Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.
Department of Pediatrics, University of Washington, Seattle.
JAMA Netw Open. 2021 Oct 1;4(10):e2127892. doi: 10.1001/jamanetworkopen.2021.27892.
IMPORTANCE: Children's physical activity and screen time are likely suboptimal during the COVID-19 pandemic, which may influence their current and future mental health. OBJECTIVE: To describe the association of physical activity and screen time with mental health among US children during the pandemic. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey was conducted from October 22 to November 2, 2020, among 547 parents of children aged 6 to 10 years and 535 parent-child dyads with children and adolescents (hereinafter referred to as children) aged 11 to 17 years and matched down to 500 children per cohort using US Census-based sampling frames. Children aged 11 to 17 years self-reported physical activity, screen time, and mental health, and their parents reported other measures. Parents of children aged 6 to 10 years reported all measures. All 1000 cases were further weighted to a sampling frame corresponding to US parents with children aged 6 to 17 years using propensity scores. EXPOSURES: Child physical activity, screen time, COVID-19 stressors, and demographics. MAIN OUTCOMES AND MEASURES: Mental health using the Strengths and Difficulties Questionnaire for total difficulties and externalizing and internalizing symptoms. RESULTS: Among the 1000 children included in the analysis (mean [SD] age, 10.8 [3.5] years; 517 [52.6%] boys; 293 [31.6%] American Indian/Alaska Native, Asian, or Black individuals or individuals of other race; and 233 [27.8%] Hispanic/Latino individuals), 195 (20.9%) reported at least 60 minutes of physical activity every day. Children reported a mean (SD) of 3.9 (2.2) d/wk with at least 60 minutes of physical activity and 4.4 (2.5) h/d of recreational screen time. COVID-19 stressors were significantly associated with higher total difficulties for both younger (β coefficient, 0.6; 95% CI, 0.3-0.9) and older (β coefficient, 0.4; 95% CI, 0.0-0.7) groups. After accounting for COVID-19 stressors, engaging in 7 d/wk (vs 0) of physical activity was associated with fewer externalizing symptoms in younger children (β coefficient, -2.0; 95% CI, -3.4 to -0.6). For older children, engaging in 1 to 6 and 7 d/wk (vs 0) of physical activity was associated with lower total difficulties (β coefficients, -3.5 [95% CI, -5.3 to -1.8] and -3.6 [95% CI, -5.8 to -1.4], respectively), fewer externalizing symptoms (β coefficients, -1.5 [95% CI, -2.5 to -0.4] and -1.3 [95% CI, -2.6 to 0], respectively), and fewer internalizing symptoms (β coefficients, -2.1 [95% CI, -3.0 to -1.1] and -2.3 [95% CI, -3.5 to -1.1], respectively). More screen time was correlated with higher total difficulties among younger (β coefficient, 0.3; 95% CI, 0.1-0.5) and older (β coefficient, 0.4; 95% CI, 0.2-0.6) children. There were no significant differences by sex. CONCLUSIONS AND RELEVANCE: In this cross-sectional survey study, more physical activity and less screen time were associated with better mental health for children, accounting for pandemic stressors. Children engaged in suboptimal amounts of physical activity and screen time, making this a potentially important target for intervention.
重要性：在 COVID-19 大流行期间，儿童的身体活动和屏幕时间可能不太理想，这可能会影响他们当前和未来的心理健康。 目的：描述大流行期间美国儿童身体活动和屏幕时间与心理健康之间的关联。 设计、设置和参与者：这是一项横断面调查研究，于 2020 年 10 月 22 日至 11 月 2 日进行，调查对象为年龄在 6 至 10 岁的 547 名儿童父母和年龄在 11 至 17 岁的 535 对父母-子女对，其中包括儿童和青少年（以下简称儿童），并使用美国人口普查为基础的抽样框架，将每个队列中的儿童人数匹配到 500 人。年龄在 11 至 17 岁的儿童自我报告身体活动、屏幕时间和心理健康情况，其父母报告其他措施。年龄在 6 至 10 岁的儿童父母报告了所有措施。所有 1000 例病例均进一步使用倾向评分加权到与年龄在 6 至 17 岁的美国父母相对应的抽样框架。 暴露因素：儿童身体活动、屏幕时间、COVID-19 压力源和人口统计学特征。 主要结果和测量：使用困难问卷（Strengths and Difficulties Questionnaire）评估心理健康，包括总体困难和外化、内化症状。 结果：在纳入分析的 1000 名儿童中（平均[标准差]年龄为 10.8[3.5]岁；517[52.6%]名男孩；293[31.6%]名美国印第安人/阿拉斯加原住民、亚洲人或黑人个体或其他种族个体；233[27.8%]名西班牙裔/拉丁裔个体），195 名（20.9%）儿童每天至少有 60 分钟的身体活动。儿童报告每周平均（标准差）有 3.9（2.2）天进行至少 60 分钟的身体活动和 4.4（2.5）小时的娱乐性屏幕时间。COVID-19 压力源与年轻（β系数，0.6；95%CI，0.3-0.9）和年长（β系数，0.4；95%CI，0.0-0.7）组的总体困难程度显著相关。在考虑 COVID-19 压力源后，每周进行 7 天（与 0 天相比）的身体活动与年轻儿童的外化症状减少有关（β系数，-2.0；95%CI，-3.4 至-0.6）。对于年龄较大的儿童，每周进行 1 至 6 天（与 0 天相比）和 7 天（与 0 天相比）的身体活动与总困难程度较低有关（β系数，-3.5 [95%CI，-5.3 至-1.8]和-3.6 [95%CI，-5.8 至-1.4]），外化症状减少（β系数，-1.5 [95%CI，-2.5 至-0.4]和-1.3 [95%CI，-2.6 至 0]），内化症状减少（β系数，-2.1 [95%CI，-3.0 至-1.1]和-2.3 [95%CI，-3.5 至-1.1]）。更多的屏幕时间与年轻（β系数，0.3；95%CI，0.1-0.5）和年长（β系数，0.4；95%CI，0.2-0.6）儿童的总体困难程度增加有关。性别之间没有显著差异。 结论和相关性：在这项横断面调查研究中，更多的身体活动和更少的屏幕时间与儿童的心理健康状况较好相关，这与大流行压力源有关。儿童的身体活动和屏幕时间量不理想，这使其成为一个潜在的重要干预目标。
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