Combination Effect of Outdoor Activity and Screen Exposure on Risk of Preschool Myopia: Findings From Longhua Child Cohort Study.

Evidence regarding screen use and outdoor activity during very early childhood (i. e., from aged 1 to 3 years) and their potential combined links to the later preschool myopia is limited. This information is needed to release effective public health messages and propose intervention strategies against preschool myopia. We collected information regarding very early childhood screen use, outdoor activity and the kindergartens vision screenings of 26,611 preschoolers from Longhua Child Cohort Study by questionnaires. Logistic regression models were used to examine the associations between reported outdoor activity, screen use from 1 to 3 years of age, and preschool myopia. Throughout very early childhood, from 1 to 3 years, the proportion of children exposed to screens increased (from 35.8 to 68.4%, p < 0.001), whereas the proportion of children who went outdoors ≥7 times/week (67.4-62.1%, p < 0.001) and who went outdoors for ≥60 min/time (53.3-38.0%, p < 0.001) declined. Exposure to fixed screen devices [adjusted odds ratio (AOR) = 2.66, 95% confidence interval (CI) = 2.09-3.44], mobile screen devices (AOR = 2.76, 95% CI = 2.15-3.58), and limited outdoor activity (AOR = 1.87, 95% CI = 1.42-2.51) during early childhood were associated with preschool myopia. Among children whose parents were myopic, the interactions between outdoor activity and fixed or mobile screen use on later preschool myopia were significant; the ORs and 95% CI were 3.34 (1.19-9.98) and 3.04 (1.06-9.21), respectively. Our findings suggest the possibility that the impact of screen exposure during early childhood on preschool myopia could be diminished by outdoor activity for children whose parents have myopia.

Screen Exposure during Early Life and the Increased Risk of Astigmatism among Preschool Children: Findings from Longhua Child Cohort Study.

Screen media usage has become increasingly prevalent in daily life with children being exposed to screens at an early age. This is a growing public health concern with evidence linking screen exposure to detrimental health outcomes, whereas relationship between screen exposure and the presence of astigmatism among preschoolers remains unknown, thus we aimed to resolve this issue. During the 2017 survey of the Longhua Child Cohort Study, data of 29,595 preschoolers were collected via a caregiver-reported questionnaire regarding socio-demographics, screen exposure and refraction. Cox regression models were adopted to generate adjusted prevalence ratios (APR) and 95% confidence intervals (CI) to estimate the association between early screen exposure and astigmatism. 28,029 preschoolers were included in the final analysis. After adjustment for potential confounders, screen exposure during early life was significantly associated with the increased risk of astigmatism (APR and 95% CI: 2.25, 1.76-2.88), and the greatest risk was observed in the period from birth to 1-year (APR and 95% CI: 3.10, 2.41-3.98). The risk of astigmatism increased with both the total years of exposure and the average daily duration of screen exposure. Our findings suggested that preschoolers who were exposed to screens during early life might have an increased risk of astigmatism.

Associations Between Screen Exposure in Early Life and Myopia amongst Chinese Preschoolers.

This study aimed to explore the association between screen exposure in early life and preschool myopia. During the baseline survey of the Longhua Child Cohort Study (LCCS), data of 29,595 preschoolers were collected via a caregiver-reported questionnaire regarding children's socio-demographic characteristics, visual status, screen exposure and relevant parental information. Data of 26,433 preschoolers with normal eyesight or myopia were included in the analysis and cox regression modelling was employed to assess the associations. Results suggested the hypothesis that screen exposure in early life could be significantly and positively associated with preschool myopia, and in agreement with this hypothesis was the association being strengthened with the increasing daily exposure duration and total years of exposure; in the stratification analysis based on the presence of parental myopia, these associations still existed, and the strength of associations was stronger in preschoolers with myopic parents than those without. Moreover, a statistically significant association was only observed between initial screen exposure that occurred during 0-1-years old and myopia for preschoolers without myopic parents, while the significant associations were observed between initial screen exposure that occurred during 0-1, 1-2, 2-3, and after 3 years old and myopia for preschoolers who had myopic parents, with the strongest association found in the group of children initially exposed to electronic screens during 0-1 year old. Thus our findings indicated the hypothesis that screen exposure in early life might be associated with the occurrence of preschool myopia, and that the postnatal first year might be the sensitive period for the association. However, it is premature to conclude that early screen time leads to myopia with current data. Further longitudinal studies performed with cycloplegia are necessary to verify the hypothesis and shed light on the more urgent question whether early screen exposure contributes to the later myopia epidemic of school-aged children.

Teacher's Type D Personality and Chinese Children's Hyperactive Behaviors: Moderation Effect of Parental Type D Personality and Mediation Effect of Teacher-Student Relationship.

This study aimed to explore the association between teacher's type D personality (TDP) and children's hyperactive behaviors, along with the moderation effect of parental TDP and the mediation effect of the teacher-student relationship. In this prospective study, a total of 25,852 children were surveyed from 2014 to 2016 in Longhua District of Shenzhen, China, and followed up 1 year later. At baseline, parents provided data on parental TDP and children's hyperactive behaviors, while teachers reported on their TDP. At follow-up, parents provided data on children's hyperactive behaviors again, and teachers described their relationship with each student. Two-level multilevel logistic models were conducted to assess the influence of a teacher's TDP, parental TDP, and their interaction on children's hyperactive behaviors. Mediation analysis was used to examine the mediating role of the teacher-student relationship. Results indicated that teachers' TDP was not a significant predictor of children's hyperactive behaviors after 1 year in kindergarten. Conversely, maternal and paternal TDP were prospectively and positively associated with children's subsequent hyperactive behaviors. However, the children with a TDP teacher, a TDP mother, and/or a TDP father had higher risk of hyperactive behaviors than those with either a TDP teacher or a TDP mother or a TDP father. In addition, the teacher-student relationship was not a significant mediator between teacher's TDP and children's hyperactive behaviors. Further, researchers may consider the effect of the combination of teacher's TDP, maternal TDP, and paternal TDP on hyperactive behaviors in children in further studies.

Associations between Environmental Tobacco Smoke Exposure in Early Life and Astigmatism among Chinese Preschool Children.

This study aimed to investigate the association between environmental exposure to tobacco smoke (ETS) during early life and astigmatism in Chinese preschool children. In this cross-sectional study, information concerning prenatal and postnatal ETS exposure at three stages of early life (during pregnancy, from birth to one year and from one to three years), visual problems of children and parents (including a confirmed diagnosis of astigmatism), socio-demographics and perinatal characteristics were obtained from 27,890 parent-reported questionnaires. Logistic regression analyses were undertaken to yield adjusted odds ratios (OR) for assessing their associations. After adjusting for the potential confounders, children were more likely to exhibit astigmatism when they were exposed to ETS during pregnancy + from one to three years [OR (95% CI) = 1.37 (1.02, 1.84)], or from birth to one year + from one to three years [OR (95% CI) = 1.36 (1.11, 1.66)], or during pregnancy + from birth to one year + from one to three years old [OR (95% CI) = 1.29 (1.16, 1.45)], compared to children without ETS exposure at any stage of early life. In Chinese preschool children, prenatal and postnatal astigmatism was associated with ETS exposure; the greater the ETS dose, the greater the astigmatism risk.

Parental Type D Personality and Children's Hyperactive Behaviors: The Mediating Role of Parent⁻Child Interactive Activities.

This study explored the associations between parental Type D personality (TDP), parent⁻child interactive activities, and children's hyperactive behaviors. Moreover, the study examined whether parent⁻child interactive activities mediated the associations between parental TDP and children's hyperactive behaviors. A cross-sectional survey was conducted among children from all kindergartens in a district of a southern city in China. Data on parental TDP, the frequency of parent⁻child interactive activities, children's hyperactive behaviors, and socio-demographic characteristics were provided by 47,648 parent⁻child dyads. Multiple regression analysis was employed to assess the associations between parental TDP, parent⁻child interactive activities, and children's hyperactive behaviors. Mediation analysis was applied to explore the mediating role of parent⁻child interactive activities on the associations between parental TDP and children's hyperactive behaviors. Parental TDP was negatively associated with the frequency of parent⁻child interactive activities and positively associated with children's hyperactive behaviors. The frequencies of parent⁻child interactive activities were negatively associated with children's hyperactive behaviors. The frequency of parent⁻child interactive activities partially mediated the associations between parental TDP and children's hyperactive behaviors. Future research may consider parental TDP and parent⁻child interactive activities as potential important predictors of hyperactive behaviors in children. Such research will help identify further targets for intervention to reduce hyperactive behaviors in children.

Understanding the associations among parents teaching safety rules to children, safety behaviors and unintentional injuries in Chinese preschool children.

Child unintentional injuries are one of the most prominent global health threats and parents may play a vital role in these injuries. This study thus aims to explore the associations of parents teaching safety rules with preschool children's safety behaviors and unintentional injuries. A total of 62,922 children registered at 182 kindergartens in Longhua District of Shenzhen, China during the fall semester of 2016, were included in this cross-sectional study. Their parents were invited to complete a self-administered questionnaire covering information about socio-demographics, parents teaching safety rules to children, child safety behaviors and unintentional injuries. Logistic and linear regression models were carried out to test the associations among parents teaching safety rules, child safety behaviors, and child unintentional injuries. Whether child safety behaviors mediated the relationship between parents teaching safety rules and child unintentional injuries was assessed using Hayes' PROCESS macros for SPSS. Regression analyses revealed that the higher scores of both mothers' and fathers' teaching safety rules to children were significantly associated with the reduced risks of child unintentional injuries and the modest improvements in child safety behaviors, after adjusting for potential confounders. Furthermore, mediation analysis illustrated that child safety behaviors mediated 18.1% of the association between mothers teaching safety rules and child unintentional injuries and 30.3% of the association between fathers teaching safety rules and child unintentional injuries, respectively. These findings suggest that parents teaching safety rules to children is beneficial for mitigating unintentional injury risks among Chinese preschool children through improving child safety behaviors.

Antenatal Training with Music and Maternal Talk Concurrently May Reduce Autistic-Like Behaviors at around 3 Years of Age.

Antenatal training through music and maternal talk to the unborn fetus is a topic of general interest for parents-to-be in China, but we still lack a comprehensive assessment of their effects on the development of autistic-like behaviors during early childhood. During 2014-2016, 34,749 parents of children around the age of 3 years who were enrolled at kindergarten in the Longhua district of Shenzhen participated in this study. Self-administered questionnaires regarding demographics, antenatal music training, and maternal talk to the fetus during pregnancy were completed by the children's primary caregivers. Autistic-like behaviors were assessed using the Autism Behavioral Checklist. Tobit regression analyses revealed that antenatal music training and maternal talk to the fetus was associated with a reduction in autistic-like behaviors in children, with a dose-dependent relationship. Furthermore, factorial analysis of covariance indicated a significant interaction effect between antenatal music training and maternal talk to the fetus on the autistic-like behaviors and found that children who often experienced antenatal music training and maternal talk concurrently had the lowest risk of autistic-like behaviors, while children who were never exposed to maternal talk and only sometimes experienced antenatal music training had the highest risk. Our results suggest that antenatal training through both music and maternal talk to the unborn fetus might reduce the risk of children's autistic-like behaviors at around 3 years of age.