Elsevier

Preventive Medicine

Volume 53, Issues 4–5, October–November 2011, Pages 316-320
Preventive Medicine

Screen time, physical activity and mental health among urban adolescents in China

https://doi.org/10.1016/j.ypmed.2011.09.002Get rights and content

Abstract

Objective

To test the association between screen time (ST), physical activity (PA) and self-reported psychological problems among urban adolescents aged 11 to 16 years.

Methods

In 2010, total 5003 boys and girls were analyzed from 4 junior high schools in Bengbu city of China. The Depression Self-rating Scale for Children, Screen for Child Anxiety Related Emotional Disorders and School Life Satisfaction Rating Questionnaire were administered to obtain information on current mental health. Self-reported ST, PA and dietary intake were also assessed. Logistic regression analyses were used to explore the effects of ST and PA on psychological problems.

Results

Approximately 26.1% of adolescents were exposed to ST for more than 2 h/day. High ST was a risk factor for depressive symptoms (odds ratio (OR) = 1.52, 95% confidence interval (CI): 1.31–1.76), anxiety symptoms (OR = 1.36, 95%CI: 1.18–1.57) and school life dissatisfaction (OR = 2.07, 95%CI: 1.79–2.38). Sufficient vigorous PA (VPA) was a protective factor for depressive symptoms (OR = 0.78, 95%CI: 0.67–0.91) and school life dissatisfaction (OR = 0.73, 95%CI: 0.62–0.85). The combination of high ST and insufficient VPA was associated with the highest prevalence of various psychological problems.

Conclusions

High ST and insufficient VPA interact to increase depressive, anxiety symptoms and school life dissatisfaction among Chinese adolescents.

Highlights

► More than 1/4 adolescents in China were exposed to screen time > 2 h/day. ► Screen time and physical activity were independently associated with mental health. ► Interactions between the two factors increase additional risk for mental health.

Introduction

Mental health disturbances in children and adolescents, such as non-clinical depression and anxiety traits are key health issues in childhood and adolescence and, therefore, are of great public health concern (Hölling et al., 2008). Multiple risk behaviors have been increasingly linked with mental health. Sedentary behavior, such as watching television and using a computer, is prevalent in adolescence (Rey-López et al., 2010, Hamar et al., 2010). Over the past 20 years, US children have been participants in what is called, a “mass media explosion.” Screen time (ST) has been associated with obesity and obesity-related health problems (Martínez-Gómez et al., 2010, Vicente-Rodríguez et al., 2008), multiple risk behaviors (Carson et al., 2011), social isolation (Bickham and Rich, 2006), and reduced academic performance (Sharif and Sargent, 2006). In 2001, the American Academy of Pediatrics released guidelines recommending that ST (television and computer) in children and adolescents be limited to no more than 2 h/day (American Academy of Pediatrics, 2001).There is an absence of information on ST in Chinese adolescents and subsequently, there is a limited amount of existing literature on ST and various psychological problems in China.

Physical activity (PA) as a preventive behavior has gained increased attention for prevention of premature disease, disability, and its contribution to quality of life (Warburton et al., 2006). Recently, in addition to the positive role of PA in relation to the prevention of specific diseases and other health conditions, this impression has been reinforced by scientific evidence linking regular PA to an array of mental health benefits (Ahn and Fedewa, 2011). Several studies have found participation in PA for adolescents has been associated with decreased anxiety and depression (De Moor et al., 2006), improved academic performance (Kantomaa et al., 2010), increased self-esteem, decreased anger, decreased psychological stress and increased in quality of life/perceived life satisfaction (Valois et al., 2004). However, ST was seldom considered in these studies.

Some evidence suggests that ST is inversely associated with PA (Motl et al., 2006); although other data have shown that they are separate constructs and not functional opposites (Taveras et al., 2007). Therefore, it remains unclear if the association of ST exposure on psychological function is caused by a lack of PA or if sedentary behavior per se is an independent risk factor.

China, the most populous country in the world, is undergoing a rapid economic and lifestyle transition from traditional agricultural society to an industrialized community. With the popularity of television and computer, Chinese adolescents spend more time on watching TV and computer usage, and less time in PA than ever before. Thus, it is of unique importance to explore the interaction effect of ST and PA on mental health among adolescents in the current context of Mainland China.

The current study hypothesized that ST and low PA would be independently associated with depressive, anxiety symptoms and school life dissatisfaction. Furthermore, the study also examined the associations between various combinations of vigorous PA, ST levels and these psychological problems among Chinese adolescents.

Section snippets

Participants

In May 2010, a school-based cross-sectional survey was conducted in the junior high schools in Bengbu city of Anhui Province. The multi-stage stratified cluster random sampling method was applied to obtain study subjects. Step 1, 3 districts were randomly selected in urban areas. Steps 2, in 2 selected districts, 1 junior high school in each district were randomly sampled as the target schools. And in the other 1 district, because of limited number of students in junior high schools, we

Results

Table 1 represents characteristics of the sample split into two levels of ST. Approximately 26.1% of the sample reported ST for > 2 h/day. Adolescents who had high ST were associated with boys, 8th-grade students, not from nuclear family, lower perceived socioeconomic status, obesity and unhealthy dietary pattern (lower fruit and vegetable consumption and more fizzy drinks).

There was a positive association between ST and depressive, anxiety symptoms and school life dissatisfaction but an inverse

Discussion

The main findings from this study demonstrate that ST and VPA level independently associated with self-reported psychological problems in Chinese adolescents. In addition, high ST and insufficient VPA interact to increase psychological problems. The results also suggest that ST and VPA operate independently and also synergistically to increase risk. The findings for mental health were consistent with previous studies (Ussher et al., 2007). Without effective treatment, adolescents with mental

Conclusions

This study demonstrates that high ST and insufficient VPA interact to increase psychological problems among Chinese adolescents. Given that high ST and insufficient VPA both independently predicted depressive, anxiety symptoms and school life dissatisfaction, our results might be meaningful for school health workers. Considering that PA levels in adolescence could predict mental health in adulthood, public health policy should focus on reducing sedentary time and maintaining sufficient VPA in

Conflict of interest

The authors declare that there are no conflicts of interest.

Acknowledgments

The study was carried out with financial support of the National Natural Science Foundation of China (grant numbers 30972494). The authors are grateful to all the colleagues working in Department of Maternal and Child Health of Anhui Medical University, Bengbu Center for Disease Control and Prevention and Chinese Journal of School Health for help in data collection, all the teachers who readily consented to carry out the study during school hours, as well as to all the participated adolescents.

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