Associations of 24-hour movement behaviors with emotional and behavioral problems among Chinese adolescents

PurposeThe role of adherence to the recommendations for 24-hour movement behaviors (24-HMB), including physical activity (PA), screen time (ST), and sleep duration (SLP), in relation to emotional and behavioral problems in Chinese adolescents remains uncertain. This study aimed to investigate these associations and explore potential sex differences.MethodsThis school-based cross-sectional study included 15,071 Chinese adolescents with a mean age of 14.53 (SD: 1.65) years. Data on emotional and behavioral problems and 24-HMB (including PA, ST, and SLP) were collected. Analysis was performed using general linear mixed models, with additional sex-stratified analyses conducted.ResultsThe number of 24-HMB recommendations met was negatively associated with total difficulties (beta estimate=-0.96, 95% CI: -1.07 to -0.85) and positively related to prosocial behavior (beta estimate = 0.41, 95% CI: 0.37 to 0.46) among adolescents. Compared with none of the recommendations met, meeting all recommendations (total difficulties: beta estimate=-2.98, 95% CI: -3.41 to -2.55; prosocial behaviors: beta estimate = 1.05, 95%CI: 0.87 to 1.24) demonstrated the strongest association with both difficulties and prosocial behaviors, followed by meeting recommendations for PA + ST (total difficulties: beta estimate=-2.15, 95% CI: -2.41 to -1.90; prosocial behaviors: beta estimate = 0.98, 95% CI: 0.87 to 1.09). These associations were consistently significant in both boys and girls.ConclusionAdherence to more 24-HMB recommendations, particularly meeting all recommendations or combined PA + ST recommendations, could improve emotional and behavioral well-being among adolescent girls and boys. The significance of balanced movement behaviors for promoting adolescent mental health merits increased attention.