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Knell G, Durand CP, Kohl HW, Wu IHC, Pettee Gabriel K. Prevalence and Likelihood of Meeting Sleep, Physical Activity, and Screen-Time Guidelines Among US Youth. JAMA Pediatr. 2019;173(4):387–389. doi:10.1001/jamapediatrics.2018.4847
Sleep, physical activity, and screen-time behaviors among adolescents are risk factors for physical health (eg, obesity), mental and emotional health, behavioral outcomes (eg, tobacco use), and performance-based outcomes (eg, academic achievement).1-3 Accordingly, it is recommended that children (age 6-12 years) sleep 9 to 12 hours and adolescents (age 14-18 years) sleep 8 to 10 hours a night and that both groups accumulate at least 1 hour of moderate-intensity or vigorous-intensity aerobic physical activity and limit screen time (ie, exposure to all screen-based digital media) to less than 2 hours within a 24-hour period.3,4 Meeting recommendations for all 3 behaviors may have a greater association with health outcomes than meeting any 1 recommendation in isolation. However, the prevalence and likelihood of US adolescents meeting these recommendations in combination across various sociodemographic factors is unknown.
Cross-sectional data from the 2011, 2013, 2015, and 2017 cycles of the Youth Risk Behavior Surveillance Survey were used. Multiple imputation by chained equations were used to address missing data issues and to derive the final analytic data set including all participants. Determination of recommendations met was based on the behavioral targets defined.
Prevalence estimates and the adjusted log odds of concurrently achieving the recommendations for sleep, physical activity, and screen time were estimated by sex and in strata by age, race/ethnicity, body mass index, risky behaviors, reported asthma diagnosis, and presence of depression symptoms. The study protocol was reviewed by The University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects and received exempt status. Data are deidentified, and informed consent from participants was not required. All analyses were conducted using Stata version 15.1 (StataCorp), and results were considered significant at the .05 level (2-sided).
A total of 59 397 participants were included in the unweighted data set (Table). Overall, 5.0% (95% CI, 4.6-5.4) of US adolescents met recommendations for sleep, physical activity, and screen time concurrently. Stratified analysis by sex revealed a lower proportion of girls (3.0% [95% CI, 2.7%-3.3%]) than boys (7.0% [95% CI, 6.5%-7.5%]) met all 3 behavioral recommendations. The observed sex differences were consistent across all other subgroups of interest.
There were significant disparities in the odds of meeting all 3 behavioral recommendations by age (for participants of both sexes who were 16 years old: adjusted odds ratio [aOR], 0.77 [95% CI, 0.63-0.94] and 17 years old: aOR, 0.54 [95% CI, 0.44-0.66], compared with those 14 years and younger), race/ethnicity (non-Hispanic black participants: aOR, 0.31 [95% CI, 0.25-0.39]; Hispanic/Latino participants: aOR, 0.66 [95% CI, 0.58-0.75]; non-Hispanic Asian participants: aOR, 0.37 [95% 0.25-0.55], compared with non-Hispanic white participants), body mass index (participants who were overweight: aOR, 0.80 [95% CI, 0.68-0.95]; participants with obesity: aOR, 0.57 [95% CI, 0.47-0.69], compared with participants of normal weight), marijuana use (aOR, 0.81 [95% CI, 0.69-0.96]), and depressive symptoms (aOR, 0.44 [95% CI, 0.38-0.50]). Girls who reported alcohol use had 28% (95% CI, 7%-44%; aOR, 0.72 [95% CI, 0.56-0.93]) lower odds of meeting all the recommendations concurrently compared with girls who did not use alcohol.
Study findings indicate that only 5% of US high school students (3% of girls; 7% of boys) spend the optimal time sleeping and being physically active while limiting screen time, with important disparities shown by vulnerable subgroups. These findings demonstrate the need for future studies clarifying the role of parenting style and home environment. The multicomponent nature of these behaviors supports investigating systems-level interventions aimed at coordinating behavior changes at multiple levels of the social-ecological model.5 Future research should also evaluate the synergistic associations between these behaviors, particularly if spending the optimum time in 1 behavior leads to more or less time in the other behaviors.
Self-reported data used in these analyses may be biased. This supports the need for device-based evaluations of the 24-hour cycle, including differences in behavioral profiles on weekdays and weekends.
Finally, findings have high clinical relevance, and suggest that physicians should be encouraged to use the 5 A’s Behavior Change Framework and ask about these behaviors at every patient encounter, advise patients and parents on the importance of the behaviors, assess potential barriers to assist with counseling on best practices, and arrange for follow-up to reassess behaviors or refer to specialists as needed.6
Accepted for Publication: October 4, 2018.
Corresponding Author: Gregory Knell, PhD, Michael & Susan Dell Center for Healthy Living, Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 6011 Harry Hines Blvd, Suite V7.116A, Dallas, TX 75239 (email@example.com).
Published Online: February 4, 2019. doi:10.1001/jamapediatrics.2018.4847
Author Contributions: Dr Knell had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Knell, Durand, Kohl, Pettee Gabriel.
Acquisition, analysis, or interpretation of data: Knell, Durand, Wu, Pettee Gabriel.
Drafting of the manuscript: Knell, Durand, Wu.
Critical revision of the manuscript for important intellectual content: Knell, Durand, Kohl, Pettee Gabriel.
Statistical analysis: Knell, Durand, Wu.
Supervision: Durand, Kohl, Pettee Gabriel.
Conflict of Interest Disclosures: None reported.
Funding/Support: Financial support was via a postdoctoral fellowship at the University of Texas School of Public Health Cancer Education and Career Development Program supported by the National Cancer Institute/National Institutes of Health (grant T32 CA57712; Dr Knell).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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