Insufficient Sleep Is Associated with Obesity and Excessive Screen Time Amongst Ten-Year-Old Children in Sweden

Toddler Screen Use Before Bed and Its Effect on Sleep and Attention: A Randomized Clinical Trial

Importance

Toddler screen time has been associated with poorer sleep and differences in attention. Understanding the causal impact of screen time on early development is of the highest importance.

Objective

To test (1) the feasibility of the 7-week parent-administered screen time intervention (PASTI) in toddlers (aged 16-30 months) who have screen time in the hour before bed and (2) the impact of PASTI on toddlers' sleep and attention.

Design, Setting, and Participants

This assessor-blinded, UK-based randomized clinical trial was conducted between July 2022 and July 2023. This was a single-site study that enrolled families with a toddler aged between 16 and 30 months, living within 75 miles of the Babylab, and with 10 minutes or more of screen time in the hour before bed on 3 or more days a week. Exclusion criteria were (1) a genetic or neurological condition, (2) premature birth (<37 weeks), and (3) current participation in another study.

Interventions

Families were randomized (1:1:1) to (1) PASTI: caregivers removed toddler screen time in the hour before bed and used activities from a bedtime box instead (eg, reading, puzzles); (2) bedtime box (BB only): used matched before-bed activities, with no mention of screen time; or (3) no intervention (NI): continued as usual.

Main Outcomes and Measures

Feasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures.

Results

A total of 427 families were screened, 164 were eligible (38.4%), and 105 families were randomized (mean [SD] age, 23.7 [4.6] months; 60 male [57%]). The trial was feasible, with 99% participant (104 of 105) retention and 94% of families (33 of 35) adhering to PASTI. PASTI showed reductions in parent-reported screen time (vs NI: Cohen d = -0.96; 95% CI, -1.32 to -0.60; vs BB only: Cohen d = -0.65; 95% CI, -1.03 to -0.27). PASTI showed small to medium improvements in objectively measured sleep efficiency (vs NI: Cohen d = 0.27; 95% CI, -0.11 to 0.66; vs BB only: Cohen d = 0.56; 95% CI, 0.17-0.96), night awakenings (vs NI: Cohen d = -0.28; 95% CI, -0.67 to 0.12; vs BB only: Cohen d = -0.31; 95% CI, -0.71 to 0.10), and reduced daytime sleep (vs NI: Cohen d = -0.30; 95% CI, -0.74 to 0.13) but no difference compared with BB only. There was no observable effect of PASTI on objective measures of attention. Compared with BB only, PASTI showed a difference on parent-reported effortful control (Cohen d = -0.40; 95% CI, -0.75 to -0.05) and inhibitory control (Cohen d = -0.48; 95% CI, -0.77 to -0.19), due to an increase in BB-only scores.

Conclusions and Relevance

Results of this randomized clinical trial show that, supporting pediatric recommendations, removing screen time before toddler bedtime was feasible and showed modest preliminary beneficial effects on sleep. A future full confirmatory trial is needed before PASTI's adoption by parents and pediatricians.

Trial Registration

ISRCTN.org Identifier: ISRCTN58249751.

Insomnia severity and obesity mediated by health behaviors in adolescents

OBJECTIVE

Sleep difficulties in youth have been associated with numerous negative outcomes, such as higher risk of obesity. Though the relationship between sleep and obesity is not well clarified, past research has shown that modifiable health behaviors, such as diet, physical activity, and screen time, may explain this relationship. The purpose of this study was to simultaneously examine these health behaviors as mediators of the relationship between insomnia severity and obesity among a sample of adolescents aged 12-18 years.

METHOD

English-speaking parents/legal guardians of adolescents were invited to participate in an online survey focused on pediatric sleep patterns, health behaviors, and weight. Parents/guardians (N = 599) reported on their adolescent's diet (i.e., consumption of fruits/vegetables, fast food, and breakfast), physical activity, screen time, and BMI. A multiple mediation analysis was run to test these health behaviors as mediators of the relationship between insomnia severity and BMI, after controlling for sex, age, race, and poverty.

RESULTS

While insomnia was related to most health behaviors, screen time was the only significant mediator of the relationship between insomnia and BMI, after controlling for the effects of the other mediators and all covariates, ab = .04, 95% CrI [.01, .09].

CONCLUSIONS

Screen time has implications for both adolescents' sleep health and weight. Pediatric clinicians should systematically assess for, and provide, recommendations on ways to improve sleep and screen time use, in addition to providing traditional dietary and physical activity recommendations.

Sleep disturbance associations between parents and children with overweight and obesity

This cross-sectional study examined sleep disturbance associations between parents and their school-age children with overweight and obesity. A 7-day wrist-worn actigraph recording was performed on 246 children aged 6-9 years with overweight and obesity recruited from 10 public elementary schools in Taipei, Taiwan. Children's sleep disturbance was assessed using the Children's Sleep Habits Questionnaire. Parental subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index, with parental depressive symptoms measured using the Epidemiologic Studies-Depression Scale. General linear models were used to examine sleep disturbance associations within parent-child dyads. The results showed that 208 (84.6%) children had a clinically significant sleep disturbance score, and 123 (50%) parents had poor sleep quality. Higher children's sleep disturbance scores significantly predicted poorer parental sleep quality (b = 0.11, p < 0.001). Poorer parental sleep quality was associated with more severe sleep disturbances in children (b = 0.46, p < 0.001). This association was independent of children's actigraphic sleep (all p > 0.05) and was not attenuated by adjustment for parental depressive symptoms (b = 0.14, p < 0.001). Findings from our study suggest that sleep disturbances occur in both parents and their school-age children with overweight and obesity, with a significant bidirectional association between the two. Nurses and healthcare professionals should proactively assess and screen for sleep disturbances in parent-child dyads of children with overweight and obesity. Future studies should develop family-based sleep interventions and evaluate their effects on the sleep, health, and well-being of children with overweight and obesity and their parents.

Effect of the COVID-19 pandemic on obesity and it is risk factors: a systematic review

BACKGROUND

Coronavirus disease (COVID-19) is a contagious disease caused by the severe acute new coronavirus called SARS-CoV-2. Devastating social, economic, and health service utilisation-related activities. Increased burden and lifestyle changes due to confinement.

OBJECTIVE

This study aimed to investigate and determine the determinants of obesity during the coronavirus disease (COVID-19) pandemic from 2019 to 2023.

METHODS

Observational studies published between December 2019 and January 2023 were thoroughly searched using a PRISMA flow chart. PubMed, Google Scholar, Web of Science, HINARI, Scopus, and Embase databases were used. Two reviewers independently identified and critically evaluated the relevant literature. Studies that reported weight gain or involved BMI measurements of 25 kg/m2 or BMI z-scores for children during the COVID-19 lockdown were selected for inclusion. The Newcastle-Ottawa Scale (NOS) was used as a quality assessment instrument in nonrandomised studies to evaluate study quality. All the contributing determinants of weight increase were identified, gathered, and synthesised.

RESULTS

This systematic review identified 40 studies with a total population of 5,681,813 from 22 countries, of which 74.6% were male. The sample size from included articles ranged from 37 to 5,315,435. Of the 40 selected articles, 24 focused on adults, five on adolescents, three on children, and eight on children and adolescents. Physical inactivity, sedentary behaviour, bad eating habits, behavioural lifestyle, excessive stress, depression, anxiety, behavioural risk factors, sex, and ethnic minorities were associated with obesity during the COVID-19 pandemic lockdown.

CONCLUSION

During the COVID-19 pandemic, physical inactivity, sedentary lifestyle, and poor eating patterns were the most common risk factors for obesity. Additionally, unhealthy eating habits, excessive behavioural stress, depression, anxiety, low mood, age, gender, and ethnic minorities have been identified as risk factors for obesity during the COVID-19 pandemic.

Physical Activity and Sleep Quality in Spanish Primary School Children: Mediation of Sex and Maturational Stage

Background: sleep is a physiological process that is critical for physical and mental health in children. Childhood encompasses diverse developmental stages that may affect the impact of physical activity on sleep quality, which may also be influenced by sex. The purpose of this study was to examine the mediation effect of sex and, as well as maturational stage on the association between physical activity and sleep quality, among primary school children. Methods: this was a cross-sectional study of 954 Spanish primary school students (437 early childhood and 517 middle childhood) with a mean age of 10.5 ± 1.2 years. Participants reported their sleep quality using the Pittsburgh Sleep Quality Index and their physical activity levels using the Physical Activity Questionnaire. Results: our study found that physical activity is associated with improved sleep quality in children, particularly during middle childhood. Higher physical activity was linked to better sleep quality and reduced sleep latency (p = 0.044). Sleep quality was generally better in males than in females (p = 0.002) and was also better in early than middle childhood (p = 0.000). Conclusions: especially in middle childhood, physical activity promotes children’s sleep quality. Thus, educational institutions should promote or improve the implementation of physical activity in the school context in order to benefit children’s sleep quality and, hence, improve their quality of life and wellbeing.

Risk of Obesity Among Children Aged 2-6 Years Who Had Prolonged Screen Time in Taiwan: A Nationwide Cross-Sectional Study

Objective

To evaluate the risk of obesity in preschool children with prolonged screen time in Taiwan.

Methods

Using a nationwide survey with random sampling, we collected information on 8378 preschool children aged 2-6 years among 206 preschools in Taiwan from 2016 to 2019. Socioeconomic data, body mass index, and lifestyle of the preschool children and their caregivers were compared among the groups of preschool children who had moderate and prolonged daily screen time. We used multiple log-binomial regression models to calculate the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) of obesity associated with prolonged screen time.

Results

The prevalence of obesity in the preschool children was 13.1%, and the average screen time was 104.6 minutes. Children's age, sleep hours, outdoor play time, sugar intake, snack eating before dinner, sleep disturbance, and obesity, as well as caregiver's sex, age, education, screen time, exercise time and parent obesity were factors related to high screen time for preschool children. Compared with children with moderate screen time, children with prolonged screen time had a higher risk of obesity (PR, 1.45; 95% CI, 1.18-1.79). With a 60-minute increase in screen time, the risk of obesity increased, with an PR of 1.10 (95% CI, 1.03-1.17).

Conclusion

Preschool children with prolonged screen time had an increased risk of obesity in Taiwan. Interventions may be needed for this very susceptible population.

Prevalence and impact of the use of electronic gadgets on the health of children in secondary schools in Bangladesh: A cross-sectional study

BACKGROUND AND AIMS

Use of technological gadgets has rapidly been increasing among adolescents, which may result in health issues and technology addiction. This study focuses on the prevalence of usage of technological gadgets and health-related complications among secondary school-going children of Bangladesh.

METHODS

A total of 1803 secondary school students from 21 different districts of Bangladesh participated in the study. The children were asked questions relating to their access to electronic gadgets, time spent on outdoor activities, and whether they experienced any health-complications as an after-effect of the usage. A binary logistic regression model was adapted considering time spent on gadgets as an independent variable and health problems (physical and mental) as the dependent variable.

RESULTS

Among all the gadgets, 67.11% of the participants were reported to use mobile phones on a daily basis. Due to the ongoing COVID-19 pandemic, 24.48% of respondents used electronic gadgets for attending online classes. The participants were reported to use gadgets significantly more (P < .05) in 2020 as compared to 2019. Children showed less tendency to spend time in outdoor activities. More than 50% of the participants spend time doing outdoor activities for less than 1 hour daily. An association between gadget use and health problems like headache, backache, visual disturbance, and sleeping disturbance has been observed in our study.

CONCLUSION

This study demonstrates that different socio-demographic factors have influence on the use of gadgets by children, and this use has greatly been affecting both the physical and mental health of the secondary school-going students of Bangladesh.

Consumption of Ultra-Processed Foods in Brazilian Children: An Analysis of Regional Trends

PURPOSE

Childhood obesity has become a concern for the Brazilian Unified Health System, which has recently started to investigate children's eating habits in basic health units. This study examined the trends and ultra-processed foods (UPF) consumption in Brazilian children.

DESIGN AND METHODS

This repeated cross-sectional study included 492,630 children (2-9 years old), from different Brazilian regions, in the years 2015 and 2019. The children's food consumption was assessed by nurses using a nationally standardized instrument. Information was provided by the Food and Nutrition Surveillance System Brazilian.

RESULTS

The UPF consumption in Brazilian children is generally high and was higher among children in the South and Midwest regions. The consumption of sweetened beverages was more prevalent among all the UPF assessed and continues to increase among children in the Northeast region. Declining trends in UPF consumption were observed in children from all regions, except for the Northeast region, whose trends increased in almost all evaluated foods.

PRACTICE IMPLICATIONS

Nurses, especially, have a primary role in guiding the reduction of UPF consumption, as they are the first health professionals to have access to this information. Increasing trends in UPF consumption can be mitigated by the inclusion of nutritionists in basic health units. Brazilian children need to be assisted by public policies that promote food education.

Investigating Binge-Watching Adverse Mental Health Outcomes During Covid-19 Pandemic: Moderating Role of Screen Time for Web Series Using Online Streaming

Background and Purpose

Watching multiple episodes using streaming services, such as Netflix, Hulu, and Youku, has become widespread in recent years. While much attention has been paid to binge-watching, there is, however, a dearth of research on binge-watching and its adverse psychological effects during the COVID-19 pandemic. To the best of our knowledge, less attention has been paid to understanding the multiple influences of binge-watching on binge-watchers during the COVID-19 pandemic. Most of the past studies on this topic mainly underscored the individual's motivations for binge-watching. Also, past studies were limited and inconclusive as they mostly espoused only the underpinning adverse effects of binge-watching without looking into the association between binge-watching and screen time for web series through online streaming services during the COVID-19 pandemic. Therefore, this study sought to fill this gap by probing the association between binge-watching and psychological aftereffects.

Participants and Methods

The study employed a cross-sectional research design vis-à-vis the survey method. A sample of 1089 adult respondents was collected through an online administrated questionnaire.

Results

The findings of this study demonstrated that extensive binge-watching is an antecedent of stress, loneliness, insomnia, depression and anxiety. Furthermore, it was found that screen time on binge-watching could intensify these adverse effects of binge-watching. Interestingly, the moderating effect of screen time on binge-watching was found to be insignificant for stress and loneliness.

Conclusion

The findings of this study suggest that binge-watching correlates with psychological and mental health symptoms including stress, loneliness, insomnia, depression and anxiety. Hence, this study suggests that consumption of web series through online streaming services related literacy interventions are imperative to help the audience become critical about online streaming content and its comparison to the real social world.

Sex differences in childhood sleep and health implications

CONTEXT

Sleep is critical for optimal childhood metabolic health and neurodevelopment. However, there is limited knowledge regarding childhood sex differences in sleep, including children with neurodevelopmental disorders, and the impact of such differences on metabolic health.

OBJECTIVE

To evaluate if sex differences in childhood sleep exist and if sleep associates with metabolic health outcomes equally by sex. Using autism spectrum disorder (ASD) as a case study, we also examine sleep sex differences in children with a neurodevelopmental disorder.

METHODS

A narrative review explored the literature focussing on sex differences in childhood sleep.

RESULTS

Sex differences in sleep were not detected among pre-adolescents. However, female adolescents were more likely to report impaired sleep than males. Childhood obesity is more common in males. Shorter sleep duration may be associated with obesity in male pre-adolescents/adolescents; although findings are mixed. ASD is male-predominant; yet, there was an indication that pre-adolescent female children with ASD had more impaired sleep.

CONCLUSION

Sex differences in sleep appear to emerge in adolescence with more impaired sleep in females. This trend was also observed among pre-adolescent female children with ASD. Further research is needed on sex differences in childhood sleep and metabolic health and the underlying mechanisms driving these differences.

Screen time use impacts low-income preschool children's sleep quality, tiredness, and ability to fall asleep

BACKGROUND

Sleep is increasingly recognized as a vital part of health. Screen time has been linked to sleep quality in children. The purpose of this study was to analyze associations between screen time and sleep characteristics among low-income preschoolers.

METHODS

A total of 1,700 preschool-aged children participated in this study at 50 federally and state-funded preschool centers in Michigan. Baseline measurement for an ongoing longitudinal intervention trial was obtained for cross-sectional use. At baseline, parents reported the number of hours their child spent engaging in screen time on a typical week day and weekend. An aggregate measure of total screen time was created. Parents reported on the quality of their child's sleep, how often they were tired during the day, and whether they had difficulty falling asleep. A mixed model linear regression was created to analyze data.

RESULTS

Controlling for child's age, race, and parental income, children who engaged in more screen time were significantly more likely to have more trouble falling or staying asleep, be tired during the day, and had worse quality of sleep (P values = .004, .006 and .001, respectively). Spearman correlations of screen time, sleep variables and demographics show parents of Black children reported significantly higher weekly screen time than parents of non-Black children (r = 0.23, P < .001) and that tiredness was associated with Black race (r = 0.15, P < .001), Hispanic/Latino ethnicity (r = -0.14, P < .001), and parental education (r = 0.06, P = .016).

CONCLUSION

This report confirms prior associations between screen time and sleep reported in other pediatric populations. Further research is needed to confirm these results in other populations using more rigorous measures of screen time, sleep, and physical activity, as well as longitudinal assessments. Despite these limitations, findings suggest that interventions to help parents limit children's screen time and impact their sleep health merit investigation.

Association of overweight, obesity and insufficient sleep duration and related lifestyle factors among school children and adolescents

OBJECTIVES

To assess the prevalence of overweight, obesity and Insufficient Sleep Duration (ISD) and to investigate their relationship with related lifestyle factors among school-aged students. Obesity in childhood and adolescence is a serious health concern as it may have long term risk for overweight and obesity in adulthood.

METHODS

This is a cross-sectional study of 1,611 students aged between 10 and 18 years from Al Ain city, United Arab Emirates. Data were collected using a multistage stratified random sampling method using a validated questionnaire and the level of significance was set at p<0.05.

RESULTS

The prevalence of overweight and obesity was 42.4%. ISD was 36.6% among students. Higher BMI was significantly related to being a male and inactive (95% CI=0.03-0.23), daily coffee consumption (95% CI=0.03-0.1), older age (95% CI=0.01-0.02), less average sleep duration (95% CI=-0.02 to -0.003) and spending more time on TV/videogames (95% CI=0.01-0.07). The likelihood of ISD was significantly lower among students who consumed breakfast daily (OR=0.58, 95% CI=0.41-0.83), spent less time on smart devices (OR=0.63, 95% CI=0.47-0.84), and never consumed energy drinks or soft drinks (OR=2.64, 95% CI=1.13-6.16, OR=2.02, 95% CI=1.24-3.29, respectively).

CONCLUSIONS

The prevalence of overweight and obesity among school-aged students is high. ISD and related lifestyle factors are significantly associated with overweight and obesity. Study findings emphasize the need to address and implement successful strategies for a healthy lifestyle starting from early childhood to combat the increasing rates of overweight and obesity in adulthood.

The correlation between sleep quality and the prevalence of obesity in school-age children

BACKGROUND

The prevalence of obesity increases year by year. Sleep quality is considered to be one of the obesity causes. The current average sleep range of children in Indonesia was 6-7 hours. This study aims to analyze whether sleep quality affects the prevalence of obesity in children.

DESIGN AND METHODS

This study used a prospective cohort as the research method. The samples consisted of 37 primary school-age children (4th-6th grade) from West Java and Sumatra, which were selected using the snowball sampling technique. The data were collected by using PSQI and sleep logs (within a month).

RESULT

The statistical results showed that most of the obese children, 12 out of 19, had poor sleep quality (63.2%), while most of the non-obese children (normal),15 out of 18, had good sleep quality (83.3%). Based on the chi-square statistic, the p-value =0.011 <a (0.05) indicating that H0 was rejected, which means there was a correlation between sleep quality and obesity, with OR=8.571 (95% CI: 1.818-40.423), which means the children with poor sleep quality were likely to experience obesity 8.6 times greater than those who had good sleep quality.

CONCLUSIONS

This study found there were correlations between dietary intake, physical activity, sleep quality, and obesity in school-age children. The most dominant factor related to obesity in school-age children is the habitual sleep efficiency (OR=12.354).

Perceived Challenges and Online Harms from Social Media Use on a Severity Continuum: A Qualitative Psychological Stakeholder Perspective

Evidence suggests that problematic use of gaming, the internet, and social media among adolescents is on the rise, affecting multiple psycho-emotional domains. However, research providing a comprehensive and triangulated stakeholder perspective of perceived harms is lacking. How are adolescent online harms experienced and conceptualized by students, parents, and teachers? The present study comprised part of a qualitative needs assessment investigation with the use of focus groups and individual interviews among key stakeholder groups assessing perceived impacts with a focus on the negative consequences and perceived harms. The study’s sample consisted of students (N = 42, M_age = 13.5, SD = 2.3), parents (N = 9, M_age = 37, SD = 5.6) and teachers (N = 9, M_age = 34, SD = 4.9) from the UK. Data were analysed with thematic analysis. Findings focused primarily on social media use impacts and indicated that processes underlying impacts experienced by adolescents may be conceptualized on a severity continuum. Stakeholder consensus on perceptions of challenges and perceived harms formed the second theme, with impacts further analysed as relating to time displacement, peer judgement, sensory overload and context of the adolescent with functional (performance, task switching, use of multiple devices), cognitive (loss or deterioration of attentional focus, attention deficit), and emotional consequences (stress, anxiety, obsessive-compulsive/checking behaviours). A third theme formed was individual vulnerabilities predisposing poor mental health outcomes. The final theme related to impacts dependent on context and meaning attached. Findings suggest a consideration of a spectrum approach encompassing a broader range of potential psychological challenges and perceived harms beyond safety concerns and addiction in understanding problematic adolescent online experiences. Understanding perceived harms can aid the objective setting of interventions and consideration of mental health literacy in school curricula.

A practical approach to obesity prevention: Healthy home habits

ABSTRACT

Families have the potential to foster a healthy home environment aimed at reducing the risk of overweight and obesity. Establishing habits associated with reduced risk of obesity and overweight early in childhood can have lasting effects into adulthood. Nurse practitioners can encourage families to participate in healthy habits by addressing areas of growth for obesity prevention within the home. A review of the most recent literature, approximately over the past decade, was used to provide a consolidated source of reference for healthy home habits for the nurse practitioner. The search included terms such as "obesity," "overweight," "healthy habits," "physical activity," "obesogenic behaviors," "family meals," "screen time," "depression," "sugary beverages," and "portion sizes." The information was synthesized into three content areas: nutrition and consumption, patterns of activity, and stress within the home. Establishing healthy habits early in life can protect against the development of overweight and obesity. Nurse practitioners can serve a vital role in the prevention of pediatric, adolescent, and adult obesity. Equipped with the unique role of assisting those from a diverse patient base, nurse practitioners can inform patients how to improve healthy habits to decrease the likelihood of obesity or overweight. Encouraging behavior change related to the healthy habits associated with the prevention of overweight and obesity can have a long-term impact on the health of an entire family.

Covid-19 and Confinement: Effect on Weight Load, Physical Activity and Eating Behavior of Higher Education Students in Southern Morocco

Background:

Pandemic confinement of COVID-19 may influence dietary behaviors and physical activity, and increases the risk of stress, especially among adolescents. This increases the subsequent risk of degenerative diseases such as obesity, diabetes, cardiovascular disease, etc., which can lead to a higher risk of death. This study aims to evaluate the effect of confinement on the weight load, physical activity and dietary behavior of higher education students during the period of confinement.

Methods:

Data was collected by an anonymous online questionnaire with 406 students. Physical activity was evaluated with the International Physical Activity Questionnaire. A reference score of the National Nutrition and Health Program (PNNS-GS) was used to determine the dietary habits. Stress appreciation was assessed by using a psychological instrument known as the “Perceived Stress Scale” provided by Mind Garden.

Results:

More than a quarter of the students were overweight or obese. During the confinement of COVID-19, most of the students suffered from nutritional disorders, only one-third were moderately physically active, and the majority of students were at risk of stress. Multivariate analysis showed that the concept of threat of Stress increases the risk of weight gain at a risk level of 2.4 [95% CI 1.09–5.43], low physical activity increases the risk level to 1.9 [95% CI 1.18–3.04]. However, a balanced diet is protective against the occurrence of weight gain (ORa = 0.30, [95% CI 0.15–0.61]).

Conclusion:

The study showed that confinement appeared to contribute to weight gain and those students were more sedentary than active with unhealthy eating behaviors. Understanding these behaviors during COVID-19 confinement will help public health authorities implement future policies on recommendations when new pandemics arrive and confinement policies are implemented.

Sleep, screen time, and family meal frequency in preschool children: A pilot study

This exploratory pilot study identified the prevalence and perceptions of three healthy habits in preschool-age children by surveying their parents/caregivers. Researchers examined children's hours of sleep, screen time, and number of family meals per week.

Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis

Prolonged viewing of screen-based media is associated with poor sleep in children. Previous systematic reviews have analysed the effectiveness of interventions that aim to limit children's screen use; however, none have evaluated its effect on sleep. The aim of this systematic review was to evaluate the effect of interventions that incorporate strategies to control children's screen use on screen use and sleep. The databases Pubmed, Embase, Eric, Scopus and PsycInfo were searched during October 2017 and updated in February 2019 for experimental studies with a control that assessed interventions to control screen use in children aged 2-14 years and reported both screen use and sleep outcomes. From 3,872 initial records, 11 studies (six randomized control [RCT], four cluster RCT and one cluster, quasi-experimental) were eligible for inclusion. A total of 4,656 children aged 2-13 years were included in the studies. The mean reduction in screen time was 0.56 hr (33 min)/day (95% confidence interval [CI], 0.92, 0.20) and the mean sleep duration increased by 0.19 hr (11 min)/day (95% CI, 0.05, 0.33). Bedtime was advanced by 0.16 hr (10 min) on weekdays and by 1.0 hr at the weekend. Subgroup analyses indicated stronger intervention effects for interventions of shorter duration (<3 months), which specifically targeted screen use or sleep, and those with direct participant contact. In conclusion, small improvements in screen time and sleep duration can be achieved in children. It is not possible to determine if a reduction in screen time directly improves sleep, due to the limited number of studies, the presence of co-interventions, issues with studies' methodological quality and heterogeneity.

Factors Affecting Health-Related Behaviors in Younger School-Age Korean Children

PURPOSE

Although many studies have reported factors influencing school-age children's health behaviors, most focus on later childhood and early adolescence. It is important to understand children's own perspectives on their health-related behaviors to promote child health. This study identified factors affecting health-related behaviors among younger school-age children via self-report assessments.

DESIGN AND METHODS

Participants (N = 636) were children aged 8 to 9 years (second and third grade) at six elementary schools in South Korea. The variables examined were child characteristics, health locus of control, perceived parental attention, peer support, school environment, and health-related behaviors. A hierarchical linear regression analysis was performed to identify factors predicting younger school-age children's health-related behaviors.

RESULTS

Socioeconomic status (family affluence score) had the strongest impact on health-related behaviors, followed by health locus of control, parental attention, and peer support. Living with both parents also had a positive effect. The present results suggest that children within aged 8 to 9 years have the ability to consciously choose and implement health-related behaviors.

CONCLUSIONS

Based on these findings, recommendations are as follows: 1) collaboration between parents and health professionals, which, given the importance of parental attention, represents the best approach for guiding children's health-related behaviors; and 2) attention paid to children from low-income backgrounds (at both the school and community levels) can help prevent health inequalities arising from socioeconomic status.

Association of multimedia teaching with myopia: A national study of school children

AIM

The aim of this study was to determine whether students' exposure to digitally projected, multimedia teaching material under naturally varying classroom lighting conditions is associated with myopia risk and severity.

DESIGN

A population-based, cross-sectional study in 2012 of children in grades 4-6 across 87 schools in Taiwan.

METHODS

Students (N = 3,686) reported demographic information, outdoor time, physical activity and near work. Parents provided their myopia status. Student-reported multimedia teaching frequency and classroom lighting levels were confirmed with direct observation. School nurses conducted vision screening and ophthalmologist referral. Myopia status and severity were measured by spherical equivalent refraction; SE ≤-0.5 dioptres was coded as myopic. Binary logistic and tobit regression were used to estimate the contributions of classroom multimedia exposure and lighting to myopia risk and severity controlling for risk factors.

RESULTS/FINDINGS

Age, parental myopia and hours of near work increased the odds of myopia and predicted greater severity. Physical activity and outdoor time predicted lower risk and severity. Multimedia exposure in relatively bright classrooms was associated with greater odds of myopia. Classroom lighting levels during multimedia teaching were inversely related to severity; exposure frequency was unrelated.

CONCLUSIONS

Multimedia exposure under brighter classroom conditions may contribute to the myopia incidence in schoolchildren.

IMPACT

Teaching with digital projection technology is increasingly prevalent. This may increase children's odds of developing myopia, which has far-reaching and lifelong deleterious effects. School nurses should raise awareness of and promote strategies that reduce this risk, including working with children, parents, school personnel and system leaders to adopt eye-healthy behaviours, practices and policies.

25-Hydroxyvitamin D Status and Its Association with Sleep Duration in Chinese Schoolchildren

OBJECTIVE

To examine the association between 25-Hydroxyvitamin D (25(OH)D) levels and sleep duration among Chinese adolescents.

SUBJECTS AND METHODS

A school-based cross-sectional study was conducted among Chinese adolescents in 2017. Data on a total of 800 adolescents aged 8⁻14 years was used for this study. Anthropometric measurements such as height and weight were measured by trained research staff. Serum 25(OH)D and lipids were measured in the laboratory. Sleep habits and other health-related behaviors were tested by questionnaire.

RESULTS

25(OH)D levels were significantly positively correlated with sleep duration (r = 0.11, p < 0.05). In multivariate logistic regression analyses, insufficiency/deficiency of vitamin D (25(OH)D ≤ 20 ng/mL) was significantly associated with increased probability of short sleep (AOR = 1.67, 95% CI = 1.14⁻2.43).

CONCLUSIONS

Low 25(OH)D levels were independently associated with the risk of insufficient sleep in Chinese adolescents.

Insufficient Sleep Duration and Overweight/Obesity among Adolescents in a Chinese Population

OBJECTIVES

The objective of this study was to investigate the relationship between sleep duration and overweight/obesity among Chinese adolescents.

METHODS

A school-based cross-sectional study was conducted among Chinese adolescents in 2016. In total, 2795 school-aged Chinese children aged 12 to 13 years participated in this study. Participants were asked to complete self-administered surveys during a 45-min class period in their classroom. Details of the questionnaire about health-related behaviors included sleep habits, physical activity, screen time, cigarette use, and alcohol use. Height, weight, waist circumference and hip circumference were directly measured.

RESULTS

The mean sleep duration was 8.7 h/day. In total, 43.0% of the participants had a sleep duration of less than 9 h/day. Sleep duration was significantly inversely related to BMI, waist circumference, hip circumference and WHtR in multiple linear regression analyses in both genders. Logistic regression models showed that insufficient sleep (<9 h/day) was associated with high odds of overweight/obesity among both young boys and girls.

CONCLUSIONS

Insufficient sleep duration was associated with overweight/obesity in Chinese adolescents, and short sleep duration was probably associated with central adiposity, especially among boys.