Screen time, physical activity, and overweight/obesity among school-aged children and adolescents in Heilongjiang Province, China: a cross-sectional study.

Authors

Xiaoyu Zhao, Zixuan Ru, Yanpeng Xie, Haojing Li, Yuhua Sun, Qianqian Zhang, Yang Liu, Jiaan Yang, Xiaojun Cai, Hong Qiao

Published in

Frontiers in public health. Volume 14. Pages 1959738. Epub Oct 28, 2026.

Abstract

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.
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.
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%.
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.

PMID:
43017045
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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