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Objective@#To investigate the distribution of various types of screen time and examine the association of screen time with psychological and behavioral development problems in children aged 3-6 years, so as to provide scientific basis for children s screen use and mental health promotion.@*Methods@#A total of 3 875 mother child dyads who completed the follow up in Shanghai Maternal-Child Pairs Cohort were included. The daily usage time of children s tablet, mobile phone, TV, projectors, and other types of screens were obtained in questionnaire survey. Children s psychological and behavioral development problems were evaluated by Age-Stage Questionnaire, Third Edition (ASQ-3) and Strengths and Difficulties Questionnaire (Parent version) (SDQ). The Chi-square test, Mann Whitney U and Kruskal Wallis rank sum test were used to compare the detection rate of psychological and behavioral development problems and screen time in children with different characteristics. Multivariate binary Logistic regression was used to analyze the association of screen time with psychological and behavioral development problems.@*Results@#There were 49.91% of children having screen time more than 1 h/d. Children s TV, tablet and mobile phone screen time were 0.39(0.25, 0.96 ), 0.25(0,0.61) and 0.18(0,0.25) h/d. The detection rates of suspected developmental delay in fine motor, problem solving and personal-social domains and pro social behavior deficiency and externalizing behaviors in boys (8.54%, 6.77%, 5.46%, 30.07 %, 27.39%) were higher than that in girls (4.64%, 4.85%, 2.48%, 22.10%, 22.36%) ( χ 2=23.76, 6.49, 22.37, 31.81, 13.06, P <0.05). There were statistically significant differences in the detection rates of suspected developmental delay in communication, fine motor and problem solving, as well as internalizing behavior and externalizing behavior of children with different parents educational levels ( χ 2=14.37, 15.18, 21.10, 11.66, 9.27; 16.34, 26.75, 32.89, 16.97, 6.37, P <0.05). There were significant differences in the detection rates of suspected developmental delay in problem solving, prosocial behavior deficiency, internalizing behavior and externalizing behavior of children whose mothers had anxiety/depression symptoms during pregnancy ( χ 2= 5.61 , 9.05, 21.90, 7.17; 8.75, 6.06, 12.76 , 5.55, P <0.05). The average total screen time of boys was longer than that of girls (1.07, 1.00 h/d, Z=-2.08, P =0.04). Compared with children with other educational levels of their parents, the total screen time, mobile phone and TV screen time of children whose parents had college education or above were short (father: H =42.01, 44.49 , 21.24, mother: H =42.31, 39.21 , 26.47, P <0.01). Among all types of screen time, mobile phone screen time had the most impact on psychological and behavioral development. More mobile phone screen time increased the risk of suspected developmental delay and abnormal emotional behavior ( P < 0.05). Screen time of tablet, mobile phone and TV were positively correlated with externalizing behavior ( OR=1.36, 1.57, 1.27 , P <0.05).@*Conclusions@#Screen time is related to children s psychological and behavioral development problems and mobile phones affect the most. Parents should limit their children s screen time to avoid excessive screen time affecting their psychological and behavioral development.
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Objective@#To develop an assessment questionnaire for screen based behaviors among primary and secondary school students, so as to provide a basis for comprehensive assessment among the population.@*Methods@#Nineteen experts were invited to take part in this study from August to September 2022. The initial framework and item pool of the assessment questionnaire were developed based on literature review and a series of guidelines and standards issued by the national education and health authorities, as well as relevant domestic and foreign guidelines, and were combined with existing assessment tools that were used to evaluate screen based behavior among these age groups. Experts in related fields were selected for two rounds of Delphi consultation to determine the dimensions, items and corresponding weights of the assessment questionnaire.@*Results@#The response rates from two rounds of consultation were 95.0% and 100.0% respectively, the opinion submission rates were 89.5% and 63.2% respectively, and the authority coefficient ( Cr ) was 0.87. An assessment questionnaire was finally designed, consisting in 44 items and four dimensions, namely screen use type and time, screen use related health behaviors, safety and civilization in screen use, and reasonable arrangement of screen and non screen activities. The coefficient of variation( CV ) of each item ranged from 0.00 to 0.19, and the Kendall s W increased from 0.22 to 0.34( P <0.01). Expert opinions were in agreement and credible.@*Conclusion@#The designed assessment questionnaire can be used to comprehensively evaluate screen based behavior among primary and middle school students, and provides a basis for subsequent intervention measures to improve screen based behavior among this population.
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Objective@#To formulate an evaluation scale on daily stressors with good reliability and validity for urban secondary school students, and to provide a tool for psychological stress assessment.@*Methods@#Based on steps of instrument development, a pool of items regarding the daily stressors of junior/senior high school students was constructed by combining existing scales of adolescent life events or stressors, and a preliminary survey was conducted for items analysis and dimension evaluation among 393 middle and high school students in 2 districts of Shanghai. Then confirmatory factor analysis of the scale was conducted among 2 949 students collected by stratified cluster sampling from 11 districts in Shanghai.@*Results@#The final 28 item daily stressors evaluation scale for urban secondary school students, with an overall Cronbach s alpha coefficient of 0.94, consists of 8, 7, 7, and 6 items for the four dimensions of academic stress, physical and psychological stress, interpersonal stress and family stress, respectively. The Guttman s split half reliability was 0.88, and the test retest reliability was 0.68. Total scores of the 28 items reflect general psychological stress level of participants, with higher scores representing higher stress intensity. The confirmatory factor analysis showed that the root mean squared error of approximation ( RMSEA ) and the standardized root mean square residual ( SRMR ) were both less than 0.08, while all fit indexes were above 0.8.@*Conclusion@#The Daily Stressors Evaluation Scale for Urban Secondary School Students, with good reliability, validity and model goodness of fit, can be applicable for urban secondary school students.
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Objective@#To explore the patterns of health risk behaviors among secondary school students in Shanghai, so as to provide a basis for implementing targeted interventions.@*Methods@#From May to June 2021, 21 junior high schools, regular high schools and secondary vocational schools were selected from Shanghai, and the occurrence of dangerous health behaviors of 6 092 students were investigated in the form of self-filled questionnaires. The clustering analysis of the sample was performed by Ward s departure and peace method.@*Results@#Three types of clustering characteristics were found in this study: being bullied, depression (64.9%), loneliness (48.2%), and insomnia (42.4%) in the high-risk group (1 004, 16.5%); excessive video games (53.1%) and sugary drinks (89.3%) and fried food intake (79.0%) in the medium-risk group (1 585, 26.0%); the low-risk group (3 503, 57.5%) was characterized by extremely low alcohol consumption (0) and smoking (0.4%). The reporting rate on sugary beverage intake, fried food intake, physical activity, malicious teased, solicited, isolated/intentionally excluded, outside the group activities, threatened, kicked/hit/pushed/locked in house, smoking, unhealthy weight loss, playing video game overtime were statistically significant among the three groups ( χ 2=36.74, 41.85, 30.07, 652.68, 334.40, 669.89, 358.84, 233.12, 101.46, 88.45, 230.15, P <0.01) .The difference in reporting rates of loneliness, depression, insomnia and drinking were significant among the three groups (Fisher s test, P <0.01). The majority of junior high school students, general high school students and girls in the high-risk group; boys, general high school students and junior high school students in the excessive video game and unhealthy diet group.@*Conclusion@#There are clusters of health-related risk behaviors among secondary school students in Shanghai, focusing on two major aspects: poor lifestyle and mental health. Targeted interventions should be implemented according to the characteristics of health-related risk behaviors clustering to enhance the intervention effect.
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Objective@#To develop the Daily Stressor Evaluation Questionnaire for Primary School Students and to evaluate the reliability and validity of the questionnaire.@*Methods@#In November 2020, a convenience sampling method was used to conduct semi structured interviews with 10 primary school students in Jiading District, Shanghai. Through literature review, semi structured interviews, and expert consultation, 59 question items were developed, and 138 elementary school students in 2 districts in Shanghai were selected for a pre survey in March 2021, and the formal questionnaire was formed after item screening and parallel analysis. Stratified cluster sampling was used to survey a total of 1 618 fourth and fifth grade students enrolled in five elementary schools in Jiading District, Shanghai from April to May, 2021, to further test the reliability of the questionnaire.@*Results@#The Daily Stressor Evaluation Questionnaire for Primary School Students contained 4 dimensions and 22 items in total. The internal consistency test showed that cronbach α coefficient of the questionnaire was 0.904 and Cronbach α coefficient of each dimension was between 0.689 to 0.803. The Guttman split half reliability was 0.885 and ranged from 0.582 to 0.732 for each dimension. The results of the validation factor analysis showed that the χ 2/df of the questionnaire was less than 4, the root mean square error of approximation was less than 0.08, and the Tueker Lewis index and comparative fit index were above 0.80. The critical value of using the ROC curve to evaluate the questionnaire was 31 points. At this point, the area under the curve was determined to be 0.783, while the sensitivity and specificity were found to be 71.43% and 73.39%, respectively. Additionally, the positive predictive value and negative predictive value were calculated to be 23.26% and 95.79%, respectively.@*Conclusion@#The Daily Stressor Evaluation Questionnaire for Primary School Students developed in this study has good reliability and validity and can be used as an assessment tool for evaluating stressors in primary school students.
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Objective@#The current situation and associated factors of primary and middle school students screen time and related eye hygiene in different periods before and after COVID-19 were investigated, so as to provide a scientific basis for taking targeted measures of preventing and controlling myopia among those students.@*Methods@#A total of 11 402 students were selected from 24 primary schools, 18 junior high schools and 16 high schools by multi stage stratified cluster sampling method. And a questionnaire survey was conducted among students and their parents to understand students screen time and screen hygiene behaviors and related factors in different periods before and after the outbreak of COVID-19.@*Results@#The rate of screen overuse was 7.26%, 9.12% and 35.30% during school days, weekends and home study, respectively. The overuse rate of mobile phones and tablets at home increases with the increase of school stage. Totally 16.30% of students use mobile phones for online learning. The screen overuse rate of those who have not been diagnosed with myopia was lower than that of those who have been diagnosed during home study( OR=0.77, P <0.05). The higher the parents educational level was, the lower the screen overuse rate of children during the weekends became( P <0.05). In any period, the high proportion of screens used in homework and poor home screen eye environment increased the risk of screen overuse and poor eye hygiene ( P <0.05). Parental good behavior was conducive to reducing the risk( OR= 0.65-0.97, P <0.05). When the family had regulation on the screen use time, the implementation of laxity would increase the risk of screen overuse ( OR=1.18-2.48, P <0.05).@*Conclusion@#The screen overuse rate of urban primary and middle school students during home study is high, and a certain proportion of students still use mobile phones for online learning. The proportion of screens used in homework, home screen eye environment and screen use management are related to screens overuse. More attention should be paid to those with myopia and low educational level of parents.
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Objective@#To development teacher health literacy on students visual protection questionnaire for kindergarten, primary and middle schools, and to provide a basis for quantitative assessment of visual protection health literacy of school teachers.@*Methods@#Based on official documents related to prevention and control of myopia as well as the integrated definition of health literacy of WHO Europe, the framework for technical evaluation was established. Totally 24 multi disciplinary experts in related fields conducted two round Delphi expert consultation. Evaluation items, questions and corresponding weights were determined based on experts opinions and scores.@*Results@#In two rounds of Delphi consultation, the response rates were 83.3% and 79.2% respectively, and the authority coefficient was 0.91. The final questionnaire was composed by dimensions of core knowledge of myopia, daily instruction, guidance for myopic behaviors, promotion of outdoor activities, and creation of teaching light environment, including 30 and 23 items for middle and primary school teachers and kindergarten teachers respectively. The coefficient of variation ( CV ) of the five dimensions ranged from 0.07 to 0.15, and that of each question ranged from 0.08 to 0.29. Expert opinions were accordant and credible.@*Conclusion@#A reliable questionnaire of teacher health literacy on students visual protection health literacy for school teachers is established, which can be used as the entry point and effectiveness evaluation basis for the school based intervention of myopia.
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Objective@#To determine the influencing factors of electronic screen time of urban preschoolers before and after the COVID-19 outbreak, so as to provide a scientific basis for the control of digital screen use and early prevention of myopia among preschoolers.@*Methods@#Using multi stage cluster random sampling method, a cross sectional survey of 8 244 kindergarten students in a district of Shanghai was implemented, through parent questionnaire collecting the time child spent on various electronic screens before and after the COVID-19 outbreak, estimated the weighting screen time, and emphatically analyzed the relationship between family electronic screen supervision behavior and preschoolers weighting screen time.@*Results@#The proportion of daily over use time on average of mobile phones, computers and TV/projection screens among the surveyed preschool children during COVID-19 was 30.52%, 51.40% and 56.82%, respectively. On school days before the epidemic, the proportion was 21.94%, 41.80% and 47.51% respectively. After controlling for primary covariates, parents frequent control of children s electronic screen use, parents guidance for electronic screen use were significantly associated with lower weighted screen refractive time ( OR =0.60-0.77, P < 0.05 ). The use of electronic screen when parents accompanied their children, the use of electronic screen time by parents but not strictly implemented were significantly associated with higher weighted screen refractive time and increased screen refractive time ( OR =1.18-1.80, P <0.05).@*Conclusion@#Urban preschoolers electronic screen time was high during and before COVID-19. In the control measures of preschool children s electronic screen time, attention should be paid to the management of electronic screen use within the family and parents role model.
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Abstract@#The adiposity peak (AP) and adiposity rebound (AR) are the highest and lowest points of the body mass index (BMI) growth trajectory in early life. They are also the most significant characteristics. Epidemiological studies have reported the timings and BMI magnitudes of AP and AR in different populations worldwide. Others have observed the impacts of prenatal, postpartum, feeding, economic and social factors on the timing and magnitude of them. In addition, longitudinal studies have tracked the health effect of the timing and magnitude of them on many adverse health outcomes in later life. Based on literature reviews, we summarize the global epidemiological characteristics of AP and AR, while identifying pre and early life determinants as well as their possible long term health effects, so as to provide scientific evidence for the prevention and management of obesity and related chronic diseases. We also highlight current controversies regarding this issue, while outlining directions for future research.
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Objective@#To explore the characteristics of the adiposity peak and rebound in early life among first year primary school students with different body weight measures, so as to provide scientific evidence for the development of prevention interventions to manage childhood overweight and obesity.@*Methods@#A total of 2 330 first year primary school students who received routine physical examinations from September to December in 2019 were selected. According to body mass index (BMI) status, participants were divided into three categories:healthy weight, overweight, and obese. The BMI growth trajectories of the three groups were fitted by gender using the generalized additive mixed model from 1 to 80 months, retrospectively. Each subject s age at the adiposity peak and rebound, and associated BMI values, were calculated.@*Results@#The prevalence of overweight and obesity was 16.31 % (380/ 2 330 ) and 16.09% (375/2 330), respectively. For first year students with obesity, the BMI value continued to be higher than their overweight or healthy weight counterparts during the first 80 months of life. The age at the adiposity peak for these students, whose BMI status varied, was about nine months. However, the BMI of children with overweight or obesity was much higher than that of healthy weight subjects. Age at adiposity rebound was 72 months for healthy weight children, 52 to 55 months in children defined as overweight, and 22 to 23 months in children with obesity. For healthy weight children, the fitted value of BMI at the adiposity rebound was less than that of overweight and obese children.@*Conclusion@#Age at the adiposity peak was largely similar among first year students with different BMI patterns; however, age at adiposity rebound was different. Age at adiposity rebound among children with obesity was much earlier than that of other subjects, and their BMI values were much higher.
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Objective@#To explore the influence of birth weight and growth patterns during infancy on overweight and obesity among first grade primary school pupils, so as to provide a theoretical basis for the formulation of early life prevention and intervention policies.@*Methods@#In 2019, data related to routine physical examinations were collected for primary school pupils in the Minhang District of Shanghai, and information regarding birth and follow ups was collected retrospectively. Physical examination data of 4 434 pupils at 12 months of age were obtained. A multiple linear regression model was used to analyze the relationship between growth patterns during infancy and body mass index (BMI) in the first grade of primary school. A generalized linear model was employed to analyze the relationship between birth weight and growth patterns during infancy and overweight and obesity in the first grade of primary school. A hierarchical analysis was conducted.@*Results@#A linear relationship was observed between growth patterns during infancy and BMI and the BMI Z score of first grade primary school pupils [ β(β 95%CI)=0.30(0.24-0.35),0.12(0.10- 0.15 ), P <0.01]. In addition to subjects classified as small for gestational age (SGA), catch up growth during infancy was identified among subjects who were classified as appropriate for gestational age (AGA) and large for gestational age (LGA). LGA at birth and catch up growth during infancy were independent risk factors for overweight and obesity among first grade primary school children ( RR =1.31-1.55, P <0.05). The hierarchical analysis showed that catch up growth increased the risk of overweight and obesity among first grade primary school pupils classified as AGA [ RR(RR 95%CI )=1.74(1.42-2.14),1.87(1.56-2.26)], and increased the risk of obesity among first grade primary school pupils classified as SGA and LGA [ RR(RR 95%CI )=3.74(1.04-13.49),3.24(1.62-6.46)]( P <0.05). Among those who exhibited catch up growth during infancy, LGA increased the risk of obesity among first grade primary school pupils ( RR= 2.60 , 95%CI=1.35-5.02, P <0.01), but not the risk of being overweight ( P =0.13).@*Conclusion@#Birth weight and growth patterns during infancy have an impact on overweight and obesity among children in the first grade of primary school. It is suggested that attention should be paid to growth and physical development in early life for those classified as LGA and AGA, and catch up growth in children should be closely monitored.
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Objective@#To explore the effect of breastfeeding duration on age at adiposity rebound, and provide a scientific theoretical basis for identifying early life factors of obesity in children and adolescents, while promoting early intervention.@*Methods@#In September 2019, first graders from a primary school in Minhang District, Shanghai, were selected to participate in this study, and their growth information was retrospectively collected. The natural cubic spline function was used to fit the body mass index trajectory of the subjects from 1 to 80 months, and age at adiposity rebound was calculated. A total of 6 148 subjects were selected, and complete data of adiposity rebound timing and breastfeeding duration were obtained. A multiple linear regression model was used to analyze the relationship between these two variables.@*Results@#The average breastfeeding duration of all children included in the study was (3.71±3.28) months, and most of the subjects (69.63% for male and 70.45% for female) were breastfed for less than 4 months. A positive linear relationship was found between them [male, B =0.16(0.02-0.30), female, B =0.34(0.18- 0.51 ), total, B =0.23(0.12-0.34), P <0.05]. The linear relationship was determined using the multivariate model.@*Conclusion@#Breastfeeding duration independently affected age at adiposity rebound. Prolonging the duration of breastfeeding within 24 months of age may help to delay the timing of adiposity rebound,and thus reduce later risks of overweight and obesity.
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Abstract@#The prevalence of childhood overweight and obesity is rising rapidly and younger and younger people suffer from the obesity problem. Children with obesity are at greater risk of lifelong or even cross generational adverse health consequences. Prevention of childhood obesity is an urgent public health issue. The risk of obesity has been established in the early years of life. Therefore, it is necessary to strengthen studies in early life course risk factors. We should not only focus on the matrix in the perinatal period and intrauterine environment factors, but also on postnatal rearing factors, postnatal catch up growth and adiposity rebound.
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Objective@#To evaluate the satisfaction of parents with students eye health services after one year implementation of the "Three-year Action Plan for the Prevention and Control of Myopia in Children and Adolescents in Minhang District (2019-2021)", and to provide a reference for optimizing intervention measures.@*Methods@#A total of 20 176 parents were selected with multi-stage sampling method for the satisfaction evaluate.@*Results@#Health services in appointed medical institutions(6 849, 84.65%), providing feedback on the vision screening(16 915, 83.84%) and procedures in appointed medical institutions(6 704, 82.91%) were the top three terms for parents satisfaction with children and adolescents eye health services, respectively. While the eye behavior and eye environment intervention(8 467, 42.01%), parents informing(7 850, 38.91%) and regular follow-up management(7 222, 33.67%) were the top three that were suggested to improvement. Comparative analysis showed that the school period and the history of previous diagnosis of eye diseases had an impact on the satisfaction of children and adolescents eye health services and the demand for improvement significantly (P<0.05).@*Conclusion@#After one year of intervention, parents are generally satisfied with the eye health services for students. At the same time, students with different characteristics parents focused on difference needs for health services. It urges more refined and personalized eye health services should be provided.