title: Psychological distress, television viewing, and physical activity in children aged 4 to 12 years.
abstract: OBJECTIVE
  Sedentary behavior and physical activity may be independent risk factors for psychological distress in adolescents, although there is no existing information for children. We examined the cross-sectional association between psychological distress, television and screen entertainment time, and physical activity levels among a representative sample of children aged 4 to 12 years from the 2003 Scottish Health Survey.
  
  
  METHODS
  Participants were 1486 boys and girls (mean age: 8.5 +/- 2.3 years). Parents answered on behalf of children who were required to be present. The parents completed the Strengths and Difficulties Questionnaire and information on television and screen entertainment time, physical activity, and dietary intake of their children.
  
  
  RESULTS
  An abnormally high Strengths and Difficulties Questionnaire total difficulties score (20-40) was found in 4.2% of the sample. Approximately 25% of the children were exposed to television and screen entertainment at least 3 hours/day. In general linear models, television and screen entertainment time per week and physical activity levels were independently associated with the Strengths and Difficulties Questionnaire total difficulties score after adjustment for age, gender, area deprivation level, single-parent status, medical conditions, and various dietary intake indicators. There was also an additive interaction effect showing that the combination of high television and screen entertainment time and low physical activity was associated with the highest Strengths and Difficulties Questionnaire score. Higher television and screen entertainment exposure (>2.7 hours/day) alone resulted in a 24% increase in the Strengths and Difficulties Questionnaire score in comparison with lower television and screen entertainment exposure (<1.6 hours/day), although when combined with low physical activity this resulted in a 46% increase.
  
  
  CONCLUSIONS
  Higher levels of television and screen entertainment time and low physical activity levels interact to increase psychological distress in young children.
authors.affiliation: University College London, Department of Epidemiology and Public Health, 1-19 Torrington Place, London WC1E 6BT, United Kingdom. m.hamer@ucl.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Stamatakis
authors.forename: Gita
authors.initials: G
authors.lastname: Mishra
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D012309:Risk-Taking; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013690:Television; D013997:Time Factors