综合干预对儿童视屏时间影响的研究

Effect of comprehensive intervention on children's screen time

摘要

目的 分析综合干预项目(DECIDE-children)对儿童视屏时间的影响及可能的中介因素,为控制儿童视屏时间提供依据。方法 于2018年9月至2019年6月,在北京、山西、新疆的24所小学进行整群分层随机抽样,纳入1392名四年级学生,以1∶1的比例分为干预组或对照组,干预组儿童开展为期一学年的饮食运动行为综合干预,对照组参加常规教学.使用基线和终期随访问卷调查儿童视屏时长和运动与视屏知识、家长对儿童视屏时间的限制相关指标.使用线性回归及广义线性回归模型进行关联研究,非参数百分位Bootstrap法检验中介效应,调整基线调查的年龄和性别。结果 在1392名调查对象中,基线调查时视屏时间≥2h/d的儿童有289人(20.8%).与基线结果相比,终期干预组中家长限制儿童视屏时间不超过2h/d的比例、儿童的运动与视屏知识满分率增加大于对照组(OR_adj=1.64、2.27);儿童视屏时间≥2h/d的比例减少大于对照组(OR_adj=0.57)(均P<0.05).中介效应检验结果显示,家长限制儿童视屏时间不超过2h/d的中介效应占总效应比例为4.01%,儿童运动与视屏知识满分的中介效应占比为11.40%(均P<0.05)。结论 该综合干预项目可以增加儿童视屏时间达到指南标准的比例,其中家长限制儿童视屏时间不超过2h/d和儿童的运动和视屏知识满分发挥了部分中介作用.

Abstract

Objective To analyze effect of a comprehensive intervention project DECIDE-children on children's screen time and to explore potential mediating factors, so as to provide a basis for controlling children's screen time. Methods A cluster-stratified random sampling was conducted in 24 primary schools in Beijing, Shanxi Province and Xinjiang Uygur Autonomous Region. A total of 1392 fourth-grade students were enrolled and they were divided into intervention group or control group at a 1∶1 ratio. The children in the intervention group received a comprehensive intervention on diet and physical activities for one academic year, while those children in the control group remained to receive regular teaching activities. The data such as children's average daily screen time, knowledge about exercise and screen time, as well as parental limitations on children's screen time were collected by using a questionnaire at baseline and final follow-up survey. Linear regression and generalized linear regression models were applied for association analysis. The non-parametric percentile Bootstrap method was used to test mediating effects to adjust age and gender at baseline. Results At baseline, among the 1392 study subjects, 289 children (20.8%) had a daily screen time ≥2 hours. Compared to the baseline, at the final follow-up survey, the proportion of the parents who limited children's screen time less than 2h/d (OR_adj=1.64, P=0.002) and the proportion of the children who achieved full scores in exercise and screen knowledge (OR_adj=2.27, P<0.001) in the intervention group increased greatly. And decrement in the proportion of the children with a screen time ≥2h/d in the intervention group was greater than the control group (OR_adj=0.57, P<0.001). The mediating effect test shown that the mediating effect of parental limitations on children's screen time less than 2h/d accounted for 4.01% of total effect (P<0.05), while the mediating effect of children's exercise and screen knowledge accounted for 11.40% of total effect (P<0.05). Conclusion This comprehensive intervention project can improve the proportion of children with a daily screen time meeting the guideline recommendation, of which, parental limitations on children's daily screen time and children's knowledge of exercise and screen exert partial mediating roles in reducing children's screen time.

关键词

视屏时间 / 家长限制 / 儿童知识 / 干预 / 中介效应

Key words

screen time / parental limitation / children knowledge / intervention / mediating effect

参考文献

[1] Jones A, Armstrong B, Weaver R G, et al. Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis[J]. Int J Behav Nutr Phys Act, 2021, 18(1): 126-145.

[2] Nagata J M, Abdel Magid H S, Pettee Gabriel K. Screen Time for Children and Adolescents During the Coronavirus Disease 2019 Pandemic[J]. Obesity (Silver Spring), 2020, 28(9): 1582-1583.

[3] 唐蕾, 赵勇, 曾茂, 等. 视屏时间与儿童肥胖关系的定性循证研究[J]. 中国妇幼健康研究, 2022, 33(10): 7.

[4] World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour[M/OL]. Geneva: World Health Organization, 2020: 104 [2024-1-15]. https://iris.who.int/bitstream/handle/10665/336656/9789240015128-eng.pdf?sequence=1.

[5] 中国儿童青少年身体活动指南制作工作组. 中国儿童青少年身体活动指南[J]. 中国循证儿科杂志, 2017, 12(6): 401-409.

[6] 刘湘, 刘征, 李燕琴. 2020年寒假期间西安市276例3~12岁儿童电子屏幕暴露的研究[J]. 中国妇幼健康研究, 2021, 32(10): 7.

[7] 成雪, 于冬梅, 赵丽云, 等. 2016-2017年中国中小学生电子屏幕使用现状[J]. 卫生研究, 2022, 51(3): 347-352.

[8] Zhu Z, Tang Y, Zhuang J, et al. Physical activity, screen viewing time, and overweight/obesity among Chinese children and adolescents: an update from the 2017 physical activity and fitness in China - the youth study[J]. BMC Public Health, 2019, 19(1): 197-204.

[9] Yan Y, Qi J, Yin H. Screen time among school-aged children of aged 6-14: a systematic review[J]. Glob Health Res Policy, 2023, 8(1): 12-30.

[10] Liu Z, Gao P, Gao A, et al. Effectiveness of a Multifaceted Intervention for Prevention of Obesity in Primary School Children in China: A Cluster Randomized Clinical Trial[J]. JAMA Pediatrics, 2022, 176(1): e214375- e214375.

[11] Shi B, Choirat C, Coull B A, et al. CMAverse: A Suite of Functions for Reproducible Causal Mediation Analyses[J]. Epidemiology, 2021, 32(5): 20-22.

[12] 拾翔宇, 张士城, 丁乾, 等. 云南省10~12岁不同体质水平小学生能量平衡相关行为及其影响因素的差异研究[J]. 哈尔滨体育学院学报, 2022, 40(3): 90-96.

[13] Nguyen P, Le L K, Nguyen D, et al. The effectiveness of sedentary behaviour interventions on sitting time and screen time in children and adults: an umbrella review of systematic reviews[J]. Int J Behav Nutr Phys Act, 2020, 17(1): 117.

[14] Alshloul M N. Oral Health Knowledge, Attitude, and Practice Among School Children in Abha-Saudi Arabia[J]. J Sch Nurs, 2023, 39(4): 295-304.

[15] 马莹, 苏彬彬, 霍家康, 等. 全国7省父母视屏时间和限制行为对6~17岁儿童青少年视屏时间的联合影响研究[J]. 中国儿童保健杂志, 2021, 29(10): 1063-1067.

[16] Goncalves W S F, Byrne R, Viana M T, et al. Parental influences on screen time and weight status among preschool children from Brazil: a cross-sectional study[J]. Int J Behav Nutr Phys Act, 2019, 16(1): 27-34.

[17] Neshteruk C D, Tripicchio G L, Lobaugh S, et al. Screen Time Parenting Practices and Associations with Preschool Children's TV Viewing and Weight-Related Outcomes[J]. Int J Environ Res Public Health, 2021, 18(1): 7359-7367.

[18] Veldman S L C, Altenburg T M, Chinapaw M J M, et al. Correlates of screen time in the early years (0-5 years): A systematic review[J]. Prev Med Rep, 2023, 33(1): 102214-102230.

基金资助

国家自然科学基金项目(81973053)

国家重点研发计划项目(2016YFC1300204)