Background Early childhood is a foundational period for establishing lifelong sleep health habits. In the context of increasing digital device use from infancy, understanding how screen use disrupts sleep is essential for informing public health guidelines and supporting families to develop healthy digital technology use and sleep routines. The present study seeks to examine how digital technology use, differentiated by device type and timing, relates to sleep patterns and problems in children aged 6-months to 6-years. Methods Cross-sectional, secondary data analysis of the first year (2023-24) online survey from the four-year longitudinal Australian Children of the Digital Age (ACODA) Study. Participants were 3,324 caregivers of Australian children aged between 6-months and 6-years. Caregivers completed an online survey assessing socio-demographics, child sleep and napping patterns, sleep problems, sleep disturbance and daytime impairment, and digital technology use. Screen use was assessed by parent report of device type (handheld devices vs. static devices), duration of use, bedroom use, and frequency of using devices in the 2-hours prior to bed in the evening. Results Almost 60% of 1-year-olds adhered to National 24-hour screen use guidelines, however, fewer than half of children across all other age groups adhered to these same guidelines, with adherence lowest among 2- and 3-year-olds. Handheld devices were the most common device-types used in bedrooms. Usage in bedrooms increased with age, reaching almost 40% among 5-year-olds. In adjusted models, greater handheld device use and frequent evening screen exposure were associated with shorter night sleep duration, later sleep time, and increased sleep problems across most age groups. The effects of static device use on sleep varied by age. Conclusion This study highlights that children in Australia are exposed to digital technologies early and often, and that there may be differential effects on sleep depending on device type, timing and age leading to reductions in sleep duration and later sleep time in children aged 6-months to 6-years. Findings support the need for clearer public health messaging and further research using objective measures to better understand mechanisms to inform policy and practice.

Children's screentime is commonly viewed as passive and problematic. Current focus on reducing the time children spend using digital technologies has meant screentime is quantified often at the expense of considering the quality of children's digital interactions. These 'clocking' practices tend to overlook the potential for children's digital play to foster movement and relationships with others. Building upon childhood scholarship that has suggested children's experiences of time are not always linear, nor in line with adults' expectations, we consider alternative temporalities in relation to children's screentime. We explore video data from weekly digital playgroups in the Children's Technology Play Space (CTPS), a living lab for the Australian Research Council Centre of Excellence for the Digital Child, focused on movement to highlight that children's play can intersperse between the digital and the physical, and at times can concurrently be both. As such, we challenge the assumption that screentime is always sedentary. Considering how interactions between children, adults, nonhuman things, and digital technologies such as Augmented Reality (AR) enabled varied movement and imagination, we invite conceptions of children's sedentary screentime to be re-thought.

While there is growing evidence on 24-hour movement behaviours (physical activity, sedentary behaviour, and sleep) in non-displacement settings, understanding these behaviours among displaced children remains limited. This scoping review explored evidence on 24-hour movement behaviours, including active play and health among forcibly displaced children (birth to 12 years) affected by conflict or natural disasters. We followed JBI guidelines and PRISMA extensions for scoping reviews. Seven databases (PubMed, Medline, Web of Science, Scopus, CINAHL, PsycINFO, and ProQuest) were searched for peer-reviewed studies published in English between January 2000 and July 2024. We used the Population, Concept and Context framework to set eligibility criteria based on our research questions. Two independent reviewers screened the records, and the first author extracted the data, which was then double-checked by a co-author. Data were analysed using narrative synthesis. A total of 28 articles met the inclusion criteria, all of which relied on parent- or self-reports. Forcibly displaced children generally had low levels of physical activity, high sedentary behaviour, including excessive screen time, and disrupted sleep. Girls were less active than boys. An increased risk of obesity and developmental delays were found to be prevalent among forcibly displaced children. Disaster-related stress negatively associated with muscular strength, whereas child-friendly spaces, structured activities, and physical education enhanced the resilience and well-being of displaced children. However, a limited number of child-friendly play spaces were observed in displacement settings. This scoping review highlights the urgent need to promote healthy levels of 24-hour movement behaviours and recognise the right to play among forcibly displaced children, considering limited active play spaces in such settings. Future research should prioritise mixed methods, including device-based measures, particularly in low- and middle-income countries, to gain better insights and inform humanitarian responses.

Despite the vast array of app choices available to children and evidence of a high prevalence of persuasive design features (e.g., rewards, character pressure, and aesthetic manipulation) within these apps, little is known about how, and to what extent, these design elements influence children’s digital app play. The current study investigated the effects of app persuasive design and children’s self‐regulation, and their interaction, on children’s ability to disengage from digital devices. The study adopted a three‐arm acute experimental design, wherein 73 children, aged 3–5 years, were randomly assigned to engage with one of three apps (of high, moderate, or low persuasive design), with a novel “digital disengagement” paradigm that measured the time to disengage from app play and researcher‐rated degree of independent disengagement. Children’s self‐regulation outside of digital contexts was also assessed. General linear models were used to compare the main effects of and interaction between app condition and child self‐regulation on children’s digital disengagement. Given similar disengagement means in high and moderate conditions, these were collapsed and compared with the low condition. Significant interactions between persuasive design (moderate‐high and low) and self‐regulation (high and low) were found for disengagement time and degree of independent disengagement for one of the two self‐regulation measures. Young children with higher self‐regulation were able to disengage from the digital device regardless of persuasive design level (even at moderate‐high levels). Children with lower self‐regulation disengaged more easily and promptly under low persuasive design but took longer and needed more support to disengage when exposed to moderate‐high persuasive design. This first‐of‐its‐kind study offers novel insight into which children are more susceptible to extended digital engagement due to persuasive design. The study highlights the importance of considering the design elements within apps together with the child’s abilities to aid families make more informed digital choices.

Background: Regular engagement in physical activity (PA), reduced screen-based sedentary time, or adequate sleep duration is independently linked to cognitive benefits, but such associations in an integrated manner have been rarely investigated with longitudinal design, especially among preschoolers. Methods: This longitudinal study explored associations between 24-hour movement guideline adherence and cognitive outcomes in 157 Australian preschoolers (M = 4.48 years, SD = 0.35, 52.2 % female). Using baseline parent-reported movement behaviours and direct cognitive assessments at 7-month and 1-year follow-up, we applied linear mixed regression models, adjusted for age, sex, maternal education, family income, and continuous PA, sleep, and screen time measures. Results: Meeting PA guidelines alone significantly predicted higher school readiness at 7 months (Estimate = 22.42, 95 % CI 9.56-35.28, p = 0.001, d = 1.40) and 1-year follow-up (Estimate = 22.54, 95 % CI 13.29-31.78, p < 0.001, d = 1.41), and enhanced cognitive flexibility at 1-year follow-up (Estimate = 4.01, 95 % CI 2.10-5.93, p < 0.001, d = 0.94). Sleep guideline adherence also predicted higher flexibility 1-year follow-up (Estimate = 1.82, 95 % CI 0.66-2.97, p = 0.002, d = 0.43). All other beta estimates were non-significant after Bonferroni correction. Only 17.2 % of the involved preschoolers met all guidelines. Conclusion: Supporting adherence to the 24-Hour Movement Guidelines could enhance school readiness within one academic year.

Screen-based devices have become a pervasive feature in the lives of young children. Understanding the ecological influences determining young children’s screen use is imperative for promoting healthy screen habits. While individual studies have examined various factors influencing children’s screen use across the early years, few studies have explored multiple ecological influences simultaneously. This research examines longitudinal associations between children’s home environment, parent management practices and neighbourhood influences on children’s screen time, through 4 to 7 years of age. Analyses draw on data from 2485 children in the Infant Cohort of a nationally representative sample of children and families participating in the Longitudinal Study of Australian Children (LSAC). Bivariate and multiple linear regression models were developed to assess contributions of child, parenting, home and neighbourhood variables, measured at 4–5 years, in predicting children’s daily screen time at 6–7 years. Girls had lower screen time than boys at 6–7 years of age. Higher household socio-economic status, child participation in home learning activities and out-of-home extra-curricular activities, parenting consistency, and screen management practices including restricted bedroom access, presence and enforcement of screen rules, and parent-reported ease in managing screen time were also all significant predictors of lower daily screen time at age 6–7 years. Neighbourhood factors including liveability, sense of belonging and area-based socio-economic index were not significant predictors of children’s screen time, after child, parenting and home factors were included in the model. Providing guidance to families about building healthy screen practices from an early age should focus on parenting consistency and management of screen time, as well as responsiveness to engage children in other activities. Home routines on screen use, when consistently managed, can provide young children with opportunities to learn to self-regulate their own screen use behaviours from an early age and build healthy screen time habits.

BACKGROUND:Encouraging healthy eating and physical activity in children has long-term benefits for their health and development, however many do not meet the requirements for fruit and vegetable consumption, or physical activity. Experiential learning (EL) has been shown to improve children's healthy eating and physical activity-related knowledge, attitudes, and behaviour. Children's museums provide opportunities for hands-on EL activities that can engage families. This study examined stakeholder perspectives on the perceived feasibility, acceptability, fidelity and impact of an EL health-promoting program in a children's museum. METHODS:A qualitative case study was conducted at the Early Start Discovery Space, a university-based children's museum, in Australia. The study involved implementing a 4-week Healthy Living program comprising EL activities related to food and movement for children aged 0-10 years. Perceived feasibility, acceptability, fidelity and impact were assessed through focus groups and observations. Focus groups (23 participants, 17 caregivers and 6 museum staff) were conducted post-implementation. Focus groups were audio-recorded, transcribed verbatim and analysed using thematic analysis. 15 HL sessions were observed throughout implementation. RESULTS:Stakeholders perceived that the HL program was feasible and acceptable. As a result of consultation between researchers and museum staff, the HL program was easily implemented in the museum. Stakeholders suggested that children and their carers enjoyed the HL activities and were engaged in the HL activities. Aspects of fidelity were explored and showed that most sessions were delivered as intended, however, the delivery of the key messages was suboptimal. Perceived changes in children's knowledge, attitudes behaviour relating to healthy eating and physical activity were minimal. CONCLUSIONS:Key stakeholders (museum staff and caregivers) provided insights regarding perceived feasibility and acceptability of the HL program delivered in the children's museum. Preliminary findings highlight the potential of children's museums as a setting for EL health eating and physical activity programs. Further, this study highlights the significance of stakeholder engagement, collaboration, and incorporation of hands-on and enjoyable activities to promote healthy habits in children. Future studies, with larger sample sizes, should be conducted to extend the results from this study.

There are no reviews describing current measurement protocols and accelerometer processing decisions that are being used in 24-h MovBeh studies, across the lifespan. We aim to synthesise information on methods for assessing 24-h movement behaviors using accelerometry across all age groups. PubMed, PsycINFO, SPORTDiscus, and EMBASE were searched until December 2022. Observational or intervention reports describing accelerometry methods in studies on combinations of movement behaviors, with a 24-h protocol across all ages, were included. This review included 102 studies: three studies in toddlers, 15 in preschoolers, 17 in children, 23 in adolescents and 44 in adults and older adults. The Actigraph GT3X was the most commonly used device; the majority of the included reports collected data for seven days, including three weekdays and one weekend day, with a ≥ 16 h/day per 24-h period for valid data. The criteria for non-wear time varied between ≥ 20 and ≥ 90 min of consecutive zero counts, depending on the age group. The most common epoch used was 15 or 60 s for youth and adults, respectively. The choice of sleep algorithms and SB/PA cut-points, of the included reports, depended on age and the original validation/calibration study. To deal with non-compliant participants, exclusion of non-compliant participants from the analysis was most frequently used. Most studies used diaries/logs to complement the accelerometer data. Accelerometer protocols and methodological decisions varied considerably between reports. Therefore, consensus on methodological decisions is needed to improve precision and comparability between studies, which is challenging given the complexity of the procedures, the number of available brands and types of accelerometers, and the plethora of programming options.

Background : Understanding the factors influencing 24-hour movement behaviors is important for designing appropriate health promotion strategies. We examined the multidimensional correlates of physical activity, sedentary behavior, screen time, and sleep among children under 5 years of age in Ethiopia. Methods : Cross-sectional study conducted in Adama and Lume district, Ethiopia. Children were recruited from urban kindergartens and rural villages. Physical activity, sedentary time, and sleep were assessed using accelerometry. Screen time and correlates were parent reported. Variables were selected a priori, using the social ecological model and considering country context. Linear mixed models were used to test associations between child-, family-, and community-level correlates and time spent in 24-hour movement behaviors, accounting for clustering effect. Results : Four hundred and thirty children participated (mean age 4.2 [0.6] y). Girls spent less time in total of physical activity (TPA) and moderate- to vigorous-intensity physical activity (MVPA) and more time sedentary than boys. Children who spent more time outdoors had higher TPA and MVPA, longer sleep duration, and shorter sedentary and screen time. Children of educated parents had lower TPA and MVPA and higher sedentary time than those with no formal education. Children of parents who reported using a screen device with their child for educational purposes spent less time in MVPA, had shorter sleep, and had more screen time than those who did not. Rural children had higher TPA and MVPA, longer sleep, and shorter sedentary and screen time than urban children. Conclusion : We identified key correlates of 24-hour movement behaviors in Ethiopian children. Designing tailored health promotion strategies to support healthy levels of movement behaviors, particularly in urban areas, is needed.

BACKGROUND:There is little evidence on the associations between 24-h movement behaviours and health in children from low-income countries. We examined the associations of physical activity, sedentary behaviour, screen time and sleep with adiposity, motor skills and executive functions among 3- and 4-year-old children in Ethiopia. METHODS:Cross-sectional study conducted in Adama city and Lume Woreda, Oromia region, Ethiopia. We recruited children from kindergartens and rural Kebeles or villages. Children's time spent in physical activity, sedentary behaviour and sleep were measured using hip worn ActiGraph accelerometers. Children's screen time was parent-reported. Linear mixed models tested associations of 24-h movement behaviours with adiposity (BMI z-score), motor skills (NIH Toolbox) and executive functions (Early Years Toolbox). All models accounted for child sex, age and dietary diversity as fixed effects and clustering of children within kindergarten/villages as a random effect. RESULTS:A total of 430 children participated (4.2 ± 0.6 years). Children who slept longer had lower adiposity (-0.12, 95% CI: -0.19, -0.06). Those who had higher levels of total physical activity (TPA) (0.06, 95% CI 0.01, 0.13) and moderate to vigorous-intensity physical activity (MVPA) (0.03, 95% CI 0.01, 0.06) had higher scores on handgrip strength. Children who spent more time in sedentary behaviour had lower handgrip strength (-0.08, 95% CI -0.16, -0.01). There were no significant associations with executive functions. CONCLUSIONS:Strategies to improve adiposity and motor skills should focus on promoting healthy levels of 24-h movement behaviours, especially adequate sleep and time spent in physical activity in Ethiopian children.

Background The World Health Organisation (WHO) has called for more evidence on 24-hour movement behaviours from low- and middle-income countries. We examined the proportion of Ethiopian children aged 3.0-4.9 years who met the WHO guidelines on physical activity, sedentary behaviour and sleep for children under the age of five, and the associations between meeting the guidelines and socio-demographic factors. Methods A cross-sectional study was conducted in Adama and Lume Woreda, Ethiopia. Children were recruited through kindergartens in Adama and rural villages in Lume Woreda, Ethiopia. Physical activity and sleep were measured using ActiGraph accelerometer. Sedentary screen time and restrained sitting were parent-reported. Multivariable logistic regression models tested associations between meeting the individual and combined WHO guidelines and socio-demographic factors. Results A total of 430 children participated in the study (mean age 4.2 ± 0.6 years). More than half the children (58.0%) met all the WHO guidelines. A higher proportion met the physical activity (96.1%) and sleep guidelines (91.9%) compared to the sedentary screen time guideline (63.5%). Children who lived in rural areas were more likely to meet the sedentary behaviour (84.6% vs 38.2%, AOR = 7.31; 95%CI: 3.93, 14.02), sleep (98.6% vs 83.8%, AOR = 8.60; 95%CI: 3.55, 23.73) and combined (81.3% vs 30.1%, AOR = 7.41; 95%CI: 4.04, 13.97) guidelines than those who lived in urban areas. Conclusions Children from rural Ethiopia were more compliant with the WHO guidelines than their urban counterparts. Strategies to reduce screen time and promote healthy movement behaviours in urban areas are needed. Further studies with a larger representative sample might provide better insight across the regions of the country.

Canada, Australia, the World Health Organization and other countries have released 24-hour movement guidelines for the early years which integrate physical activity, sedentary behaviour, and sleep, focusing on supporting children to achieve a healthy 24-hour day. The guideline evidence synthesis, however, highlighted the dearth of high-quality evidence, particularly from large-scale studies. The Sleep and Activity Database for the Early Years (SADEY) project aims to assemble a large, pooled database of 24-hour movement behaviours and health indicators in young children (birth to 5.99 years), to advance knowledge in these areas. This paper describes the SADEY design and methods. Data sets were identified with > 100 children and device-measured (hip-worn ActiGraph accelerometers) physical activity and sedentary behaviour, parent-reported or device-measured sleep, and at least one health outcome: physical (BMI, waist circumference, blood pressure), social-emotional (Strength and Difficulties Questionnaire), cognitive (Early Years Toolbox), or motor development (Test of Gross Motor Development 2). Led by the University of Wollongong co-ordinating centre, the SADEY project collates the datasets to create a pooled database. To date, 13 studies from 7 countries have been included in the database. Ethics clearance and data sharing agreements have been secured for all studies and the SADEY 1.0 database is being assembled including ~ 8,000 participants. SADEY will be used to address questions of global importance to public health policy and practice, for example – Is the mix of movement behaviours across the 24-hour day associated with healthy development?, What is the optimal mix of these behaviours?, and; What factors can be targeted to support young children in achieving the optimal mix of 24-hour movement behaviours? Additionally, SADEY seeks to develop and disseminate protocols, develop capacity on the device-based measurement of movement behaviours, and seeks partnerships with stakeholders that promote knowledge translation on movement behaviours to support healthy development among young children.

Importance The multifaceted nature of screen use has been largely overlooked in favor of a simplistic unidimensional measure of overall screen time when evaluating the benefits and risks of screen use to early childhood development. Objective To conduct a systematic review and meta-analysis to examine associations of screen use contexts in early childhood with cognitive and psychosocial outcomes. Data SourcesPsycINFO, Embase, MEDLINE Ovid, ProQuest, CINAHL, Web of Science, and Scopus were searched from inception to December 31, 2023. Study Selection A total of 7441 studies were initially identified. Studies were included if they examined associations between a contextual factor of screen use among children aged 0 to 5.99 years and cognitive or psychosocial development. Observational, experimental, and randomized clinical trial study designs were included. Data Extraction and Synthesis All studies were independently screened in duplicate following PRISMA guidelines. Effect sizes of associations (r) from observational studies were pooled using random-effects 3-level meta-analyses. The remaining study designs were narratively synthesized. Main Outcomes and MeasuresScreen use contexts included content (child directed and age inappropriate), type (program viewing and game or app use), co-use (or solo use), background television, caregiver screen use during child routines, and purpose. Outcomes were cognitive (executive functioning, language, and academic skills) or psychosocial (internalizing and externalizing behavior problems and socioemotional competence). Results Overall, 100 studies (176 742 participants) were included, and of these, 64 observational studies (pooled sample sizes ranging from 711 to 69 232) were included in meta-analyses. Program viewing (n = 14; k = 48; r, -0.16; 95% CI, -0.24 to -0.08) and background television (n = 8; k = 18; r, -0.10; 95% CI, -0.18 to -0.02) were negatively associated with cognitive outcomes, while program viewing (n = 6; k = 31; r, -0.04; 95% CI, -0.07 to -0.01), age-inappropriate content (n = 9; k = 36; r, -0.11; 95% CI, -0.17 to -0.04), and caregiver screen use during routines (n = 6; k = 14; r, -0.11; 95% CI, -0.20 to -0.03) were negatively associated with psychosocial outcomes. Co-use was positively associated with cognitive outcomes (n = 8; k = 28; r, 0.14; 95% CI, 0.03 to 0.25). Conclusions and Relevance Findings show small to moderate effect sizes that highlight the need to consider screen use contexts when making recommendations for families, clinicians, and educators beyond screen time limits; including encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers.

BACKGROUND:Today's youth are growing up in an evolving digital world, and concerns about the potential detrimental effects of excessive screen use on biopsychosocial outcomes in childhood are mounting. Parents worry about the impacts of screen-use on their children's wellbeing but at the same time frequently fail to meet their own ideal screen time limits regarding their children's screen use. There is an opportunity to shift research focus away from inflexible and often unrealistic childhood screen time guidelines towards exploration of positive parenting strategies that may have multiple beneficial and significant effects on children's screen-related outcomes. An emerging body of literature suggests that screen time and nature exposure act on psychosocial outcomes in contrasting ways. There is evidence to suggest that exposure to natural environments may counteract some of the potential negative psychosocial effects of excessive screen use; however, this relationship is poorly understood. The overarching aim of this scoping review is to source, categorise, and synthesise existing research exploring the associations between nature exposure, screen use, and parenting across childhood. METHODS:This mixed-methods systematic scoping review will be conducted following Arksey and O'Malley's framework with methodological enhancements from Levac and associates and recommendations from the Joanna Briggs Institute's methodological guidance for conducting scoping reviews. Five electronic databases will be searched from August 2022 onwards. Two reviewers will independently screen titles, abstracts, and full-text articles. Peer reviewed articles related to the constructs of nature exposure, screen use, and parent/child relations will be considered in the context of early to late childhood. Study characteristics will be collated using a data charting tool collaboratively developed by the research team. Evidence will be presented using tabular and textual form and described using qualitative thematic analysis. DISCUSSION:This review will gather information about how key definitions are conceptualised, defined, and measured across the literature and map existing trends and areas for future research. It is intended that this review will inform and guide future research direction, recommendations, and programs aimed at supporting parents to navigate the challenges of parenting in a digital age. OSF REGISTRATION: https://doi.org/10.17605/OSF.IO/TFZDV.

BackgroundChildren's physical activity and screen time behaviours impact their physical health and well-being. In Australia, less than half of children meet daily physical activity recommendations and only one-third meet daily screen time recommendations. Nearly half a million Australian school children aged 5-12 attend Outside School Hours Care (OSHC) weekly, activities undertaken at OSHC play a key role in meeting these recommendations. Currently, physical activity and screen time practices in OSHC vary and lack policy guidance. The Activated OSHC program is a policy-based intervention that supports OSHC services to implement the physical activity and screen time guidelines.Methods192 OSHC services across Australia will be recruited. 96 services will be randomly allocated to receive the Activated OSHC program. OSHC coordinators will complete online surveys examining physical activity and screen time scheduling, cost, acceptability, and feasibility. Primary outcome; changes in the proportion of intervention and control services meeting OSHC sector physical activity and screen time guidelines, and secondary outcomes; changes in children's physical activity and screen time behaviours; changes in staff behaviour will be assessed using mixed-effects regression models.DiscussionThe aim of this study is to examine the impact of the Activated OSHC program on children's physical activity and screen time.ImpactRecent Australian research in Outside School Hours Care (OSHC) has identified significant inconsistency in practices related to physical activity and screen time, compounded by an absence of explicit policy guidance.The Activated OSHC program is a policy-based intervention that supports OSHC services to implement the Australian OSHC physical activity and screen time guidelines.This study will assess the implementation and effectiveness of the Activated OSHC program in an effectiveness-implementation hybrid type 2 trial design.Implementation of outside school hours care sector physical activity and screen time guidelines may improve children's physical activity and screen time behaviours.

Importance The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain. Objective To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries. Design, Setting, and Participants Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023. Exposures Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers. Main Outcomes and Measures The proportion of children who met the World Health Organization guidelines for physical activity (>= 180 min/d of total physical activity and >= 60 min/d of moderate- to vigorous-intensity physical activity), screen time (<= 1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis. Results Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle-income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle-income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8). Conclusions and Relevance Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.

Abstract Background Sleep, sedentary behaviour, and physical activity are essential components within the 24-hour time frame. Existing questionnaires used to measure these behaviours have insufficient measurement properties and are unsuitable for assessing compliance with the WHO Physical Activity and 24-hour Movement Guidelines. To describe the development process of the 24-hour Movement Questionnaire (QMov24h) and its testing. The QMov24h was developed to gather detailed information on sleep, sedentary behaviour, and physical activity. Methods The sample comprised 117 participants (58% women), aged 30.95 ± 13.56 years. The development process of the QMov24h followed the COSMIN guidelines: (i) Construction of items; (ii) Face validity with end-users; (iii) Content validity with experts; (iv) Criterion validity against accelerometry and convergent validity against diary assessments; and (v) 7-day test-retest reliability. Results The QMov24h presented adequate content and face validity. The QMov24h showed moderate criterion validity for sleep (rho=0.343;p<0.001), light physical activity (rho=0.31;p=0.002) and total aerobic physical activity (rho=0.343;p<0.001), as well as strong criterion validity for sedentary behaviour (rho=0.428;p<0.001) and aerobic moderate-to-vigorous physical activity (rho=0.534;p<0.001). Reliability varied from poor to excellent (ICC from 0.38 to 0.962;p<0.001) for all questionnaire variables. Regarding compliance of the 24-hour movement guidelines, the questionnaire also showed a strong to almost perfect percentage of agreement with accelerometry (from 69% to 94.3%), and minimal to strong reliability (k from 0.38 to 0.87) between the first and second administrations of the QMov24h. Conclusions The QMov24h questionnaire is a valid and reliable tool for assessing levels of movement behaviours and compliance with guidelines in adults. Its measurement properties are comparable to, or even better than, those of existing questionnaires, while posing a similar burden to participants. The QMov24h is useful for research, clinical practice, and public health surveillance. The QMov24h has strong psychometric properties, making it suitable for translation, cultural adaptation, and testing in diverse populations for broader international use.

The World Health Organisation (WHO) has called for more evidence on 24-hour movement behaviours from low- and middle-income countries. We examined the proportion of Ethiopian children aged 3.0-4.9 years who met the WHO guidelines on physical activity, screen time and sleep for children under the age of five, and the associations between meeting the guidelines and socio-demographic factors. A cross-sectional study was conducted in Adama and Lume district, Ethiopia. Children were recruited through kindergartens in Adama city and rural villages of Lume district, Ethiopia. Physical activity and sleep were measured using ActiGraph accelerometer. Screen time and restrained sitting were parent-reported. Multivariable logistic regression models tested associations between meeting the individual and combined WHO guidelines and socio-demographic factors. A total of 430 children participated in the study (mean age 4.2 ± 0.6 years). More than half the children (58.0

The multifaceted nature of screen use has been largely overlooked in favor of a simplistic unidimensional measure of overall screen time when evaluating the benefits and risks of screen use to early childhood development. To conduct a systematic review and meta-analysis to examine associations of screen use contexts in early childhood with cognitive and psychosocial outcomes. PsycINFO, Embase, MEDLINE Ovid, ProQuest, CINAHL, Web of Science, and Scopus were searched from inception to December 31, 2023. A total of 7441 studies were initially identified. Studies were included if they examined associations between a contextual factor of screen use among children aged 0 to 5.99 years and cognitive or psychosocial development. Observational, experimental, and randomized clinical trial study designs were included. All studies were independently screened in duplicate following PRISMA guidelines. Effect sizes of associations (r) from observational studies were pooled using random-effects 3-level meta-analyses. The remaining study designs were narratively synthesized. Screen use contexts included content (child directed and age inappropriate), type (program viewing and game or app use), co-use (or solo use), background television, caregiver screen use during child routines, and purpose. Outcomes were cognitive (executive functioning, language, and academic skills) or psychosocial (internalizing and externalizing behavior problems and socioemotional competence). Overall, 100 studies (176 742 participants) were included, and of these, 64 observational studies (pooled sample sizes ranging from 711 to 69 232) were included in meta-analyses. Program viewing (n = 14; k = 48; r, −0.16; 95% CI, −0.24 to −0.08) and background television (n = 8; k = 18; r, −0.10; 95% CI, −0.18 to −0.02) were negatively associated with cognitive outcomes, while program viewing (n = 6; k = 31; r, −0.04; 95% CI, −0.07 to −0.01), age-inappropriate content (n = 9; k = 36; r, −0.11; 95% CI, −0.17 to −0.04), and caregiver screen use during routines (n = 6; k = 14; r, −0.11; 95% CI, −0.20 to −0.03) were negatively associated with psychosocial outcomes. Co-use was positively associated with cognitive outcomes (n = 8; k = 28; r, 0.14; 95% CI, 0.03 to 0.25). Findings show small to moderate effect sizes that highlight the need to consider screen use contexts when making recommendations for families, clinicians, and educators beyond screen time limits; including encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers.