Associations between socioeconomic status and screen time among children and adolescents in China: A cross-sectional study

PLOS ONE RESEARCH ARTICLE Associations between socioeconomic status and screen time among children and adolescents in China: A cross-sectional study Youzhi Ke1, Sitong Chen2, Jintao Hong3, Yahan Liang1, Yang Liu ID1,4* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 School of Physical Education, Shanghai University of Sport, Shanghai, China, 2 Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia, 3 Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China, 4 Shanghai Research Center for Physical Fitness and Health of Children and Adolescents, Shanghai, China * Abstract Background OPEN ACCESS Citation: Ke Y, Chen S, Hong J, Liang Y, Liu Y (2023) Associations between socioeconomic status and screen time among children and adolescents in China: A cross-sectional study. PLoS ONE 18(3): e0280248. https://doi.org/ 10.1371/journal.pone.0280248 Editor: Md. Tanvir Hossain, Khulna University, BANGLADESH Received: July 3, 2022 Accepted: December 24, 2022 Published: March 23, 2023 Copyright: © 2023 Ke et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work was supported by grants from the National Social Science Foundation of China (No.19BTY077), the Program for Overseas Highlevel talents at Shanghai Institutions of Higher Learning (Dr. Yang Liu), and Shanghai Key Laboratory of Human Performance (Shanghai University of Sport, No.11DZ2261100). The funders had no role in the study design, data Socioeconomic status (SES) is an important determinant of screen time (ST) in children and adolescents, however, the association between SES and ST is not fully understood in China. This study aimed to investigate the association between SES and ST (operationalized as meeting the ST guidelines; no more than 2 hours per day) in Chinese children and adolescents. Methods Cross-sectional data of 2,955 Chinese children and adolescents aged 8 to 17(53.4% girls) were used. SES was measured using indicators of parental education and perceived family wealth. ST was assessed with detailed items from the Health Behaviour School-aged Children survey questionnaires. Descriptive statistics and a Chi-square test were used to report the sample characteristics and analyse ST differences across different sociodemographic groups. A binary logistic regression was then applied to analyse the association of SES indicators with ST in children and adolescents. Results Overall, 25.3% of children and adolescents met the ST guidelines. Children and adolescents with higher parental education levels were 1.84 [95% CI 1.31–2.57; father] and 1.42 [95% CI 1.02–1.98; mother] times more likely to meet the ST guidelines than those with lower parental education levels. Associations between SES and ST varied across sex and grade groups. Moreover, the associations of SES with ST on weekdays and weekends were different. Conclusions This study demonstrated the association between SES and ST in children and adolescents, highlighting the importance of targeting children and adolescents with low SES levels as an PLOS ONE | https://doi.org/10.1371/journal.pone.0280248 March 23, 2023 1 / 15 PLOS ONE collection, analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Associations between socioeconomic status and screen time intervention priority. Based on our findings, specific interventions can be tailored to effectively reduce ST. Future studies are encouraged to use longitudinal or interventional designs to further determine the association between SES and ST. Introduction Sedentary behaviour is defined as any waking behaviour characterized by energy of �1.5 metabolic equivalents undertaken in a sitting, reclining, or recumbent posture [1]. Screen time (ST), which refers to time spent in watching TV, playing computer games, or playing video games in another way, is an important source of sedentary behaviour, although it does not necessarily reflect total sedentary behaviour time [2]. High levels of ST have become a widespread public health concern [3, 4], as it has been recognized as a health risk factor [5, 6] independent of physical activity (PA) levels [7]. The Canadian 24-Hour Movement Guidelines recommend that children and adolescents limit daily ST no more than 2 hours [8, 9]. Evidence has shown that excessive ST in children and adolescents is associated with various unhealthy behaviours such as irregular sleep [10, 11], eating disorders, poor eating habits [12, 13], as well as physical health outcomes, including obesity, cardiovascular disease, musculoskeletal disease, and higher all-cause mortality [14, 15]. In addition, excessive ST is also strongly associated with a decline in children’s cognitive and social skills [16]. Despite increasing health awareness of ST, high levels of ST remain prevalent in children and adolescents [17, 18]. Guthold et al. compared data from 34 countries, and they found that the percentage of children and adolescents who reported 3 hours or more of ST per day exceeded 30% [19]. In the United States, less than 20% of children and adolescents failed to meet the ST guidelines [20], with ST up to 7.7 hours per day [21]. A similar disappointing situation has been reported in Canada, where children and adolescents spend an average of 8.6 hours per day being sedentary [22]. Children and adolescents also reported an increase in ST in low- and middle-income countries. For example, in China, only 25.5% of children and adolescents meet the ST guidelines [23], with TV viewing time increased from 1 hours per day in 1997 to 1.43 hours per day in 2004 [24], then remaining relatively stable between 2004 and 2011 [25]. ST has become an independent factor negatively affecting the health of children and adolescents [26]. ST habits that develop during childhood and adolescence tend to be maintained in later life, which suggests that ST in early life can predict future ST habits and health outcomes [27, 28]. Given this, ST interventions for children and adolescents should be carried out as early as possible [29]. Researchers studying Chinese population have also found that excessive ST is associated with psychological, emotional, and social problems among children and adolescents [30, 31]. Despite these results, little is known about the association between socioeconomic status (SES) and ST in Chinese children and adolescents. With the ongoing advancement of technology and rapid changes in lifestyles, ST including watching TV or playing with a mobile phone has become an important part of daily life in young people [32]. Due to (...truncated)