Associations between TV viewing, sitting time, physical activity and insomnia among 100,839 Brazilian adolescents

How do teenagers sleep? Analysis of factors related to sleep disorders in a group of Polish high school students

Insomnia is the most common sleep disorder in the adolescent population. Resulting from a complex interplay of genetic, biological, social, and environmental factors, it affects disturbances in everyday functioning in many aspects of life. The aim of the study was to analyze the factors related to the occurrence of insomnia among high school students.

MATERIAL

The study was conducted among 2364 high school students aged between 14 and 19 years old (the average age 17.92 ± 1.10), of which there were 2068 girls and 295 boys.

METHOD

Athens Insomnia Scale (AIS) and authorial demographic data questionnaire involved questions about physical activity during the day, smoking, frequency of upper respiratory tract infections, problems with concentration and memory, school achievements, and the use of mobile devices at bedtime were used to assess examined parameters. The scale and questionnaires were shared on-line via social media.

RESULTS

Analyzing the results obtained in the study group, the average score of 8.42 ± 4.16 was obtained in the AIS, which allows the assessment of sleep disorders bordering on normal. After division into groups of girls and boys, 8.38 ± 4.56 points were obtained, respectively for girls and 8.43 ± 4.27pts. for boys - the difference was not statistically significant. Similarly, statistically significant differences were not found when dividing the groups into the one in which adolescents used the phone just before bedtime and the one that did not use it. The act of sleeping alone or with another person in the room also did not differentiate the groups statistically, as well as the place of residence. Statistically significant worse results in the AIS scale were obtained by people who declared worse physical activity during the day and smoking cigarettes, as well as those who reported more frequent problems with concentration and memory, had worse school performance and suffered from upper respiratory infections more often.

CONCLUSIONS

1). Sleep disorders may be related to factors such as smoking cigarettes or lack of physical activity, as well as difficulties in concentrating attention, memory disorders or worse academic performance and a tendency to contract upper respiratory tract infections. 2). Elimination of factors that may adversely affect the quality of sleep is particularly important in the group of adolescents, in whom the developing structures of the central nervous system may be particularly sensitive to deficiencies in this area. 3). Exploration of the interplay of study duration, screen time, and semester-specific stressors on sleep quality could yield further insights.

Patterns of sedentary behaviour in adults with acute insomnia derived from actigraphy data

BACKGROUND

Sleep disorders, such as insomnia, have been associated with extended periods of inactive, sedentary behaviour. Many factors contribute to insomnia, including stress, irregular sleep patterns, mental health issues, inadequate sleeping schedules, diseases, neurological disorders and prescription medications.

OBJECTIVES

Identification of the patterns of sedentary time and its duration in adults with acute insomnia and healthy controls to determine the statistically significant sedentary bouts; comparison of the sedentary behaviour patterns in acute insomnia adults with healthy controls.

METHODS

We investigate the daytime actigraphy data and identify temporal patterns of inactivity among adults with acute insomnia and healthy adults. Seven days of actigraphy data were utilised to calculate sedentary time and bouts of variable duration based on a threshold of activity counts (<100 counts per minute). Statistical analysis was applied to investigate sedentary bouts and total sedentary time during weekdays and weekend. A logistic regression model has been used to determine the significance of sedentary bouts.

RESULTS

We found that individuals with acute insomnia accumulate a significant amount of their sedentary time in medium (6-30 minutes and 31-60 minutes) and longer (more than 60 minutes) duration bouts in comparison to healthy adults. Furthermore, a low p value for total sedentary time (2.54 ⋅ 10-4) association with acute insomnia supports the finding that acute insomnia individuals are significantly more engaged in sedentary activities compared to healthy controls. Also, as shown by the weekend vs weekday analysis, the physical and sedentary activity patterns of acute insomnia adults demonstrate higher variability during the weekdays in comparison to the weekend.

CONCLUSION

The results of the present study demonstrate that adults with acute insomnia spend more time in low-intensity daily physical activities compared to healthy adults.

Association between Suicidal Behaviors in Adolescence and Negative Emotions, the Level of Stress, Stress Coping Strategies and the Quality of Sleep

Suicidal behaviors in adolescents stem from complex processes deeply rooted in various spheres of life and functioning. The study was aimed at assessing the relationship between selected negative emotions, the quality of sleep, the level of perceived stress as well as stress coping strategies and suicidal ideation and attempts among high school students. The examined group consisted of adolescents aged 16-18 recruited by social-media groups in Poland. The study was based on a diagnostic survey with the application of CAWI method. The other research tools applied in the study included: Hospital Anxiety and Depression Scale-Modified, Perceived Stress Scale-10, How do you cope?-Questionnaire, Athens Insomnia Scale as well as the authors' own questionnaire on suicidal ideation and suicide attempts. Anxiety, depression, aggression and insomnia as well as a high level of stress were statistically more common in girls than in boys (p < 0.001). The high level of negative emotions and insomnia, in turn, increased the risk of suicidal ideation (OR = 3.59, 95% CI: 2.13-6.06 and OR = 2.35, 95% CI: 1.60-3.46), as well as suicide attempts (OR = 6.29, 95% CI: 2.93-14.80 and OR = 3.29, 95% CI: 2.07-5.35). Additionally, high level of stress was associated with more than twice larger odds of suicidal ideation (OR = 2.26, 95% CI: 1.13-4.63). Significantly higher prevalence of suicidal ideation (p = 0.017) and suicide attempts (p = 0.016) was observed in girls. A high level of negative emotions and stress accompanied by a low quality of sleep are factors predisposing people to suicidal ideation and attempted suicide.

Fatigue due to smartphone use? Investigating research trends and methods for analysing fatigue caused by extensive smartphone usage: A review

BACKGROUND: The easy accessibility of smartphones has led to a fivefold increase in their use. People use smartphones almost anywhere, including during travelling and studying. During the global COVID-19 pandemic, the average smartphone screen time has increased from 2.25 to 4.8 hours per day. In India, smartphone usage increased by 68%, and the average screen time increased from 2.42 to 6.9 hours. This dependency on smartphones has led to smartphone addiction. Inappropriate postures during the prolonged use of smartphones can exert adverse effects such as musculoskeletal disorders, digital eye strain, loss of focus and attention. OBJECTIVES: This study was undertaken to understand the effects of prolonged smartphone utilisation and explored fatigue measurement techniques. METHODS: A total of 130 studies examining the effects of smartphone utilisation published in the previous 10 years were identified from the following databases: IEEE, Science Direct, PubMed, PubMed Central, and Google Scholar are reviewed. This study was conducted from September 2019 to January 2021. RESULTS: One in every four adolescents were prone to smartphone addiction, which causes poor mental health. Moreover, India’s research on the effects of excessive smartphone usage is limited. CONCLUSIONS: Studies are required to establish the correlation between fatigue levels and smartphone usage patterns.

Assessing adolescent diet and physical activity behaviour, knowledge and awareness in low- and middle-income countries: a systematised review of quantitative epidemiological tools

PURPOSE

Quantitative epidemiological tools are routinely used to assess adolescent diet and physical activity (PA) constructs (behaviour, knowledge, and awareness) as risk factors for non-communicable diseases. This study sought to synthesize evidence on the quantitative epidemiological tools that have been used to assess adolescent diet and PA constructs in low to middle-income countries (LMIC).

METHODS

A systematised review was conducted using 3 databases (EbscoHost, Scopus and Web of Science).

RESULTS

We identified 292 LMIC studies assessing adolescent diet and PA. Identified studies predominantly explored behavioural (90%) constructs with a paucity of studies investigating knowledge and awareness. The majority of studies used subjective (94%) and self-administered (78%) tools. Only 39% of LMIC studies used tools validated for their contexts.

CONCLUSIONS

The findings highlight the need for more contextual tools for assessing adolescent diet and PA in LMICs. Diet and PA measurement tools used in future research will need to incorporate measures of knowledge and awareness for a more comprehensive understanding of the epidemiology of diet and PA in adolescents. Furthermore, there is a need for more evidence on the reliability and validity of these tools for use, in both cross sectional and longitudinal studies, in LMIC contexts.

The Association between Physical Activity and Smartphone Addiction in Korean Adolescents: The 16th Korea Youth Risk Behavior Web-Based Survey, 2020

Many side effects of smartphone addiction have been reported, such as a lack of sleep, obesity, and poor concentration. However, the relationship between physical activity (PA) and smartphone addiction has not been fully elucidated. This study aimed to analyze the relationship between physical activity and smartphone addiction among 53,534 Korean adolescents using raw data from the 16th (2020) Korea Youth Risk Behavior Web-based Survey (KYRBS). The dependent variables were the general user group, potential risk user group, and high-risk user group for smartphone addiction. The independent variables were moderate PA (over 5 days per week), vigorous PA (over 3 days per week), and strength exercise (over 3 days per week). Sex, body mass index (BMI), school grade, academic achievement, sleep satisfaction, depression, loneliness, and stress were selected as confounding variables. A complex sample logistic regression analysis was performed. Potential smartphone addiction risk users showed statistically significant odds ratios of 1.423 (p < 0.001), 1.379 (p < 0.001), and 1.383 (p < 0.001) based on general users participating in moderate PA, vigorous PA, and strength exercise, respectively. High-risk users showed statistically significant odds ratios of 1.475 (p < 0.001), 1.484 (p < 0.001), and 1.619 (p < 0.001), respectively. In conclusion, to prevent smartphone addiction among Korean adolescents, participation in moderate PA for more than five days a week, vigorous PA for more than three days a week, or strength exercise for more than three days a week is considered effective.

Mental health problems among Chinese adolescents during the COVID-19: The importance of nutrition and physical activity

Mental health problems are common among adolescents and greatly influenced by stressful events. This study sought to assess the prevalence and correlates of insomnia, depressive and anxiety symptoms among Chinese adolescents during the COVID-19.

METHOD

Cross-sectional study (N = 1,794 adolescents, mean age = 15.26) was conducted in May 2020. An online survey was used to collect socio-demographic data, COVID-related fear (COVID-fear), nutrition, physical activity (PA) level and the symptoms of insomnia, depression and anxiety.

RESULTS

The prevalence of insomnia, depressive and anxiety symptoms was 37.80%, 48.20% and 36.70%, respectively, among Chinese adolescents during the pandemic. Generalized linear models revealed that female, left behind children, and students with greater COVID-fear tended to report symptoms of insomnia, depression and anxiety concurrently. After adjusting for socio-demographic factors and COVID-fear, better nutritional status and moderately active PA were both associated with lower levels of depressive and anxiety symptoms, while highly active PA was associated with lower levels of insomnia, depressive and anxiety symptoms.

CONCLUSIONS

These findings suggest that more attention should be paid to psychological health among adolescents while combating COVID-19. To promote adolescents' mental health, educators should help adolescents develop a healthy lifestyle with balanced diet and regular exercise.

Daily physical activity, human development index and insomnia in a representative sample of Brazilian adolescents: a cross-sectional analysis

BACKGROUND

Although there is a growing body of research pointing towards the need to investigate how different movement behaviors, such as physical activity and sleep, influence each other, the joint relationship between these factors and insomnia has been little explored among adolescents in developing countries.

OBJECTIVES

To investigate the association between daily physical activity and insomnia in a national sample of Brazilian adolescents, according to the Human Development Index (HDI) of each Brazilian region.

DESIGN AND SETTINGS

Cross-sectional study on 102,072 Brazilian students aged 11 to 19 years, selected from all regions of the country.

METHODS

Information on insomnia and physical activity was self-reported by adolescents.

RESULTS

Our analyses revealed that girls who accumulated at least 60 minutes/day of physical activity on up to three days/week were less prone to present insomnia. This pattern of association was maintained only for those who lived in high HDI regions (odds ratio, 0.87; 95% confidence interval, 0.75-0.99). For boys, there was a positive association between the number of active days and protection against insomnia, especially for those who lived in high HDI regions.

CONCLUSION

Even amounts of physical activity that were lower than the weekly guidelines, were associated with better sleep quality for Brazilian adolescents, especially girls, and even for those who lived in regions with greater social and economic vulnerability.

The Evolutionarily Mismatched Impact of Urbanization on Insomnia Symptoms: a Short Review of the Recent Literature

PURPOSE OF REVIEW

For the most part of human existence, individuals have been living a rural lifestyle in a rural setting. However, such sleep-conducive conditions have largely been transformed dramatically by urbanization within a relatively short span of time in recent history, and the resulting evolved mechanisms-environment mismatch is theorized to bring about an increased risk for insomnia symptoms. This brief review of the recent literature is designed to evaluate the veracity of this proposition.

RECENT FINDINGS

The majority of recent findings have suggested that most proposed evolutionarily mismatched urban factors are indeed related to the presence of insomnia symptoms. However, there is a general paucity of longitudinal evidence (and for some other factors, a lack of enough evidence of any kind). Although there is a preponderance of recent findings indicating a link between evolutionarily mismatched urban phenomena and insomnia symptoms, more longitudinal data are needed before any causative conclusion can be drawn.

Do TV viewing and frequency of ultra-processed food consumption share mediators in relation to adolescent anxiety-induced sleep disturbance?

OBJECTIVE

To investigate the role of potential shared mediators in the association of TV viewing and frequency of ultra-processed food consumption with anxiety-induced sleep disturbance.

DESIGN

Cross-sectional study.

SETTING

Data from the Adolescent School-Based Health Survey, a Brazilian nationally representative survey of ninth-grade adolescents conducted in 2015, were used.

PARTICIPANTS

99 791 adolescents (52 015 girls) with a mean age of 14·3 years (range 11-19) participated. All variables were collected through a self-reported questionnaire based on the Global School-Based Student Health Survey. Anxiety-induced sleep disturbance was the outcome. Over 4 h/d of TV viewing and daily consumption of ultra-processed foods were the exposures. Body satisfaction, loneliness, self-rated health and eating while watching TV or studying were mediators. Age, ethnicity, food insecurity, type of city (capital or interior), country region and physical activity were covariates. Logistic regression and mediation models (Karlsson-Holm-Breen method) assessed associations.

RESULTS

Both daily ultra-processed food consumption (boys: OR 1·48, 95 % CI 1·30, 1·70; girls: OR 1·46, 95 % CI 1·34, 1·60) and TV viewing (boys: OR 1 24, 95 % CI 1·08, 1·43; girls: OR 1·09, 95 % CI 1·00, 1·19) were associated with higher odds for anxiety-induced sleep disturbance. Loneliness and eating while watching TV or studying (only among girls) consistently mediated the association of both daily ultra-processed food consumption (loneliness: boys 17·4 %, girls 23·4 %; eat while watching TV or studying: girls 6·8 %) and TV viewing (loneliness: boys 22·9 %, girls 45·8 %; eat while watching TV or studying: boys 6·7 %, girls 17·9 %) with anxiety-induced sleep disturbance.

CONCLUSIONS

Daily ultra-processed food consumption and TV viewing share mediators and can act in synergic mechanisms in the association with anxiety-induced sleep disturbance. Therefore, future interventions should focus in the reduction of both behaviours in combination.

Does More Sedentary Time Associate With Higher Risks for Sleep Disorder Among Adolescents? A Pooled Analysis

Purpose: To investigate the association between sedentary behavior and anxiety-induced sleep disorder at a global perspective. Methods:A total of 254,924 adolescents (mean age: 14.45 ± 1.42 years; 52.8% girls) who participated in the Global School-Based Student Health Survey were included for analysis. Self-reported questionnaires assessed anxiety-induced sleep disorder and sedentary behavior. Multivariable logistic regression analysis and countrywide meta-analysis were used for investigating the association between sedentary behavior and anxiety-included sleep disorder. Results:The results showed that sedentary time was linearly associated with higher OR of anxiety-related sleep disorder in adolescents across the countries and that 8 h or more per day increased the OR by 2.17 times. Countrywide meta-analysis showed that 8 h or more per day of sedentary behavior yielded an OR = 1.40 (95% CI = 1.34-1.46) of anxiety-induced sleep disorder. Moreover, the association between sedentary behavior and sleep anxiety was significant in adolescents over the age of 11 years regardless of sex. Conclusions:The findings from this study suggest that as sedentary behavior increases, sleep disorders also increase, independently of sex among adolescents. Effective preventive strategies are needed to be taken to decrease sedentary behavior that could be used to improve mental health and sleep quality among adolescents.

Moving More and Sitting Less as Healthy Lifestyle Behaviors are Protective Factors for Insomnia, Depression, and Anxiety Among Adolescents During the COVID-19 Pandemic

PURPOSE

This study aimed to investigate associations of physical activity time (PAT) and sitting time (ST) independently and jointly with insomnia, depressive and anxiety symptoms among Chinese adolescents in the context of COVID-19.

METHODS

A cross-sectional study including 965 adolescents (mean age = 15.26, SD = 0.46) was conducted in May 2020. PAT, ST and the symptoms of insomnia, depression and anxiety were assessed with the International Physical Activity Questionnaire Short Form, the Youth Self-Rating Insomnia Scales, the 9-item Patient Health Questionnaire and the Generalized Anxiety Disorder scale via an online survey platform. Logistic regression was used to analyze the association between COVID-19-related fear, PAT, ST and combinations of PAT and ST with insomnia, depressive and anxiety symptoms.

RESULTS

COVID-19-related fear was associated with higher odds of insomnia, depressive and anxiety symptoms. PAT was associated with lower odds of insomnia and depressive symptoms, while ST was associated with higher odds of these three symptoms. After combining PAT and ST, the group with both low PAT and high ST was set as the referent. For insomnia, groups with low ST reported significantly lower odds of symptoms. For depression, groups with high PAT and/or low ST reported lower odds of symptoms. Regarding anxiety, only the group with both high PAT and low ST reported lower odds of symptoms. Generally, group with both high PAT and low ST reported lower odds of the three symptoms than the referent.

CONCLUSION

COVID-19-related fear was a risk factor for developing insomnia, depressive and anxiety symptoms among Chinese adolescents. Fortunately, moving more and sitting less were good for sleep and mental health in Chinese adolescents during the pandemic. Educators should help adolescents to be more physically active in their daily life in the primary prevention of adolescent insomnia, depression and anxiety.

Association between different contexts of physical activity and anxiety-induced sleep disturbance among 100,648 Brazilian adolescents: Brazilian school-based health survey

Physical activity (PA) practice can be a protective factor for anxiety-induced sleep disturbance (AISD), however the association between different contexts of PA and anxiety-induced sleep disturbance is not clear. We aimed to analyze the association between different contexts of PA and AISD. Data from the Brazilian School-based Health Survey [n=100,648; age: 14.3y (range:11-18 years)], conducted in 2015, were used. Higher PA during transport was associated with higher AISD. PA during physical education classes presented lower odds for AISD. PA practiced outside school was associated with reduced AISD among boys. The association between PA and AISD seems to be context-dependent.

Insomnia in Relation to Academic Performance, Self-Reported Health, Physical Activity, and Substance Use Among Adolescents

Purpose: Insomnia affects up to one in four adolescents and has been shown to have a negative impact on their mental and physical health. This study aimed to investigate the association between insomnia, academic performance, self-reported health, physical activity, school start time, and substance use among adolescents. Methods: A survey with a cross-sectional design was completed by adolescents (15–17 years old; n = 1504) in southern Sweden. The Minimal Insomnia Symptoms Scale (MISS) was used to operationalize insomnia. A multiple logistic regression analysis was used to analyze the relationship between insomnia and self-reported health, failed school courses, substance use, school start time, family financial situation, screen time, and gender. Results: Insomnia (MISS ≥ 6) was associated with poor self-reported health (OR: 4.35), failed school courses (OR: 1.47), and use of alcohol and/or cigarettes (OR: 1.43). When the combined effect of self-reported health and physical activity were investigated, a combination of low physical activity (≤1 time/week) and poor self-reported health was strongly associated with insomnia (OR: 18.87). Conclusions: Insomnia was associated with other problems that in themselves are risk factors for poor health. This highlights the need for a holistic health-promoting approach to prevent insomnia, such as efforts to promote physical activity, school success, and the reduction of alcohol/cigarette use.

Joint association of ultra-processed food and sedentary behavior with anxiety-induced sleep disturbance among Brazilian adolescents

AIMS

We analyzed the joint association of high ultra-processed food ingestion and sedentary behavior (SB) with anxiety-induced sleep disturbance among Brazilian adolescents.

METHODS

Data from the Brazilian Scholar Health Survey, a nationally representative survey of 9th grade adolescents [mean: 14.28 years (range: 11-18 years)] conducted in 2015 (n = 100,648) were used. Self-reported anxiety-induced sleep disturbance, SB (TV viewing and total sitting time), and frequency of ingestion of different ultra-processed foods were collected. Age, ethnicity, type of city (capital or interior), region of the country, and habitual physical activity (global scholar survey questionnaire) were covariates. Logistic regression analyses were conducted to assess the associations.

RESULTS

High ultra-processed food ingestion plus low SB [boys:OR:1.44(99%CI:1.16-1.79), girls:OR:1.41(99%CI:1.22-1.63)] were risk factors for anxiety-induced sleep disturbance. The highest risk of anxiety-induced sleep disturbance was observed among those who joint high ultra-processed food ingestion with high SB [boys:OR:1.85(99%CI:1.46-2.35), girls:OR:1.62(99%CI:1.39-1.89)]. In addition, the interaction of high ultra-processed food ingestion with TV-viewing substantially increased the odds of anxiety-induced sleep disturbance [boys:OR:2.03(99%CI:1.61-2.56), girls:OR:2.04(99%CI:1.76-2.36)].

CONCLUSIONS

Both the high consumption of ultra-processed foods and SB (especially TV-viewing) appear to be independently associated with anxiety-induced sleep disturbance in both sexes. However, the co-occurrence of both negative lifestyle behaviors is associated with a substantial increase in the risk of anxiety-induced sleep disturbance. Future longitudinal research is required to confirm/refute our findings and explore potential mechanisms.

Bully victimization is a correlate of sleep loss over worry (SLOW) among adolescents in four South-East Asian countries

OBJECTIVE

To examine the unique contribution of bully victimization to sleep loss over worry (SLOW) among adolescents in four Southeast Asian countries, while controlling for loneliness and selected lifestyle factors.

METHODS

Data was derived from the Global School-Based Student Health Survey (2014-2015). Responses from a total of 13,043 adolescents in four Southeast Asian countries (Bangladesh, Brunei, Indonesia, and Timor Leste) were examined. Weighted frequencies of SLOW, bully victimization, loneliness, and selected lifestyle factors were first calculated, and Pearson's chi-square test was used to compare sample characteristics by severity of SLOW. A multivariate logistic regression analysis was constructed for each country to assess the unique contribution of bully victimization to SLOW, adjusting for demographics, loneliness, and selected lifestyle factors.

RESULTS

The prevalence of SLOW and bully victimization ranged between 38.0% and 44.6%, and 20.5%-24.9% respectively. Bully victimization and loneliness were consistently and positively linked to SLOW, with greater odds seen among students with severe SLOW who were bullied for 3 days or more (adjusted odds ratios (AORs) and 95% confidence intervals (CIs) Bangladesh: 6.00 [2.57-14.01]; Brunei: 2.48 [1.42-4.32]; Indonesia: 3.36 [2.02-5.59]; Timor Leste: 4.27 [2.15-8.48]) and experienced high level of loneliness (AORs and 95% CIs Bangladesh: 7.03 [3.46-14.29]; Brunei: 4.97 [3.63-6.79]; Indonesia: 8.71 [4.55-16.69]; Timor Leste: 2.97 [2.25-3.93]). Increased odds of severe SLOW were also seen among those engaged in sedentary behavior for 3 h or more per day (AORs and 95% CIs Indonesia: 1.85 [1.40-2.45]; Timor Leste: 1.61 [1.18-2.19]), and among those consuming fast food for three or more days per week (AORs and 95% CIs Brunei: 2.20 [1.26-3.86]; Indonesia: 1.98 [1.19-3.31]). The association of lifestyle factors and SLOW differed across countries.

CONCLUSION

Given the unique contributions of bully victimization to SLOW, we recommend countries in Southeast Asia to include sleep health as a component of adolescent health promotion, and to include reducing bully and bully victimization in strategies aimed at improving sleep health.

A gender analysis of the impact of physical education on the mental health of brazilian schoolchildren

This paper investigates the effect of attending physical education classes on mental health indicators - loneliness and insomnia - of Brazilian schoolchildren. The identification strategy consists of separating the sample into two parts: people who practice physical activity and who attend physical education classes at school and people who, despite not attending physical education classes, practice physical activities. The data are from the 2015 National Adolescent School-based Health Survey (PeNSE), and the sample pairing method is the Propensity Score Matching with robustness analysis using the Bivariate Probit method and the sensitivity is tested using the method developed by Ichino, Mealli, and Nannicini (2008). For both girls and boys the results showed that physical education exerts a negative effect, reducing the probability of reporting problems of insomnia and loneliness among schoolchildren who attend the discipline. Although they show similar magnitudes, the observed effects are greater for boys, in both measures. The study investigates - in a rigorous and unprecedented way in the literature - the effect of physical education classes on the insomnia and loneliness of Brazilian school children. The results are important for the formulation of discipline maintenance policies in the curriculum of schoolchildren in Brazil.

High Sedentary Behavior Is Associated with Depression among Rural South Africans

The study aimed to investigate the association between sedentary behavior and depression among rural South Africans. Data were analyzed from the cross-sectional baseline survey of the "Health and Aging in Africa: A Longitudinal Study of an INDEPTH community in South Africa (HAALSI)". Participants responded to various measures, including sociodemographic information, health status, anthropometric measures, and sedentary behavior. The sample included 4782 persons (40 years and above). Overall, participants engaged in <4 h (55.9%), 4-<8 h (34.1%), 8-<11 h (6.4%), or 11 or more h a day (3.5%) of sedentary behavior, and 17.0% screened positive for depression. In multivariable logistic regression, which was adjusted for sociodemographic variables (Model 1) (Odds Ratio, or OR: 2.45, Confidence Interval, or CI: 1.74, 3.46) and adjusted for sociodemographic and health variables, including physical activity (Model 2) (OR: 3.00, CI: 2.00, 4.51), high sedentary time (≥11 h) was independently associated with depression. In combined analysis, compared to persons with low or moderate sedentary behavior (<8 h) and moderate or high physical activity, persons with high sedentary behavior (≥8 h) and low physical activity were more likely to have depression in Model 1 (OR: 1.60, CI: 1.65, 3.13) and Model 2 (OR: 1.60, CI: 1.05, 2.44). Findings support that sedentary behavior and combined sedentary behavior and low physical activity may be a modifiable target factor for strategies to reduce depression symptoms in this rural population in South Africa.