Does spending more time on electronic screen devices determine the weight outcomes in obese and normal weight Saudi Arabian children?

Parental Knowledge and Practices of Sleep Hygiene Among Children in Saudi Arabia: A Cross-Sectional Study

BACKGROUND

 Sleep hygiene is crucial for child development, influencing physical health, cognitive function, and emotional well-being. Parental knowledge and practices significantly influence children's sleep habits, yet gaps in understanding persist, impacting sleep quality and overall health outcomes. In Saudi Arabia, rapid societal changes and modern lifestyles pose unique challenges to maintaining healthy sleep habits among children. This study aims to assess parental knowledge and management of sleep hygiene, providing insights for targeted interventions tailored to Saudi cultural contexts.

METHODS

 This cross-sectional study assessed parental knowledge and management of sleep hygiene among children in Saudi Arabia. Participants (N=729) were recruited from pediatric clinics and online forums, comprising parents with at least one child aged 0-18 years who completed surveys in Arabic or English. A comprehensive survey collected demographic data, parental sleep hygiene knowledge, practices, and concerns. Data were gathered between January and March 2024 via online and clinic-based distribution and analyzed using SPSS version 25 for descriptive statistics.

RESULTS

 The survey was completed by 729 participants, predominantly aged 25-44 years (70.4%), holding predominantly bachelor's degrees (34.7%), and employed full-time (49.7%). The majority reported having 2-3 children (54.9%). Findings indicated that 69.1% (504 participants) correctly identified school-aged children's sleep needs, and 71.0% (518 participants) recognized the importance of limiting electronic device use before bedtime. Sleep management practices revealed that 81.3% (592 participants) of parents adhered to bedtime routines, and 65.6% (478 participants) managed electronic device use appropriately. Bedtimes typically ranged from 7 to 9 PM for 90.5% (658 participants) of children, with wake-up times clustered between 6 and 8 AM for 75.6% (551 participants). Parental concerns showed reliance on online resources (60.4%) and pediatricians (54.7%) for sleep information, with 73.9% (539 participants) expressing interest in further education on sleep hygiene.

CONCLUSIONS

 This study highlights parental awareness of sleep hygiene practices in Saudi Arabia but underscores gaps in knowledge regarding caffeine effects and optimal napping practices. Tailored educational interventions are essential to enhance parental understanding and promote healthier sleep habits, thereby optimizing child well-being in the region.

Screen time among school-aged children of aged 6-14: a systematic review

BACKGROUND

Screen time refers to the time an individual spends using electronic or digital media devices such as televisions, smart phones, tablets or computers. The purpose of this study was to conduct systematic review to analyze the relevant studies on the length and use of screen time of school-aged children, in order to provide scientific basis for designing screen time interventions and perfecting the screen use guidelines for school-aged children.

METHODS

Screen time related studies were searched on PubMed, EMBASE, Clinical Trials, Controlled Trials, The WHO International Clinical Trials Registry Platform, the Cochrane Central Register of Controlled Trials, CNKI, and Whipple Journal databases from January 1, 2016 to October 31, 2021. Two researchers independently screened the literature and extracted the data, and adopted a qualitative analysis method to evaluate the research status of the length and usage of screen time of school-aged students.

RESULTS

Fifty-three articles were included. Sixteen articles studied screen time length in the form of continuous variables. Thirty-seven articles studied screen time in the form of grouped variables. The average screen time of schoolchildren aged 6 to 14 was 2.77 h per day, and 46.4% of them had an average screen time ≥ 2 h per day. A growth trend could be roughly seen by comparing studies in the same countries and regions before and after the COVID-19 outbreak. The average rates of school-aged children who had screen time within the range of ≥ 2 h per day, were 41.3% and 59.4% respectively before and after January 2020. The main types of screen time before January 2020 were watching TV (20 literatures), using computers (16 literature), using mobile phones/tablets (4 literatures). The mainly uses of screens before January 2020 were entertainment (15 literatures), learning (5 literatures) and socializing (3 literatures). The types and mainly uses of screen time after January 2020 remained the same as the results before January 2020.

CONCLUSIONS

Excessive screen time has become a common behavior among children and adolescents around the world. Intervention measures to control children's screen use should be explored in combination with different uses to reduce the proportion of non-essential uses.

Leisure screen time predicts free sugar consumption in children

OBJECTIVE

This study aimed to investigate free sugar consumption (FSC) in relation to leisure screen time in children.

METHODS

Cross-sectional data of 424 healthy Saudi children ages 6 to 12 y were included in this study. Data pertaining to sociodemographic characteristics and leisure screen time (including time spent viewing TV, gaming, and use of electronic devices [e.g., computer, tablet, and smartphone]) in children were collected from mothers via an online questionnaire. A phone interview was later conducted with the mother and child to assess FSC using a previously validated 40-item food frequency questionnaire.

RESULTS

Our data found that a large proportion of children exceeded the maximum limit of screen time recommended for children, of ≤2 h/d (61.7%; n = 262). Child and maternal ages and child's birth order among siblings were significantly associated with the duration of leisure screen time (screen time within the recommendation of ≤2 h/d versus screen time that exceeded the recommendation; P < 0.050). Exceeding the recommendation of screen time predicted an increase of 8.96 g/d of FSC from liquid foods, 10.7 g/d of FSC from solid foods, and 19.3 g/d of total FSC.

CONCLUSIONS

Exceeding the recommendation of screen time is associated with greater FSC in children. Future interventions should be directed toward restricting screen time and FSC in children.

Change in Growth Status and Obesity Rates among Saudi Children and Adolescents Is Partially Attributed to Discrepancies in Definitions Used: A Review of Anthropometric Measurements

Anthropometric measurements are the first step in determining the health status in children and adolescents. Clinicians require standardized protocols for proper assessment and interpretation. Therefore, this study aims to review the literature of international and Saudi national guidelines and studies previously conducted in Saudi children and adolescents to provide recommendations to establish Saudi guidelines in line with the Saudi 2030 Vision. Systematic search was conducted in several databases: Medline, PubMed, Saudi Digital Library and Google Scholar from January 1990 to January 2021. Further, 167 studies measured anthropometrics in Saudi children/adolescents; 33 of these studies contributed to the establishment/adjustment of Saudi growth charts or specific cutoffs or studied the trend of growth in representative samples or adjusted the international curves to be used in Saudis. This review warrants updating growth charts and establishing the standard cutoffs of Saudi adolescent anthropometrics to avoid over/underreporting. This review provides insights and recommendations regarding the resources that can be used to establish national guidelines in anthropometric measurements for Saudi children/adolescents. This review will help policymakers and the Ministry of Health to establish standardized protocols to be used in Saudi Arabia for anthropometric measurements that may assist in detecting malnutrition.

Relationship between Behavioural Intention for Using Food Mobile Applications and Obesity and Overweight among Adolescent Girls

Changes in the body mass index (BMI) of children and adolescents have been linked to mobile usage, particularly food applications. This study aimed to investigate the relationship between food application usage and obesity and overweight among adolescent girls. This cross-sectional study was conducted among adolescent girls aged 16-18 years. Data were collected using a self-administered questionnaire from female high schools in five different regional offices across Riyadh City. The questionnaire included questions regarding demographic data (age and academic level), BMI and behavioural intention (BI) scale comprising three constructs: attitude towards behaviour, subjective norms and perceived behavioural control. Of the included 385 adolescent girls, 36.1% were 17 years old, and 71.4% had normal BMI. The overall mean BI scale score was 65.4 (SD 9.95). No significant differences were observed between overweight or obesity in relation to the overall BI score and its constructs. A high BI score was more associated with participants studying in the east educational office than those who were enrolled in the central educational office. Behavioural intention to use food applications greatly influenced the adolescent age group. Further investigations are necessary to determine the influence of food application services among individuals with high BMI.

Exploring obesity, physical activity, and digital game addiction levels among adolescents: A study on machine learning-based prediction of digital game addiction

Primary study aim was defining prevalence of obesity, physical activity levels, digital game addiction level in adolescents, to investigate gender differences, relationships between outcomes. Second aim was predicting game addiction based on anthropometric measurements, physical activity levels. Cross-sectional study design was implemented. Participants aged 9-14 living in Kirikkale were part of the study. The sample of the study consists of 405 adolescents, 231 girls (57%) and 174 boys (43%). Self-reported data were collected by questionnaire method from a random sample of 405 adolescent participants. To determine the physical activity levels of children, the Physical Activity Questionnaire for Older Children (PAQ-C). Digital Game addiction was evaluated with the digital game addiction (DGA) scale. Additionally, body mass index (BMI) status was calculated by measuring the height and body mass of the participants. Data analysis were performed using Python 3.9 software and SPSS 28.0 (IBM Corp., Armonk, NY, United States) package program. According to our findings, it was determined that digital game addiction has a negative relationship with physical activity level. It was determined that physical activity level had a negative relationship with BMI. In addition, increased physical activity level was found to reduce obesity and DGA. Game addiction levels of girl participants were significantly higher than boy participants, and game addiction was higher in those with obesity. With the prediction model obtained, it was determined that age, being girls, BMI and total physical activity (TPA) scores were predictors of game addiction. The results revealed that the increase in age and BMI increased the risk of DGA, and we found that women had a 2.59 times greater risk of DGA compared to men. More importantly, the findings of this study showed that physical activity was an important factor reducing DGA 1.51-fold. Our prediction model Logit (P) = 1/(1 + exp(-(-3.384 + Age*0.124 + Gender-boys*(-0.953) + BMI*0.145 + TPA*(-0.410)))). Regular physical activity should be encouraged, digital gaming hours can be limited to maintain ideal weight. Furthermore, adolescents should be encouraged to engage in physical activity to reduce digital game addiction level. As a contribution to the field, the findings of this study presented important results that may help in the prevention of adolescent game addiction.

The Effects of a Physical Activity, Nutrition, and Body Image Intervention on Girls in Intermediate Schools in Saudi Arabia

BACKGROUND

This cluster-randomized study aimed to evaluate the effects of an intervention focused on physical activity, nutrition, and body image perception among girls in intermediate schools in Saudi Arabia. A seminar was delivered to the mothers of the girls in the experimental group. The experimental group then attended six interactive sessions within 3 months featuring physical activity, nutrition, and body image perception, followed by a 3-month follow-up period. A total of 138 respondents (68 in the experimental group and 70 in the control group) completed the intervention. Each participant's body mass index-for-age z-score and waist circumference were measured, and they completed a physical activity, sedentary behavior, and body image perception questionnaires before and after the intervention and at the follow-up. The intervention was evaluated using within- and between-groups generalized estimating equations. There were no significant changes in the respondents' body mass index-for-age z-score or waist circumference (p > 0.05). However, immediate significant improvements were seen in physical activity, sedentary behavior, and body image satisfaction among the experimental group, and these improvements remained at follow-up (p < 0.001). These differences were more significant among the experimental group than among the control group. We found this intervention effective. Future studies can adapt this intervention for adolescent boys and extend its duration to improve the body mass index outcome.

The Impact of Digital Screen Time on Dietary Habits and Physical Activity in Children and Adolescents

Background: Over the last few decades, the time children spend using electronic devices has increased significantly. The aim of the study was to evaluate the impact of screen time on dietary behaviors and physical activity in children and adolescents. Methods: An online survey was conducted among parents of preschool and school-aged children during the COVID-19 lockdown in Poland. There were 3127 surveys used in the analysis. Results: Survey responses referred to 1662 (53%) boys and 1465 (47%) girls, with a mean age of 12.1 ± 3.4 years. During a routine weekday, most children (71%) spent >4 h on educational activities using electronic devices, and 43% of children spent 1−2 h using devices for recreational purposes. The majority of children (89%) were exposed to screens during meals, and ate snacks between main meals (77%). There was an association between screen time and the exposure to screens during meals, and between screen time and time spent performing physical activity. Conclusions: This study revealed that the majority of children were exposed to screens during meals, which is a risk factor of obesity. The promotion of the judicious use of digital devices and healthy dietary habits associated with the use of screens may be an important component of obesity prevention strategies.

Trend and Causes of Overweight and Obesity among Pre-School Children in Kuwait

Identifying life risk factors of obesity early will help inform policymakers to design evidence-based interventions. The following study aims to assess the trend of overweight and obesity over four years among pre-school Kuwait children, and to examine their association with breakfast skipping (BF), sugary and sweetened beverage (SSB) consumption, and screen time. Children aged 2-5 years (n = 5304) were selected from 2016 to 2019 national surveys. Overweight and obesity were defined according to the World Health Organization references. The children's mothers were asked about the BF of their children the day of the survey, their frequency of SSB consumption, and their weekly screen time use. Logistic regression was used to identify the risk factors associated with overweight/obesity. No significant decline (p values ≥ 0.12) was found for both overweight and obesity. Contrastingly, BF skipping, SSB consumption, and screen time declined (p < 0.0001). The BF skippers were found to have a 31% lower risk of being overweight. Daily TV watching, for 2-3 h, increases the odds of obesity by 5.6-fold. Our findings are encouraging regarding the decline in risky behaviours over time. However, more effort should be made both at the micro- and macro-level for a sustainable reduction in overweight and obesity.

Physical and Sedentary Activities and Childhood Overweight/Obesity: A Cross-Sectional Study among First-Year Children of Primary Schools in Modena, Italy

Children obesity is a serious public health issue. This study aimed to investigate physical/sedentary activities of first-year primary schools children in Modena, and their association with overweight/obesity and dietary habits of children and family characteristics to identify the risk factors for unhealthy lifestyles. Child physical/sedentary activities were gathered through an anonymous questionnaire administered to parents, as well as family characteristics and weight/height of child and parents. Logistic regression models, eventually adjusted for parents' sociodemographic characteristics, were used to analyze data. Questionnaires were delivered by 660 families (74.2%), of which 72 without anthropometric data were excluded. Three out of four children spent in physical activities less than 7 h/week, while 63.9% dedicated to sedentary activities two or more hours/day. From multivariate analysis, the habit significantly affecting children's overweight/obesity was spending time on tablets/Personal Computers/mobile phones/videogames. Higher parental education level resulted in a protective factor for implementing unhealthy lifestyles in terms of time dedicated to physical/sedentary activities. Our results suggest the need of interventions to increase time for physical activity and to promote a responsible use of digital media involving the entire families to reach all parents regardless of their education and nationality with a possible relapse on other family members.

The Relationship between Technology Use and Physical Activity among Typically-Developing Children

Objectives: This study aimed to investigate the relationship between technology use and physical activity level and to measure the association between sociodemographic characteristics of the participants, technology use, and physical activity level among Saudi children. Materials and Methods: This cross-sectional study was conducted among 458 parents of typically-developing Saudi children (6–12 years). A translated validated questionnaire used for data collection consisted of three parts: Children’s Physical Activity Questionnaire (CPAQ), Questionnaire on the Impact of Technology on Children (used to investigate the impact of technology on children’s physical activity) and sociodemographic questions (e.g, children’s age and sex, age, educational level, marital status of parents and monthly income). Data were analyzed using Pearson correlation and Mann-Whitney U test to assess the relationship between technology use and physical activity level. A chi-squared test was used to assess the relationship between technology use and sociodemographic variables. Statistical significance was set at p < 0.05. Results: Mean age of the sampled children was (8.44 ± 2.07). Data analysis revealed that high use of technology was significantly associated with low level of activity. Pearson’s correlation analysis showed a negative relationship between a high level of activity and technology use (r = −0.138, p = 0.047). Ownership of a device was significantly associated with higher technology time consumption. Regression analysis revealed that age of the child, educational level of the parents, screen time use, and owning electrical devices significantly predicted the level of practicing physical activity among children of sampled parents (p < 0.05). Conclusions: practicing inadequate physical activity among children could be influenced by educational level of parents, screen time use, and owning electrical devices. Therefore, parental involvement is required to reduce time of exposure to technology screens among children.

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.