Health Reports
Physical activity, screen time and sleep duration: Combined associations with psychosocial health among Canadian children and youth

by Felix Bang, Karen C. Roberts, Jean-Philippe Chaput, Gary S. Goldfield, and Stephanie A. Prince

Release date: July 2, 2020

DOI: https://www.doi.org/10.25318/82-003-x202000500002-eng

Adequate sleep duration, physical activity and low sedentary time are all independently associated with better health status among children and youth.^{Note 1}^{Note 2}^{Note 3}^{Note 4} Recently, in an international first, Canada adopted the 24-Hour Movement Guidelines for Children and Youth (24-Hour Guidelines),^{Note 5} which provide integrated recommendations for physical activity, sedentary time and sleep.

The 24-Hour Guidelines recommend that children and youth have at least 60 minutes of moderate-to-vigorous physical activity (MVPA) per day.^{Note 5} Physical activity is known to have both physical and psychosocial health benefits, including better general psychosocial health (e.g., behavioural conduct, quality of life, self-esteem and lower psychological distress), physical health (e.g., motor development, body composition, cardiometabolic health, fitness and bone health) and improved cognitive development (e.g., cognition and academic achievement).^{Note 3} The majority of Canadian children and youth (64%) are not meeting the current MVPA recommendations.^{Note 6}

Sedentary behaviour is defined as any waking behaviour with a low energy expenditure (⋜ 1.5 metabolic equivalents) while in a sitting, reclining or lying position.^{Note 7} Physical activity and sedentary behaviour are distinct from one another and must be examined separately.^{Note 8} An individual can be highly physically active but also highly sedentary. The 24-Hour Guidelines for school-aged children recommend that recreational screen time be restricted to a maximum of two hours per day, and that sitting for extended periods be limited. Examples of recreational screen time include computer or Internet use, television viewing and video gaming. Higher duration and frequency of screen time and television viewing are known to be associated with poorer body composition, higher cardiometabolic risk, and unfavourable behavioural conduct and prosocial behaviour (e.g., behavioural problems, aggression and inattention).^{Note 1} A consistent association between screen time and poorer mental health status among children and youth has also been found.^{Note 9} About half of Canadian children and youth (51%) are not meeting screen time recommendations.^{Note 6}

The 24-Hour Guidelines also include sleep recommendations that call for consistent bedtimes and wake-up times, with 9 to 11 hours of uninterrupted sleep per night for children aged 5 to 13 years and 8 to 10 hours of uninterrupted sleep per night for youth aged 14 to 17 years.^{Note 5} Sleep is essential for optimal health and functioning. Longer sleep duration has been associated with lower adiposity, better emotional regulation, higher academic achievement, and greater quality of life and well-being in children and youth.^{Note 2} Evidence suggests inadequate sleep among children and youth is associated with negative psychosocial health, including low self-esteem, depression, poor perceived mental health, low life satisfaction, poor relations with parents and poor social support.^{Note 10} American data from the nationally representative 2003 National Survey of Children’s Health found that children with inadequate sleep (based on a parental report of inadequate past-week sleep) were more likely to report depressive symptoms.^{Note 11} A substantial proportion of Canadian children and youth (about 25%) are not meeting sleep recommendations.^{Note 6}^{Note 12}^{Note 13}

The 24-Hour Guidelines recognize that all movement behaviours across a 24-hour period are important for overall health.^{Note 14} To date, few studies have investigated the association between adherence to the 24-Hour Guidelines and health among children and youth,^{Note 15}^{Note 16}^{Note 17} and none have focused exclusively on psychosocial health. It is important to understand how the 24-hour movement continuum and meeting the 24-Hour Guidelines may influence the psychosocial health of Canadian children and youth. Therefore, the objective of this study was to determine the associations between adherence to the 24-Hour Guidelines, its component recommendations (i.e., physical activity, screen time and sleep duration) and psychosocial health (i.e., social, emotional and behavioural) among Canadian children and youth. Adherence to the 24-Hour Guidelines was expected to be associated with better psychosocial health among Canadian children and youth.

Methods

Data source

Data used in this study were from the Canadian Health Measures Survey (CHMS), an ongoing cross-sectional survey that collects health data from a representative sample of the Canadian population.^{Note 18} The target population of the CHMS includes people aged 3 to 79 years living in the 10 Canadian provinces, and excludes people living in the three territories, people living on reserves and other Aboriginal settlements, full-time Canadian Forces members, the institutionalized population, and residents of certain remote regions.^{Note 18} The CHMS includes a questionnaire administered by an interviewer in the homes of respondents and a visit to a mobile examination centre (MEC) where the physical measures of respondents are taken. A parent or guardian of children aged 5 to 11 answers the household questionnaire on their behalf. Ambulatory respondents are asked to wear an Actical accelerometer over their right hip on an elasticized belt for seven consecutive days following their visit to the MEC. The CHMS was approved by Health Canada’s Research Ethics Board, and written informed consent and assent are required from all participants.

Data from Cycle 2 (2009 to 2011), Cycle 3 (2012 to 2013) and Cycle 4 (2014 to 2015) were used in these analyses. Cycle 1 data were excluded because Cycle 1 did not collect data from children aged 3 to 5 years. Analyses were restricted to children (5 to 11 years) and youth (12 to 17 years) with a minimum of four days of valid accelerometer data.^{Note 19} For 5-year-old children, a valid day of wear time was at least 5 hours, while for those aged 6 years and older, valid wear time was defined as 10 or more hours per day.^{Note 19} The overall response rates for the household questionnaire, MEC visit and return of sufficient valid accelerometer data were 42.4% for 2009 to 2011, 38.8% for 2012 to 2013 and 37.5% for 2014 to 2015. Statistics Canada’s survey weights specific to the accelerometer subsample were used. CHMS cycles were combined following Statistics Canada guidelines, where survey weights were adjusted by dividing by the number of cycles used.^{Note 20} Weights account for the potential bias introduced by nonresponse at the household, questionnaire and MEC levels, as well as differences between people with and without valid accelerometer data.^{Note 21} Details on the CHMS survey design and sampling frame are available via Statistics Canada.^{Note 18}

Independent variables

Physical activity

MVPA was measured using accelerometers.^{Note 19} Average minutes per day were calculated as total physical activity minutes per number of valid days. Physical activity was coded as a binary variable (⋝ 60 minutes per day compared with < 60 minutes per day), with people who failed to meet the recommendation of an average of 60 minutes per day of MVPA being used as the reference group compared with those who met the recommendation.

Screen time

The 24-Hour Guidelines provide specific recommendations for screen time. In the CHMS, screen time was either parent-reported (children aged 6 to 11 years) or self-reported (youth aged 12 to 17 years). Screen time was assessed using the following questions on the household interview:

“In a typical week in the past 3 months, how much time did you (your child) usually spend on a computer, tablet or iPad, including watching videos, playing computer games, emailing or using the Internet?”
“In a typical week in the past 3 months, how much time did you (your child) usually spend playing other types of video games on a game console or hand-held electronic device?”
“In a typical week in the past 3 months, how much time did you (your child) usually spend watching television, DVDs or videos?”

Screen time was categorized as a binary variable based on meeting (or not meeting) the recommended maximum of two hours per day of recreational screen time. Response options from 2009 to 2011 (none, less than one hour, one to two hours, three to four hours, five to six hours and seven or more hours) differed from those of 2012 to 2015 (none, less than one hour, one hour to less than three hours, three to less than five hours, five to less than seven hours and seven or more hours). For consistency, mid-point values of the six response options from 2009 to 2011 were assigned to those from 2012 to 2015.^{Note 6}

Sleep duration

Sleep duration was either parent-reported (children aged 5 to 11 years) or self-reported (youth aged 12 to 17 years) in the CHMS household questionnaire. Participants responded to the question “How many hours do you (your child) usually spend sleeping in a 24-hour period, excluding time spent resting?” Responses were rounded to the closest half hour by the interviewer. Sufficient sleep was defined based on the 24-Hour Guidelines thresholds: 9 to 11 hours per night for children aged 5 to 13 years, and 8 to 10 hours per night for youth aged 14 to 17 years.^{Note 5} Sleep was coded as a binary variable with those who did not meet age-specific recommendations being used as the reference group for comparison with those who met the recommendations.

24-Hour Guidelines adherence

The 24-Hour Guidelines consist of a series of recommendations for physical activity, sedentary behaviour and sleep. As recommended, children and youth were considered to have met the 24-Hour Guidelines if, on average, they met the time-specific recommendations for MVPA, recreational screen time and sleep duration.^{Note 4}

Dependent variables

Social difficulties

The Strengths and Difficulties Questionnaire (SDQ) is used to measure emotional and behavioural difficulties in children and youth.^{Note 22} The SDQ is a 25-question measure that assesses some of the fundamental domains of child psychosocial health. The SDQ was administered as part of the household questionnaire and was completed by a parent or guardian for both children and youth. The SDQ is scored across five subscales, including emotional symptoms, conduct problems, hyperactivity or inattention, peer relationship problems and prosocial behaviour. For the present analysis, a total difficulties score was computed by summing scores from all of the subscales, excluding the prosocial scale. It yielded a possible range of 0 to 40, categorized into normal, borderline, and abnormal behaviour ratings.^{Note 22} Total difficulties were recoded as a binary variable by collapsing borderline and abnormal into a single category (scores ranging from 14 to 40) called “at risk of psychopathology,” compared with “normal” (scores from 0 to 13). The SDQ has been shown to have moderate test/retest reliability (ICC = 0.84),^{Note 23} internal consistency (Cronbach’s alpha = 0.73‒0.78),^{Note 24}^{Note 25} good concurrent validity^{Note 25} and good discriminant validity.^{Note 26}

Stress

Respondents aged 12 years and older were asked to self-report their level of stress by responding to the following question: “Thinking about the amount of stress in your life, would you say that most days are: (not at all stressful, not very stressful, a bit stressful, quite a bit stressful, or extremely stressful)?” Stress was coded as a binary variable. Those who responded “quite a bit stressful” or “extremely stressful” were categorized as having high stress, compared with those who reported little to no stress.

General mental health

Respondents aged 12 years or older were asked to rate their general mental health by responding to the following question: “In general, would you say your mental health is: (excellent, very good, good, fair, or poor)?” General mental health was coded as a binary variable. Those who responded “good,” “fair” or “poor” were categorized as “good to poor,” compared with those who reported very good or excellent general mental health, categorized as “very good to excellent”.

Covariates

Potential covariates included sex (male or female), highest level of household education (college or university compared with less than college or university), family status (married or common-law parents compared with single parents) and body mass index (BMI) z-score (a continuous score based on the World Health Organization growth reference curves for school-aged children).^{Note 27} BMI was calculated using measured height and weight data collected from respondents at the MEC visit. All other covariates were self- or parent-reported. The covariates were added to the models for their potential to influence any of the outcomes and for their bivariate association with meeting 24-Hour Guidelines recommendations. Previous research has indicated that household education has a significant correlation with sleep duration and sedentary time among Canadian youth.^{Note 28}^{Note 29}^{Note 30}

Statistical analysis

Analyses were conducted using survey procedures in SAS EG version 5.1 (SAS Institute Inc., Cary, North Carolina), incorporating appropriate survey and bootstrap weights provided by Statistics Canada. Respondents missing physical activity, screen time, sleep duration or covariate data were excluded from the analyses. Descriptive analyses generated proportions and 95% confidence intervals (CIs) of all independent, covariate and dependent variables. Differences in the proportion of baseline characteristics between children and youth were identified with chi-square tests. Differences in group means for continuous measures (e.g., BMI z-score) were identified using t-tests. Results were considered statistically significant when p was less than 0.05 (two-sided tests).

Initially, binary unadjusted logistic regression was used to assess the associations between meeting individual or different combined recommendations from the 24-Hour Guidelines and covariates with each of the individual psychosocial outcomes for children and youth, separately. Covariates that were significantly associated with the psychosocial outcomes in the unadjusted analysis were included in the multivariate logistic regression models. The final multivariate models were adjusted for sex, household education, family status (married or common-law parents) and BMI z-score. Specific details on the Hosmer–Lemeshow forward model building strategy can be found elsewhere.^{Note 18} All analyses were age stratified between children (5 to 11 years) and youth (12 to 17 years) since available outcome measures differed between the two groups. Multivariate model odds ratios (ORs) and their 95% CIs are reported.

Results

After three cycles of the CHMS were combined, a total of 4,584 respondents aged 5 to 17 years were identified as having completed the household, clinic and activity monitoring components of the survey (Figure 1). After respondents without sleep, screen time, physical activity or covariate data were excluded, the final unweighted sample used for analyses was 4,250 respondents. The final sample comprised of 2,773 children and 1,477 youth, with 1,539 respondents for 2009 to 2011, 1,398 for 2012 to 2013, and 1,313 for 2014 to 2015.

Figure 1
Study sample flow diagram

Table 1 provides descriptive characteristics of the weighted sample. The sample was split almost evenly between boys and girls. The majority of children and youth were from households where the highest education level was the college or university level and where they lived with parents who were married or common law. The average BMI z-scores were 0.39 (SD = 0.04) among children and 0.44 (SD = 0.05) among youth.

Table 1
Weighted population characteristics

The proportion of children and youth who met all three 24-Hour Guidelines recommendations was low: 13.9% of children and 4.8% of youth. When the component recommendations are examined separately, the sleep recommendations were met the most (84.0% among children and 64.7% among youth), followed by the recommendations for MVPA (47.7% among children and 25.8% among youth) and screen time (32.6% among children and 24.7% among youth). Table 1 also provides the proportion of the sample that met individual and combined recommendations. Children were more likely to meet all of the individual and combined recommendations than youth. The majority of children (87.1%) and youth (87.5%) had SDQ scores that were not considered at risk for poor psychosocial health. While 77.8% (just over three-quarters) of youth reported that they had very good to excellent general mental health, 84.0% reported they were not stressed.

Results from the multivariate logistic regression analyses are presented in Table 2. The statistically significant findings related to the SDQ were found only among youth. Among youth, meeting two or more of the 24-Hour Guidelines recommendations was associated with substantially higher odds of possessing a normal SDQ score compared to those not meeting any of the guidelines (OR = 3.10; 95% CI: 1.17–8.19). Those who met the combination of sleep and MVPA recommendations had higher odds of good psychosocial health compared with those who did not meet those recommendations. Youth who met the screen time recommendations had just over 2.6 times higher odds of good psychosocial health (OR = 2.64; 95% CI: 1.21‒5.73) compared to those who did not meet the screen time recommendations.

Table 2
Multivariate logistic regression results of the associations between meeting the 24‐Hour Guidelines and psychosocial health, Canadian children and youth (reference group = abnormal)

In addition to the SDQ results, youth who met the sleep recommendations were also found to have a higher likelihood of not being stressed compared with those who did not (OR = 1.96; 95% CI: 1.16‒3.29). There was also a significant association between sleep and mental health among youth, whereby meeting the sleep recommendations increased the odds of them reporting very good to excellent mental health (OR = 1.67; 95% CI: 1.18‒2.39).

Discussion

This study examined the association between adherence to the 24-Hour Guidelines and psychosocial health among Canadian children and youth. A small proportion of children and youth met all three time-specific recommendations from the 24-Hour Guidelines, while the majority met only one or two recommendations. Sleep duration was the recommendation most often met by both children and youth. Overall, children were more likely to meet individual recommendations than youth. Greater adherence to the recommendations was found to be associated with increased odds of good psychosocial health among youth. Sleep duration was also associated with stress and mental health among youth. Those who met the sleep duration recommendations had higher odds of reporting lower stress and better mental health status than those who did not meet the sleep recommendations.

Similar to previous studies, the proportion of children and youth who met the 24-Hour Guidelines was low.^{Note 6}^{Note 15}^{Note 16} The difference in the proportions of children and youth who met all three movement recommendations was significant. In most of the categories examined, the proportion of youth who met the recommendations was no more than half the proportion of children in the same categories. This is consistent with previous research into individual behaviours, which found declines in these behaviours as children aged.^{Note 6}^{Note 12}^{Note 13}

Youth who met two or more recommendations had reduced odds of being at risk for poor psychosocial health, compared with those who met none of the recommendations. The findings from this present study further highlight the importance of the 24-hour movement continuum^{Note 14} and the association of adequate sleep, sufficient physical activity and limited sedentary time (especially screen time) with psychosocial health.

The results of this study agree with what has been previously reported. Previous studies examining data from the CHMS also found that adhering to the 24-Hour Guidelines was associated with indicators of positive psychosocial health (SDQ, emotional problems, prosocial behaviours and life satisfaction). Specifically, a dose–response relationship has also been reported, whereby meeting a greater number of recommendations was associated with greater positive psychosocial health outcomes.^{Note 15}^{Note 16} A review of the literature found no other international publications that examined integrated 24-hour movement guidelines for children and youth and their associations with psychosocial health.

Although it is important to meet all of the 24-Hour Guidelines recommendations, sleep appears to be a key correlate of psychosocial health among youth. Across all four psychosocial health outcomes, meeting sleep duration recommendations was associated with lower odds of self-reported stress and increased odds of very good to excellent mental health, and was borderline significant in the SDQ models. With a larger sample size, it is expected that meeting sleep duration recommendations would also have a statistically significant association with lower odds of being at risk for poor psychosocial health.^{Note 16} The sleep duration findings are considered clinically meaningful. The combination of meeting sleep and MVPA recommendations was associated with lower odds of at-risk SDQ scores among youth.

In contrast to previous research,^{Note 3}^{Note 9}^{Note 31}^{Note 32} meeting physical activity recommendations individually or in combination with sleep or screen recommendations did not have a significant association with psychosocial health outcomes. It is possible that the dimensions of psychosocial health status that were assessed by CHMS measures were not sensitive to the effects of regular MVPA.

Previous research has shown that although time spent sleeping, doing MVPA and looking at a screen may be related, they do not directly displace one another.^{Note 8} A decrease in sedentary time may not result in an increase in MVPA or sleep duration. It is important to note that light physical activity makes up the largest proportion of waking time likely to be displaced with sedentary behaviour. A previous compositional analysis found that the total complement of movement behaviours (physical activity, sedentary behaviour and sleep) over a 24-hour period was integral to optimal physical, social and emotional health.^{Note 33} Combined with the findings of the present study, the literature suggests that adherence to all components of the 24-Hour Guidelines is important for general health, but screen and sleep behaviours appear to be more strongly related to the measures of psychosocial health used in this study.

Similar to psychosocial health findings from the Canadian Community Health Survey,^{Note 34} a very high proportion of Canadian children and youth have good self-rated mental health, low self-rated stress and normal SDQ scores. However, this limits precision and the ability to detect a relationship between meeting the 24-Hour Guidelines and psychosocial health. Additionally, a very low proportion of the sample met all three movement recommendations, creating a high variance for this exposure. This required collapsing children and youth who met two or three guidelines into a single category.

Limitations

This study has limitations that should be acknowledged. First, all household questionnaire data were proxy-reported by a parent or guardian for children aged 5 to 11 years, and self-reported for youth aged 12 to 17 years. There is often a mismatch between self- or proxy-reported data and observed or device-measured behaviours.^{Note 35}^{Note 36}^{Note 37} This mismatch may have resulted in misclassification bias, which would have affected the findings of this study.

Changes in the response options for survey questions used to measure recreational screen time between Cycles 2 and 3 of the CHMS pose a challenge when combining cycles. This study applied a similar methodology as previous studies that also combined CHMS cycles,^{Note 6}^{Note 15} in that the same values for corresponding response categories were used. However, unlike in previous studies, the corresponding values for the response options provided by Cycle 3, rather than Cycle 2, were used. This was felt to better align with the current surveillance estimates being reported.^{Note 38}^{Note 39}

Because of the cross-sectional design of this study, causal inferences and directionality cannot be identified. Furthermore, it is possible that other factors not studied here, either at the respondent or the parental level, are on the causal pathway. However, this study improves on previous studies with similar limitations since it used a nationally representative sample, overcoming previous issues attributed to convenience samples.

Conclusion

Very few Canadian children and youth, in particular, adhere to the new Canadian 24-Hour Guidelines. Adherence to individual (especially sleep and screen time) and/or combined recommendations were generally associated with better psychosocial and mental health among youth.

Funding

Stephanie Prince was funded by a Canadian Institutes of Health Research - Public Health Agency of Canada Health System Impact Fellowship.

References

Footnote 1.

Carson V, Hunter S, Kuzik N, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Applied Physiology, Nutrition, and Metabolism 2016; 41(6): S240-65.

Return to note 1 referrer

Footnote 2.

Chaput J, Gray CE, Poitras VJ, et al. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Applied Physiology, Nutrition, and Metabolism 2016; 41(6): S266-82.

Return to note 2 referrer

Footnote 3.

Poitras VJ, Gray CE, Borghese MM, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Applied Physiology, Nutrition, and Metabolism 2016; 41(6): S197-239.

Return to note 3 referrer

Footnote 4.

Tremblay MS, Carson V, Chaput J, et al. Canadian 24-hour movement guidelines for children and youth: an integration of physical activity, sedentary behaviour, and sleep. Applied Physiology, Nutrition, and Metabolism 2016; 41(6): S311-27.

Return to note 4 referrer

Footnote 5.

Canadian Society for Exercise Physiology. 24-Hour Movement Guidelines for Children and Youth. 2016. Available at: https://csepguidelines.ca/children-and-youth-5-17/.

Return to note 5 referrer

Footnote 6.

Roberts KC, Yao X, Carson V, et al. Meeting the Canadian 24-hour movement guidelines for children and youth. Health Reports 2017; 28(10): 3-7.

Return to note 6 referrer

Footnote 7.

Tremblay MS, Aubert S, Barnes JD, et al. Sedentary behavior research network (SBRN)-terminology consensus project process and outcome. International Journal of Behavioral Nutrition and Physical Activity 2017; 14(1): 75.

Return to note 7 referrer

Footnote 8.

Pearson N, Braithwaite R, Biddle SJ, et al. Associations between sedentary behaviour and physical activity in children and adolescents: a meta-analysis. Obesity Reviews 2014; 15(8): 666-75.

Return to note 8 referrer

Footnote 9.

Biddle SJ, Asare M. Physical activity and mental health in children and adolescents: a review of reviews. British Journal of Sports Medicine 2011; 45(11): 886-95.

Return to note 9 referrer

Footnote 10.

Shochat T, Cohen-Zion M, Tzischinsky O. Functional consequences of inadequate sleep in adolescents: a systematic review. Sleep Medicine Reviews 2014; 18(1): 75-87.

Return to note 10 referrer

Footnote 11.

Smaldone A, Honig JC, Byrne MW. Sleepless in America: inadequate sleep and relationships to health and well-being of our nation's children. Pediatrics 2007; 119 Supplement 1: S29-37.

Return to note 11 referrer

Footnote 12.

Michaud I, Chaput JP. Are Canadian children and adolescents sleep deprived? Public Health 2016; 141: 126-9.

Return to note 12 referrer

Footnote 13.

Chaput J, Janssen I. Sleep duration estimates of Canadian children and adolescents. Journal of Sleep Research 2016; 25(5): 541-8.

Return to note 13 referrer

Footnote 14.

Chaput J, Carson V, Gray C, et al. Importance of all movement behaviors in a 24 hour period for overall health. International Journal of Environmental Research and Public Health 2014; 11(12): 12575-81.

Return to note 14 referrer

Footnote 15.

Carson V, Chaput J, Janssen I, et al. Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Preventive Medicine 2017; 95: 7-13.

Return to note 15 referrer

Footnote 16.

Janssen I, Roberts KC, Thompson W. Is adherence to the Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth associated with improved indicators of physical, mental, and social health? Applied Physiology, Nutrition, and Metabolism 2017; 42(7): 725-31.

Return to note 16 referrer

Footnote 17.

Walsh JJ, Barnes JD, Cameron JD, et al. Associations between 24 hour movement behaviours and global cognition in US children: a cross-sectional observational study. The Lancet Child & Adolescent Health 2018; 2(11): 783-91.

Return to note 17 referrer

Footnote 18.

Statistics Canada. Canadian Health Measures Survey (CHMS) Ottawa: Statistics Canada, 2018. Available at: http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5071&lang=en&db=imdb&adm=8&dis=2.

Return to note 18 referrer

Footnote 19.

Colley RC, Garriguet D, Janssen I, et al. Physical activity of Canadian children and youth: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports 2011; 22(1): 15-23.

Return to note 19 referrer

Footnote 20.

Statistics Canada. Instructions for Combining Multiple Cycles of Canadian Health Measures Survey (CHMS) Data. Ottawa: Statistics Canada, 2019.

Return to note 20 referrer

Footnote 21.

Statistics Canada. Canadian Health Measures Survey (CHMS) Data User Guide: Cycle 4. Ottawa: Statistics Canada, 2017.

Return to note 21 referrer

Footnote 22.

youthinmind. The Strengths and Difficulties Questionnaires. Available at: https://sdqinfo.org/.

Return to note 22 referrer

Footnote 23.

Giannakopoulos G, Dimitrakaki C, Papadopoulou K, et al. Reliability and validity of the strengths and difficulties questionnaire in Greek adolescents and their parents. Health 2013; 5(11): 1774.

Return to note 23 referrer

Footnote 24.

Goodman R. Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry 2001; 40(11): 1337-45.

Return to note 24 referrer

Footnote 25.

Muris P, Meesters C, van den Berg F. The strengths and difficulties questionnaire (SDQ). European Child & Adolescent Psychiatry 2003; 12(1): 1-8.

Return to note 25 referrer

Footnote 26.

Silva TB, Osório FL, Loureiro SR. SDQ: discriminative validity and diagnostic potential. Frontiers in Psychology 2015; 6: 811.

Return to note 26 referrer

Footnote 27.

de Onis M, Onyango AW, Borghi E, et al. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization 2007; 85: 660-7.

Return to note 27 referrer

Footnote 28.

Chang VC, Chaput JP, Roberts KC, et al. Factors associated with sleep duration across life stages: results from the Canadian Health Measures Survey. Health Promotion and Chronic Disease Prevention in Canada 2018; 38(11): 404-18.

Return to note 28 referrer

Footnote 29.

LeBlanc AG, Broyles ST, Chaput J, et al. Correlates of objectively measured sedentary time and self-reported screen time in Canadian children. International Journal of Behavioral Nutrition and Physical Activity 2015; 12(1): 38.

Return to note 29 referrer

Footnote 30.

Biddle SJ, Atkin AJ, Cavill N, et al. Correlates of physical activity in youth: a review of quantitative systematic reviews. International Review of Sport and Exercise Psychology 2011; 4(1): 25-49.

Return to note 30 referrer

Footnote 31.

Ströhle A. Physical activity, exercise, depression and anxiety disorders. Journal of Neural Transmission 2009; 116(6): 777.

Return to note 31 referrer

Footnote 32.

Ahn S, Fedewa AL. A meta-analysis of the relationship between children's physical activity and mental health. Journal of Pediatric Psychology 2011; 36(4): 385-97.

Return to note 32 referrer

Footnote 33.

Carson V, Tremblay MS, Chaput J, et al. Associations between sleep duration, sedentary time, physical activity, and health indicators among Canadian children and youth using compositional analyses. Applied Physiology, Nutrition, and Metabolism 2016; 41(6): S294-302.

Return to note 33 referrer

Footnote 34.

Statistics Canada. Health Characteristics, Two-year Period Estimates. Table 13-10-0113-01. Ottawa: Statistics Canada, 2019. Available at: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=13100.

Return to note 34 referrer

Footnote 35.

Adamo KB, Prince SA, Tricco AC, et al. A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: a systematic review. International Journal of Pediatric Obesity 2009; 4(1): 2-27.

Return to note 35 referrer

Footnote 36.

Colley RC, Wong SL, Garriguet D, Janssen I, Gorber SC, Tremblay MS. Physical activity, sedentary behaviour and sleep in Canadian children: parent-report versus direct measures and relative associations with health risk. Health Reports 2012; 23(2).

Return to note 36 referrer

Footnote 37.

Colley RC, Butler G, Garriguet D, Prince SA, Roberts KC. Comparison of self-reported and accelerometer-measured physical activity among Canadian youth. Health Reports 2019; 30(7): 3-12.

Return to note 37 referrer

Footnote 38.

Public Health Agency of Canada. Canadian Chronic Disease Indicators, Quick Stats, 2018 Edition. Ottawa: Public Health Agency of Canada, 2018.

Return to note 38 referrer

Footnote 39.

Public Health Agency of Canada. Physical Activity, Sedentary Behaviour and Sleep (PASS) Indicators: Quick Stats, Children (Aged 5 to 11) and Youth (Aged 12 to 17), Canada, 2017 Edition. Ottawa: Public Health Agency of Canada, 2017.

Return to note 39 referrer

Date modified:: 2020-07-02

Language selection

Search and menus

Search

Health Reports
Physical activity, screen time and sleep duration: Combined associations with psychosocial health among Canadian children and youth

Methods

Data source

Independent variables

Dependent variables

Covariates

Statistical analysis

Results

Discussion

Limitations

Conclusion

Funding

Health Reports Physical activity, screen time and sleep duration: Combined associations with psychosocial health among Canadian children and youth

Methods

Data source

Independent variables

Dependent variables

Covariates

Statistical analysis

Results

Discussion

Limitations

Conclusion

Funding

Note of appreciation

Standards of service to the public

Copyright

Health Reports
Physical activity, screen time and sleep duration: Combined associations with psychosocial health among Canadian children and youth