Association of Screen Time Activities with Lifestyle Behaviors in Middle-School Children.

Research analyzing the link between different screen time activities and childhood health have had varied results. We examined the relationship between total screen time and subtype to beneficial diet and physical activity behaviors (BDPAB) in middle-school children. This cross-sectional study analyzed data from 110 middle schools participating in a school-based health program between September 2013 and February 2023. Based on self-reported health behavior surveys, data from 12,751 sixth graders were available for analysis. BDPAB included ≤ 1 serving/day of sugary beverages; ≤ 1 serving/day sugary foods/chocolate candy; ≤ 1 serving/day fried or fatty foods; ≥ 1 servings/day of fruits or vegetables; ≥ 1 day/week physical education class; ≥ 1 out-of-school sport/year; ≥ 1 team sport/year, and ≥ 1 session/week of moderate to vigorous activity. Independent of media subtype (television, computer, video game, mobile device), consuming > 2 h of screen time was associated with lower odds of all BDPAB, with the exception of physical education class participation. Both moderate screen time (4 - < 8 h) and high screen time (≥ 8 h) usage were associated with lower odds of performing the majority of BDPAB. Temporal trends (2013-2014, 2015-2016, 2017-2019, and 2020-2023) revealed an upward trend of BDPAB up until the COVID-19 pandemic, in which the proportion of students exhibiting BDPAB decreased. Increasing use of screen time, regardless of modality, is associated with reduced frequency of BDPAB. These findings re-enforce the potential negative impact of extensive screen use. Promoting balanced and healthy screen habits represents a potential intervention to promote BDAPB.