Are one-year changes in adherence to the 24-hour movement guidelines associated with flourishing among Canadian youth?

Prospective associations between adherence to 24-hour movement guidelines and mental well-being in Chinese adolescents

Most evidence regarding the relationships between adherence to 24-hour movement guidelines and adolescent mental health have been derived from cross-sectional studies or have ignored positive mental health indicators. The current prospective study examined the associations between adherence to 24-hour movement guidelines and changes in mental well-being among Chinese adolescents over three months. 816 Chinese adolescents (Mage = 14.76 years; SD = 0.81) completed baseline and follow-up scales of 24-hour movement behaviours, mental well-being, and covariates. Linear mixed-effects models were used for data analyses, with adjustments for covariates and mental well-being at baseline. There was a significant improvement in mental well-being across the three months, and the improvement in mental well-being was positively associated with meeting any single guidelines and both physical activity and sleep guidelines but not adherence to all three guidelines. Meeting both physical activity and sleep recommendations appears to exert more significant benefits on mental well-being than meeting one or two other recommendations. An integrative approach to mental health promotion by focusing on 24-hour movement behaviours (at least physical activity and sleep) may be more effective than focusing on a single behaviour alone.

Longitudinal relationship between adolescents' mental health, energy balance-related behavior, and anthropometric changes

Energy balance-related behaviors (EBRBs) are considered the immediate causes of adolescents' body weight increases, but adolescents have identified mental health as a contributor. Cross-sectional studies have reported associations between adolescents' mental health and obesity, but causal relationships and the role of EBRBs within this can only be established using longitudinal studies. This systematic review summarizes the findings of longitudinal studies investigating this relationship, in addition to the role of EBRB in the relationship. Multiple electronic databases were searched for longitudinal studies using keywords related to the adolescent population, mental health, EBRB, and body weight. In total, 1216 references were identified and screened based on previously defined eligibility criteria. Sixteen articles met the inclusion criteria. Most studies indicated that mental health-related measures like depression, anxiety, and body dissatisfaction were related to an increase in body weight later. As this review is focused on behavioral mediators, six studies reported associations between mental health-anthropometry dyad and EBRBs such as eating habits, screen time, physical activity, and sleep-as well as stressors like peer victimization. Future studies may focus on streamlining mental health measures and body weight outcomes to assess this relationship. Furthermore, more longitudinal investigations are needed to provide insight into the role of EBRBs in the mental health-body weight relationship during adolescence.

Sleep duration change among adolescents in Canada: Examining the impact of COVID-19 in worsening inequity

Purpose

The purpose of this study was to assess if adolescent sub-populations in Canada (i.e., based on race/ethnicity, sex/gender, socioeconomic status, and urbanicity groups) experienced a larger change in sleep duration and guideline adherence between 2019 and 2020 (pre-pandemic) and the 2020-2021 (mid-pandemic) school years.

Methods

Longitudinally linked data from 2019 to 2020 (pre-pandemic) and 2020-2021 (mid-pandemic) of a prospective cohort study of secondary school students (M = 14.2, SD = 1.3 years, N = 8209) in Canada were used for analyses. Regression modelling tested the main effects of race/ethnicity, sex/gender, socioeconomic status, and urbanicity on changes in sleep duration as well as adherence to Canada's 24-h Movement Guidelines for sleep (8-10 h/night). Interactions between identity variables (race/ethnicity or sex/gender) and other main effect variables were subsequently tested.

Results

Females gained more sleep (4.5 [1.5, 7.5] min/day more) and increased guideline adherence (AOR = 1.16 [1.04, 1.30] than males on average. Asian race/ethnic identity was associated with less sleep gain than White identity -10.1 [-19.4, -0.8], but not guideline adherence. Individuals in large urban areas gained less sleep and adhered less to guidelines than individuals from any other level of urbanicity (-21.4 [-38.5, -4.2] to -15.5 [-30.7, -0.2] min/day). Higher individual SES scores were associated with greater sleep gain (linear trend: 11.16 [1.2-21.1]). The discrepancies in sleep gain and guideline adherence between males and females were significantly modified by race/ethnicity and urbanicity.

Discussion

Increases in sleep duration may be one of the few benefits to adolescents during the COVID-19 pandemic but were not equally distributed across sub-populations. Efforts to promote better sleep adherence may need to account for sex/gender differences, especially in less urbanized areas and certain racial/ethnic groups.

Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study

Both obesity and poor mental wellbeing have a high prevalence in European youth. Adolescents in six countries identified mental wellbeing factors as main drivers of youth obesity through systems mapping. This study sought to (1) explore the dynamics of the interplay between poor mental wellbeing, energy balance-related behaviors, and adolescent overweight and obesity prevalence and (2) test the effect of intervention point scenarios to reduce adolescent obesity. Drawing on the youth-generated systems maps and a literature synthesis, we built a simulation model that represents the links from major feedback pathways for poor mental wellbeing to changes in dietary, physical activity, and sleep behaviors. The model was calibrated using survey data from Norway, expert input, and literature and shows a good fit between simulated behavior and available statistical data. The simulations indicate that adolescent mental wellbeing is harmed by socio-cultural pressures and stressors, which trigger reinforcing feedback mechanisms related to emotional/binge eating, lack of motivation to engage in physical activity, and sleep difficulty. Targeting a combination of intervention points that support a 25% reduction of pressure on body image and psychosocial stress showed potentially favorable effects on mental wellbeing-doubling on average for boys and girls and decreasing obesity prevalence by over 4%.

The associations between screen time and mental health in adolescents: a systematic review

BACKGROUND

Adolescents have extensive use of screens and, they have common complains related to mental health. Here a systematic review was done to understand the association between screen time and adolescent's mental health.

METHOD

This review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA. An update search was performed in January 2023 with the following keywords: "screen time," "adolescent," and "mental health" on PubMed, PsycINFO and Scopus databases.

RESULTS

50 articles were included, most have found associations between screen exposure and mental health in adolescents. The most used device by adolescents was the smartphone and the use on weekdays was associated with diminished mental well-being. Social media use was negatively associated with mental well-being and, in girls, associated at higher risk for depression.

CONCLUSION

Excessive screen time in adolescents seems associated with mental health problems. Given the profusion and disparity of the results, additional studies are needed to clarify elements such as the screen content or the interaction of adolescents with different screen devices.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022302817.

Differential Associations Between Meeting 24-Hour Movement Guidelines With Mental Wellbeing and Mental Illness Among Chinese Adolescents

PURPOSE

Contemporary mental health models simultaneously consider psychological distress and wellness. Researchers have proposed that adhering to the 24-hour movement guidelines (24-HMG) contributes to mental health. 24-HMG integrates recommendations of time distribution among sleep, screen use, and moderate to vigorous physical activity (MVPA). Yet, there are few studies on the relationship between meeting 24-HMG and mental health, especially mental wellbeing. This study aimed to examine the associations between adherence to 24-HMG with mental wellbeing and mental illness among Chinese adolescents.

METHODS

Cross-sectional data of 67,281 Chinese adolescents aged 10-17 years (mean age = 13.0 years, 51.9% males) were collected by sending online questionnaires to local primary and middle schools in Shenzhen in 2021. We used multilevel generalized linear models to analyze associations between meeting 24-HMG with mental wellbeing (subjective wellbeing, resilience, and positive youth development) and mental illness (depression and anxiety).

RESULTS

Only 1.7% of participants met recommendations for all three behaviors (sleep, screen use, and MVPA). Compared with meeting none of the recommendations, participants who met one or more recommendations reported significantly better performance in mental wellbeing (all p < .001); on the contrary, meeting one or more recommendations (except for only meeting the MVPA recommendation) were significantly related to lower severity of mental illness (all p < .001). The relationship between the number of recommendations met with mental well-being and mental illness indicators presented a dose-response pattern (all p < .001).

DISCUSSION

Meeting 24-HMG was associated with superior mental health, including a higher propensity for mental wellbeing and a lower risk of mental illness. The importance of limiting screen time and getting enough sleep should be highlighted in promoting mental health in adolescents.

Sociodemographic and mental health characteristics associated with changes in movement behaviours due to the COVID-19 pandemic in adolescents

Objectives

Control measures enacted to control the spread of COVID-19 appear to have impacted adolescent movement behaviours. It remains unclear how these changes relate to sociodemographic characteristics and indicators of mental health. Understanding these relationships can contribute to informing health promotion efforts. The purpose of this study is to examine sociodemographic and mental health characteristics associated with changes in movement behaviours (physical activity, screen time, sleep duration) due to the COVID-19 pandemic among adolescents.

Methods

This cross-sectional study used May-June 2020 survey data and included 7349 students from Quebec, Ontario, and British Columbia (Canada). ANOVA, χ2 tests, and estimation of effect sizes using Cohen's d and h tests were performed between self-reported perceived changes (increase; decrease; no change) to physical activity, TV watching, social media use, and sleep duration as a result of the COVID-19 pandemic and gender, age, race/ethnicity, income, depression and anxiety symptoms, flourishing-languishing, and self-rated mental health.

Results

Over half of students reported increases in TV viewing and social media use and approximately 40% reported decrease in physical activity and increase in sleep duration due to the COVID-19 pandemic. More females (68.9%) than males (54.3%) reported increase in social media use (Cohen's h ≥ 0.2-0.5). No change from pre-COVID-19 social media use and sleep duration were associated with fewer depression and anxiety symptoms and better self-rated mental health compared to reports of an increase or decrease. These effect sizes ranged from small-to-moderate to moderate-to-large (Cohen's d/h ≥ 0.2-0.8). Decreased physical activity and sleep duration were associated with better psychological functioning with effects sizes of small-to-moderate. Compared to an increase or no change, decreased sleep had the largest effect size of less frequent depression symptoms (Cohen's d ≥ 0.5-0.8).

Conclusion

Maintaining pre-COVID-19 screen time and sleep duration during early stages of the COVID-19 lockdown was generally beneficial to mental health, with sleep being particularly important in regards to symptoms of depression. Psychological functioning was more related to physical activity and sleep than screen time during the pandemic.

Changes in Canadian Adolescent Time Use and Movement Guidelines During the Early COVID-19 Outbreak: A Longitudinal Prospective Natural Experiment Design

BACKGROUND

Comprehensive, prospective, longitudinal data are lacking on the effects of the COVID-19 outbreak on adolescents' movement behaviors (moderate to vigorous physical activity [MVPA], sleep, recreational screen use, and strengthening exercises). The purpose was to compare movement behavior changes among adolescents affected by the pandemic with controls.

METHODS

Survey data from 10,659 students at 82 Canadian secondary schools (aged 12-19 y) during the 2018-2019 and 2019-2020 school years were analyzed. One-year change in time spent in movement behaviors and likelihood of meeting Canadian 24-hour movement guidelines was compared between preoutbreak controls (October 2019-March 2020) and early outbreak respondents (May-July 2020) after controlling for sociodemographic factors.

RESULTS

Compared with controls, the early outbreak group reported a greater decrease in time spent in MVPA and greater increases in time spent in sleep and recreational screen use. The early outbreak group was less likely to meet MVPA and recreational screen time guidelines but more likely to meet guidelines for strengthening exercises and sleep duration.

CONCLUSIONS

Findings for MVPA and screen time changes were in the same direction as retrospective reports from children and youth samples. Sleep adherence may have improved due to no longer having to commute to school. Strengthening exercises may represent physical activity that is easier to do in the home with minimal equipment leading to improved adherence during restrictions.

Prevalence of meeting 24-Hour Movement Guidelines from pre-school to adolescence: A systematic review and meta-analysis including 387,437 participants and 23 countries

BACKGROUND

Meeting the 24-Hour Movement Guidelines (physical activity, screen time, and sleep duration) has been associated with positive health indicators. However, there are no previous meta-analyses that have examined the overall adherence to the 24-Hour Movement Guidelines from pre-school to adolescence across the world. Therefore, the main purpose of this systematic review and meta-analysis was to examine the overall (non)adherence to the 24-Hour Movement Guidelines among preschoolers, children, and adolescents worldwide.

METHODS

Four electronic databases (MEDLINE, Scopus, Web of Science, and Cochrane Database of Systematic Reviews) were searched for quantitative studies published in Spanish and English between January 2016 and May 2021. Studies that were conducted with apparently healthy participants and reported the overall (non)adherence to the 24-Hour Movement Guidelines in preschoolers and/or children and/or adolescents were included.

RESULTS

Sixty-three studies comprising 387,437 individuals (51% girls) aged 3-18 years from 23 countries were included. Overall, 7.12% (95% confidence interval (95%CI): 6.45%-7.78%) of youth met all three 24-Hour Movement Guidelines, and 19.21% (95%CI: 16.73%-21.69%) met none of the 3 recommendations. Concerning sex, adherence to all recommendations was significantly lower in girls (3.75%, 95%CI: 3.23%-4.27%) than in boys (6.89%, 95%CI: 5.89%-7.89%) (p < 0.001). However, there were no sex differences regarding adherence to any of the 3 individual recommendations (girls, 15.66%, 95%CI: 8.40%-22.92%; boys, 12.95%, 95%CI: 6.57%-19.33%). In terms of age group, adherence to the 3 recommendations was 11.26% (95%CI: 8.68%-13.84%), 10.31% (95%CI: 7.49%-13.12%), and 2.68% (95%CI: 1.78%-3.58%) in preschoolers, children, and adolescents, respectively. Conversely, 8.81% (95%CI: 5.97%-11.64%) of preschoolers, 15.57% (95%CI: 11.60%-19.54%) of children, and 28.59% (95%CI: 22.42%-34.75%) of adolescents did not meet any of the recommendations. South America was the region with the lowest adherence (all: 2.93%; none: 31.72%). Overall adherence to the 24-Hour Movement Guidelines was positively related to country Human Development Index (β = -0.37, 95%CI: -0.65 to -0.09; p = 0.010).

CONCLUSION

Most young people fail to meet the three 24-Hour Movement Guidelines, particularly adolescents, girls, and those who are from countries with a lower Human Development Index. Moreover, 1 in 5 young people did not meet any of these recommendations. Therefore, these results highlight the need to develop age- and sex-specific strategies to promote these movement behaviors from the early stages of life.

Movement Behaviors and Mental Wellbeing: A Cross-Sectional Isotemporal Substitution Analysis of Canadian Adolescents

Background: Studies have shown reallocating screen time for healthy movement behaviors such as physical activity and sleep can provide important benefits for mental health. However, the focus on positive aspects of mental health such as wellbeing has received limited attention, particularly among adolescents. The purpose of this study was to examine the effects of reallocating physical activity, screen time, and sleep on mental wellbeing in adolescents.

Methods: This study involved cross-sectional analysis of data from Wave 1 of the ADAPT study. A total of 1,118 Canadian adolescents enrolled in grade 11 classes (M_AGE = 15.92; 54.5% female) self-reported their movement behaviors using the International Physical Activity Questionnaire – Short Form to assess moderate-to-vigorous physical activity and daily recall questionnaires to assess recreational screen time and sleep. Participants also completed three measures of mental wellbeing: the Flourishing Scale, Rosenberg Self-Esteem Scale, and a brief Resiliency scale from the Canadian Campus Wellbeing Survey.

Results: Isotemporal substitution analysis revealed replacing 60 min of screen time with either moderate-to-vigorous physical activity or sleep has significant benefits for mental wellbeing. Comparatively, reallocating 60 min between moderate-to-vigorous physical activity and sleep does not impact mental wellbeing.

Discussion: Findings suggest healthy movement behaviors confer similar beneficial effects for adolescent’s mental wellbeing. Health promotion campaigns targeted toward adolescents should consider highlighting that reallocation of screen time to either sleep or moderate-to-vigorous physical activity may provide important benefits for mental wellbeing.

The Canadian 24-hour movement guidelines and self-rated physical and mental health among adolescents

OBJECTIVE

The Canadian 24-hour movement guidelines for children and youth recommend a minimum of 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and 8-11 h/night of sleep depending on age. The objective of this study was to examine the associations of meeting combinations of these recommendations with self-rated physical and mental health.

METHODS

This study used data from the 2017 (n = 5739) and 2019 (n = 6960) cycles of the Ontario Student Drug Use and Health Survey (OSDUHS), a biennially repeated cross-sectional study of Ontario students in grades 7 through 12. Multivariable ordered logistic regression models were adjusted for age, gender, ethnoracial background, subjective socio-economic status, and body mass index z-scores.

RESULTS

Similar patterns were seen in the 2017 and 2019 samples. Compared with meeting none of the recommendations, meeting different combinations of recommendations in the 2019 sample was associated with positive self-rated physical and mental health. A dose-response gradient between the number of recommendations met and self-rated physical (p < 0.001) and mental (p < 0.001) health was observed, with meeting one (AOR: 1.82; 95% CI: 1.58-2.09), two (AOR: 3.54; 95% CI: 2.98-4.22), or three recommendations (AOR: 6.34; 95% CI: 4.46-9.02) being increasingly associated with positive self-rated physical health compared with meeting none; and meeting one (AOR: 1.51; 95% CI: 1.33-1.71), two (AOR: 2.70; 95% CI: 2.31-3.17), or three recommendations (AOR: 3.58; 95% CI: 2.57-4.98) being increasingly associated with positive self-rated mental health compared with meeting none.

CONCLUSION

Meeting the 24-hour movement guidelines is associated with better self-rated physical and mental health among adolescents.

Longitudinal association between movement behaviours and depressive symptoms among adolescents using compositional data analysis

BACKGROUND

Research examining the associations between movement behaviours and mental health indicators within a compositional framework are sparse and limited by their cross-sectional study design. This study has three objectives. First, to describe the change in movement behaviour composition over time. Second, to explore the association between change in movement behaviour composition and change in depressive symptoms. Third, to explore how reallocations of time between movement behaviours are associated with changes in depressive symptoms.

METHODS

Longitudinal data of 14,620 students in grades 9-12 (mean age: 14.9 years) attending secondary schools in Canada (Ontario, British Columbia, Alberta, Quebec) were obtained from two waves (2017/18, 2018/19) of the COMPASS study. Moderate-to-vigorous physical activity (MVPA), recreational screen time, and sleep duration were self-reported. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (Revised)-10 (CESD-R-10). Compositional data analyses using pivot coordinates and compositional isotemporal substitution for longitudinal data were used to analyse the data. Analyses accounted for school clustering, were stratified by gender and age (< or ≥ 15 years), and were adjusted for race/ethnicity, body mass index z-score, baseline movement behaviour composition, and baseline depressive symptoms.

RESULTS

There were significant differences in movement behaviour composition over time across all subgroups. For example, the relative contributions of MVPA and sleep duration to the movement behaviour composition decreased over time while screen time increased among younger boys and girls and older girls. Increasing sleep duration relative to the remaining behaviours (i.e. screen time and MVPA) was associated with lower depressive symptoms among all subgroups. Increasing screen time relative to the remaining behaviours (i.e. MVPA and sleep duration) was associated with higher depressive symptoms among all subgroups. Increasing MVPA relative to the remaining behaviours (i.e. screen time and sleep duration) was associated with lower depressive symptoms in older girls only. Isotemporal substitution estimates indicated that decreasing screen time by 60 minutes/day and replacing that time with 60 minutes of additional sleep is associated with the largest change in depressive symptoms across all subgroups.

CONCLUSIONS

Findings from this prospective analysis suggest that increased sleep duration and reduced screen time are important determinants of lower depressive symptoms among adolescents.

Cross-Sectional and Longitudinal Associations between 24-Hour Movement Behaviours, Recreational Screen Use and Psychosocial Health Outcomes in Children: A Compositional Data Analysis Approach

It remains unclear whether the time-use composition of 24-h movement behaviours (sleep, sedentary time (ST), physical activity (PA)) and recreational screen use are independently associated with psychosocial health. This study examined the cross-sectional and longitudinal associations between 24-h movement behaviour composition, recreational screen use and psychosocial health outcomes in children. Measures completed at baseline (n = 127; 11.7 years) and follow-up (n = 88; 12.8 years) included accelerometer-based 24-h movement behaviours, self-reported recreational screen use and psychosocial health (Strengths and Difficulties Questionnaire, Kessler’s Psychological Distress Scale). Linear mixed models were used to examine the cross-sectional and longitudinal associations between the 24-h movement behaviour composition and recreational screen use levels with psychosocial health outcomes. Overall, the movement behaviour composition (p < 0.05) and recreational screen use levels (p < 0.01) were both cross-sectionally but not longitudinally associated with psychosocial health outcomes. Relative to other behaviours, sleep was negatively associated, while light-intensity PA was positively associated with internalising problems and total difficulties scores. ST was positively associated with internalising problems. High levels of recreational screen use (>2 h/day) were associated with greater externalising problems, total difficulties scores and psychological distress. These findings reinforce the importance of achieving a balance between different types of movement behaviours over a 24-h period for psychosocial health.

Can We Reverse this Trend? Exploring Health and Risk Behaviours of Grade 12 Cohorts of Ontario Students from 2013-2019

Adolescents engage in multiple health risk behaviours that put them at risk of future chronic disease. By the time students graduate from secondary school, they may be engaging in behaviours that set them on a particular health trajectory. It is important to monitor the co-occurrence of health risk behaviours of cohorts of grade 12 students over time to highlight important areas for intervention. The purpose of this study was to examine trends in health and risk behaviours over six waves among subsequent cohorts of grade twelve students from Ontario, Canada. A total of 44,740 grade 12 students participated in the COMPASS study across the six waves (2013/14 to 2018/19), and self-reported movement (physical activity, screen time, sleep), dietary (fruit and vegetables, breakfast), and substance use (smoking, vaping, binge drinking, and cannabis use) behaviours. Over 91.0% of students reported engaging in three or more health risk behaviours, with increases in the number of students reporting inadequate sleep, not eating breakfast on every school day, and vaping over time. Although modest, the wave 6 cohort reported slightly more risk behaviours compared with the wave 1 cohort, highlighting the importance of multidimensional health promotion strategies across multiple settings.

Psychosocial Characteristics by Weight Loss and Engagement in a Digital Intervention Supporting Self-Management of Weight

There is substantial variability in weight loss outcomes. Psychosocial characteristics underlying outcomes require better understanding, particularly on self-managed digital programs. This cross-sectional study examines differences in psychosocial characteristics by weight loss and engagement outcome, and which characteristics are most associated with weight loss, on a self-managed digital weight loss program. Some underexplored psychosocial characteristics are included, such as flourishing, or a sense of meaning and purpose in life. A questionnaire was emailed to a random sample of 10,000 current users at week 5 in the program and 10,000 current users at week 17. The questionnaire was completed by 2225 users, and their self-reported weight and recorded program engagement data were extracted from the program’s database. Multiple comparison tests indicated that mental health quality of life, depression, anxiety, work-life balance, and flourishing differed by weight loss outcome at program end (week 17; ≥5%, 2–5%, below 2%) and by engagement tertile at program beginning and end (weeks 5 and 17). Only anxiety was associated with weight loss in a backward stepwise regression controlling for engagement and sociodemographic characteristics. Flourishing did not predict weight loss overall but predicted the weight loss outcome group. Our findings have implications for creating more effective interventions for individuals based on psychosocial characteristics and highlight the potential importance of anxiety in underexplored self-managed digital programs.

A systematic review of screen-time literature to inform educational policy and practice during COVID-19

There is an urgent need for consensus around the matter of screen time (ST) during the COVID-19 pandemic. Some governments announced restrictions for online schooling time per day to protect students from perceived risks of prolonged screen-use, but critics and an emerging body of research question such regulations. Our review of 52 empirical studies found (a) an overwhelming majority of literature shows effect sizes too small to be of practical or clinical significance, and (b) findings more specifically on educational ST are inconclusive and critically underrepresented. These facts, along with the undeniable benefits of online learning in the absence of brick-and-mortar schooling and the ominous forecasts of learning loss caused by prolonged school closure, inform our recommendations for a more moderate policy and practical stance on restrictions - one that is focused on responsibly leveraging the educational and social benefits of ST in a world still recovering from the COVID-19 pandemic.