{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T18:05:10Z","timestamp":1784225110570,"version":"3.55.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Portugal Inova\u00e7\u00e3o Social through European Union funds","award":["CENTRO2030-FSE+-02333900"],"award-info":[{"award-number":["CENTRO2030-FSE+-02333900"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to investigate the interaction between parental myopia and school-related lifestyle patterns, and myopia in a sample of Portuguese adolescents. Based on previously reported data, we examined whether environmental and behavioural correlates traditionally associated with myopia, such as outdoor time, physical activity practice, screen time, and academic load, maintain their significance in a non-metropolitan European context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This analysis involved a sample of 874 adolescents (10\u221218 years). Myopia was measured using non-cycloplegic open-field autorefraction and defined as a spherical equivalent\u2009\u2264\u2009\u22120.50D in the worse eye. Potential factors correlated with myopia were collected through supervised questionnaires completed by students and parents. Data were analysed using univariate and multivariable logistic regression to identify independent associations adjusting for demographic and behavioural covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence rate of myopia was 22.5%. The multivariable model identified family history of myopia as the strongest association (OR up to 3.75; CI:2.03\u20136.95; p\u2009&lt;\u20090.001). Attending a higher school level (OR=2.20; CI:1.07\u20134.52; p\u2009=\u20090.032) and schools in urban locations (OR=1.59; CI:1.00\u20132.50; p\u2009=\u20090.048) showed a significant association. Regarding lifestyle, regular physical activity (\u2265 2 times per week) was associated with odds of myopia (OR=0.47; CI:0.29\u20130.77; p\u2009=\u20090.003) even after adjustment for parental history of myopia. Although included in the fully adjusted model, factors such as smartphone use and breastfeeding did not reach statistical significance (p\u2009&gt;\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite the low population-density environment in this region, myopia prevalence was comparable to that reported in other European studies. The identified associations suggest that both parental history and school-related lifestyle factors should be considered when interpreting myopia patterns in adolescence. These findings may help inform school-based strategies aimed at promoting healthier visual and behavioural habits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353283","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T17:28:30Z","timestamp":1784222910000},"page":"e0353283","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associated factors of myopia in a Portuguese sample of adolescents: Parental history and school-related lifestyle"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5001-3534","authenticated-orcid":true,"given":"Am\u00e9lia Fernandes","family":"Nunes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Cunha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e1rio","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Castelo-Branco","family":"Sousa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Albuquerque","family":"Godinho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"issue":"5","key":"pone.0353283.ref001","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050","volume":"123","author":"BA Holden","year":"2016","journal-title":"Ophthalmology"},{"issue":"3","key":"pone.0353283.ref002","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1136\/bjo-2024-325427","article-title":"Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis","volume":"109","author":"J Liang","year":"2025","journal-title":"Br J Ophthalmol"},{"issue":"5","key":"pone.0353283.ref003","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1167\/iovs.62.5.3","article-title":"IMI Risk Factors for Myopia","volume":"62","author":"IG Morgan","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"3","key":"pone.0353283.ref004","first-page":"382","article-title":"Myopia Genetics and Heredity","volume":"9","author":"Y-M Wang","year":"2022","journal-title":"Children (Basel)"},{"issue":"2","key":"pone.0353283.ref005","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1136\/bjo-2022-322773","article-title":"Risk factors for myopia among children and adolescents: an umbrella review of published meta-analyses and systematic reviews","volume":"108","author":"Z-Q Ying","year":"2024","journal-title":"Br J Ophthalmol"},{"issue":"9","key":"pone.0353283.ref006","article-title":"Global risk factor analysis of myopia onset in children: A systematic review and meta-analysis","volume":"18","author":"M Yu","year":"2023","journal-title":"PLoS One"},{"issue":"4","key":"pone.0353283.ref007","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1111\/opo.13464","article-title":"Myopia is predominantly genetic or predominantly environmental?","volume":"45","author":"VJ Verhoeven","year":"2025","journal-title":"Ophthalmic Physiol Opt"},{"issue":"3","key":"pone.0353283.ref008","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1111\/aos.14942","article-title":"Near work, screen time, outdoor time and myopia in schoolchildren in the Sunflower Myopia AEEC Consortium","volume":"100","author":"C Lanca","year":"2022","journal-title":"Acta Ophthalmol"},{"issue":"7","key":"pone.0353283.ref009","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1111\/ceo.14277","article-title":"Association between sleep duration, sleep quality, bedtime and myopia: A systematic review and meta-analysis","volume":"51","author":"XX Wang","year":"2023","journal-title":"Clin Exp Ophthalmol"},{"issue":"7","key":"pone.0353283.ref010","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1111\/aos.13316","article-title":"Physical activity in relation to development and progression of myopia - a systematic review","volume":"95","author":"A Suhr Thykjaer","year":"2017","journal-title":"Acta Ophthalmol"},{"issue":"1","key":"pone.0353283.ref011","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40101-024-00354-7","article-title":"The influence of the environment and lifestyle on myopia","volume":"43","author":"S Biswas","year":"2024","journal-title":"J Physiol Anthropol"},{"issue":"1","key":"pone.0353283.ref012","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12886-019-1220-0","article-title":"A review on the epidemiology of myopia in school children worldwide","volume":"20","author":"A Grzybowski","year":"2020","journal-title":"BMC Ophthalmol"},{"issue":"5","key":"pone.0353283.ref013","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1167\/iovs.62.5.2","article-title":"IMI Impact of Myopia","volume":"62","author":"P Sankaridurg","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0353283.ref014","doi-asserted-by":"crossref","DOI":"10.2196\/42694","article-title":"Effects of Greenness on Myopia Risk and School-Level Myopia Prevalence Among High School-Aged Adolescents: Cross-sectional Study","volume":"9","author":"C Zhang","year":"2023","journal-title":"JMIR Public Health Surveill"},{"key":"pone.0353283.ref015","first-page":"1101","article-title":"Prevalence of anisometropia in children and adolescents","volume":"10","author":"AF Nunes","year":"2021","journal-title":"F1000Res"},{"issue":"2","key":"pone.0353283.ref016","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1111\/opo.13429","article-title":"Factors associated with myopia in the Portuguese child population: An epidemiological study","volume":"45","author":"M\u00c1 S\u00e1nchez-Tena","year":"2025","journal-title":"Ophthalmic Physiol Opt"},{"issue":"1","key":"pone.0353283.ref017","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.1186\/s12889-024-19914-8","article-title":"Prevalence, sociodemographic risk factors, and coverage of myopia correction among adolescent students in the central region of Portugal","volume":"24","author":"AF Nunes","year":"2024","journal-title":"BMC Public Health"},{"issue":"10","key":"pone.0353283.ref018","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1097\/OPX.0000000000000926","article-title":"Changes in Myopia Prevalence among First-Year University Students in 12 Years","volume":"93","author":"J Jorge","year":"2016","journal-title":"Optom Vis Sci"},{"issue":"9","key":"pone.0353283.ref019","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/iovs.66.9.7","article-title":"IMI-Instrumentation for Myopia Management","volume":"66","author":"D Jones","year":"2025","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"6","key":"pone.0353283.ref020","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1111\/opo.13022","article-title":"Systematic review and meta-analysis on the agreement of non-cycloplegic and cycloplegic refraction in children","volume":"42","author":"S Wilson","year":"2022","journal-title":"Ophthalmic Physiol Opt"},{"key":"pone.0353283.ref021","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12886-016-0247-8","article-title":"Accuracy of PlusOptix A09 distance refraction in pediatric myopia and hyperopia","volume":"16","author":"A Payerols","year":"2016","journal-title":"BMC Ophthalmol"},{"key":"pone.0353283.ref022"},{"issue":"6","key":"pone.0353283.ref023","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1093\/aje\/kwk052","article-title":"Relaxing the rule of ten events per variable in logistic and Cox regression","volume":"165","author":"E Vittinghoff","year":"2007","journal-title":"Am J Epidemiol"},{"issue":"5","key":"pone.0353283.ref024","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s11135-006-9018-6","article-title":"A caution regarding rules of thumb for variance inflation factors","volume":"41","author":"RM O\u2019brien","year":"2007","journal-title":"Qual Quant"},{"issue":"5","key":"pone.0353283.ref025","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1080\/08164622.2021.1878833","article-title":"Refractive error, axial length, environmental and hereditary factors associated with myopia in Swedish children","volume":"104","author":"P Demir","year":"2021","journal-title":"Clin Exp Optom"},{"issue":"10","key":"pone.0353283.ref026","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1136\/bjophthalmol-2019-315024","article-title":"Thirty-five-year trend in the prevalence of refractive error in Austrian conscripts based on 1.5 million participants","volume":"104","author":"L Yang","year":"2020","journal-title":"Br J Ophthalmol"},{"issue":"1","key":"pone.0353283.ref027","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1186\/s12889-022-14377-1","article-title":"The relationship between myopia and near work, time outdoors and socioeconomic status in children and adolescents","volume":"22","author":"D Philipp","year":"2022","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0353283.ref028","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/aos.16688","article-title":"Time spent outdoors in childhood related to myopia among young adults in the Swedish ABIS cohort","volume":"103","author":"T Bro","year":"2025","journal-title":"Acta Ophthalmol"},{"key":"pone.0353283.ref029","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.pmedr.2018.10.003","article-title":"Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study","volume":"12","author":"JM Twenge","year":"2018","journal-title":"Prev Med Rep"},{"issue":"12","key":"pone.0353283.ref030","article-title":"Urban Living Environment and Myopia in Children","volume":"6","author":"X Li","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"2","key":"pone.0353283.ref031","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/opo.12943","article-title":"Prevalence of myopia among urban and suburban school children in Tamil Nadu, South India: findings from the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study","volume":"42","author":"A Gopalakrishnan","year":"2022","journal-title":"Ophthalmic Physiol Opt"},{"issue":"12","key":"pone.0353283.ref032","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.3760\/cma.j.issn.0366-6999.20133118","article-title":"Effect of maternal age on pregnancy: a retrospective cohort study","volume":"127","author":"X Liu","year":"2014","journal-title":"Chin Med J (Engl)"},{"issue":"1","key":"pone.0353283.ref033","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1136\/bjophthalmol-2017-311774","article-title":"Association of low birth weight with myopic refractive error and lower visual acuity in adulthood: results from the population-based Gutenberg Health Study (GHS)","volume":"103","author":"A Fie\u00df","year":"2019","journal-title":"Br J Ophthalmol"},{"issue":"1","key":"pone.0353283.ref034","doi-asserted-by":"crossref","first-page":"10025","DOI":"10.1038\/s41598-018-27878-0","article-title":"Breastfeeding and myopia: A cross-sectional study of children aged 6-12 years in Tianjin, China","volume":"8","author":"S Liu","year":"2018","journal-title":"Sci Rep"},{"issue":"7","key":"pone.0353283.ref035","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1016\/j.ophtha.2015.03.018","article-title":"Increasing Prevalence of Myopia in Europe and the Impact of Education","volume":"122","author":"KM Williams","year":"2015","journal-title":"Ophthalmology"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T17:28:36Z","timestamp":1784222916000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353283"}},"subtitle":[],"editor":[{"given":"Andrzej","family":"Grzybowski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0353283","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]}}}