BACKGROUND
Previous studies showed a significant association between screen time (ST) and health-related quality of life (HRQoL) in children. However, the mechanisms underlying the association are unclear.
OBJECTIVE
To determine the extent to which time spent (physical activities and sleep duration) and relationship factors (dysfunctional parent-child interaction and peer problems) mediate the association between children’s ST and their HRQoL.
METHODS
A population-representative sample of 1,033 parents of primary school children (49.3% female; Mage = 8.5, SDage = 1.9) in Hong Kong participated in the study over the course of one year (two waves). Children’s ST was reported by parents. The study outcome, children’s HRQoL, was assessed using the 23-item Pediatrics Quality of Life Inventory Parent-Proxy Report (PedsQL). Mediators, including dysfunctional parent-child interaction (PCDI), peer problems (SDQ-PP), weighted daily time spent in moderate-to-vigorous physical activity (MVPA), and weighted average of daily sleep duration, were assessed to test the displacement and relational hypotheses.
RESULTS
Multilevel structural equation modeling with a 1-1-1 mediation framework showed a statistically significant direct effect (β = -0.77, 95% CI -1.02 to -0.53) of ST on PedsQL. The association was partially mediated by both relationship factors (PCDI: β = -0.09, 95% confidence interval [CI] -0.15 to -0.03; mediation proportion = 8.33%; SDQ-PP: β = -0.13, 95% CI -0.23 to -0.03; mediation proportion = 12.74%) at the within-person level, but not time spent factors (i.e., sleep duration and MVPA).
CONCLUSIONS
Impairments in parent-child and peer relationships partially mediated the association between duration of screen time and children’s HRQoL. These findings suggest that relationship-focused intervention might buffer the negative associations of increased screen time on children’s functioning.
CLINICALTRIAL
Not applicable.