Abstract
BACKGROUND: The purpose of this study was to investigate the five-year trends in 24-hour movement behavior (24hrMB) guideline adherence among children and adolescents in the United States (U.S.) using the 2018-2022 waves of the National Survey of Children's Health (NSCH), giving particular attention to disparities in guideline adherence with respect to sex, age, and overweight/obesity status. METHODS: This secondary data analysis study utilized a successive independent samples design involving data from five waves (2018-2022) of the U.S. NSCH. Robust Poisson regression models were used to examine adherence to 24hrMB guidelines (physical activity [PA], screentime [ST], sleep [SL]), with survey year included as a categorical independent variable. Post-hoc marginal prevalences were calculated for each survey year and Cochrane-Armitage tests for trend were used to examine trends in 24hrMB guideline adherence across 2018-2022. Models were adjusted for age, sex, race/ethnicity, household income level relative to the Federal Poverty Level, metropolitan statistical area status, and overweight/obesity status, in addition to adherence to the guidelines not included as the outcome variable. Separate models were also employed to analyze interactions between sex, age, and overweight/obesity status and 24hrMB guideline adherence across survey years. RESULTS: A total of 135,309 (Weighted N = 48,419,077) children and adolescents (mean age = 11.9 ± 3.5 years, 48.9% female, 71.3% White) were included in the analytical sample. From pooled data across 2018-2022, 20.8% met PA guidelines, 49.6% met ST guidelines, 64.7% met SL guidelines, and 9.7% met all three guidelines concurrently. Except for SL, which remained stable, the predictive prevalence of adherence to every combination of 24hrMB guideline was significantly lower in 2022 compared to 2018, with variations in trends between individual guidelines and years. The largest predicted prevalence difference from 2018 to 2022 was adherence to ST guidelines, which was 0.52 (95%CI 0.50-0.54) in 2018 and 0.47 (95% CI 0.46-0.48) in 2022 (p < 0.001). The largest year-to-year predictive prevalence difference was also adherence to ST guidelines from 2019 to 2020, which was 0.52 (95% CI 0.50-0.53) in 2019 and 0.40 (95% CI 0.39-0.42) in 2020 (p < 0.001). Cochran-Armitage tests for trend revealed a significant downward trend in guideline adherence for all 24hrMB across 2018-2022 (X(2)(range) = 45.9-826.2, p < 0.01). CONCLUSIONS: The predictive prevalence of adherence to every combination of 24hrMB guideline was significantly lower in 2022 compared to 2018, except for individual SL guideline adherence, which remained stable. These findings are concerning from a public health perspective, as meeting 24hrMB guidelines is linked to numerous indicators of healthy development for children and youth, underscoring the need for effective multi-level behavioral interventions to address the continued decline in meeting 24hrMB guidelines among youth.