Screen time and health issues in Chinese school-aged children and adolescents: a systematic review

Zhang et al. BMC Public Health (2022) 22:810

https://doi.org/10.1186/s12889-022-13155-3

RESEARCH

Screen time and health issues in Chinese

school-aged children and adolescents:

a systematic review and meta-analysis

Youjie Zhang*

, Shun Tian, Dan Zou, Hengyan Zhang and Chen‑Wei Pan*

Abstract

Backgrounds: Many literature reviews summarized relationships between screen time and child health, but they

only included a few studies conducted in Chinese children and adolescents. The potential infuence of screen time

may vary by social context. The current systematic review and meta-analysis aimed to evaluate relationships between

screen time and health issues among Chinese school-aged children and adolescents.

Methods: Peer-reviewed articles written in Chinese and English were retrieved from CNKI, Wanfang, PubMed,

Embase, and Web of Science from inception to June 2020. The Downs & Black checklist was applied to assess study

quality. Meta analyses used random efect models and mixed efects model to calculate pooled adjusted odds ratios

and 95% confdence intervals. Heterogeneity, sensitivity, and publication bias were assessed using Q and I

2

statistics,

“one-study removed” analysis, the funnel plot, trim and fll analysis, and classical fail-safe N, respectively.

Results: In total, we identifed 252 articles reporting 268 studies with unique samples. These studies investigated

relationships between screen time and health issues of adiposity, myopia, psycho-behavioral problems, poor aca‑

demic performance, cardiometabolic disease risks, sleep disorder, poor physical ftness, musculoskeletal injury,

sub-health, and miscellaneous issues of height and pubertal growth, injury, sick leave, and respiratory symptoms.

Proportions of studies reporting positive relationships with screen time were lowest in adiposity (50.6%) and higher in

myopia (59.2%) and psycho-behavioral problems (81.8%). Other health issues were examined in 10 or less studies, all

of which had more than half showing positive relationships. The pooled odds ratio from 19 studies comparing health

risks with the screen time cutof of 2 hours per day was 1.40 (95% CI: 1.31 to 1.50, I

2=85.9%). The pooled efect size

was 1.29 (95% CI: 1.20 to 1.39) after trimming 7 studies for publication bias adjustments.

Conclusions: Findings exclusively generated from Chinese school-aged children and adolescents resonate those

mainly from western countries. Evidence suggests that higher levels of screen time are related with greater risks of

various health issues, although the relationships appear to be weak and intertwined with other confounding factors.

Future studies need to investigate health-specifc dose efects and mechanisms of screen time.

Keywords: Screen time, Child health, Chinese, Child, Adolescent

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Background

Electronic devices have become daily essentials in the

modern days even for the young. Children and adoles￾cents spend more time on screen-based activities than

ever before [1, 2]. Concerns over the adverse efects

of screen time have increased. Several authoritative

Open Access

*Correspondence: [email protected]; [email protected]

School of Public Health, Medical College of Soochow University, 199 Ren

Ai Road, 215123 Suzhou, Jiangsu, China