{
  "abstract": "Introduction: Childhood overweight and obesity are major public health concerns in China. The activity displacement hypothesis provides a plausible framework linking electronic-device use, physical activity, and weight status, but its applicability may vary across settings. This study examined overweight/obesity and explored whether physical-activity frequency formed a statistical pathway between daily electronic-device use and overweight/obesity among school-aged children and adolescents in Heilongjiang Province, China.\n\nMethods: This cross-sectional secondary analysis used data collected between October 2024 and April 2025 from participating schools in Daqing, Heihe, and Yichun/Wangkui. Of 26,535 survey records, 14,095 had nonmissing values for the outcome, exposure, age, and prespecified covariates and were retained in the original analysis. The questionnaire recorded average total daily electronic-device use, exercise frequency, nighttime sleep duration, and parental education. Multivariable logistic regression and sex- and grade-stratified models were fitted. To harmonize exposure specification, additional logistic models treated daily electronic-device use continuously, with and without adjustment for physical-activity frequency; school-clustered robust standard errors were examined as a sensitivity analysis. An exploratory bootstrap decomposition with 1,000 iterations estimated direct and indirect statistical associations through physical-activity frequency.\n\nResults: Among 14,095 participants, the prevalence of overweight/obesity was 38.2%. Male sex showed the strongest association (OR = 2.67, 95% CI: 2.48–2.87). A higher physical-activity frequency score (OR = 0.94) and a higher approximate sleep-duration score (OR = 0.96) were inversely associated with overweight/obesity. In the added continuous-exposure analysis, each additional reported hour/day was weakly associated before adjustment for physical activity (OR = 1.019, 95% CI: 1.002–1.035, p = 0.025) but not after adjustment (OR = 1.014, 95% CI: 0.998–1.031, p = 0.085); neither estimate was statistically significant with school-clustered robust standard errors. The exploratory decomposition yielded a direct probability difference of 0.0033 and an indirect probability difference of 0.0011 through physical-activity frequency; the descriptive indirect proportion was 24.35%.\n\nConclusion: The association between reported daily electronic-device use and overweight/obesity was small and sensitive to exposure specification, physical-activity adjustment, and variance estimation. The fitted models were compatible with a small indirect statistical association through physical-activity frequency, but the cross-sectional data do not establish temporal ordering or causal mediation. Longitudinal studies using validated measures are needed.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University",
    "Heilongjiang Academy of Chinese Medical Sciences",
    "Heilongjiang Provincial Maternal and Child Health Hospital",
    "e-Health Research Institute, School of Management, Harbin Institute of Technology",
    "The Second Affiliated Hospital of Harbin Medical University"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Xiaoyu Zhao"
    },
    {
      "affs": [
        0
      ],
      "name": "Zixuan Ru"
    },
    {
      "affs": [
        1
      ],
      "name": "Yanpeng Xie"
    },
    {
      "affs": [
        1
      ],
      "name": "Haojing Li"
    },
    {
      "affs": [
        2
      ],
      "name": "Yuhua Sun"
    },
    {
      "affs": [
        3
      ],
      "name": "Qianqian Zhang"
    },
    {
      "affs": [
        1
      ],
      "name": "Yang Liu"
    },
    {
      "affs": [
        4
      ],
      "name": "Jiaan Yang"
    },
    {
      "affs": [
        1
      ],
      "name": "Xiaojun Cai"
    },
    {
      "affs": [
        0
      ],
      "name": "Hong Qiao"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dhxzb9pvphsjd.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1959738",
  "fulltext_url": null,
  "id": "dhxzb9pvphsjd",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1959738/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2739|Obesity, Physical Activity, Diet"
    ]
  ],
  "openalex": "W7224105793",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1959738/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-28",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/dhxzb9pvphsjd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:24Z",
      "native_id": "10.3389/fpubh.2026.1959738",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1959738/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Obesity, Physical Activity, Diet",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Screen time, physical activity, and overweight/obesity among school-aged children and adolescents in Heilongjiang Province, China: a cross-sectional study",
  "title_text": "Screen time, physical activity, and overweight/obesity among school-aged children and adolescents in Heilongjiang Province, China: a cross-sectional study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:24Z",
  "url": "https://research.draconitic.com/paper/dhxzb9pvphsjd",
  "venue": "Frontiers in Public Health",
  "versions": []
}