTIVE

Although previous studies have shown that screen time (ST), fast foods (FFs) and sugar-sweetened beverages (SSBs) consumption are associated with depressive symptoms in adolescents, research on these associations in Chinese adolescents is scarce. This study aimed to examine the association between ST, FFs, SSBs and depressive symptoms in Chinese adolescents, and explore the mediating effects of FFs and SSBs in the association between ST and depressive symptoms.

METHODS

This school-based nationwide survey was carried out among 14,500 students in four provinces of China. The Children's Depression Inventory was used to assess the participants' depressive symptoms. ST, FFs and SSBs consumption was measured by a self-reported questionnaire. The Bayesian multiple mediation model was used to analyze the mediation effect.

RESULTS

ST, FFs and SSBs, were more likely to be associated with depressive symptoms, and ORs (95%CI) was 1.075 (1.036-1.116), 1.062 (1.046-1.078) and 1.140 (1.115-1.166), after we adjusted for sociodemographic variables. Additionally, in Bayesian multiple mediation model, direct effect, mediating effect, total effect, the ratio of mediating effect to total effect was 0.125, 0.034, 0.159, and 0.214, respectively. All path coefficients of the three mediation paths are statistically significant (p < 0.05).

CONCLUSIONS

Our study demonstrates that ST, FFs and SSBs consumption are associated with depressive symptoms in Chinese adolescents. It is likely that FFs and SSBs partially mediate the association between ST and depressive symptoms by chain-mediating effects.