Screen time, physical activity, and overweight/obesity among school-aged children and adolescents in Heilongjiang Province, China: a cross-sectional study
5 affiliations
- 1Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University
- 2Heilongjiang Academy of Chinese Medical Sciences
- 3Heilongjiang Provincial Maternal and Child Health Hospital
- 4e-Health Research Institute, School of Management, Harbin Institute of Technology
- 5The Second Affiliated Hospital of Harbin Medical University
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.
Methods: 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.
Results: 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%.
Conclusion: 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.
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BibTeX
@article{zhao2026screen,
title = {{Screen time, physical activity, and overweight/obesity among school-aged children and adolescents in Heilongjiang Province, China: a cross-sectional study}},
author = {Xiaoyu Zhao and Zixuan Ru and Yanpeng Xie and Haojing Li and Yuhua Sun and Qianqian Zhang and Yang Liu and Jiaan Yang and Xiaojun Cai and Hong Qiao},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1959738},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1959738/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Screen time, physical activity, and overweight/obesity among school-aged children and adolescents in Heilongjiang Province, China: a cross-sectional study
AU - Xiaoyu Zhao
AU - Zixuan Ru
AU - Yanpeng Xie
AU - Haojing Li
AU - Yuhua Sun
AU - Qianqian Zhang
AU - Yang Liu
AU - Jiaan Yang
AU - Xiaojun Cai
AU - Hong Qiao
PY - 2026
DA - 2026/10/28
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1959738
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1959738/full
AB - 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. Methods: 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. Results: 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%. Conclusion: 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.
SN - 2296-2565
ER -