Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China

Comparison of physical activity and physical fitness in children and adolescents of Chinese Han and Tibet ethnicity

Background

Physical activity (PA) and physical fitness (PF) are important markers of health status in children and adolescents in different ethnicities. In this study, we aimed to compare the PA and PF indicators between Tibetan and Han children and adolescents.

Methods

Children and adolescents of 4-9 grades were recruited in Shigatse (n = 963) and Shanghai (n = 2,525) respectively. The information related to demographic, PA, and PF was collected via a self-reported questionnaire. PA was assessed through the participation of moderate to vigorous PA (MVPA), muscle-strengthening exercise (MSE) and organized sport participation (OSP). PF was estimated using the International Fitness Scale containing components of overall fitness, cardiorespiratory fitness, speed and agility, muscular strength and flexibility.

Results

Han (mean age = 13.45 ± 3.3 years; 49.7% girls) and Tibet (mean age = 13.8 ± 2.5 years; 48.3% girls) children and adolescents from Shanghai and Shigatse completed the questionnaire survey. It was revealed that Tibetan students had higher MVPA, MSE and OSP than children and adolescents of Han ethnicity (p < 0.01, small to medium effect size). A relatively higher percentage of student in Shanghai did not participate in any form of PA. On the other hand, less Tibetan students thought their PF indicators including overall fitness, cardiorespiratory fitness, speed and agility, muscular strength and flexibility were poor or very poor than their counterparts of Han ethnicity (p < 0.01, small to medium effect size).

Conclusion

Tibetan children and adolescents have higher levels of PA and PF in comparison to their Han counterparts. More children and adolescents of Han ethnicity engage in no PA and think their PF indicators were poor.

Cross-cultural adaptation and validation of the Korean version of the quality of life assessment in spina bifida for children (QUALAS-C-K)

PURPOSE

This study aimed to translate and cross-culturally adapt the QUAlity of Life Assessment in Spina bifida for Children (QUALAS-C) and validate the Korean version of the QUALAS-C (QUALAS-C-K).

MATERIALS AND METHODS

Three urologists translated the QUALAS-C into Korean. Facial and content validity were assessed in the pilot study. Back-translation into English was performed. In the main study, the QUALAS-C-K and Korean version of KIDSCREEN-27 were administered simultaneously. Test-retest reliability was confirmed by re-administering the QUALAS-C-K. Internal consistency was verified using Cronbach's alpha. Factor analysis was performed, and convergent and divergent validity were demonstrated using the Korean version of KIDSCREEN-27.

RESULTS

A total of 53 children with spina bifida participated in the main study. Cronbach's alpha for the overall instrument determined good internal consistency (0.72-0.85), the intraclass correlation coefficient showed good stability (0.74-0.77), and the factor analysis converged to the same two-factor structure as in the original version. Construct validity revealed weak-to-moderate associations (r ≤ 0.57) between QUALAS-C-K and K-KIDSCREEN-27, indicating that QUALAS-C-K measures different aspects of the HRQOL than K-KIDSCEEN-27.

CONCLUSIONS

The QUALAS-C-K is a reliable and valid instrument for assessing the health-related quality of life of children with SB in Korea.

Association between meeting the 24-h movement guidelines and psychosocial health in children: A cross-sectional study

OBJECTIVE

Emerging evidence suggests that meeting the 24-h movement guidelines is associated with optimal mental health. However, there remains some uncertainty regarding this association in children. Therefore, this study aimed to examine the association between meeting the 24-h movement guidelines and psychosocial health in children.

METHODS

A cross-sectional study design was employed to investigate 2005 children aged 9-12 years from four districts of Shanghai, China. The 24-h movement behaviours were assessed using selected items from the Health Behaviour in School-aged Children (HBSC) survey questionnaire. Children's self-rated psychosocial health was evaluated using the Strengths or Difficulties Questionnaire (SDQ). Generalised Linear Models with the ordinal logistic module were employed to analyse the association between meeting the 24-h movement guidelines and psychosocial health.

RESULTS

The overall prevalence of meeting all three 24-h movement recommendations was 10.2%. Among children, 7.9% of them exhibited abnormal total difficulties, with a notable difference between sex (boys: 11.2%, girls: 7.0%, p = 0.001). Meeting all three 24-h movement behaviour recommendations was associated with reduced total difficulties, emotional symptoms, conduct problems, hyperactivity and peer problems. Furthermore, a dose-response association was observed, indicating that meeting a greater number of 24-h movement behaviour recommendations was associated with enhanced psychosocial health, particularly in boys.

CONCLUSION

The findings of this study highlight the positive association between meeting the 24-h movement guidelines and psychosocial health in children. Notably, meeting more of these recommendations was associated with a lower likelihood of experiencing psychosocial problems, with greater benefits observed in boys compared with girls.

Psychosocial and health behavioural characteristics of longitudinal physical activity patterns: a cohort study from adolescence to young adulthood

BACKGROUND

The decline in physical activity (PA) during adolescence is well-established. However, while some subgroups of adolescents follow the general pattern of decreased activity, others increase or maintain high or low activity. The correlates and determinants of different PA patterns may vary, offering valuable information for targeted health promotion. This study aimed to examine how psychosocial factors, health behaviours, and PA domains are associated with longitudinal PA patterns from adolescence to young adulthood.

METHODS

This prospective study encompassed 254 participants measured at mean ages 15 and 19. Device-measured moderate-to-vigorous PA was grouped into five patterns (activity maintainers, inactivity maintainers, decreasers from moderate to low PA, decreasers from high to moderate PA, increasers) via a data-driven method, K-Means for longitudinal data. Multinomial logistic regression was used to analyse the associations between health behaviours, psychosocial factors, PA domains, and different PA patterns.

RESULTS

A lack of sports club participation characterised inactivity maintainers throughout adolescence. Difficulties in communicating with one's father at age 15 were associated with higher odds of belonging to inactivity maintainers and to decreasers from moderate to low PA. Lower fruit and vegetable consumption at age 19 was also related to increased odds of belonging to the groups of inactivity maintainers and decreasers from moderate to low PA. Smoking at age 19 was associated with being a decreaser from moderate to low PA.

CONCLUSIONS

Diverse factors characterise longitudinal PA patterns over the transition to young adulthood. Sports club participation contributes to maintained PA. Moreover, a father-adolescent relationship that supports open communication may be one determinant for sustained PA during adolescence. A healthier diet and non-smoking as a young adult are associated with more favourable PA development.

Changes in the prevalence of obesity in Czech adolescents between 2018 and 2022 and its current non-genetic correlates - HBSC study

BACKGROUND

The main aim of the study is to examine changes in the prevalence of obesity in Czech adolescents between 2018 and 2022 and its current non-genetic correlates with respect to the adolescents' families'socioeconomic status (SES) in 2022.

METHODS

The sample of 24,535 adolescents (n = 11,629/12,9062018/2022; boys: 50.4/50.6%2018/2022) aged 10.5-16.5 years that was analysed was drawn from two nationally representative cohorts of Czech youngsters from the last two cycles of the Health Behaviour in School-aged Children (HBSC) online questionnaire survey from 2018 to 2022. Obesity is represented by the > 97th percentile interval on the World Health Organization Body Mass Index percentile chart, with distinctions by sex and the age of adolescents. The differences in the prevalence of obesity between boys and girls from all SES family categories in 2018 and 2022 were tested using a chi-square test (χ2). Multiple logistic regression analysis with repeated measures was used to analyse correlates of obesity in 2022.

RESULTS

Between 2018 and 2022, there was no significant difference in the prevalence of obesity in girls or boys in any of the SES categories of families. Adolescents from low-SES families have the highest prevalence of obesity, 11% for boys and 5.8% for girls, significantly higher (p < .001) than its prevalence among adolescents from high-SES families, by + 4.8% points for boys and + 3.9% points for girls. Among adolescents from low-SES families, individuals who engaged in moderate-to-vigorous physical activity (PA) daily (p < .005) or vigorous PA three times per week (p < .05) were significantly less likely to be obese than their less active peers. Skipping breakfast significantly (p < .05) increased the odds of obesity, but only among adolescents from low-SES families. Shorter screen time (ST) significantly (p < .05) reduced the odds of obesity for all categories of adolescent SES.

CONCLUSIONS

Obesity is most pronounced in adolescents from low-SES families as a result of a long-term positive energy balance mediated by unbalanced behaviour. Significantly lower odds of obesity in adolescents from low-SES families were confirmed to be associated with regular practice of the recommended PA, shorter ST, and not skipping breakfast.

A Cross-Sectional Association Between Screen-Based Sedentary Behavior and Anxiety in Academic College Students: Mediating Role of Negative Emotions and Moderating Role of Emotion Regulation

Purpose

The study aims to explore the relationship and potential mechanisms between screen time and anxiety and have a clear understanding of the role of negative emotions and emotion regulation, thus providing guidance for Chinese college students to improve mental health.

Methods

We conducted a questionnaire survey by selecting 1721 academic college students from 6 colleges and universities in 5 provinces in China, and the data were analyzed through the Process program of SPSS for mediating effect and moderating effect.

Results

There is a significant positive relationship between screen time and anxiety, negative emotions play a mediating role between the two (indirect effect = 0.32, p < 0.001), mediating effect accounts for 59.88% of the total effect, and emotion regulation regulates the direct relationship between screen time and anxiety (interaction effect = 0.027, p < 0.001).

Conclusion

This study sheds light on the potential mechanisms by which screen time affects anxiety in academic college students, providing a fresh perspective on anxiety reduction. Screen time positively affects anxiety levels, where negative emotions have a mediating role and emotion regulation has a moderating role. In the future, we can control screen ++time, increase physical activities, reduce negative emotions, and improve the emotional regulation ability to relieve anxiety, so as to improve the mental health of academic college students, and expect to have a positive impact on future learning, life, and planning.

Can Moving More and Sitting Less Improve the Academic Engagement of Adolescents?- A Study Based on Junior High School Students in Shanghai, China

Purpose

The purpose of this study was to examine the relationships between academic engagement and moderate-to-vigorous physical activity (MVPA), muscle-strengthening exercise (MSE) and sedentary behavior (SB) among adolescents, so as to provide evidence from the perspective of exercising for students to learn efficiently, teachers to improve classroom teaching, and schools to improve educational quality.

Methods

A questionnaire survey was conducted in 12 junior high schools in Shanghai, China, which were selected by a multi-stage stratified cluster sampling method. Then, with the valid data of 2078 students collected from the survey. A data analysis was performed using SPSS Statistics 26.0. Multiple linear regression models were adopted to analyze the factors affecting adolescent academic engagement and to determine whether MVPA, MSE, and SB play roles in it.

Results

(1) The differences in academic engagement depended on the exercise adherence to the recommended amount of MVPA, MSE, and screen-based SB. (2) In terms of the three independent variables of total time, MSE (β = 0.206) and MVPA (β = 0.175) showed a significant positive correlation with academic engagement, while SB (β = -0.155) was negatively correlated with academic engagement. (3) From the linear regression model of eight combination groups divided by the exercise adherence to the recommended amount of MVPA, MSE and SB, the group that met none of the recommendations (β = -0.235) showed a significant negative effect on academic engagement, while the groups that met any two or all three of the recommendations demonstrated strong positive correlations with academic engagement (P < 0.001).

Conclusion

Increasing adolescents' muscle-strengthening exercise and moderate-to-vigorous physical activity and reducing sedentary behavior can effectively promote academic engagement. Therefore, adolescents are suggested to reach the recommended amounts of physical activity, muscle-strengthening exercise, and sedentary behavior so as to improve academic engagement more effectively.

Longitudinal reallocations of time between 24-h movement behaviours and their associations with inflammation in children and adolescents: the UP&DOWN study

BACKGROUND

While there is evidence that physical activity, sedentary behaviour (SB) and sleep may all be associated with modified levels of inflammatory markers in adolescents and children, associations with one movement behaviour have not always been adjusted for other movement behaviours, and few studies have considered all movement behaviours in the 24-hour day as an exposure.

PURPOSE

The aim of the study was to explore how longitudinal reallocations of time between moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), SB and sleep are associated with changes in inflammatory markers in children and adolescents.

METHODS

A total of 296 children/adolescents participated in a prospective cohort study with a 3-year follow-up. MVPA, LPA and SB were assessed by accelerometers. Sleep duration was assessed using the Health Behavior in School-aged Children questionnaire. Longitudinal compositional regression models were used to explore how reallocations of time between movement behaviours are associated with changes in inflammatory markers.

RESULTS

Reallocations of time from SB to sleep were associated with increases in C3 levels (difference for 60 min/d reallocation [d₆₀] = 5.29 mg/dl; 95% confidence interval [CI] = 0.28, 10.29) and TNF-α (d₆₀ = 1.81 mg/dl; 95% CI = 0.79, 15.41) levels. Reallocations from LPA to sleep were also associated with increases in C3 levels (d₆₀ = 8.10 mg/dl; 95% CI = 0.79, 15.41). Reallocations from LPA to any of the remaining time-use components were associated with increases in C4 levels (d₆₀ ranging from 2.54 to 3.63 mg/dl; p < 0.05), while any reallocation of time away from MVPA was associated with unfavourable changes in leptin (d₆₀ ranging from 3088.44 to 3448.07 pg/ml; p < 0.05).

CONCLUSIONS

Reallocations of time between 24-h movement behaviours are prospectively associated with some inflammatory markers. Reallocating time away from LPA appears to be most consistently unfavourably associated with inflammatory markers. Given that higher levels of inflammation during childhood and adolescence are associated with an increased risk of chronic diseases in adulthood, children and adolescents should be encouraged to maintain or increase the level of LPA to preserve a healthy immune system.

Compositional associations of time spent in sleep, screen time, and physical activity with polysubstance use in adolescents

This study of grade 6-10 students used compositional analysis to examine the relationship between the movement behavior composition (time in sleep, screen time, and physical activity) and polysubstance use (frequency of using cigarettes, alternative tobacco products, alcohol, cannabis, and illicit drugs). In grades 6-8 students and grades 9-10 girls: 1) sleep was negatively associated with polysubstance use, 2) screen time was positively associated with polysubstance use, and 3) reallocating physical activity or screen time into sleep was associated with lower polysubstance use. In grades 9-10 boys, reallocating 60 min/day from physical activity into screen time or sleep was associated with greater polysubstance use.

Social Connectedness and Smoking among Adolescents in Ireland: An Analysis of the Health Behaviour in Schoolchildren Study

Continuing progress with preventing smoking initiation is a key to the tobacco endgame. Home- and school-based social networks shape the health behaviour of children and adolescents. This study described the relationship between social connectedness and smoking behaviour in school-aged children in Ireland. The 2014 Irish Health Behaviour in School-aged Children (HBSC) surveyed self-reported smoking status and measured perceptions of social connectedness and support with validated and reliable questions across a random stratified sample of 9623 schoolchildren (aged 10-19). Overall, 8% of school-aged children reported smoking, in the last 30 days 52% reported smoking daily, and prevalence increased with age (p < 0.001). Compared with schoolchildren who did not smoke, perceptions of social connectedness and perceptions of support at home, from peers, and at school were significantly poorer for schoolchildren who smoked across all measures examined (p < 0.001). The poorest rated measures were for school connectedness and teacher support for smokers. Policies and practices that build and support positive environments for schoolchildren must continue to be prioritised if progress on preventing smoking initiation is to be sustained.

Adherence to 24-h movement guidelines among Chinese children and adolescents with intellectual disabilities

BACKGROUND

Meeting 24-h movement guidelines for children and adolescents has been associated with improved health indicators. However, the literature examining adherence to 24-h movement guidelines among Chinese children and adolescents with intellectual disability (ID) remains lacking. This study aims to investigate the prevalence of meeting the 24-h movement guidelines and its socio-demographic correlates for this population.

METHODS

The sample includes 319 Chinese students with ID. Accelerometers are used to measure moderate-to-vigorous physical activity time and sleep duration. Questionnaires are adopted to measure screen time (ST) and demographic factors. Associations among socio-demographic factors, body mass index and 24-h movement are analysed by using multivariable logistic regressions.

RESULTS

The proportions of participants who meet none, moderate-to-vigorous physical activity, ST, sleep duration and all three recommendations are 8.15%, 33.54%, 54.23%, 75.55% and 17.55%, respectively. In general, multivariable logistic regression analysis indicates that older participants are less likely to meet the ST guidelines [odds ratio (OR): 0.931; 95% confidence interval (CI): 0.869-0.998] and more likely to meet the sleep guidelines (OR: 1.106; 95% CI: 1.016-1.204) than younger individuals. Participants with moderate ID are less likely to meet the sleep guidelines (OR: 0.345; 95% CI: 0.140-0.850) than those with profound ID. Individuals from families with middle-income (OR: 0.434; 95% CI: 0.226-0.836) and high-income (OR: 0.219; 95% CI: 0.080-0.605) levels were less likely to meet the physical activity guidelines than those from low-income families. Furthermore, participants from high-income families were less likely to meet ST (OR: 0.426; 95% CI: 0.187-0.969) and all three movement guidelines (OR: 0.083; 95% CI: 0.010-0.659) than those in the low household income groups.

CONCLUSIONS

Interventions that improve the health-related behaviours of children and adolescents with ID are needed, particularly those that target their increased engagement in physical activity.

Combinations of physical activity, screen time and sleep, and their association with subjective wellbeing in children

BACKGROUND

Subjective wellbeing is an important indicator of health outcomes in children. 24-hour movement behaviours (i.e., physical activity, sedentary behaviour, sleep and their combination), a set of modifiable lifestyle behaviours, have been demonstrated to be associated with subjective wellbeing. Thus, the aim of this study was to investigate the relationship between the compliance of the 24-h movement guidelines and subjective wellbeing in a sample of Chinese children.

METHODS

Cross-sectional data from primary and secondary school students in Anhui Province, China were used for the analysis. A total of 1098 study participants (mean age: 11.6 years, body mass index: 19.7 ± 2.9) were included, of which 51.5% were boys. Physical activity, screen time, sleep, and subjective wellbeing were measured using validated self-reported questionnaires. Multivariable logistic regression analysis was used to assess the relationships between the compliance of different combinations of 24-h movement guidelines and subjective wellbeing in participants.

RESULTS

The compliance of (i.e., physical activity recommendations, screen time recommendations and sleep recommendations) 24-h movement guidelines was associated with better subjective wellbeing (OR: 2.09; 95CI%: 1.01-5.90) compared to the compliance of none of the guidelines. Furthermore, there was a dose-response relationship between the number of guidelines met (3 > 2 > 1 > 0) and improved subjective wellbeing (p < 0.05). Despite some exceptions, there was a significant relationship between the compliance of different combinations of the guidelines and better subjective wellbeing.

CONCLUSION

This study found that the compliance of 24-h movement guidelines was associated with greater subjective wellbeing in Chinese children.

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.

Associations between 24-h Movement Behavior and Internet Addiction in Adolescents: A Cross-Sectional Study

OBJECTIVE

This study aimed to explore the relationship between 24-h activity behavior and Chinese adolescents' Internet addiction.

METHODS

A survey of 2045 adolescents (56.5% boys) was conducted, and adolescents' 24-h movement behavior and Internet addiction were measured via a questionnaire. Descriptive statistics were used to analyze the basic situation of the respondents; chi-square analysis was used to compare gender differences, and logistic regression was used to analyze the relationship between 24-h exercise guide entries and Internet addiction.

RESULTS

From the number of 24-h movement behavior guides, 25.3% of the children did not meet the recommended amount of any kind of activity behavior guide, while 50.4% and 21.7% of the children reached the recommended amount of one and two activity behavior guidelines, respectively; only 3.2% of the children met the recommended amount of all three activity behavior guidelines. Adolescents who did not meet the recommended 24-h activity behavior guidelines were more likely to have Internet addiction (OR = 8.46, 95 CI = 3.06-23.36), and were more likely to have one item (OR = 4.50, 95 CI = 1.64-12.39) or two items (OR = 3.12, 95 CI = 1.11-8.74).

CONCLUSIONS

Physical activity, static behavior, and sleep may all have a greater impact on adolescents' Internet addiction, among which physical activity has a greater impact on adolescents' Internet addiction. Different combinations of 24-h movement behavior have different effects on adolescents' Internet addiction.

Measuring sleep health in primary school-aged children: A systematic review of instruments and their content validity

Study Objectives

This review aimed to summarize instruments that measure one or more domains of sleep health (i.e. duration, quality, efficiency, timing, daytime sleepiness and sleep-related behaviors) in a general population of 4–12-year old children, and to assess these instruments’ content validity. Other measurement properties were evaluated for instruments with indications of sufficient content validity.

Methods

A systematic literature search was performed in PubMed, PsycINFO, Web of Science, and EmBase. Methodological quality, content validity, and other measurement properties were assessed via the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Instruments with indications of sufficient content validity (i.e. relevance, comprehensiveness and comprehensibility) were further evaluated on other measurement properties (i.e. other aspects of validity, reliability, responsiveness). A modified GRADE approach was applied to determine the quality of evidence.

Results

Twenty instruments, containing 36 subscales, were included. None of the instruments measured all sleep health domains. For five (subscales of) instruments sufficient relevance and comprehensibility was found. The quality of evidence ranged from very low to moderate. For these five instruments all additional measurement properties were assessed. Sufficient results were found for structural validity (n = 1), internal consistency (n = 1), and construct validity (n = 1), with quality of evidence ranging from very low to high.

Conclusions

Several (subscales of) instruments measuring domains of child sleep health showed good promise, demonstrating sufficient relevance, comprehensibility, and some also sufficient results on other measurement properties. However, more high quality studies on instrument development and the evaluation of measurement properties are required.

PROSPERO registration number: CRD42021224109

Different types of screen-based sedentary time and anxiety in adolescents: Video games may be more important

Aim

Evidence demonstrates the negative impact of excessive screen-based sedentary time (screen-based sedentary behavior; SSB) on mental health in adolescents. However, little is known regarding the associations between different types of SSBs and anxiety symptoms in adolescents. Thus, this study sought to explore the associations between different types of SSBs and anxiety symptoms in a sample of Chinese adolescents.

Methods

A web-based questionnaire survey was used to collect data. In total, 1,998 study participants conveniently recruited in Guangdong Province completed the questionnaire. Of them, 1,331 study participants provided valid data for variables of interest. SSB was categorized into television/movie time, video game time, and internet-surfing time. Anxiety symptoms were assessed using Zung Self-Rating Anxiety Scale, a validated assessment in Chinese youth populations. Generalized linear models were used to explore the associations between different types of SSBs and anxiety symptoms.

Results

In adolescents, video game time of 6 or more h was positively and significantly associated with anxiety symptoms (odds ratio = 5.25, 95% CI: 1.86-14.84, p < 0.01). This association was also observed specifically in boys (odds ratio = 5.12, 95% CI: 1.56-17.44, p < 0.05); however, in girls, there were no associations between different types of SSBs and anxiety symptoms.

Conclusion

Interventions aiming at reducing video games in adolescents, especially in boys, should be designed to prevent anxiety symptoms. This kind of intervention should also take sex differences into consideration. Future studies are encouraged to confirm the veracity of the findings in this study.

Associations between socioeconomic status and physical activity: A cross-sectional analysis of Chinese children and adolescents

Objectives

Although socioeconomic status (SES) has been shown to be an important determinant of physical activity (PA) in adults, the association in children and adolescents remains less consistent based on evidence from western developed countries. The purpose of this study, therefore, is to investigate associations between SES and PA among Chinese children and adolescents.

Methods

A cross-sectional study was conducted with a self-reported questionnaire in China. The multi-stage stratified cluster sampling method was used, and 2,955 children and adolescents (8–17 years old, 53.4% girls) were enrolled in this study. SES was assessed by measuring parental education levels, perceived family wealth, and Family Affluence Scale II (FAS II). PA was assessed by reliable and valid items from the Health Behavior School-aged Children Surveillance questionnaires. Descriptive statistics were used to report sample characteristics, including demographic characteristics, levels of PA, and SES. The Chi-square test was applied to analyze the differences of PA in gender and school period. Binary logistic regression was used to analyze the association between SES and PA among children and adolescents.

Results

Overall, 10.4% of children and adolescents accumulated moderate-to-vigorous physical activity (MVPA) at least 60 min per day. Boys were more physically active than girls (14.1% vs. 7.2%, p &lt; 0.001). Higher socioeconomic status was positively associated with higher physical activity levels among children and adolescents, especially using FAS and mother education level as SES measures. The association between SES and PA varied by gender and grade group, and the effects of SES are also different on weekdays and weekends.

Conclusion

This study found socioeconomic disparities in PA among Chinese children and adolescents, and showed the importance of targeting children and adolescents with low SES intervention priority. Based on these research findings, it is suggested that SES, especially for FAS and mother education level, should be considered when designing and implementing the promotion of regular PA in children and adolescents. Health policymakers may use this information to develop interventions to reduce health inequalities among children and adolescents in the future.

Associations of physical activity with academic achievement and academic burden in Chinese children and adolescents: do gender and school grade matter?

Background

Physical activity (PA) was significantly associated with cognition and mental health in children and adolescent. However, there were few studies examining the associations of PA with academic achievement (AA) and academic burden (AB) by gender and school grade. Hence, this study aimed to 1) investigate the associations of moderate-to-vigorous PA (MVPA) with AA and AB in Chinese children and adolescents, and 2) assess whether these associations vary by gender and school grade.

Methods

Using a multi-stage stratified cluster sampling design (at four different regions in Southern east China), 2653 children and adolescents (8–19 years old, 51.2% girls) were included. A self-reported questionnaire was used to collect data on study participants’ gender, school grade, family social economic status (SES), parental education level, MVPA, AA and AB. Binary logistic regression was applied to examine the associations of MVPA with AA (groups: above-average AA, average and below-average AA) and AB (groups: reporting AB, reporting no AB) with odds ratios (ORs) and 95% confidence intervals (CIs). After testing gender*grade interaction, those associations were explored by gender and school grade separately.

Results

In the overall sample, compared with children and adolescents who did not meet the PA guidelines (at least 60 min MVPA daily), children and adolescents who met the PA guidelines were more likely to have above-average (OR = 1.61, 95% CI: 1.21–2.11) AA, and report no AB (OR = 1.61, 95% CI: 1.13–2.30). In both genders, meeting the PA guidelines was positively associated with above-average AA (OR = 1.43, 95% CI: 1.01–2.03 for boys; OR = 2.22, 95% CI: 1.43–3.44 for girls). However, the significant relationship between meeting the PA guidelines and AB was observed only in girls (OR = 1.99, 95% CI: 1.17–3.39). Meeting the PA guidelines was positively associated with above-average AA (OR = 1.68, 95% CI: 1.18–2.40), and reporting no AB (OR = 1.77, 95% CI: 1.08–2.91) only in middle school students.

Conclusions

This study suggested that sufficient PA may be a contributary factor of improved AA and lower level of AB in Chinese children and adolescents. However, associations of PA with AA and AB may be different across gender or school grade. Promoting PA among girls or middle school students may be a good approach to improve AA and reduce AB.

Associations of sport participation, muscle-strengthening exercise and active commuting with self-reported physical fitness in school-aged children

Background

Numerous studies suggest a positive association between physical activity and physical fitness in schoolchildren. However, little is known about some neglected forms of physical activity and their associations with physical fitness. This study was conducted via a self-reported questionnaire, owing to the COVID-19 pandemic in many regions in China.

Purpose

This study explores the associations between participating in sports, muscle-strengthening exercises, and active commuting with self-reported physical fitness assessed by the International Fitness Scale (IFIS).

Methods

A total of 3,807 study participants (ages 11–17) from 12 public schools in South-eastern China were recruited, with 2,407 providing valid data on variables for analysis. Study participants were asked to self-report their sociodemographic factors (i.e., sex, grade, age), participation in sports (never, 1–3 times per month, 1–2 times per week, and 3 or more times per week), muscle-strengthening exercise (0–7 days) and active commuting (0–5 days). Generalized linear models were used to explore the associations between sports participation, muscle-strengthening exercise, and active commuting with self-reported physical fitness (comprising general physical fitness, cardiorespiratory fitness, muscular strength, speed and agility, and flexibility). A total of 2,407 children and adolescents with a mean age of 13.82 (±2.1) years were included in the study's final analysis.

Results

The study found no significant association between active commuting and physical fitness. Regarding participating in sports and muscle-strengthening exercises, positive, significant associations were found, which showed that a higher frequency of participating in sports and more participation in muscle-strengthening exercises are associated with improved physical fitness.

Conclusion

This study offered evidence on the roles of some aspects of physical activity in physical fitness. To promote health in children and adolescents, they should be encouraged to participate in more sports and engage in muscle-strengthening exercises.

Relationship of 24-Hour Movement Behaviors with Weight Status and Body Composition in Chinese Primary School Children: A Cross-Sectional Study

24 h movement behaviors, specifically physical activity (PA), sedentary behavior, and sleep, play a crucial role in the prevention and intervention of childhood obesity. This study aimed to examine the association of 24 h movement behaviors with weight status and body composition among Chinese primary school children. Using a random stratified sampling, 978 eligible participants (9.1 ± 1.4 years, 53.2% boys) were recruited from 1 May to 15 July 2021. Demographics included children’s age, gender, grade, parents’ education level, and household income. Movement behaviors were measured by validated self-reported scales. Weight status and body composition (percent of body fat, PBF; fat-free mass, FFM; skeletal muscle mass, SMM) were measured objectively. Results indicated that participants who were younger, boys, and at lower grade showed higher guidelines adherence. PA was inversely associated with PBF, while screen time (ST) was positively associated with overweight/obesity risk and FFM. Sleep showed no association with any health indicators. Meeting the behavioral guidelines was associated with better weight status and lower PBF, yet not with FFM and SMM. Interventions to improve the Children’s weight status and PBF should involve enhancing their overall movement behaviors and considering their demographic differences. More research on examining the association of movement guidelines adherence with body composition indicators is needed.

Meeting 24-Hour Movement and Dietary Guidelines: Prevalence, Correlates and Association with Weight Status among Children and Adolescents: A National Cross-Sectional Study in China

China is confronted with a “double burden” of underweight and overweight/obesity in children and adolescents. This study aimed to investigate the prevalence and correlates of meeting 24 h movement and dietary guidelines among Chinese children and adolescents. Further, the study aimed to examine the association of meeting 24 h movement and dietary guidelines with weight status in Chinese children and adolescents. A total of 34,887 Chinese children and adolescents were involved. Only 2.1% of participants met the 24 h movement guidelines. Compared to those who met all three 24 h movement guidelines, those who only met the sleep duration guideline was significantly associated with a higher risk of underweight (p < 0.05), and those who only met the moderate-to-vigorous physical activity, or screen time guidelines were significantly associated with a higher risk of overweight/obesity (p < 0.05). Compared with those meeting the dietary guidelines, those who did not meet the soft drink intake guideline had a significantly lower risk of underweight (p < 0.05), those who did not meet the fruit intake guideline had a significantly lower risk of overweight/obesity (p < 0.05), and those who did not meet the milk intake guideline showed a significantly higher risk of overweight/obesity (p < 0.001). These findings indicate a significant association between meeting the 24 h movement and dietary guidelines and weight status among Chinese children and adolescents.

Gender inequalities in physical activity among adolescents from 64 Global South countries

PURPOSE

The aims of this study were to (a) describe gender inequalities in physical activity (PA) among adolescents from Global South countries, and (b) investigate the relationship between gender inequalities in PA and contextual factors, such as geographic region, human development index, gender inequality index, and unemployment rates.

METHODS

We analyzed cross-sectional data from the Global School-Based Student Health Survey conducted in Global South countries between 2010 and 2020 among 13- to 17-year-old adolescents. Country-context variables were retrieved from secondary data sources (World Health Organization, World Bank, and Human Development Reports). PA was assessed by a self-administered questionnaire querying the number of days in the past week in which participants were physically active for a total of at least 60 min. PA absolute gender inequalities were evaluated by the differences in the prevalence between boys and girls, 95% confidence intervals (95%CIs) were estimated using the bootstrap method. Relative inequalities were obtained through Poisson regression. Meta-analyses with random effects were used to calculate pooled estimates of absolute and relative inequalities.

RESULTS

Based on 64 Global South countries/surveys, the prevalence of PA was 6.7 percentage points (p.p.) higher in boys than in girls, ranging from 0.5 p.p. in Afghanistan to 15.6 p.p. in Laos (I²= 85.1%). The pooled ratio for all countries showed that boys presented a PA prevalence 1.58 times higher than girls (95%CI: 1.47-1.70) on average. The highest absolute and relative inequalities were observed in high income countries. Countries with higher Human Development Index rankings and lower Gender Inequality Index rankings also presented greater gender differences.

CONCLUSION

Given that girls are overall less active than boys across the globe, the findings of this study reinforce that macro- and micro-level changes should be actively sought if we aim to increase population levels of PA in adolescents and promote equity in PA.

Reliability and validity of using the global school-based student health survey to assess 24 hour movement behaviours in adolescents from Saudi Arabia

This study aimed to examine the reliability and validity of Global School-based Student Health Survey (GSHS) to measure 24-hour movement behaviours (moderate-to-vigorous physical activity - MVPA; sedentary behaviour in the form of recreational screen time - ST; and sleep) in Saudi Arabian youths. A total of 120 (50% female) participants aged 12-15 years old were recruited from eight Saudi public middle schools. Participants completed GSHS survey twice and wore GENEActiv accelerometers for seven consecutive days and completed a diary log. ICC indicated moderate reliability in all 24-hour movement behaviours (ICC = 0.41 - 0.60), whereas ST and sleep were strongly reliable for females only (ICC = 0.61 - 0.80). Kappa agreements for all 24-hr movement behaviours were moderate (k = 0.41 - 0.60), but fair in MVPA and ST for males only (k = 0.21 - 0.40). Spearman's indicated low validity (r = 0.1 - 0.3) in MVPA and sleep between GSHS and GENEActiv. However, kappa test results indicated poor-to-slight agreements (k = <0.00 - 0.2) in MVPA and sleep, but fair in MVPA for males only (k = 0.21 - 0.4). GSHS provided good reliability for single items of 24-hour movement behaviours, and the validity was acceptable and in line with other comparable questionnaires.

Physical activity, screen time and the incidence of neck and shoulder pain in school-aged children

This study investigated the associations of accelerometer-measured physical activity, sedentary time and screen time with the incidence of neck and shoulder pain in school-aged children over a two-year follow-up. Children (aged 10–15) were measured at baseline 2013 (T0) (n = 970) and at follow-ups 2014 (T1) and 2015 (T2). Neck and shoulder pain frequency and screen time were determined with a web-based questionnaire. Daytime moderate to vigorous physical activity and sedentary time were measured with an accelerometer. Logistic regression was applied, and the results were adjusted for age, gender, body mass index and bedtime. Accelerometer-measured physical activity or sedentary time at baseline were not associated with the incidence of neck and shoulder pain at the two-year follow-up. Associations of neck and shoulder pain incidence with overall screen time (p = 0.020), and especially with passive gaming time (p = 0.036) and social media time (p = 0.023) were found at the first but not the second follow-up. The neck and shoulder pain incidence associated with overall screen time, passive gaming time and social media time at the first follow-up. The importance of limiting screen time, should be explored in order to find new approaches in preventing neck and shoulder pain in school-aged children.

Correlates of Meeting the Muscle-Strengthening Exercise Guidelines in Children and Adolescent

This study aimed to explore the potential correlates of muscle-strengthening exercise (MSE) in Chinese children and adolescents. A convenient sample (n = 3733) was recruited into this study. Self-reported questionnaires were used to collect information on sex, grade, ethnicity, residence, family composition, moderate to vigorous physical activity (MVPA), family income, parent's education level and MSE in children and adolescents as well as their parent(s). The prevalence of meeting the MSE guidelines was 62.1%. Children and adolescents who were in primary or middle school were more likely to meet the MSE guidelines ([primary school] OR = 2.33, 95% CI: 1.16-4.68; [middle school] OR = 4.62, 95% CI: 2.27-9.39). Children and adolescents with Han ethnicity had a higher likelihood to meet the MSE guidelines (OR = 1.97, 95% CI: 1.37-2.83). Children and adolescents meeting the MVPA recommendation were more likely to meet the MSE guidelines (OR = 5.41, 95% CI: 3.97-7.37). Relative to those who had a parent not meeting the MSE guidelines, those with either father or mother meeting the MSE guidelines were more likely to meet the MSE guidelines (OR = 1.32, 95% CI: 1.13-1.55). Our study may offer evidence for future MSE interventions in Chinese children and adolescents.

Test-retest reliability of selected HBSC items in Vietnam: well-being, physical and sedentary activities, and eating behaviours

Background

Valid and reliable research tools to assess children’s and adolescent’s health-related behaviour are highly needed across the globe. Rapid economic development, globalization, and associated lifestyle challenges observed in most countries support the need for high-quality evidence in adolescents to target health-promoting policies and interventions. This study aims to examine the test–retest reliability of selected well-being, physical and screen-time related siting activities, and eating behaviour items of the Health Behaviour in School-Aged Children (HBSC) questionnaire in a sample of Vietnamese adolescents.

Methods

Data were collected in autumn 2018 in Vietnam (3-week interval). The sample consisted of 410 adolescents (41.0% of boys; mean age = 12.61; SD = 1.24).Test–retest reliability was evaluated using the single measure Intraclass Correlation Coefficients (ICC) and Cohen’s kappa statistic stratified by sex, grade and place of residence (urban or rural).

Results

The reliability analyses of the well-being items were poor to good ICC values (0.43–0.79) and moderate to large Cohen’s kappa values (0.33–0.77). The physical activity and eating behaviour items were moderate (ICC = 0.54–0.65; Cohen’s kappa = 0.38–0.57). The screen-time related siting activities items were moderate to large (ICC = 0.51–0.72; Cohen’s kappa = 0.42–0.53). There was more item stability among females than males. The social media item was not as stable for 6^th graders (ICC = 0.45) compared with older adolescents (ICC 0.68–0.77).

Conclusions

The findings show that with regards to age, sex and place of residence, self-reported health, life satisfaction, physical and screen-time related siting activities, as well as eating behaviour items of the HBSC questionnaire have a sufficient test–retest reliability to be used in national self-report surveys for Vietnamese adolescents while health complaints items showed borderline reliability.

The Combinations of Physical Activity, Screen Time, and Sleep, and Their Associations with Self-Reported Physical Fitness in Children and Adolescents

Much evidence has indicated that adherence to the 24 h movement guidelines (physical activity, screen time and sleep) is associated with physical health, while little is known about the adherence to the 24 h movement guidelines and self-reported physical fitness in adolescents. This study, therefore, aims to explore the association between the 24 h movement guidelines (in isolation or combination) and self-reported physical fitness in a sample of Chinese adolescents in an age range of 10-17.

METHODS

A convenient sample of 3807 children and adolescents from 12 schools was adopted in the present study. A questionnaire based on the Health Behaviour in School-aged Children was used to assess physical activity and screen time, and the Pittsburgh Sleep Scale was utilized to measure sleep duration. The International Fitness Scale was used to assess physical fitness in study participants. Ordinal logistic regression was performed to estimate the association between adherence to the 24 h movement guidelines and self-reported physical fitness.

RESULTS

Of all study participants, 0.9% of them met the 24 h movement guidelines, and meeting the guidelines was significantly associated with higher levels of self-reported physical fitness. The analysis for the association between specific combinations of 24 h movement guidelines and self-reported physical fitness underscored the importance of meeting the physical activity recommendations.

CONCLUSION

Adherence to more recommendations contained in the 24 h movement guidelines was associated with higher self-reported physical fitness, especially cardiorespiratory fitness and muscular strength. Our study also stressed the importance of promoting moderate to vigorous physical activity in children and adolescents. Further works should focus on the association of a recommendation of adherence with other health indicators and replicate this study on larger samples among Chinese children and adolescents. Additionally, longitudinal or interventional studies that include more socio-demographic factors are needed to explore the association between 24 h movement guidelines and self-reported physical fitness, and the 24 h movement guidelines also should be promoted on a large scale in Chinese children and adolescents. Moreover, it is also needed to gain better insights into the directionality of the relationship between compliance with 24 h movement guidelines and self-reported physical fitness, as well as the mechanisms underlying the associations in Chinese children and adolescents.

Prevalence and correlates of meeting the muscle-strengthening exercise recommendations among Chinese children and adolescents: Results from 2019 Physical Activity and Fitness in China-The Youth Study

PURPOSE

This study aimed to describe the national prevalence of Chinese children and adolescents who met the World Health Organization muscle-strengthening exercise (MSE) recommendations and identify correlates of meeting the MSE recommendations.

METHODS

Cross-sectional data from the 2019 Physical Activity and Fitness in China-The Youth Study, a nationally representative sample of Chinese children and adolescents (n = 80,413; mean age = 13.7 years; 53.9% girls) and their parents, were analyzed. Children and adolescents who reported engaging ≥3 days (up to 7 days) of MSE per week were classified as meeting the MSE recommendations. MSE, demographics, lifestyle behaviors (sport participation, moderate-to-vigorous physical activity, screen time, and sleep duration), exercise intention, peer and parental support, and parental MSE participation were assessed through self-reports. Logistic regression models were used to determine the correlates of meeting the MSE recommendations. The analyses were completed in 2020.

RESULTS

Overall, 39.3% of children and adolescents met the MSE recommendations. Girls, 10th-12th graders, minorities, those from lower income households and those from families with lower parental education were less likely to meet the MSE recommendations. Children and adolescents who were proficient in ≥2 sports were more likely to meet the MSE recommendations (adjusted odds ratio (aOR) = 1.44, 95% confidence interval (95%CI): 1.26-1.65), as were those with more moderate-to-vigorous physical activity (aOR = 1.57, 95%CI: 1.53-1.61). Additionally, children and adolescents with high exercise intention (aOR = 1.60, 95%CI: 1.51-1.69), those whose parents met the adult MSE recommendations (aOR = 1.46, 95%CI: 1.40-1.52), and those who received high peer (aOR = 1.27, 95%CI: 1.20-1.34) and parental support (aOR = 1.07, 95%CI: 1.04-1.12) were more likely to meet the MSE recommendations.

CONCLUSION

Less than two-fifths of Chinese children and adolescents met the World Health Organization MSE recommendations. The correlates identified in our study can help inform the development of school and community based strategies and policies to enhance participation in MSE and improve muscular fitness of all Chinese children and adolescents.

Is the Health Behavior in School-Aged Survey Questionnaire Reliable and Valid in Assessing Physical Activity and Sedentary Behavior in Young Populations? A Systematic Review

Backgrounds

Using the self-reported questionnaire to assess the levels of physical activity (PA) and sedentary behavior (SB) has been a widely recognized method in public health and epidemiology research fields. The selected items of the Health Behavior in School-aged (HBSC) Survey Questionnaire have been used globally for measurements and assessments in PA and SB of children and adolescents. However, there are no comprehensive and critical reviews to assess the quality of studies on reliability and validity of selected items for PA and SB measurement and assessment derived from the HBSC. Thus, this review aimed to critically assess the quality of those studies and summary evidence for future recommendations.

Methods

A systematic review protocol was used to search potentially eligible studies on assessing reliability and validity of PA and SB measures of the HBSC questionnaire. electronically academic databases were used. The information on the reliability and validity of the PA and SB measures were extracted and evaluated with well-recognized criteria or assessment tools.

Results

After a literature search, six studies were included in this review. The reliability of PA measures of the HBSC questionnaire showed a moderate agreement while the reliability of SB measures showed a great variation across the different items in the different subgroups. The validity of the PA measures had acceptable performance, whereas no studies assess the validity of the SB measures. The included studies all had quality weaknesses on reliability or validity analysis.

Conclusions

The PA and SB measures of the HBSC questionnaires were reliable in assessing PA and SB among adolescents. However, a little evidence showed that PA measures are partially valid in assessing PA, but no evidence confirmed the validity of SB measures. The included studies all had methodological weaknesses in examining the reliability and validity of the PA and SB measures, which should be addressed in the future. Further studies are encouraged to use a more standardized study design to examine the reliability and validity of the PA and SB measures in more young populations.

The Associations of Active Travel to School With Physical Activity and Screen Time Among Adolescents: Do Individual and Parental Characteristics Matter?

Little is known about the relationship of active travel to school (ATS) with physical activity (PA) and screen time (ST) by individual and parental characteristics among adolescents, especially in China. To address the research gap, this study aimed to explore the difference of sex, age, living environment, parental occupation and education level in the relationship of ATS with PA and ST among students of grades 7–12 (aged 10–18 years) using cross-sectional data. In 13 cities of Hubei province, China, students from 39 public schools were recruited to engage in the survey. In total, 5,898 students (response rate = 89.6%) were invited into this study. Participants were required to report their ATS (including its types), PA and ST as well as sociodemographic information using a validated questionnaire. Descriptive analyses were used to report the information of all variables. Regression models were used to analyse the relationships of ATS and its types with PA and ST. In a total of 4,128 participants (boys: 50.9%; younger adolescents: 61.9%) included in the final analysis, the proportion of those with ATS was 47.3%. Regarding the types of ATS, walking accounted for over 30%, while cycling was 13.2%. Participants with ATS were more likely to have sufficient PA (OR = 1.26, 95% CI: 1.14–1.39), especially among boys, younger adolescents and those with lower parental education level. However, ATS was not associated with ST (OR = 0.94, 95% CI: 0.86–1.01). Participants with cycling had a higher odds ratio of being physically active (OR for cycling = 1.47, 95% CI: 1.27–1.70; OR for walking = 1.18, 95% CI: 1.06–1.32). The association of ATS types with PA and ST differed by gender, age, living environment and parental educational level as well as occupations. ATS may be a useful approach to increase PA among adolescents, but this should be explained by individual and parental characteristics.

The conception, content validation, and test-retest reliability of the Questionnaire for Screen Time of Adolescents (QueST)

OBJECTIVE

To analyze the content validity and the test-retest reliability of the Questionnaire for Screen Time of Adolescents (QueST).

METHODS

A study was conducted with high school adolescents from Southern Brazil enrolled in public education (2019). The QueST measures screen time across five constructs: studying, working/internship-related activities, watching videos, playing games, using social media/chat applications. Content validation involved consulting with experts and adolescents to evaluate whether the five constructs were clear and representing screen time behaviors, all ratings were quantified. The experts' evaluation provided Content Validity Indexes (CVI) for clarity and representativeness of the questionnaire. Students answered the QueST twice (1-week apart), and differences between applications were verified. Test-retest reliability was assessed using Intraclass Correlation Coefficients (ICC) and Bland-Altman analyses.

RESULTS

Among the experts, the CVI indicated 94% and 98% of clarity and representativeness, respectively. All items were highly clear for at least 70% of the students. Test-retest reliability was assessed with 104 students (16.3 ± 1.02 years; 66.3% girls). The ICC ranged from 0.41 (95%CI 0.24-0.56) for videos to 0.76 (95%CI 0.66-0.83) for social media/chat applications on weekdays; and from 0.24 (95%CI 0.04-0.41) for videos to 0.67 (95%CI 0.54-0.77) for social media/chat applications on weekends. The lowest mean difference was -4.6 min for working on weekdays, while the highest was 40.6 min for videos on weekends.

CONCLUSIONS

The QueST proved to be fair to excellent for measuring different screen time constructs. However, the item of videos (weekends) showed poor stability. The QueST demonstrates satisfactory content validity attested by the experts and adolescents.

Physical Health Complaints in Adolescents

Abstract. Background: Some of the physical health complaints adolescents have, such as headaches and stomachaches, cannot be explained on a somatic level. It is unclear which psychological factors can explain these complaints: stress and social support are often discussed, but emotions rarely are. Aims: This cross-sectional study aims to use social support, stress, the tendency toward negative emotions, and health behaviors to predict physical health complaints in adolescents. Method: The 2018 HBSC (Health Behavior in School-aged Children) data from the German state of Brandenburg was analyzed via structural equation and path modeling ( N = 3,068, age M = 13.05). Results: Results showed that the tendency toward negative emotions seems to be a better predictor for health complaints (β = .35) than stress (β = .17), and even better suited than social support (β = −.08) or health behavior (β = −.06 to β = .16). In the analysis of specific emotions (anger, sadness, and fear), correlations were low and between sadness and complaints they were highest (average β = .19). Limitations: The present cross-sectional study could not examine long-term outcomes. In addition, the results are limited to only a few physical complaints. Future long-term studies should examine multiple disease symptoms in adolescence. Conclusion: The investigated tendency toward negative emotions demonstrated promising results to better understand the relationship between psychological factors and physical health complaints. As negative emotions were particularly important in predicting physical health, prevention programs for adolescents should focus on dealing with negative emotions to improve their health.

Associations of 24-Hour Movement Behavior with Depressive Symptoms and Anxiety in Children: Cross-Sectional Findings from a Chinese Sample

This study examined the associations between adherence to 24-hour movement behavior guidelines (24-HMB) and the mental-health-related outcomes of depressive symptoms and anxiety in Chinese children. Data on movement behavior from 5357 children (4th and 5th grades), including physical activity, recreational screen time and sleep, were self-reported using the Health Behavior School-Aged Children Survey. Depressive symptoms and anxiety were self-reported using the Chinese version of the nine-item Patient Health Questionnaire and the Generalized Anxiety Disorder Scale, respectively. Depressive symptoms and anxiety were treated as categorical variables. Only 3.2% of the participants met physical activity, screen time, and sleep 24-HMB guidelines. Ordinal logistic regressions showed that, compared with participants who met the 24-HMB guidelines, participants who met none (odds ratio (OR) = 2.62, 95% CI: 1.76-3.90) or any one of the guidelines (OR = 1.88, 95% CI: 1.27-2.77) had higher odds of depressive symptoms. Similarly, there were higher odds of anxiety in participants who met none (OR = 2.32, 95% CI: 1.45-3.70) or any one of the recommendations (OR = 1.62, 95% CI: 1.03-2.57) compared with participants who met all the 24-HMB guidelines. Meeting the 24-HMB guidelines is associated with better mental-health-related outcomes in Chinese children. Because of the low prevalence of Chinese children meeting the 24-HMB recommendations, the present findings highlight the need to encourage children to regularly engage in physical activity, decrease their time spent sitting, and improve their sleep patterns.

If it's information, it's not "bias": a scoping review and proposed nomenclature for future response-shift research

BACKGROUND

The growth in response-shift methods has enabled a stronger empirical foundation to investigate response-shift phenomena in quality-of-life (QOL) research; but many of these methods utilize certain language in framing the research question(s) and interpreting results that treats response-shift effects as "bias," "noise," "nuisance," or otherwise warranting removal from the results rather than as information that matters. The present project will describe the various ways in which researchers have framed the questions for investigating response-shift issues and interpreted the findings, and will develop a nomenclature for such that highlights the important information about resilience reflected by response-shift findings.

METHODS

A scoping review was done of the QOL and response-shift literature (n = 1100 articles) from 1963 to 2020. After culling only empirical response-shift articles, raters characterized how investigators framed and interpreted study research questions (n = 164 articles).

RESULTS

Of 10 methods used, papers using four of them utilized terms like "bias" and aimed to remove response-shift effects to reveal "true change." Yet, the investigators' reflections on their own conclusions suggested that they do not truly believe that response shift is error to be removed. A structured nomenclature is proposed for discussing response-shift results in a range of research contexts and response-shift detection methods.

CONCLUSIONS

It is time for a concerted and focused effort to change the nomenclature of those methods that demonstrated this misinterpretation. Only by framing and interpreting response shift as information, not bias, can we improve our understanding and methods to help to distill outcomes with and without response-shift effects.

Proportion of School Attending Adolescents Meeting the Recommended Moderate-to-Vigorous Physical Activity Level and Its Predictors in Lagos, Nigeria

We aimed to assess the proportion of school attending adolescents who reached the recommended moderate-to-vigorous physical activity (MVPA) level in Lagos State, Nigeria, as well as the predictors associated with it. A cross-sectional study was conducted among 720 adolescents aged 12-19 years from 20 schools in Lagos State in 2020. MVPA level was assessed using the Activity Questionnaire for Adults and Adolescents. Predictors assessed were socio-demographic variables, anthropometric measurements, sedentary behaviour, self-efficacy, perceived benefits, and perceived barriers. Complete data was provided by 528 adolescents for the study (73% response rate). The recommended MVPA level was reached by 82.8% (95% CI 79.3-85.7) of the participants. Participants spent a median time of 44 (IQR 12.9, 110) minutes of MVPA per day on household-based activities, followed by school-based activities (21.4; 4.3, 50.4), active transportation (14.3; 0, 35), sport-based activities (8.6; 0, 58.9) and leisure-based activities (8.6; 1.1, 34.3). Participants in public schools were four times more likely to meet the recommended MVPA level compared to those in private schools (OR 3.97, 95% CI 2.46-6.42). A high proportion of school adolescents met the recommended MVPA level in Lagos State, Nigeria. Our study suggests that interventions for promoting MVPA should be targeted to private schools.

How physical activity, fitness, and motor skills contribute to math performance: Working memory as a mediating factor

PURPOSE

The purpose of this study was to examine whether physical activity, fitness, and motor skills have an indirect association with math performance via cognitive outcomes and if so, through which aspects of cognition?

METHODS

This study comprised 311 6th-9th grade adolescents (12-17 years [M age = 14.0 years], 59% girls) from seven schools throughout Finland in 2015. Math performance was measured via a teacher-rated math achievement and the Basic Arithmetic test. Cognitive functions were measured by broad cognitive test battery. Physical activity was assessed with a self-reported questionnaire and a hip-worn accelerometer. Aerobic fitness was estimated using a maximal 20-m shuttle run test, muscular fitness with curl-up and push-up tests, and motor skills with a 5-leaps test and a throwing-catching combination test. Structural equation modeling was applied to examine the associations.

RESULTS

In both boys and girls, motor skills had a positive indirect association with math outcomes through visuospatial working memory. Among girls, muscular fitness had a positive indirect association with math outcomes through visuospatial working memory. Aerobic fitness was positively associated with math achievement, but the indirect path via cognition was not observed. Self-reported physical activity had a borderline indirect positive association with math outcomes through visuospatial working memory. Accelerometer-based physical activity did not correlate with math performance.

CONCLUSION

Motor skills and muscular fitness had indirect positive associations with math performance, mediated by visuospatial working memory. The results give support to the viewpoints that the connections between motor skills, fitness, and physical activity to academic skills are mediated via specific cognitive skills.

Physical Activity Among Preadolescents Modifies the Long-Term Association Between Sedentary Time Spent Using Digital Media and the Increased Risk of Being Overweight

BACKGROUND

This study aimed to examine whether sedentary digital media use in preadolescence increases the risk of being overweight 3 years later, and whether this association differs based on preadolescents' leisure-time physical activity (LTPA) levels.

METHODS

The authors conducted a 3-year follow-up study among 4661 participants with a mean (SD) age of 11 (1) years at baseline and 14 (1) years at follow-up. A web-based questionnaire assessed sedentary digital media use and LTPA. The authors categorized baseline LTPA duration into 3 levels: 0 to 5 (low), 6 to 8 (moderate), and ≥9 (high) hours per week. In addition, the authors categorized adolescents as normal weight or overweight/obese at follow-up.

RESULTS

Greater amounts of sedentary digital media use at baseline associated with an increased risk of being overweight 3 years later even after adjusting for confounders. This only held for preadolescents with low baseline LTPA (OR = 1.14; 95% confidence interval, 1.05-1.24), but not among those with moderate (OR = 1.02; 0.91-1.15) or high (OR = 0.96; 0.85-1.08) LTPA.

CONCLUSIONS

Preadolescent LTPA modified the long-term association between sedentary digital media use and being overweight; specifically, 6 hours per week or more of LTPA mitigated the increased risk of being overweight associated with higher amounts of digital media use.

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Meeting 24-h movement guidelines: Prevalence, correlates, and the relationships with overweight and obesity among Chinese children and adolescents

BACKGROUND

Meeting 24-h movement guidelines by children and adolescents has been associated with improved indicators of health, although it has been under-studied in China. Hence, this study aimed to investigate the prevalence of meeting the 24-h movement guidelines, its correlates, and its relationships with body mass index in children and adolescents in China.

METHODS

Cross-sectional data from the 2017 Youth Study in China of 114,072 children and adolescents (mean age = 13.75 years, 49.18% boys) were used. Meeting 24-h movement guidelines (≥60 min of daily moderate-to-vigorous physical activity, ≤2 h of daily leisure screen time, 9-11 h and 8-10 h nightly sleep duration for 6-13-year-olds and 14-17-year-olds, respectively) and height and weight of all participants were assessed. The prevalence of meeting the 24-h movement guidelines and World Health Organization weight status categories were determined. Generalized linear models were used to determine the correlates of meeting the 24-h movement guidelines and the relationships of meeting the 24-h movement guidelines with overweight (OW) and obesity (OB).

RESULTS

Only 5.12% of Chinese children and adolescents met the 24-h movement guidelines, and 22.44% were classified as OW/OB. Older children and adolescents were less likely to meet the 24-h movement guidelines. Parental education level and family income were positively related to meeting the 24-h movement guidelines. Children and adolescents meeting the 24-h movement guidelines showed lower odds ratios for OW/OB. Compared with participants meeting the 24-h movement guidelines, boys in 4th-6th grades met none of the recommendations (OR = 1.22, 95%CI: 1.06-1.40), met the screen time recommendation only (OR = 1.13, 95%CI: 1.01-1.28), met the nightly sleep duration recommendation only (OR = 1.14, 95%CI: 1.03-1.28), and had significantly higher odds ratios for OW/OB. Similar trends were observed for girls in 4th-6th grades: meeting none of the guidelines (OR = 1.35, 95%CI: 1.14-1.59), meeting sleep duration guidelines only (OR = 1.23, 95%CI: 1.08-1.39), and meeting moderate-to-vigorous physical activity + nightly sleep duration guidelines (OR = 1.24, 95%CI: 1.01-1.54). For girls in 7th-9th grades, the following trend was observed: meeting none of the guidelines (OR = 1.30, 95%CI: 1.01-1.67).

CONCLUSION

Very few Chinese children and adolescents met the 24-h movement guidelines. Age (negatively correlated), parental education level, and family income (both positively correlated) were correlates of meeting the 24-h movement guidelines. Children and adolescents meeting the 24-h movement guidelines were more likely to have lower risks for OW/OB, especially in the youngest age group (Grades 4-6); and girls in the middle age group (Grades 7-9) were also more likely to have lower risks for OW/OB. Further research studies should explore additional correlates and determinants for meeting the 24-h movement guidelines. Also, future studies should use longitudinal or interventional designs to determine the relationships between meeting the 24-h movement guidelines and OW/OB and other health indicators, while taking sex and age differences into account.

Spinal pain in pre-adolescence and the relation with screen time and physical activity behavior

Background

To investigate how screen time and physical activity behavior were associated with spinal pain in pre-adolescence.

Methods

This study included 45,555 pre-adolescents who participated in the 11-year follow-up of the Danish National Birth Cohort. The 11-year follow-up included self-reported information on computer and TV behavior, aspects of physical activity, as well as frequency and intensity of spinal pain (neck-, mid back- and low back pain). Data were linked with parental socioeconomic data from Statistics Denmark registers. Associations were estimated using multinomial logistic regression models. To account for sample selection, we applied inverse probability weighting.

Results

Duration of screen time was stepwise associated with the degree of spinal pain. Compared with those spending < 2 h/day in front of a screen, screen time of ≥6 h/day was associated with a substantially increased relative risk ratio (RRR) of severe pain for both girls (RRR: 2.49, 95% CI: 2.13–2.92) and boys (RRR: 1.95, 95% CI: 1.65–2.32). Being physical inactive was likewise associated with higher likelihood of severe spinal pain (RRR: 1.22, 95% CI: 1.10–1.34) relative to those being moderately active. We observed that being physically active was seemingly associated with lower risk of spinal pain among boys with high frequency of screen time.

Conclusion

Findings indicate that both duration of screen time and physical inactivity are correlated with spinal pain in pre-adolescents with the strongest associations for screen time. Reducing screen time or increasing physical activity might help preventing spinal pain in pre-adolescents, particularly among high frequent screen users. Future prospective studies investigating the causal relationship are necessary.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04263-z.

The Role of Technology and Social Media Use in Sleep-Onset Difficulties Among Italian Adolescents: Cross-sectional Study

Background

The use of technology and social media among adolescents is an increasingly prevalent phenomenon. However, there is a paucity of evidence on the relationship between frequency of use of electronic devices and social media and sleep-onset difficulties among the Italian population.

Objective

The aim of this study is to investigate the association between the use of technology and social media, including Facebook and YouTube, and sleep-onset difficulties among adolescents from Lombardy, the most populous region in Italy.

Methods

The relationship between use of technology and social media and sleep-onset difficulties was investigated. Data came from the 2013-2014 wave of the Health Behavior in School-aged Children survey, a school-based cross-sectional study conducted on 3172 adolescents aged 11 to 15 years in Northern Italy. Information was collected on difficulties in falling asleep over the last 6 months. We estimated the odds ratios (ORs) for sleep-onset difficulties and corresponding 95% CIs using logistic regression models after adjustment for major potential confounders.

Results

The percentage of adolescents with sleep-onset difficulties was 34.3% (1081/3151) overall, 29.7% (483/1625) in boys and 39.2% (598/1526) in girls. It was 30.3% (356/1176) in 11-year-olds, 36.2% (389/1074) in 13-year-olds, and 37.3% (336/901) in 15-year-olds. Sleep-onset difficulties were more frequent among adolescents with higher use of electronic devices, for general use (OR 1.50 for highest vs lowest tertile of use; 95% CI 1.21-1.85), use for playing games (OR 1.35; 95% CI 1.11-1.64), use of online social networks (OR 1.40 for always vs never or rarely; 95% CI 1.09-1.81), and YouTube (OR 2.00; 95% CI 1.50-2.66).

Conclusions

This study adds novel information about the relationship between sleep-onset difficulties and technology and social media in a representative sample of school-aged children from a geographical location that has not been included in studies of this type previously. Exposure to screen-based devices and online social media is significantly associated with adolescent sleep-onset difficulties. Interventions to create a well-coordinated parent- and school-centered strategy, thereby increasing awareness on the unfavorable effect of evolving technologies on sleep among adolescents, are needed.

Psychosocial school environment and health risk behaviours of adolescents in Bulgaria: results from multilevel analysis

OBJECTIVES

The paper aims to study the relationships between psychosocial school environment and health risk behaviours (cigarette smoking, alcohol consumption, drunkenness, bullying perpetration and early start of sexual life) in a representative sample of Bulgarian adolescents.

METHODS

We apply multilevel analysis, using data from the Bulgarian 2017/2018 "Health Behaviour in School-aged Children (HBSC)" Study.

RESULTS

There is a significant variation between schools in Bulgaria in the proportions of students who smoke cigarettes, drink alcohol, get drunk and have an early start of sexual life. Lower school satisfaction is significantly associated with higher odds of smoking and drunkenness. The effect of school pressure differs for smoking and bullying perpetration. The effect of student support also differs for certain types of health risk behaviours. Higher student support is positively associated with frequent alcohol consumption and drunkenness. The relationship between teacher support and alcohol abuse is negative.

CONCLUSIONS

There is a significant association between characteristics of psychosocial school environment and Bulgarian adolescents' risk health behaviours (cigarette smoking, alcohol consumption, drunkenness, bullying perpetration). Comprehensive and effective health promotion policies in Bulgarian schools are needed in order to facilitate healthy lifestyles.

Medically Attended Injuries among Slovak Adolescents: Relationships with Socio-Economic Factors, Physical Fighting, and Physical Activity

There is a worrisome increase in the reporting of medically attended injuries in Slovak adolescents. The aim of this study is to examine the relationships between socio-economic factors, physical fighting, and physical activity with frequency of medically attended injuries among this population group. Data from 8902 adolescents participating in the Health Behavior in School-Aged Children study were used (mean age 13.37; 50.9% boys). The effects of family affluence, registered unemployment rate, average nominal monthly earnings of employees, physical fighting, and physical activity on frequency of medically attended injury were explored using linear regression analysis. Pearson's correlation was used to describe the associations between all selected variables. The selected model of linear regression explained 15.8% of the variance in the frequency of medically attended injuries. All variables except the registered unemployment rate showed linear positive relationships with medically attended injuries. The correlation analysis confirmed linear positive associations between medically attended injuries and physical fighting, family affluence, physical activity, and average nominal monthly earnings of employees. Further research on these variables is needed in the Slovak context. This may include analyses of the nature of the relationships between socio-economic factors and medically attended injuries, as well as systematic evaluation of applied physical fighting and physical-activity-related injury interventions to support evidence-based policy making.

Clusters of Adolescent Physical Activity Tracker Patterns and Their Associations With Physical Activity Behaviors in Finland and Ireland: Cross-Sectional Study

Background

Physical activity trackers (PATs) such as apps and wearable devices (eg, sports watches, heart rate monitors) are increasingly being used by young adolescents. Despite the potential of PATs to help monitor and improve moderate-to-vigorous physical activity (MVPA) behaviors, there is a lack of research that confirms an association between PAT ownership or use and physical activity behaviors at the population level.

Objective

The purpose of this study was to examine the ownership and use of PATs in youth and their associations with physical activity behaviors, including daily MVPA, sports club membership, and active travel, in 2 nationally representative samples of young adolescent males and females in Finland and Ireland.

Methods

Comparable data were gathered in the 2018 Finnish School-aged Physical Activity (F-SPA 2018, n=3311) and the 2018 Irish Children’s Sport Participation and Physical Activity (CSPPA 2018, n=4797) studies. A cluster analysis was performed to obtain the patterns of PAT ownership and usage by adolescents (age, 11-15 years). Four similar clusters were identified across Finnish and Irish adolescents: (1) no PATs, (2) PAT owners, (3) app users, and (4) wearable device users. Adjusted binary logistic regression analyses were used to evaluate how PAT clusters were associated with physical activity behaviors, including daily MVPA, membership of sports clubs, and active travel, after stratification by gender.

Results

The proportion of app ownership among Finnish adolescents (2038/3311, 61.6%) was almost double that of their Irish counterparts (1738/4797, 36.2%). Despite these differences, the clustering patterns of PATs were similar between the 2 countries. App users were more likely to take part in daily MVPA (males, odds ratio [OR] 1.27, 95% CI 1.04-1.55; females, OR 1.49, 95% CI 1.20-1.85) and be members of sports clubs (males, OR 1.37, 95% CI 1.15-1.62; females, OR 1.25, 95% CI 1.07-1.50) compared to the no PATs cluster, after adjusting for country, age, family affluence, and disabilities. These associations, after the same adjustments, were even stronger for wearable device users to participate in daily MVPA (males, OR 1.83, 95% CI 1.49-2.23; females, OR 2.25, 95% CI 1.80-2.82) and be members of sports clubs (males, OR 1.88, 95% CI 1.55-2.88; females, OR 2.07, 95% CI 1.71-2.52). Significant associations were observed between male users of wearable devices and taking part in active travel behavior (OR 1.39, 95% CI 1.04-1.86).

Conclusions

Although Finnish adolescents report more ownership of PATs than Irish adolescents, the patterns of use and ownership remain similar among the cohorts. The findings of our study show that physical activity behaviors were positively associated with wearable device users and app users. These findings were similar between males and females. Given the cross-sectional nature of this data, the relationship between using apps or wearable devices and enhancing physical activity behaviors requires further investigation.

Associations between various kinds of parental support and physical activity among children and adolescents in Shanghai, China: gender and age differences

Background

The associations between various kinds of parental support and children and adolescents’ physical activity (PA) are inconclusive. This study aimed 1) to examine the associations between various kinds of parental support and children and adolescents’ moderate-to-vigorous physical activity (MVPA), and 2) to examine gender and age differences in the association between each specific kind of parental support and MVPA.

Methods

Using a multi-stage stratified and random cluster sampling method, 711 schools in Shanghai were selected (data were collected from October 2014 to February 2015). In total, 61,429 school-aged children (6–18 years old, 50.7% boys) and their parents were included. Self-reported questionnaires were used to measure sociodemographic characteristics, MVPA and various kinds of parental support, including parental encouragement (PAEN), parental involvement (PAIV), parental financial support (PAFS) and, parental modeling (PAMD). Descriptive statistics and Chi-square were used to report the level of MVPA and its difference across various kinds of parental support by gender groups. The logistic regression analysis was used to examine the associations between parental support and MVPA with odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Overall, 19.4% of children and adolescents accumulated MVPA at least 60 min/day. Boys were more physically active than girls (21.4% > 17.4%, p <  0.001). According to the observation of OR estimates, girls may be more susceptible to the influences from various kinds of parental support than boys (OR = 1.59, 1.61, 1.27 and 1.63, 95% CI: 1.19–1.73 among girls, and OR = 1.48, 1.60, 1.21, and 1.60, 95% CI: 1.14–1.69 among boys for PAEN, PAIV, PAFS and PAMD respectively). PAMD is the only one supportive kind that was positively associated with MVPA in both genders across all grades (OR = 1.29–2.98, 95% CI: 1.09–4.08 among boys; OR = 1.27–2.64, 95% CI: 1.10–4.10 among girls).

Conclusions

Less than one fifth of children and adolescents accumulated 60 min MVPA per day. Various kinds of parental support have important effects on children and adolescents’ MVPA, which varied by gender and grades. PAMD, in particular, should be emphasized more than PAEN, PAIV and PAFS in family-based interventions aiming at increasing PA in the future.

Why have youth physical activity trends flatlined in the last decade? Opinion piece on "Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1.6 million participants" by Guthold et al

• Globally, physical inactivity rates in school-going adolescents are alarming. Using realist and co-creation methodologies to better understand and develop multisectoral strategies and programs and efforts to promote effective uptake of evidence-based programs into routine practice at scale are urgently needed.

The association of healthy lifestyle behaviors with mental health indicators among adolescents of different family affluence in Belgium

BACKGROUND

Healthy lifestyles may contribute to better mental health, which is particularly important in adolescence, an age at which half of all mental health problems first occur. This association may be even more relevant in adolescents of low family affluence, who show more mental health problems, as well as more unhealthy lifestyles. This study investigated healthy lifestyle behaviors, namely sufficient sleep and physical activity, daily breakfast intake, low levels of alcohol use or smoking, in relation to mental health and symptoms of mental health problems (feelings of depression, anxiety, stress and self-esteem) among adolescents from different family affluence. Furthermore, the moderating role of family affluence was examined in those relations.

METHODS

Adolescents aged 12-18y were recruited via a random sample of schools in Flanders, Belgium. A total of 1037 adolescents participated (mean age = 15.2, 49.8% female). Independent samples t-tests, Mann Whitney U-tests and χ²-tests determined the differences in healthy lifestyle behaviors and mental health indicators between adolescents of low-medium and high family affluence. Regression analyses assessed the association between healthy lifestyles and mental health outcomes and the moderating role of family affluence.

RESULTS

All healthy lifestyle behaviors were associated with at least one mental health outcome, with the exception of alcohol consumption. Adolescents from low-medium family affluence had lower levels of physical activity, less often took breakfast, had lower levels of alcohol consumption and reported lower self-esteem than adolescents from high family affluence. The results showed no moderating effect of family affluence for the association between healthy lifestyle and mental health.

CONCLUSION

These findings support the value of integrating healthy lifestyle behaviors in interventions for mental health promotion, for both youth of low-medium and high family affluence.

Public health surveillance of habitual physical activity in adolescents and adults in Namibia: a cross-sectional validation of activity questionnaires against accelerometry

BACKGROUND

Monitoring population-level physical activity is crucial for examining adherence to global guidelines and addressing obesity. This study validated self-reported moderate-to-vigorous physical activity (MVPA) against an accurate device-based method in Namibia.

METHODS

Adolescent girls (n = 52, mean age 16.2 years [SD 1.6]) and adult women (n = 51, mean age 31.3 years [SD 4.7]) completed the PACE+/GPAQ self-report questionnaires and were asked to wear an Actigraph accelerometer for 7 days. Validity of self-reported MVPA was assessed using rank-order correlations between self-report and accelerometry, and classification ability of the questionnaires with Mann-Whitney tests, kappa's, sensitivity and specificity.

RESULTS

In the adolescents, Spearman's rank coefficients between self-reported MVPA (days/week) and accelerometry measured MVPA were positive but not significant (r = 0.240; P = 0.104). In the adults, self-reported MVPA (minutes/day) was moderately and significantly correlated with accelerometer-measured MVPA (r = 0.396; P = 0.008). In both groups, there was fair agreement between accelerometry and questionnaire-defined tertiles of MVPA (adolescents κ = 0.267; P = 0.010; adults κ = 0.284; P = 0.008), and measured MVPA was significantly higher in the individuals self-reporting higher MVPA than those reporting lower MVPA.

CONCLUSIONS

The PACE+ and GPAQ questionnaires have a degree of validity in adolescent girls and adult females in Namibia, though more suitable for population than individual level measurement.

The Role of Family Time Together in Meeting the Recommendation for Physical Activity among Primary School Children

Family time may have an influence on children’s physical activity (PA) participation or may contribute to increased sedentary behaviour. The aim of this paper was to examine whether spending family time is associated with the PA of children aged 10–11. Cross-sectional data on 158 primary school children (80 girls and 78 boys) with a mean age of 10.6 ± 0.49 years were collected. Weight and height were used to calculate body mass index. The level of moderate-to-vigorous physical activity (MVPA) was determined with a physical activity screening measure. Participants wore a Vivofit^® wrist band activity tracker to measure their daily number of steps. The Health Behaviour in School-Aged Children questionnaire was used to obtain information from children about the frequency of activities undertaken by the family. Analyses entailed descriptive statistics of the total sample and by gender, t-test, and the Mann–Whitney U-test to examine the gender differences and Spearman’s correlation coefficients. It was found that 32.3% of the children did not accomplish at least 60 min per day on ≥5 of the seven days and more than 75.9% of them did not accumulate at least 12,000 or more steps daily. More boys than girls tended to be sufficiently active and met the guideline of at least 60 min per day on ≥5 of the seven days (70.5% and 65.0%, respectively) or 12,000 steps per day (25.8% and 10.0%, respectively). The number of steps during the weekday was significantly and inversely associated both in girls and in boys with active family time (r = −0.27 and r = −0.25, respectively), and with total family time (r = −0.28) and non-active family time (r = −0.25) only in boys. Average MVPA was also inversely correlated with active family time (r = −0.31), non-active family time (r = −0.24), and total family time (r = −0.29) in boys. The correlation effect size values ranged between small to medium significant differences for these measures. The findings underscore the need for community-based PA programmes designed for whole families to meet the recommended PA of children and also to develop and promote active leisure activities among families.

Sedentary Behavior Research in the Chinese Population: A Systematic Scoping Review

Background: The negative effects of sedentary behavior (SB) on public health have been extensively documented. A large number of studies have demonstrated that high prevalence of SB is a critical factor of all-cause mortality. Globally, the frequency of SB research has continued to rise, but little is known about SB in the Chinese population. Therefore, this review was conducted to scope the research situation and to fill the gaps related to the effects of SB in the Chinese population. Methods: Using a scoping review based on York methodology, a comprehensive search of published journal articles and grey literature was carried out through 12 databases. The literature research was conducted by two authors in July 2019, and included journal articles that targeted on the Chinese population were published between 1999 and 2019. The two authors screened the records independently and included those research topics related to SB in the Chinese population. Results: The number of included studies increased from 1 to 29 per year during the analyzed period, during which, a remarkable climb happened from 8 in 2013 to 19 in July 2019. Out of the 1303 screened studies, a total of 162 studies (81 English and 81 Chinese journal articles) met the inclusion criteria in this review. Most of the included studies (66.0%) reported the overall estimated prevalence of SB, in which, 43.2% of studies reported the average time of SB, and 40.0% of studies reported the cutoff point of SB. Besides this, 54.9% and 23.5% of studies focused on the outcomes and correlates/determinants of SB, and the proportions of studies based on testing the validation of measurement tools and on interventions were 3.7% and 4.9%, respectively. Nearly all of the reviewed articles used data from cross-sectional studies (75.9%) and longitudinal studies (13.6%), while intervention trials are less developed. The majority of the studies (64.8%) used self-reported surveys, and only 3.7% studies used device-based measurement tools. Furthermore, 35.8% of the included studies were focused on children and adolescents, while only a few studies investigated infants/toddlers and older adults. Both female and male were examined in most studies, and non-clinical populations were investigated in the context of SB in a relatively large number of studies. Conclusions: The number of research articles on SB in the Chinese population published per year has increased year by year, indicating a growing interest in this research area. More studies using population subgroup samples are needed, particularly among infants/toddlers, older adults, and clinical populations. To provide stronger evidence of the determinants and outcomes of SB, longitudinal studies using device-based measures of SB are required.