The combined impact of diet, physical activity, sleep and screen time on academic achievement: a prospective study of elementary school students in Nova Scotia, Canada

The effects of diet quality, eating behavior, and sleep on the academic performance among elementary school students

The academic success of children contributes to their income, social status, and public health. This study was conducted with 217 elementary school students from western China. Scores on the Chinese Children Dietary Index (CCDI), Dietary Approaches to Stop Hypertension (DASH), adjusted DASH, and KIDMED index were calculated to evaluate diet quality. Eating behavior and sleep quality were assessed using the Children's Eating Behavior Questionnaire (CEBQ) and Children's Sleep Habits Questionnaire (CHSQ), respectively. Academic achievement was measured using school-provided average grades. Higher CCDI scores, longer sleep time, lower total CHSQ scores, and lower subscores on "satiety responsiveness," "slowness in eating," "emotional undereating," and "food fussiness" dimensions of the CEBQ were associated with high academic achievement. In conclusion, good diet quality, sleep quality, healthy eating behaviors, and adequate sleep duration were associated with better academic performance. Interventions are recommended to be developed in education system to improve healthy diets and lifestyles, enhancing academic achievement.

Meeting 24-h movement behavior guidelines is linked to academic engagement, psychological functioning, and cognitive difficulties in youth with internalizing problems

BACKGROUND

This study aimed to investigate associations of meeting 24-h movement behavior (24-HMB: physical activity [PA], screen time [ST] in the school-aged youth, and sleep) guidelines with indicators of academic engagement, psychological functioning, and cognitive function in a national representative sample of U.S. youth.

METHODS

In this cross-sectional study, 1794 participants aged 6 to 17 years old were included for multivariable logistic regression to determine the above-mentioned associations, while adjusting for sociodemographic and health covariates.

RESULTS

The proportion of participants who met 24-HMB guideline(s) varied greatly (PA+ ST+ sleep = 34 [weighted 1.17 %], PA + ST = 23 [weighted 1.72 %], PA + sleep = 52 [weighted 2.15 %], PA = 34 [weighted 2.88 %], ST = 142 [weighted 7.5 %], ST+ sleep = 209 [weighted 11.86 %], sleep = 725 [weighted 35.5 %], none = 575 [weighted 37.22 %]). Participants who met ST guideline alone and integrated (ST + Sleep and ST + sleep + PA) guidelines demonstrated the consistently beneficial associations with learning interest/curiosity, caring for school performance, completing required homework, resilience, cognitive difficulties, self-regulation (ps < 0.05).

CONCLUSION

Meeting 24-HMB guidelines in an isolated or integrative manner was associated with improved academic engagement, psychological functioning, and reduced cognitive difficulties. These findings highlight the importance of the promotion of 24-HMB guidelines in youth with internalizing problems. Future longitudinal studies are needed to investigate whether changes or modifications of meeting specific 24-HMB guidelines (especially ST) is beneficial for youth with internalizing problems.

Is the association between sleep and socio-emotional development mediated by weight in toddlers aged 12 to 36 months?

Introduction

Childhood is an important stage for socio-emotional development. Understanding the associations of lifestyle habits with the healthy development of social and emotional skills is crucial for better interventions early in life. This study aims to analyze the association between sleep and socio-emotional development in toddlers aged 12 to 36 months and examine whether weight mediated these associations.

Methods

This study is part of a cluster randomized controlled trial developed in Portuguese childcare centers. A sample of 344 children (176 females) enrolled in the study. Participants' anthropometrics were measured while at childcare centers using standardized procedures. Body mass index (BMI) was computed as the body weight/height2 (kg/m2) ratio. Sleep quality was collected with the Tayside Children's Sleep Questionnaire, a 10-item scale that evaluates the child's ability to initiate and maintain sleep. Two additional questions regarding sleep duration were added. Parental questionnaires assessed the child's sex and date of birth, socioeconomic status, and total energy intake (TEI). Motor (fine and gross) was assessed using Bayley-III scales and socio-emotional (SE) by the Greenspan Social-Emotional Growth Chart questionnaire. Linear regression models were used to examine the associations between sleep (duration and quality) and SE with adjustments for sex, age, BMI, mothers' education, motor development, and TEI. Mediation analysis was conducted using path analysis.

Results

SE development was significantly associated with nighttime sleep duration even when adjusted for confounders (β = 0.223; 95% CI: 0.001, 0.004 and β = 0.168; 0.0003, 0.003; respectively). Sleep quality was not significantly associated with SE development, and the weight did not explain the associations between sleep and SE development.

Conclusion

This study supports that sleep duration is directly associated with SE development in toddlers. From a public health perspective, sleep duration should be prioritized in intervention programs to improve socio-emotional development early in life.

The individual and combined associations of health behaviours with health-related quality of life amongst junior high school students in China

Objectives

This study aimed to investigate the individual and joint associations of sedentary behaviour, physical activity (PA), sleep and breakfast eating on health-related quality of life (HRQoL) amongst Chinese junior high school students.

Methods

Data were from 783 junior high school students who participated in a health behaviour and health survey in Jining city of Shandong province of China. HRQoL was measured by the EuroQol five-dimensional questionnaire, youth version (EQ-5D-Y). Multivariable logistic and linear regressions were applied to examine the associations between health behaviours and HRQoL.

Results

Multivariable regression analyses showed that using a computer ≥ 2 h a day (vs. < 2 h/day) is associated with increased likelihood of having health problems in the three EQ-D-Y dimensions, including walking, looking after self and doing usual activities. Lower PA is associated with more problems in feeling worried, sad or unhappy, and with a lower visual analogue scale (VAS) score. Students who had insufficient sleep time (e.g., <7 h/day), and skipped eating breakfast were more likely to experience lower HRQoL in the dimensions of having pain or discomfort, and feeling worried, sad or unhappy, and a lower VAS score than those students who had longer sleep time and no breakfast skipping. Students who reported having the combined ≥ 2 unhealthy behaviours relative to the peers with 0-1 unhealthy behaviours were more likely to have lower HRQoL.

Conclusion

The findings in the present study underline the importance of promoting healthy behaviours in order to improve HRQoL amongst Chinese junior high school students.

Sleep duration and its association with adiposity markers in adolescence: a cross-sectional and longitudinal study

AIMS

Large studies linking adolescents' objectively measured sleep duration and adiposity markers are lacking. We characterized sleep duration and its cross-sectional and longitudinal associations with adiposity markers in adolescence.

METHODS AND RESULTS

Seven-day accelerometry was performed in a cohort of adolescents enrolled in the SI! Program for Secondary Schools trial in Spain at approximately ages 12 (1216 adolescents, 49.6% girls), 14 (1026 adolescents, 51.3% girls), and 16 (872 adolescents, 51.7% girls) years. Participants were classified as very short sleepers (VSS; <7 h), short sleepers (SS; 7-<8 h), or recommended-time sleepers (RTS; 8-10 h). Adjusted associations between sleep duration and adiposity markers were analysed using generalized linear and Poisson models. At ∼12 years, 33.7% of adolescents met sleep recommendations, and this percentage decreased with advancing age (22.6% at ∼14 and 18.7% at ∼16 years). Compared with RTS, overweight/obesity prevalence ratios at ∼12, 14, and 16 years among SS were 1.19 [95% confidence interval (CI): 1.09-1.30], 1.41 (95% CI: 1.34-1.48), and 0.99 (95% CI: 0.77-1.26) and among VSS were 1.30 (95% CI: 1.28-1.32), 1.93 (95% CI: 1.41-2.64), and 1.32 (95% CI: 1.26-1.37). Compared with adolescents who always met sleep recommendations, the prevalence of overweight/obesity was ∼5 times higher in those never meeting recommendations or meeting them only once. Similar trends were observed for the waist-to-height ratio (P = 0.010) and fat mass index (P = 0.024).

CONCLUSION

Most adolescents did not meet sleep recommendations. Shorter sleep duration was independently associated with unfavourable adiposity markers, and such adverse impact was cumulative. Health promotion programmes should emphasize the importance of good sleep habits.

Implementation models and frameworks used to guide community-based physical activity programs for children: a scoping review

BACKGROUND

The implementation of community-based programs is key to effective, sustainable initiatives that can support population-level changes in children's physical activity. The purpose of this scoping review was to explore the implementation models and frameworks used to develop (process models), explore (determinant frameworks), and/or evaluate (evaluation frameworks) community-based physical activity programs for children. Also, the foundational components of the implementation models and frameworks and practical application in real-world settings were described.

METHODS

The methodological framework developed by Arksey and O'Malley (2005) and the updated recommendations from Levac, Colquhoun and O'Brien (2010) were used to search, identify, and summarize applicable studies. This review also met the requirements in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Reviews Checklist (PRISMA-ScR). A detailed search of six databases and three academic journals was conducted. Information about the article, the program, and the implementation model/framework were extracted and summarized.

RESULTS

The search retrieved 42,202 articles, of which 27 met the inclusion criteria. Eleven process models, one determinant framework, and two evaluation frameworks were identified. Nineteen components were developed from the models and frameworks. Tailoring, situational analysis, and element identification were common components among the identified models and frameworks.

CONCLUSIONS

Since the execution of interventions is vital for creating successful health-promoting initiatives, researchers and program developers should consider using implementation models and frameworks to guide their community-based physical activity programs. Further research examining the application of new and existing implementation models and frameworks in developing, exploring, and evaluating community-level programs is warranted.

Associations between physical activity, screen time, sleep time and selected academic skills in 8/9-year-old children

BACKGROUND

High levels of physical activity (PA), low levels of screen time, combined with sufficient sleep time, provide better health benefits. However, few studies have examined the association of these behaviours with academic skills. Therefore, this study aims to determine how PA, screen time, and sleep time are related to selected academic skills of 8/9-year-old children while examining compliance with the guidelines on PA, sedentary behaviour, and sleep among this population group.

METHODS

This cross-sectional study included 114 primary school children (50% girls) aged 8-9years old from 2nd grade. The levels of PA, screen time, and sleep were assessed using self-reported questionnaires. The selected academic skills (based on reading and writing) were assessed by a battery of methods designed to diagnose the causes of school failure in students aged 7-9. Non-linear regression was applied to build multivariate models aimed at finding the most significant predictors for the selected academic skills separately.

RESULTS

Sixty-seven percent of children met the sleep guidelines, 22% met the screen time guidelines, and only 8% met PA guidelines. In terms of screen time, boys spent more time playing games than girls (p = .008). Moderate to vigorous intensity physical activity (MVPA) was associated with higher/better scores of the visual-auditory integration (B = -0.07, p = .040). Not meeting the sleep guidelines was associated with lower scores in visual-auditory integration among children (B = 0.12, p = .042). Children who did not meet the screen time guidelines had lower scores in perceptual-motor integration (B = -0.09, p = .040).

CONCLUSIONS

Participating in PA, limiting screen time and sufficient sleep time may benefit/support academic skills in children.

Adherence to 24-Hour Movement Recommendations and Health Indicators in Early Adolescence: Cross-Sectional and Longitudinal Associations in the Adolescent Brain Cognitive Development Study

PURPOSE

Adherence to 24-hour movement guidelines of ≥60 minutes of physical activity, ≤2 hours of screen time, and 9-11 hours of sleep has been shown to benefit cognitive, physical, and psychosocial health in children and young adolescents aged 5-13 years. However, these findings have mostly been based on cross-sectional studies or relatively small samples and the associations between adherence to guidelines and brain structure remain to be evaluated.

METHODS

Data from the Adolescent Brain Cognitive Development℠ (ABCD) study of 10,574 early adolescents aged 9-14 years from September 2016 to January 2021 were used to examine whether adherence to 24-hour movement guidelines benefits cognition (general cognitive ability, executive function, and learning/memory assessed by the National Institutes of Health Toolbox neurocognitive battery), body mass index, psychosocial health (internalizing, externalizing, and total problems from the parent-reported Child Behavior Checklist), and magnetic resonance imaging-derived brain morphometric measures at baseline (T1), ∼2 years later (T2), and longitudinally from T1 to T2 (T2-T1). Multivariable linear mixed models were used, with adjustments for sociodemographic confounders. Time elapsed and T1 outcome measures were also controlled for in longitudinal models.

RESULTS

Better cognitive scores, fewer behavioral problems, lower adiposity levels, and greater gray matter volumes were observed in those who met both sleep and screen time recommendations compared to those who met none. Longitudinal follow-up further supports these findings; participants who met both recommendations at T1 and T2 evidenced better outcome measures than those who met none.

DISCUSSION

These findings support consideration of integrated rather than isolated movement recommendations across the day in early adolescence for better cognitive, physical and psychosocial health. Although the associations between physical activity and health indicators were less consistent in this study, the significant findings from sleep and screen time demonstrate the importance of considering movement recommendations in an integrated rather than isolated manner for adolescent health. It is recommended that movement behaviors be simultaneously targeted for better developmental outcomes.

Media use, dietary intake, and diet quality of adolescents in Saudi Arabia

BACKGROUND

Excessive media use can affect diet of adolescents, but relevant data in Saudi Arabia are lacking. The present study aimed to explore the association between media use, dietary intake, and diet quality among adolescents.

METHODS

This cross-sectional study included data of 631 adolescents (ages 11-18 years) who were randomly recruited from 16 schools located in two main cities in the Western region of Saudi Arabia (Madinah and Jeddah). Envelopes including a questionnaire were sent home to collect sociodemographic data. Students then completed the short-form food frequency questionnaire to assess diet quality. Data on media use, anthropometrics, and 24-h dietary recalls were also collected.

RESULTS

A high proportion of adolescents (86.2%) exceeded media use recommendations of ≤2 h per day. Significantly higher proportions of younger adolescents, males, and non-Saudis reported media use within the recommendation compared to their peers. Media use predicted lower diet quality score (B = -0.67 [95% CI: -1.09 to -0.28]) and lower intake of calcium, zinc, vitamin D, and vitamin C (B = -104 [95% CI: -203 to -5.24], B = -2.13 [95% CI: -4.15 to -0.11], B = -23.5 [95% CI: -41.3 to -5.65], B = -24.0 [95% CI: -45.1 to -2.96], respectively).

CONCLUSION

Interventions to limit media use are urgently needed for adolescents in Saudi Arabia to improve diet quality and overall nutritional health.

IMPACT

Excessive media use can affect diet of adolescents, but relevant data are lacking in Saudi Arabia. The majority of adolescents exceed the recommendations for media use. Media use was negatively associated with diet quality and intake of calcium, zinc, vitamin D, and vitamin C. This study will inform public health entities and policy makers to draw evidence-based, culturally tailored recommendations and develop nutrition interventions to enhance diet quality and nutritional status of adolescents. Findings of this study highlight the urgency to develop intervention programs and policies that aim to limit media use among adolescents.

The impact of attention-deficit/hyperactivity disorder and specific learning disorders on academic performance in Spanish children from a low-middle- and a high-income population

Introduction

Past research has demonstrated that attention-deficit/hyperactivity disorder (ADHD), specific learning disorders (SLD), and socioeconomic status (SES) affect a host of educational outcomes. However, there are no studies examining whether SES moderates the association between these neurodevelopmental disorders (ND) and the academic achievement of children and adolescents. The present investigation examined the impact of ADHD and SLD on academic performance in 1,287 Spanish students aged 5-17 from a low-middle (LM)- and a high-income population, when adjusted for comorbidity and demographic factors that may influence educational functioning.

Methods

Parents completed a questionnaire regarding demographic data along with the Strengths and Difficulties Questionnaire. Additionally, teachers provided information on learning difficulties trough the Protocol for Detection and Management of Dyslexia. Teacher's Version. Academic performance across multiple domains (i.e., first language, foreign language, mathematics) was obtained from school records. ND were determined using standardized diagnostic methods based on the Diagnostic and Statistical Manual of Mental Disorders criteria. To examine the effects of ADHD and SLD on academic achievement and the potential moderating role of SES, a series of ordinal logistic regressions were conducted.

Results

Emotional/behavioral problems, learning difficulties, and ND were more frequent among individuals from the LM-income population. After controlling for gender, age, parental divorce/separation, grade retention, frequency of screen use, and daily meals, both ADHD and SLD were associated with worse educational outcomes. Lower SES also increased the risk for academic impairment, although the interactions with ADHD or SLD were not significant.

Conclusion

These findings indicate that ADHD and SLD exert a pervasive impact on academic performance across different socioeconomic backgrounds. Therefore, early detection and effective intervention strategies aimed at students with these ND are crucial to improve their educational functioning and mitigate the negative consequences related to academic problems.

A Longitudinal Study of Insomnia, Daytime Sleepiness, and Academic Performance in Chinese Adolescents

BACKGROUND

Longitudinal data on the associations between sleep disturbances, daytime sleepiness, and daily functioning are limited in the general adolescent population. This study examined the cross-sectional and longitudinal associations between insomnia, excessive daytime sleepiness (EDS), and subject-specific academic performance in a large sample of Chinese adolescents.

METHOD

Data were derived from the Shandong Adolescent Behavior and Health Cohort (n = 7,072) study. A self-administered questionnaire was used to assess insomnia, EDS, academic performance (overall, Chinese, mathematics, and English), behavioral and emotional problems, and family demographics. The cross-sectional analysis was conducted with baseline data while the longitudinal analysis was conducted with both baseline and 1-year follow-up data. Logistic regression analyses and mediation models were performed to examine the associations between insomnia, EDS, and academic performance.

RESULTS

Logistic regression analyses revealed that insomnia and EDS had significant cross-sectional associations with overall performance and mathematics performance after controlling for age, gender, ever smoking, ever alcohol drinking, frequent snore, sleep duration, chronic disease, anxious/depressive symptoms, parents' education, parents' occupation, and family economic status. Both insomnia (OR = 1.20, 95% CI: 1.00-1.45) and EDS (OR = 1.22, 95% CI: 1.03-1.45) at baseline were significantly associated with poor mathematics performance 1 year later. The effect of insomnia at baseline on poor academic performance 1 year later was mediated by EDS except for the Chinese subject after controlling for the covariates.

CONCLUSIONS

Insomnia and daytime sleepiness are significantly associated with poor academic performance, particularly in mathematics. EDS mediates the association between insomnia and poor academic performance. Further research is warranted to investigate the effects of sleep disturbance and daytime sleepiness on the learning process and performance across academic subjects.

Street-view greenspace exposure and objective sleep characteristics among children

Greenspace may benefit sleep by enhancing physical activity, reducing stress or air pollution exposure. Studies on greenspace and children's sleep are limited, and most use satellite-derived measures that do not capture ground-level exposures that may be important for sleep. We examined associations of street view imagery (SVI)-based greenspace with sleep in Project Viva, a Massachusetts pre-birth cohort. We used deep learning algorithms to derive novel metrics of greenspace (e.g., %trees, %grass) from SVI within 250m of participant residential addresses during 2007-2010 (mid-childhood, mean age 7.9 years) and 2012-2016 (early adolescence, 13.2y) (N = 533). In early adolescence, participants completed >5 days of wrist actigraphy. Sleep duration, efficiency, and time awake after sleep onset (WASO) were derived from actigraph data. We used linear regression to examine cross-sectional and prospective associations of mid-childhood and early adolescence greenspace exposure with early adolescence sleep, adjusting for confounders. We compared associations with satellite-based greenspace (Normalized Difference Vegetation Index, NDVI). In unadjusted models, mid-childhood SVI-based total greenspace and %trees (per interquartile range) were associated with longer sleep duration at early adolescence (9.4 min/day; 95%CI:3.2,15.7; 8.1; 95%CI:1.7,14.6 respectively). However, in fully adjusted models, only the association between %grass at mid-childhood and WASO was observed (4.1; 95%CI:0.2,7.9). No associations were observed between greenspace and sleep efficiency, nor in cross-sectional early adolescence models. The association between greenspace and sleep differed by racial and socioeconomic subgroups. For example, among Black participants, higher NDVI was associated with better sleep, in neighborhoods with low socio-economic status (SES), higher %grass was associated with worse sleep, and in neighborhoods with high SES, higher total greenspace and %grass were associated with better sleep time. SVI metrics may have the potential to identify specific features of greenspace that affect sleep.

Preliminary Effectiveness of a Strategy to Promote Healthy Lifestyle Habits in Schoolchildren

Purpose: To measure the preliminary effectiveness of a strategy to promote healthy lifestyle habits in schoolchildren, aged 6 to 12 years, living in the Andean region of Colombia, 2018–2021. Design and Methods: This is a Nursing Methodological Research, developed in phases: (1) Context and schoolchildren characterization; (2) Strategy design guided by the Whittemore and Grey criteria and the Bronfenbrenner ecological conceptual model; (3) Strategy validation with 11 experts; (4) Trial to evaluate preliminary effectiveness. We applied the strategy in seven different schools with the educational community including 955 schoolchildren between 6 and 12 years of age, 551 parents, 130 teachers and 7 members of the food staff. Results: Our health promotion strategy “Prosalud” has five components: citizenship feeding and nutrition, physical activity, and rest; environment protection, and directing one’s own life. It includes all the participants of the educational community. Conclusions: According to experts, the health promotion strategy “Prosalud” is valid to help promoting healthy lifestyle habits among schoolchildren. This strategy demonstrates its preliminary effectiveness in a group of school children from 6 to 12 years of age, their parents, teachers, and school food staff, in the Andean region of Colombia.

The Association between Sugar-Sweetened Beverages and High-Energy Diets and Academic Performance in Junior School Students

This study aimed to understand the consumption frequency of sugar-sweetened beverages (SSBs) and high-energy diets in junior school students in China and to explore the relationship between SSBs and high-energy diets and academic performance. Information about 9251 junior school students was retrieved from the China Education Panel Survey (CEPS) database. The Mann−Whitney U test and the Kruskal−Wallis test were used to compare differences in academic performance based on the variables of interest. Generalized linear mixed models were used to analyze the association between the consumption frequency of SSBs and high-energy diet and student academic performance, fixed and random effects were included to control for confounding factors. The proportions of the “often” consumption group of SSBs and high-energy diets were 21.5% and 14.6%, respectively. For SSBs, the total score of the “often” consume group was 4.902 (95%CI: −7.660~−2.144, p < 0.001) points lower than that of the “seldom” consume group. Scores of Chinese math, and English were 0.864 (95%CI: −1.551~−0.177, p = 0.014), 2.164 (95%CI: −3.498~−0.831, p = 0.001), and 1.836 (95%CI: −2.961~−0.710, p = 0.001) points lower, respectively. For high-energy diets, the scores of total, Chinese and English in the “sometimes” consume group were 2.519 (95%CI: 0.452~4.585, p = 0.017), 1.025 (95%CI: 0.510~1.540, p < 0.001) and 1.010 (95%CI: 0.167~1.853, p = 0.019) points higher than that of the “seldom” consume group, respectively. Our findings suggested that consumption of SSBs was often negatively associated with academic performance in junior school students, while medium consumption of high-energy diets had a positive correlation. The positive association between high-energy diets and academic performance may be related to the food items included in the high-energy diets consumed by Chinese students. Schools and families should pay more effort to reduce the consumption of SSBs, and for high-energy diets, the focus should be on food selection and avoiding excessive intake. Longitudinal studies are needed to further test these findings among adolescents.

Associations between meeting 24-hour movement guidelines and academic achievement in Australian primary school-aged children

BACKGROUND

Few studies have investigated associations between academic achievement and meeting recommendations from the 24-hour (24-h) movement guidelines. The specific guidelines associated with the most benefit academic achievement are unknown. Utilizing both self-report and objective movement data, this study examined associations between academic achievement and meeting individual recommendations and combinations of recommendations from the 24-h movement guidelines (sleep, physical activity, and screen time).

METHODS

Data from CheckPoint, a cross-sectional study nested between Waves 6 and 7 of the Longitudinal Study of Australian Children, were used. Movement behaviors were measured using 24-h wrist-worn accelerometry (GENEActiv (Activinsights, Kimbolton, UK)) and were self-reported by children using the Multimedia Activity Recall for Children and Adolescents. Academic achievement was measured using a nationally administered standardized test in literacy and numeracy. Analysis of covariance, with t tests with sequential Bonferroni adjustments, was used to compare academic achievement with all possible combinations of meeting recommendations, adjusting for demographic confounders. Two models were considered: guideline compliance assessed by self-report (n = 1270, mean age = 11.99 years, 52% males) and by accelerometry (for moderate-to-vigorous intensity physical activity (MVPA) and sleep)) and self-report (screen time) in combination (n = 927, mean age = 11.97 years, 52% males).

RESULTS

Literacy achievement significantly differed based on self-report (F_{(7, 1258)} = 3.08, p = 0.003) and accelerometer derived (F_{(7, 915)} = 2.40, p = 0.02) guideline compliance. Numeracy achievement significantly differed based on self-report (F_{(7, 1258)} = 2.92, p = 0.005) but not accelerometer derived guideline compliance (F_{(7, 915)} = 0.80, p = 0.58). When assessed by self-report, children who met all guidelines (t₍₃₃₄₎ = -4.05, p = 0.0001) or met the screen time and sleep guidelines in combination (t₍₁₂₅₎ = -5.02, p < 0.001) had superior literacy achievement. Meeting the self-report MVPA guideline in any combination was associated with higher numeracy scores (p < 0.05). Post-hoc analyses showed no differences in academic achievement for any category of accelerometer derived guideline compliance.

CONCLUSION

The findings suggest that limiting recreational screen time is important for literacy achievement and that encouraging compliance with the MVPA guideline is important for numeracy achievement.

The influence of sedentary behaviour on mental health among children and adolescents: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Systematic reviews that have examined associations between sedentary behaviour (SB) and mental health among children and adolescents are mainly based on cross-sectional investigations. There is a lack of evidence for a prospective relationship between SB and mental health in children and adolescents. This systematic review synthesized longitudinal studies that examined prospective associations between SB and mental health among children and adolescents.

METHODS

We conducted computer searches for English language literature from electronic databases of PubMed, Embase, PsycInfo and Google scholar, and manually screened the references of existing relevant studies to select studies for the synthesis. We included observational longitudinal studies that assessed the association between SB and mental health among children and adolescents. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

In total, 58 longitudinal studies met the inclusion criteria and were synthesized in the review. We found that higher SB among children and adolescents was associated with increased depression, anxiety and other mental health problems later in life. A dose-response association between SB and mental health was observed, suggesting that children and adolescents who spend more time on SB may have a higher risk of developing poorer mental health later.

CONCLUSIONS

The findings in the present study suggest that intervention programs targeting reducing SB may benefit to the prevention of poor mental health among children and adolescents. Future intervention studies especially randomized controlled trials are needed to elucidate a causal relationship between SB and mental health among children and adolescents.

Analysis and Prediction of Influencing Factors of College Student Achievement Based on Machine Learning

To effectively improve students' performance and help educators monitor students' learning situations, many colleges are committed to establishing systems that explore the influencing factors and predict student academic performance. However, because different colleges have different situations, the previous research results may not be applicable to ordinary Chinese colleges. This paper has two main objectives: to analyze the fluctuation of Chinese ordinary college student academic performance and to establish systems to predict performance. First, according to previous research results and the current situation of Chinese college students, a questionnaire was designed to collect data. Second, the chi-square test was used to analyze the contents of the questionnaire and identify the main features. Third, taking the main features as input, four classification prediction models are established by machine learning. Some traits of the students who did not pass all the examinations were also discovered. It might help student counselors and educators to take targeted measures. The experiment shows that the support vector machine classifier (SVC) model has the best and most stable effect. The average recall rate, precision rate, and accuracy rate reached 82.83%, 86.18%, and 80.96%, respectively.

Association Between Ideal Cardiovascular Health and Executive Function in Chinese Primary School Children

Aims: Little information exists on the associations of cardiovascular health, a new metric proposed by the American Heart Association, and executive function, particularly in children. We aimed to explore this topic.

Methods: We studied 3,798 children aged 6–12 years from 5 schools in Guangzhou, China. The executive function of children was evaluated using parent reports of the Behavioral Rating Inventory of Executive Function, which included 2 composite indexes and 8 subscale scores. We calculated the number of ideal cardiovascular health (range: 0–7) based on smoking, body mass index, physical activity (PA), diet, blood pressure, cholesterol, and glucose. A generalized linear mixed model was used to assess the association of the number of ideal cardiovascular health metrics and executive function.

Results: Compared with children exhibiting 1–3 ideal cardiovascular health metrics, decreases of 1.37–2.63 points (indicating better performance) in metacognition index and its 5 subscale indexes (initiate, working memory, plan/organize, organization of materials, and monitor) were observed in children who attained 5 or 6–7 ideal metrics (all p for trend <0.001). Ideal diet and ideal PA were independently associated with lower indexes of behavioral regulation and metacognition.

Conclusions: The number of ideal cardiovascular health was positively associated with performance of executive function in children.

Diet structure and academic achievement of children from difficult families: a cross-sectional study of Chinese children

OBJECTIVES

Welfare policy focuses on vulnerable populations, such as children with difficult family backgrounds. Education is a crucial way to reduce poverty. This study explored the relationship between children's diet structure and academic achievement and compared these across different family backgrounds.

DESIGN

A cross-sectional study was conducted to survey the health status of children from difficult families based on a random sampling method in 2018. Survey data were collected from children and their guardians with a questionnaire. A multi-sample latent class model and an ordinal logistic model were applied for data analysis.

SETTING

This study was conducted in 31 provinces nationwide. Two provinces in the Central (Shandong and Jiangxi), Eastern (Hebei and Henan) and Western (Chongqing and Shanxi) regions and one province in the Northeast (Liaoning) were selected considering different stratum of economic development.

PARTICIPANTS

A total of 2099 children with difficult family backgrounds and 666 children from ordinary families were surveyed.

RESULTS

The dietary structure of children from ordinary families was significantly better than that of children with difficult or unstable family backgrounds ([Formula: see text] =9.178, p<0.01). Children from difficult families had an intake of dairy products and fruits below dietary standards. The difference in academic achievement between children in the balanced and deprived groups was statistically significant (OR=0.640, 95% CI 0.429 to 0.955). Other determinants of the academic achievement of children in difficult families were parents' education level (OR=1.331, 95% CI 1.162 to 1.525), family economic status (OR=0.835, 95% CI 0.748 to 0.932) and parents' academic concern (OR=0.373, 95% CI 0.252 to 0.553).

CONCLUSIONS

To address the differences between children from difficult families and ordinary families, policymakers should develop support policies for difficult children, guide the formation of a reasonable dietary structure. Besides, enhancing family closeness and fostering family nurturing behaviours are the keys to promote the good academic development of children from difficult families.

The impact of psychopathology on academic performance in school-age children and adolescents

Psychiatric symptoms have consistently been associated with negative educational outcomes. However, possible confounding variables, such as comorbid mental and environmental conditions, have not been well addressed. This study examined whether mental health problems were significantly linked to academic performance in a Spanish school-based sample, after adjustment for co-occurring psychiatric symptoms and multiple contextual factors. Parents completed a questionnaire regarding child's sociodemographic characteristics (i.e., gender, age, type of school, socioeconomic status, ethnicity), stressful events (i.e., adoption, parental divorce/separation, grade retention) and lifestyle (i.e., diet, sleep, screen time), along with the Child Behavior Checklist (CBCL). Academic performance was obtained from school records. The sample comprised 7036 students aged 5-17 with full data on the CBCL. Mixed-effects ordinal logistic regression analyses were conducted to investigate the association between psychopathology and academic achievement, controlling for potential confounders. When examined separately, higher scores on the CBCL scales were related to lower grades, regardless of sociodemographic factors. However, after controlling for the presence of other psychiatric symptoms, we found that students who reported more anxious/depressed and thought problems were less likely to perform poorly, while those with increased levels of attention problems and delinquent behavior had higher risk for academic underachievement. These associations remained mainly the same once stressful events and lifestyle were taken into account. This investigation demonstrates that anxious/depressed symptoms, thought problems, attention problems, and delinquent behavior are independently associated with academic performance, which emphasize the need for preventive and treatment interventions targeted at students' mental health to improve their psychological well-being and functioning at school.

A lifestyle score in childhood and adolescence was positively associated with subsequently measured fluid intelligence in the DONALD cohort study

PURPOSE

Lifestyle scores which combine single factors such as diet, activity, or sleep duration showed associations with cognitive decline in adults. However, the role of a favourable lifestyle in younger age and the build-up of cognitive reserve is less clear, which is why we investigated longitudinal associations between a lifestyle score in childhood and adolescence and fluid intelligence obtained on average 6 years later.

METHODS

In the DONALD cohort, a lifestyle score of 0 to 4 points including healthy diet and duration of moderate-to-vigorous physical activity, sedentary behaviour and sleep was repeatedly assessed in participants aged 5 and 19 years. Data on fluid intelligence were assessed via a German version of the culture fair intelligence test (CFT), using CFT 1-R in children 8.5 years of age or younger (n = 62) or CFT 20-R in participants older than 8.5 years (n = 192). Multivariable linear regression models were used to investigate prospective associations between the lifestyle score and the fluid intelligence score.

RESULTS

Mean lifestyle score of all participants was 2.2 (0.7-4) points. A one-point increase in the lifestyle score was associated with a higher fluid intelligence score (4.8 points [0.3-7.3], p = 0.0343) for participants completing the CFT 20-R. Furthermore, each additional hour of sedentary behaviour was associated with a lower fluid intelligence score (- 3.0 points [- 5.7 to - 0.3], p = 0.0313). For younger participants (CFT 1-R), no association was found in any analysis (p > 0.05).

CONCLUSION

A healthy lifestyle was positively associated with fluid intelligence, whereby sedentary behaviour itself seemed to play a prominent role.

Cost-effectiveness and return on investment of school-based health promotion programmes for chronic disease prevention

BACKGROUND

While school-based health prevention programmes are effective in addressing unhealthy diet and physical inactivity, little is known about their economic implications. We conducted an economic evaluation of the programmes that were previously identified as feasible, acceptable, and sustainable in the Canadian context.

METHODS

This study builds on a meta-analysis of the effectiveness of feasible, acceptable, and sustainable school-based health promotion programmes. A micro-simulation model incorporated intervention effects on multiple risk factors to estimate incremental cost-effectiveness and return on investment (ROI) of comprehensive school health (CSH), multicomponent, and physical education (PE) curriculum modification programmes. Cost-effectiveness was expressed as the programme costs below which the programme would be cost-effective at a CA$50 000 threshold level.

RESULTS

The estimated costs below which interventions were cost-effective per quality-adjusted life year gained were CA$682, CA$444, and CA$416 per student for CSH, multicomponent, and PE curriculum modification programmes, respectively. CSH programmes remained cost-effective per year of chronic disease prevented for costs of up to CA$3384 per student, compared to CA$1911 and CA$1987 for multicomponent and PE curriculum modification interventions, respectively. If the interventions were implemented at total discounted intervention costs of CA$100 per student, ROI through the avoidance of direct healthcare costs related to the treatment and management of chronic diseases would be 824% for CSH, 465% for multicomponent interventions, and 484% for PE curriculum modification interventions.

CONCLUSIONS

Whereas each examined intervention types showed favourable economic benefits, CSH programmes appeared to be the most cost-effective and to have the highest ROI.

Independent and combined associations between multiple lifestyle behaviours and academic grades of inner urban and peri-urban high school students: a cross-sectional study in Chongqing, China

OBJECTIVES

This study aims to assess the independent and combined associations between multiple lifestyle behaviours and academic grades of inner urban high school students (IUHSSs) and peri-urban high school students (PUHSSs).

DESIGN

A cross-sectional study was conducted.

PARTICIPANTS

There are 1481 high school students (49.9% boys) in this study, who were enrolled from one inner urban and two peri-urban schools in Chongqing, China.

OUTCOME MEASURES

Academic grades were assessed based on the students' self-reported grade ranking in the last cumulative examination.

RESULTS

In IUHSSs and PUHSSs, high frequency of sugar-sweetened beverage consumption was unlikely to obtain high academic grades (OR 0.56, 95% CI 0.32 to 0.99 and 0.63, 95% CI 0.42 to 0.96), respectively). Among IUHSSs, meeting the recommendations for weekday screen time and egg consumption (OR 1.57, 95% CI 1.06 to 2.34 and 1.60, 95% CI 1.04 to 2.47, respectively) and high frequency of fruit consumption (1.67, 95% CI 1.11 to 2.50) were significantly associated with high academic grades; meeting the recommendation for weekday sleep duration was unlikely to obtain high academic grades (0.46, 95% CI 0.21 to 0.98). Among PUHSSs, meeting the recommendations for weekend sleep duration (1.40, 95% CI 1.02 to 1.93) and eating dinner regularly (1.55, 95% CI 1.01 to 2.37) had significant associations with high academic grades. No significant associations were found between physical activity and academic grades in both IUHSSs and PUHSSs (p>0.05). Moreover, IUHSSs with 9-13 healthy lifestyle behaviours were 3.25 times more likely to achieve high academic grades than IUHSSs with 1-6 healthy lifestyle behaviours (3.25, 95% CI 1.96 to 5.40). No significant associations were found in the combined associations between multiple lifestyle behaviours and academic grades among PUHSSs (p>0.05).

CONCLUSIONS

Correlations were observed between lifestyle behaviours and academic grades among high school students, and cumulative associations between multiple healthy lifestyle behaviours and academic outcomes appear to be stronger than the independent associations. These findings are particularly applicable to IUHSSs.

Parents' Report of Canadian Elementary School Children's Physical Activity and Screen Time during the COVID-19 Pandemic: A Longitudinal Study

COVID-19 public health protocols have altered children’s daily routines, limiting their physical activity opportunities. The purpose of this study was to examine how the COVID-19 pandemic affected children’s (ages 10–12 years) physical activity and screen time, and to explore the impact of gender, socioeconomic status (SES), and public health constraints (i.e., facility use and social interaction) on the changes in children’s health behaviors. Online surveys were disseminated to parents at two time points: before COVID-19 (May 2019 to February 2020) and during COVID-19 (November to December 2020). Wilcoxon signed-rank tests were used to assess changes in physical activity and screen time, and for subgroup analyses. Parents (n = 95) reported declines in children’s physical activity (Z = −2.53, p = 0.01, d = 0.18), and increases in weekday (Z = −4.61, p < 0.01, d = 0.33) and weekend screen time (Z = −3.79, p < 0.01, d = 0.27). Significant changes in physical activity and screen time behaviors were identified between gender, SES, and facility use groups. All social interaction groups underwent significant changes in screen time. Overall, COVID-19 protocols have negatively influenced children’s physical activity and screen time. Due to the negative consequences of inactivity and excessive screen time, resources must be made available to support families during the pandemic.

Comparative Study of Risk Profiles for Non-Communicable Diseases in Urban and Suburb Adolescents in Padang City (Indonesia)

Adolescence is when we still like to experiment and often develop bad habits which may lead to non-communicable diseases (NCDs) in the future. This study aimed to understand the lifestyle at risk of non-communicable diseases in adolescents that live in the urban and rural areas of Padang city. This research method is comparative descriptive with a descriptive-analytical approach, with a total sample of 788 people. The study was conducted from March 2019 to November 2019. Results: A total of 57.77% of respondents in urban areas and 69.54% of respondents in rural areas like to eat junk food. 45.35% urban respondents and 60.21% rural respondents like to consume high-sweetened beverages. 73.4% of urban respondents and 7.6% of rural respondents like to smoke. 80.6% of urban respondents and 87.8% of rural respondents lack physical activity. 59.9% of urban respondents and 49.05% of rural respondents do not like to exercise. 67% of urban respondents and 80.2% of rural respondents sleep late at night. Conclusion: The risk behavior of non-communicable diseases in rural adolescents is higher than in urban adolescents. It is recommended that parents, teachers, and health workers work together to carry out intervention activities for healthy lifestyles for all adolescents.

Adolescent Health Behaviors and Difficulty Concentrating, Remembering, and Making Decisions

The purpose of this study was to examine the associations among physical activity, dietary behaviors, and other salient health behaviors such as smoking, alcohol consumption, and sleeping with self-reported adolescent mental health on the 2017 National Youth Risk Behavior Survey (YBRS). A multistage cluster sampling procedure was employed to yield a representative sample of US adolescents. The number of sampled adolescents with usable data was 14 765. Weighted logistic regression models were employed to examine the predictive utility of independent health behaviors associating with reported mental health problems (difficulty concentrating, remembering, or making decisions), and meeting multiple health behavior criteria with reported mental health problems adjusting for age, sex, body mass index percentile, and race/ethnicity. Meeting physical activity guidelines, consuming breakfast every day, not smoking and/or consuming alcohol in the past 30 days, and sleeping at least 8 hours per night independently associated with lower odds of mental health problems (P < .01). For every one additional positive health behavior met, there were significantly lower odds of reported mental health problems (OR = 0.73, 95%CI 0.68-0.78, P < .001). Meeting salient positive health behavior criteria and meeting multiple positive health behavior criteria associated with lower odds of self-reported difficulty concentrating, remembering, or making decisions on the 2017 National YRBS.

Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019

Background

Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam.

Methods

We analyzed data of 7,541 adolescents aged 13–17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models.

Findings

The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 – 0·93; females: OR = 0·69, 95% HDI: 0·47 – 0·98).

Interpretation

Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence.

Funding

The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.

Fitness and executive function as mediators between physical activity and academic achievement

Physical activity is related with academic achievement in children. This cross-sectional study aimed to assess whether cardiorespiratory fitness (CRF) and executive function act as mediators of the association between moderate to vigorous physical activity (MVPA) and academic achievement. This study included 186 schoolchildren (9-11 years) from Cuenca, Spain. Sociodemographic variables, anthropometric variables, academic achievement, executive function (inhibition, cognitive flexibility and working memory), CRF (20-m shuttle run) and physical activity (by accelerometry) were measured. Serial mediation models were estimated using the Hayes´ PROCESS macro. The significant paths in the model mediating this relationship between MVPA and academic achievement were as follows: MVPA → CRF → academic achievement (IE = 0.068, 95% CI: [0.018; 0.127]; IE = 0.079, 95% CI: [0.029; 0.144]; and IE = 0.090, 95% CI: [0.032; 0.165], controlling for inhibition, cognitive flexibility and working memory, respectively), MVPA → CRF → inhibition → academic achievement (0.018, 95% CI: [0.001; 0.047]) and MVPA → cognitive flexibility → academic achievement (0.087, 95% CI: [0.012; 0.169]). The relationship between MVPA and academic achievement may not be direct but mediated by CRF, cognitive flexibility, and inhibition via CRF. Physical activity interventions to improve AA should be focused on improvements in CRF and executive function.

Intervention Effects of the Health Promotion Programme "Join the Healthy Boat" on Objectively Assessed Sedentary Time in Primary School Children in Germany

Sedentary behaviour (SB) in children is related to negative health consequences that can track into adulthood. The programme "Join the Healthy Boat" promotes reduced screen time and a less sedentary lifestyle in schoolchildren. This study investigated the effects of the programme on children's SB. For one year, teachers delivered the programme. A total of 231 children (7.0 ± 0.6 years) participated in the cluster-randomised study; there were 154 one year later at follow-up. Children's SB was assessed using multi-sensor accelerometery, screen time via parental questionnaire. Effects were analysed using (linear) mixed effects regression models. At baseline, children spent 211 (±89) min daily in SB, at follow-up 259 (±109) min/day with no significant difference between the intervention (IG) and control group (CG). SB was higher during weekends (p < 0.01, for CG and IG). However, at follow-up, daily screen time decreased in IG (screen time of >1 h/day: baseline: 33.3% vs. 27.4%; follow-up: 41.2% vs. 27.5%, for CG and IG, respectively). This multi-dimensional, low-threshold intervention for one year does not seem to achieve a significant reduction in children's SB, although screen time decreased in IG. Therefore, it should be considered that screen time cannot be the key contributor to SB and should not solely be used for changing children's SB. However, if screen time is targeted, interventions should promote the replacement of screen time with active alternatives.

Weight transitions and psychosocial factors: A longitudinal cohort study of Finnish primary school children with overweight

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Children most probably stayed in their initial weight category.

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Probabilities of transitioning across weight categories differ between genders.

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Girls of nuclear families transition to obesity at a lower rate than their peers.

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Experiences of crises and bullying are related to obesity development among boys.

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Multistate models are useful for analyzing childhood obesity development.

For targeted prevention and treatment of childhood obesity, primary health care needs methods to identify children potentially developing obesity. The objectives of this study were to examine transitions across weight categories and their association with psychosocial family- and school-related factors, data on which were retrieved from health records. This longitudinal cohort study comprised 507 Finnish children with overweight, identified from a random sample of 2000 sixth graders in Helsinki in 2013. We applied Markov multistate models to analyze the transition rates over six primary school years between BMI SDS categories of normal weight, overweight and obesity, as assessed by Finnish BMI-for-age reference, and to examine relations between transition rates and family- and school-related factors. Among 3116 pairs of consecutive growth measurements from 225 girls and 282 boys aged 6–14, 719 transitions from weight category to another occurred. The highest 1-year probabilities were 0.76 for girls to stay in overweight and 0.80 for boys to stay in obesity. Transitions from normal weight to overweight and from obesity to overweight were more probable than vice versa. Transitions from overweight into obesity were among girls associated with older age (HR 2.63) and divorced or single parents (HR 2.29), as well as among boys with experiences of crises (HR 2.40) and being bullied (HR 1.66). Factors identifiable in school health care and associated with the probability of transition towards obesity should be considered when planning individual support and intervention programs.

Lifestyle habits and academy performance amongst forcibly displaced students: A cross-sectional survey in a school of dentistry

INTRODUCTION

There is no recognised investigation examining the influence of some lifestyle comportments on academic performance (AP) in forcibly displaced students in higher education. Thus, the frequency of physical inactivity (PI), insufficient sleep (IS), alcohol consumption (AC), drug consumption (DC) and cigarette smoking (CS) and the independent and combined consequences of these habits on AP in forcibly displaced dental students were investigated.

MATERIALS AND METHODS

A sample of 185 students was studied (thirty-seven forcibly displaced and 148 non-displaced students). This cross-sectional study used an institutional administrative database that included students' demographic features and lifestyle behaviours. Multivariate analyses were performed to evaluate the independent and combined effects of lifestyle behaviours on AP.

RESULTS

PI, IS, AC, DC and CS were observed in 51%, 43%, 83%, 27% and 16% of forcibly displaced students, respectively. Compared with non-displaced students, forcibly displaced students presented higher frequencies for all of these behaviours (P < .05), lower AP (P < .0001) and lower socio-economic status (P = .003). Unadjusted regression models showed independent and significant associations between forcibly displaced students and PI (P = .01), IS (P = .01), AC (P = .01), DC (P < .0001), CS (P = .02) and low AP (P = .006). The multivariate model for AP and forcibly displaced students increased odds by 4.6 times (1.5-11; 95% CI). Moreover, the lifestyle comportments studied were also statistically significant, showing combined effects. The variables of gender and age were not statistically significant in the adjusted model.

CONCLUSIONS

This research observed high frequencies of the behaviours analysed in forcibly displaced students. Furthermore, independent and combined effects of them on AP were detected.

Testing a school-based program to promote digital health literacy and healthy lifestyle behaviours in intermediate elementary students: The Learning for Life program

Promoting digital health literacy and healthy lifestyle behaviours in children can lead to positive long-term health outcomes and prevent chronic diseases. However, there are few school-based interventions promoting this education to intermediate elementary students. The objective of this study was to test the effectiveness of a novel intervention to increase students' digital health literacy and health knowledge. Learning for Life is a classroom-based education program, developed for grade 4-7 students and delivered by teachers over six weeks. Three Canadian schools were recruited to deliver the intervention in 2018. This study had a pre-post design and no control group. Students' self-reported digital health literacy and healthy lifestyle behaviours were measured at pre-intervention (n = 126), post-intervention (n = 119), and two-month follow-up (n = 104). Students at pre-intervention had a mean (SD) age of 10.98 (0.56) years (57.1% females). Almost all (97%) students had unsupervised access to the Internet through a computer or smartphone. From pre- to post-intervention, students' digital health literacy increased (p = 0.009), but decreased from post-intervention to follow-up (p < 0.001). Post-intervention, the majority of students could identify at least one healthy behaviour (e.g., exercising one hour/day) and reported making at least one healthy change in their lives (e.g., eating more fruits/vegetables). This study demonstrated that the Learning for Life intervention can improve intermediate elementary students' digital health literacy over the short-term and help them learn and retain healthy lifestyle knowledge and behaviours. These findings affirm the need for interventions promoting digital healthy literacy and healthy lifestyle behaviours for this age group.

Screen time and sleep disorder in preschool children: identifying the safe threshold in a digital world

OBJECTIVES

Sleep disorder is a common problem in children that can jeopardize their health and well-being. With the popularity of electronic devices such as portable tablets and smartphones in the 21st century, children are spending much more time on screen, but the impact of such change on children's sleep disorder has been less investigated so far. This study aims to examine the dose-response association between time spent on different electronic devices and children's sleep disorder.

STUDY DESIGN

The design of this study is a cross-sectional study.

METHODS

We randomly selected 2278 children aged 3-6 years from 15 kindergartens in Tongling, China. The potentially non-linear association between screen-viewing time (i.e. television [TV], computer, iPad, Phone) and the risk of sleep disorder was examined using a logistic generalized additive model.

RESULTS

We observed a J-shaped association between TV viewing time and the risk of sleep disorder, with a threshold of 1 h/day. For each 1 h/day increment in TV viewing time over the threshold, the risk of sleep disorder increased by 12.35% (95% confidence interval: 1.87-23.92%). This association seemed to be greater for girls than boys and for TV viewing at weekend than on weekdays, but the difference was not statistically significant (P-value>0.05). We did not find adequate evidence of an adverse effect of more time spent on computer, iPad and Phone.

CONCLUSIONS

This study suggests a positive but non-linear relationship between time spent on watching TV and sleep disorder in Chinese preschool children. Setting the TV viewing time limit less than 1 h/day may help reduce the risk of developing sleep disorder. Further investigation is also needed to examine and compare the effects of heavy use of other electronic devices on sleep disorder.

Frequency of physical inactivity and insufficient sleep, and their mixed effects on academic achievement in ethnic minority students: A matched case-control study in a dental school

BACKGROUND

Ethnic minorities are underrepresented in health sciences programs in various nations. Furthermore, there is no known research studying the occurrence of physical inactivity (PI) and insufficient sleep (IS), and their effects on academic achievement (AA) in ethnic minority students (EMS) in higher education.

OBJECTIVE

The objective of this study is to explore the occurrence of PI and IS, and their independent and mixed effects on AA in EMS of a dental school.

MATERIALS AND METHODS

Thirty EMS and sixty non-EMSs were matched (1:2) in this case-control study. It was utilized as an administrative dataset that stores register related to the students. Moreover, the grade point average was considered an indicator of AA. Logistic regressions models were run, expressed in odds ratios, complemented by confidence intervals (CIs) of 95%.

RESULTS

A total of 73% and 60% EMS were PI and slept insufficiently, respectively. The groups presented statistically significant differences (P < 0.0001) in physical activity, sleep, and AA, with inferior values for EMS. All unadjusted models showed that PS, IS, and low AA were strongly associated with EMS, demonstrating their independent effect. After controlling for PI and IS, the multivariate model for AA and EMS increased odds by 6.5 times (95%CI: 1.8-23;), indicating that EMS is strongly associated with low AA. Besides, PI and IS were also statistically significant higher (< 0.0001) in the model, demonstrating their mixed effect.

CONCLUSIONS

This study found a higher occurrence of PI and IS in EMS. Besides, independent and mixed effects of these variables on low AA in EMS were very significant.

Psychophysiological Stress Markers and Behavioural Differences between Rural and City Primary School Students

Academic performance could be affected by multiple factors, including stress and learning environment location. The aim of this study was to analyze differences in psychophysiological stress markers, behavior and academic performance of rural and city students. A sample of 181 children (7.91 ± 2.29 years) from elementary schools were evaluated on their grades, subjective academic performance, heart rate variability, state anxiety, nutritional information and physical activity habits. Results presented significant higher values in parasympathetic modulation and physical education grades in rural students than in city students, who showed higher significant values in state anxiety, the ability to complete tasks, physical activity habits and several items relating to their food and drink habits. No significant differences were found in the average grades between the two groups. However, some correlations were found between school performance and stress, physical fitness and nutritional habits. Thus, school location may affect the stress and anxiety status, nutritional habits and physical activities of students, but there were no significant differences in academic performance. In addition, body mass index, quantity of food intake and stress markers may be related to the academic performance attained.

Associations between meeting sleep, physical activity or screen time behaviour guidelines and academic performance in Australian school children

BACKGROUND

Current guidelines suggest too little sleep, too little physical activity, and too much sedentary time are associated with poor health outcomes. These behaviours may also influence academic performance in school children. The primary purpose of this study was to examine the relationships between sleep, physical activity, or sedentary behaviours and academic performance in a school with a well-developed and integrated technology use and well-being program.

METHODS

This was a cross-sectional survey of students (n = 934, Grades 5-12) in an Australian school with a bring-your-own device (tablet or laptop computer) policy. Students reported sleep, physical activity, and sedentary (screen and non-screen) behaviours. Academic performance was obtained from school records. Linear regressions were used to test the association between behaviours and academic performance outcomes.

RESULTS

Seventy-four percent of students met sleep guidelines (9 to 11 h for children 5-13 years and 8 to 10 h for 14-17 year olds), 21% met physical activity guidelines (60 min of moderate-to-vigorous physical activity every day), and 15% met screen time guidelines (no more than 2 h recreational screen time per day); only 2% met all three. There were no associations between meeting sleep guidelines and academic performance; however later weekend bedtimes were associated with poorer academic performance (- 3.4 points on the Average Academic Index, 95%CI: - 5.0, - 1.7, p < .001). There were no associations between meeting physical activity guidelines and academic performance. Meeting screen guidelines was associated with higher Average Academic Index (5.8, 95%CI: 3.6, 8.0, p < .001), Maths 7.9, 95%CI: 4.1, 11.6, p < .001) and English scores (3.8, 95%CI: 1.8, 5.8, p < .001) and higher time in sedentary behaviours was associated with poorer academic performance, including total sedentary behaviours in hrs/day (5.8 points on Average Academic Index, 95%CI: 3.6, 8.0, p < .001. Meeting at least two of the three behaviour guidelines was associated with better academic performance.

CONCLUSIONS

Sleep and sedentary behaviours were linked to academic performance. School communities should emphasize comprehensive wellness strategies to address multiple behaviours to maximize student health and academic success.

Association of Sedentary Behavior with Brain Structure and Intelligence in Children with Overweight or Obesity: The ActiveBrains Project

We investigated the associations of different sedentary behaviors (SB) with gray matter volume and we tested whether SB related to gray matter volume is associated with intelligence. Methods: 99 children with overweight or obesity aged 8–11 years participated in this cross-sectional study. SB was measured using the Youth Activity Profile-Spain questionnaire. T1-weighted images were acquired with a 3.0 T Magnetom Tim Trio system. Intelligence was assessed with the Kaufman Brief Test. Whole-brain voxel-wise multiple regression models were used to test the associations of each SB with gray matter volume. Results: Watching TV was associated with lower gray matter volume in six brain regions (β ranging −0.314 to −0.489 and cluster size 106 to 323 voxels; p < 0.001), playing video games in three brain regions (β ranging −0.391 to −0.359, and cluster size 96 to 461 voxels; p < 0.001) and total sedentary time in two brain regions (β ranging −0.341 to −0.352, and cluster size 897 to 2455 voxels; p < 0.001). No brain regions showed a significant positive association (all p > 0.05). Two brain regions were related, or borderline related, to intelligence. Conclusions: SB could have the potential to negatively influence brain structure and, in turn, intelligence in children with overweight/obesity.

Weight Status, Adherence to the Mediterranean Diet, Physical Activity Level, and Sleep Behavior of Italian Junior High School Adolescents

Inadequate diet, physical activity, and sleep-related behaviors are potential risk factors for overweight and obese, therefore we investigated the relations between body mass index (BMI) and behavioral factors in a sample of Italian adolescents. Four hundred nine Italian secondary school students (46% females, 12.5 ± 0.6 y.o.) were enrolled in this cross-sectional study. Anthropometric measures, adherence to the Mediterranean Diet (KIDMED), physical activity level (PAQ-C), sleep duration, daytime sleepiness (PDSS), sleep quality, and school achievement data were collected through an online questionnaire. The percentage of overweight adolescents was slightly lower (14%) compared to the regional and the national figures. Approximately 88% of the sample reported a medium/high adherence to the Mediterranean Diet and 77% a moderate/vigorous physical activity level. The average sleep duration was in line with the international sleep recommendation for adolescents and 82% had a medium/high sleep quality. No differences were found between genders except for BMI (lower in females). Unexpectedly, no differences were found among the BMI groups (normal weight vs. overweight vs. obese) for lifestyle variables; in contrast, Mediterranean Diet adherence was associated with sleep habits. Further investigation is required to better explore the associations among behavioral variables involved in adolescents' healthy development.

Lifestyle clusters and academic achievement in Australian Indigenous children: Empirical findings and discussion of ecological levers for closing the gap

Participation in sport and physical activity can improve academic outcomes and has been identified as a potential mechanism for addressing educational disadvantage and ‘closing the gap’ in Australian Indigenous communities.

To explore this possibility in relation to sport and lifestyle we performed a cluster analysis on data from the Footprints in Time study (also known as the Longitudinal Study of Indigenous Children), using data from Waves 3–6 (2010–2013, ages 5–9 years) of this cohort study. Cluster inputs were organised according to not only sports participation, but also screen time, sleep duration and unhealthy food intake, as reported in parent surveys. Associations between lifestyle cluster membership and academic outcomes from standardised tests from 2014-5 (Progressive Achievement Tests [PATs] for Maths and Reading, and National Assessment Program for Literacy and Numeracy [NAPLAN]) were examined using linear models. Analyses were adjusted for age, sex, remoteness and parental education.

Three clusters were identified: Low Sport (36% of sample), characterised by low sports participation and low sleep duration; Junk Food Screenies (21% of sample), with high screen time and high intake of unhealthy foods; and High Sport (43% of sample), showing high sports participation and low screen time. Cluster membership was associated with academic performance for NAPLAN Literacy and Numeracy, and for PAT Maths. The High Sport cluster consistently performed better on these tests, with effect sizes (standardised mean differences) ranging from 0.10 to 0.38.

We discuss the ecological dynamics potentially contributing to lifestyle cluster membership and ways in which policy can support healthier High Sport lifestyles associated with better academic performance.

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Sport holds cultural significance in Indigenous communities.

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Few data relating to sport and lifestyle outcomes within these communities have been examined.

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Sport participation varies among lifestyle clusters: Low Sport (36%), Junk Food Screenies (21%), High Sport (43%).

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The High Sport cluster performed consistently better on literacy and numeracy tests.

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Ecological Systems Theory is used to consider ways to improve sport participation, lifestyles and education outcomes.

Screen time behaviour in a sample of 11- to 12-year-old Greek-Cypriot children: A cross-sectional study of parental and child reports

Objective:

This cross-sectional study examined the association between parental and child-reported correlates and children’s screen time.

Methods:

Children (N = 154) and their parents completed questionnaires examining correlates of screen time. Children recorded the time they devoted to screen-based and study-related sedentary activities and wore a pedometer for 6 days (four weekdays and two weekend days). Parents also provided information relating to the time their children devoted to screen time.

Results:

Children reported significantly higher time watching television and playing electronic games as well as higher total screen time during the weekend compared to weekdays. On the contrary, they reported significantly lower time doing homework and recorded significantly lower steps during the weekend compared to weekdays. The scale ‘Parent-child Television Viewing’ yielded significant associations with both parent and child-reported total screen time and television watching. Associations ranged from r = 0.193, p < 0.05 to r = 0.599, p < 0.001. The scales ‘Child Screen Time with Friends’ and ‘Friends’ Norms for Screen Time’ demonstrated significant associations with child-reported electronic games and total screen time, and with parent-reported electronic games and computer use. Associations ranged from r = 0.180, p < 0.05 to r = 0.478, p < 0.001. Variance explained for total screen time at the multivariate level ranged from 8% to 37% with the scale ‘Parent-child Television Viewing’ having significant associations with both parent and child-reported weekday total screen time.

Conclusions:

Obtaining data from both parents and children may provide further understanding of screen time behaviour. While parental factors appear to be consistently associated with children’s total screen time, studies may consider focusing more on parents to reduce time spent watching television, and more on friends to limit time spent in electronic games.

Lifestyle Habits Predict Academic Performance in High School Students: The Adolescent Student Academic Performance Longitudinal Study (ASAP)

This study aimed to determine if lifestyle habits could predict changes in cognitive control and academic performance in high school students using a longitudinal approach. One hundred and eighty-seven grade seventh to ninth students (mean age: 13.1 ± 1.0 years old) completed a 3-year prospective study. Lifestyle habits, cognitive control, and academic performance were assessed every year during the 3-year study. Results show that in female students, screen time measures were negatively correlated with academic performance and cognitive control. Furthermore, changes (Δs) in sleeping habits were associated with Δs in academic performance in both genders, whereas Δs in eating habits and in studying time were correlated with Δs in academic performance only in male students. Moreover, in female students, screen time, social media use, and eating habits measures seem to predict the variance in the Δs of cognitive control measures (r² between 8.2% and 21.0%), whereas, in male students, studying time, eating, and sleeping habits appear to explain the variance in the Δs of academic performance measures (r² between 5.9% and 24.8%). In conclusion, results of the present study indicate that lifestyle habits were able to predict Δs in cognitive control and academic performance of high school students during a 3-year period.

A School-Based Intervention Using Health Mentors to Address Childhood Obesity by Strengthening School Wellness Policy

Purpose and Objectives

The objective of our study was to strengthen wellness policy in Title 1 schools by implementing a mentored behavior-change model that extends the continuum of care from academic to community settings and mobilizes existing public resources in accordance with US Preventive Services Task Force screening guidelines for childhood obesity management.

Intervention Approach

Team Kid POWER! (KiPOW!) health mentors (students and trainees in medical and health-related fields) in 2 geographically and demographically distinct school districts, the District of Columbia and Orange County, California, delivered standardized health curricular modules to fifth grade classrooms, modeled healthy eating behaviors during school lunchtime, and engaged in active play at recess.

Evaluation Methods

Initial interventions in the the District of Columbia and Orange County delivered 10 sessions in which all participants received the intervention. Two subsequent interventions in Orange County, for 5 weeks (Lite) and 10 weeks (Full), included controls. Pre–post measurements of body mass index (BMI) and blood pressure were documented in all participants. A mixed linear regression model, which included a random effect for each school, estimated differences between Full and Lite interventions compared with controls, adjusting for site, sex, and baseline status of the dependent variable.

Results

KiPOW! Full, but not KiPOW! Lite, was associated with a modest reduction in BMI percentile compared with control (KiPOW! Full, P = .04; KiPOW! Lite, P = .41), especially in Orange County (P < .001). Systolic blood pressure improved in Full (P < .046) more than in Lite interventions (P = .11), and diastolic blood pressure improved in both Full (P = .02) and Lite (P = .03) interventions. Annual renewal of the school and volunteer commitment needed to maintain KiPOW! was found to be sustainable.

Implications for Public Health

KiPOW! is a generalizable academic–community partnership promoting face-to-face contact between students and trusted health mentors to reinforce school wellness policies and foster youth confidence in decision-making about nutrition- and activity-related behaviors to achieve reduced BMI percentile and lowered blood pressure.

Characteristics of Canadian Youth Adhering to Physical Activity and Screen Time Recommendations

The purpose of the study was to describe adherence to screen time (ST) and physical activity (PA) recommendations among Canadian youth. The present study was based on a representative sample of Canadian students from Grades 7 through 12 (N = 47,203). ST and PA as well as demographic (gender, ethnicity, grade, and province of residence) and individual (alcohol, tobacco and cannabis usage, school connectedness) correlates were self-reported by youth. In total, 49.2% (99% confidence interval [CI] = [46.3%, 52.2%]) of participants respected none of the recommendations, while 40.2% (99% CI [37.0%, 43.3%]) and 20.8% (99% CI [19.2%, 22.4%]) respected PA or ST recommendations, respectively. In terms of the correlates of health-related behavior, White ethnicity, alcohol use, and feeling more connected to school were positively correlated with adherence. Attending school in Quebec and smoking cannabis increased risk of poor compliance. The present findings may help the design of school-based health promotion strategies designed to increase PA and reduce ST.

Adolescent Health Lifestyles and Educational Risk: Findings From the Monitoring the Future Study, 2010-2016

INTRODUCTION

Research has linked educational risk to various risky health behaviors (e.g., drug use, violence, risky sexual behaviors). This study builds upon this research by examining the link between additional health lifestyle indicators-nutritional risk factors, low sleep quantity, and low exercise frequency-and academic risk factors among a recent, nationally representative sample of adolescents.

METHODS

Data from the 7 most recent cohorts (2010-2016) of the Monitoring the Future survey were analyzed in 2018 (n=45,757-46,206). A multistage random sampling technique was used to acquire the sample.

RESULTS

All examined risky health lifestyle indicators were associated with significantly greater odds of school disengagement and lower academic expectations. Youth were especially likely to exhibit educational risks when they engaged in multiple risky health behaviors. Each additional risky health lifestyle indicator conferred significant increases in the odds of every examined educational risk factor, with the odds of school disengagement increasing by a factor of 7.48 when youth engaged in 4 or more risky health behaviors (relative to none).

CONCLUSIONS

Findings suggest that activities that promote adolescent health across multiple dimensions (i.e., nutrition, physical exercise, and sleep) may also promote academic engagement and expectations for future academic achievements.

The longitudinal impact of diet, physical activity, sleep, and screen time on Canadian adolescents' academic achievement: An analysis from the COMPASS study

Adequate amounts of physical activity, sleep, and screen time along with a healthy diet have been demonstrated to have positive associations with academic achievement. No longitudinal study has investigated the simultaneous relationship between all of these behaviours and academic achievement. Data from 11,016 adolescent participants of the COMPASS study in Alberta and Ontario were analysed. Students self-reported their adherence to Canadian recommendations for health behaviours and academic achievement in Math and English on school-based surveys administered in the 2015/16 and 2016/17 waves of COMPASS. Multinomial generalized estimating equations were used to evaluate the association between longitudinal changes in adherence to recommendations and academic achievement at follow-up. Models were adjusted for self-reported sociodemographic information, body weight status, and baseline academic achievement. Students who adhered to a greater number of recommendations performed better than students who adhered to fewer recommendations. Meeting recommendations for Meat and Alternatives (protein-rich foods) and screen time were consistently associated with higher academic achievement compared to students who did not meet these recommendations. A change from not meeting recommendations for Vegetables and Fruit to meeting the recommendation in the following year was associated with higher achievement in both subjects. There was no association between sleep behaviours or physical activity and academic achievement. Results indicate that adherence to recommendations for protein-rich foods, screen time, and vegetables and fruit show promise as behavioural targets for higher academic achievement among youth. Further study using objectives measurements of behaviours and further consideration of socioeconomic variables is merited.

The influence of diet quality and dietary behavior on health-related quality of life in the general population of children and adolescents: a systematic review and meta-analysis

OBJECTIVE

The association between diet quality, dietary behavior and health-related quality of life has been mostly examined in children and adolescents with specific chronic diseases. No systematic review has synthesized the influence of diet quality and dietary behavior on health-related quality of life in the general population of children and adolescents. The purpose of this study was to systematically review the primary studies that evaluated the association between diet quality, dietary behavior and health-related quality of life in the general population of children and adolescents and to synthesize the findings for the association.

METHODS

A computer search in the databases of MEDLINE, EMBASE and PSYCINFO was performed to retrieve English language studies that were published from 1946 up to April 8, 2018. We also screened the PubMed-related articles and the reference lists of the existing relevant literature to identify other eligible studies. We synthesized the association between diet quality, dietary behavior and health-related quality of life using both a qualitative method and meta-analysis. We reported the review following up the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline.

RESULTS

Seventeen studies were included in the synthesis including twelve cross-sectional studies and five longitudinal studies. We found that diet quality and dietary behavior were associated with health-related quality of life in children and adolescents. The positive effect of healthy diets on health-related quality of life was observed for multiple domains of health-related quality of life, including physical, school and emotional functioning, and psychosocial quality of life. We observed a dose-response relationship between the diet exposure and health-related quality of life, where an unhealthy dietary behavior or lower diet quality was associated with decreased health-related quality of life among children and adolescents.

CONCLUSION

The findings of the systematic review suggest the importance of promoting healthy diets and nutrition for good health-related quality of life among children and adolescents. Future research is needed to strengthen the evidence for prospective relationships and for the dose-response effect between diet quality, dietary behavior and health-related quality of life among children and adolescents.

Association between lifestyle, parental smoke, socioeconomic status, and academic performance in Japanese elementary school children: the Super Diet Education Project

Background

Health and education are closely linked. However, few studies have explored the correlates of children’s academic performance in Japan. We aimed to investigate comprehensively the associations of low academic performance among school children with lifestyles, parental smoke, and socioeconomic status.

Methods

In 2016, children aged 6 to 13 years from the Super Diet Education School Project were surveyed using questionnaires. The survey explored the lifestyles and subjective academic performance of 1663 children and asked their parents about parental smoke and subjective socioeconomic status. Academic performance and socioeconomic status were divided into three levels. Then, we defined subjective academic performance in the lower two levels as low academic performance. The odds ratios (OR) were analyzed by logistic regression analysis.

Results

Among all participants, 299 (18.0%) children reported low academic performance. In general, low academic performance was significantly associated with late wakeup time (OR = 1.36 for 6:30 to < 7 a.m. and OR = 2.48 for ≥ 7 a.m.), screen time ≥ 2 h (OR = 1.35), studying at home < 1 h (OR = 1.82), paternal smoke (OR = 1.47), maternal smoke (OR = 1.87), and low socioeconomic status (OR = 1.48). Analyses stratified by grade showed stronger associations between academic performance and socioeconomic status in senior (OR = 1.62 for middle, OR = 1.52 for low in grades 4 to 6) than in junior children (OR = 1.15 for middle, OR = 1.38 for low in grades 1 to 3).

Conclusions

Children’s lifestyles, parental smoke, and socioeconomic status were significantly associated with low academic performance among Japanese children. Parents and health care providers should take these findings into consideration to prevent children from having low academic performance.