{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:37:08Z","timestamp":1791387428853,"version":"4.3.3"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T00:00:00Z","timestamp":1739836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In China, approximately 30 and 70% of primary and middle school students, respectively, have myopia, making myopia prevention and control necessary. Eye-use behaviors are closely related to myopia, highlighting the importance of determining the behavioral compliance rates of children. Parental awareness also affects children\u2019s behaviors. Therefore, we assessed the myopia-related behaviors and parental awareness of school-aged children in different city tiers of China with different refractive statuses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A population-based, cross-sectional study was conducted on Chinese children from 110 cities aged 7\u201315\u202fyears. Samples were equally allocated to each subgroup of city tiers, children\u2019s age groups, and children\u2019s refractive statuses. Questionnaires were designed to investigate children\u2019s behaviors, including responses to sitting position, time of eye use (single continuous near work time and breaks in between, total near work time after school each day), eye rest (break time and style during near work and outdoor time per week), light conditions in the learning environment at home, and parents\u2019 knowledge about myopia prevention and control. Associations between parental awareness and children\u2019s behaviors were analyzed using logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 896 questionnaires were collected. The prevalence of children\u2019s poor behaviors related to myopia ranged from 23.44 to 84.82%, with the highest and lowest being sitting position and the use of eye-protecting lamps, respectively. Children in third-tier cities were more likely to have poor sitting position (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.01), a non-open view in front of a desk at home (<jats:italic>p<\/jats:italic>\u202f=\u202f0.02), and more near activities during break times (<jats:italic>p<\/jats:italic>\u202f=\u202f0.04). After adjustment for parental myopia condition and the child\u2019s sex, poor parental awareness was mainly associated with not using an eye-protecting lamp (odds ratio [OR]: 1.95, 95% confidence interval [CI]: 1.40\u20132.72), poor break styles (OR: 1.60, 95% CI: 1.21\u20132.12), and excessive total near work time (OR: 1.45, 95% CI: 1.02\u20132.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Myopia-related behaviors were poorly performed in children, particularly among older children and those living in third-tier cities. Eye-protecting lamps, time spent doing near work, and break style were all associated with parental awareness, suggesting that better parental awareness helps children in the long run. More targeted measures could be adopted to help improve children\u2019s behaviors.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1520977","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T05:20:57Z","timestamp":1739856057000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Comparison of myopia-related behaviors among Chinese school-aged children and associations with parental awareness of myopia control: a population-based, cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Chaoying","family":"Ye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujia","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingxue","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianmin","family":"Shang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomei","family":"Qu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1038\/519276a","article-title":"The myopia 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Central People\u2019s government of the People\u2019s republic of China","year":"2021"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.ophtha.2018.05.010","article-title":"The associations between near visual activity and incident myopia in children: a nationwide 4-year follow-up study","volume":"126","author":"Ku","year":"2019","journal-title":"Ophthalmology"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"315258","DOI":"10.1136\/bjophthalmol-2019-315258","article-title":"Objectively measured near work, outdoor exposure and myopia in children","volume":"104","author":"Wen","year":"2020","journal-title":"Br J Ophthalmol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"109202","DOI":"10.1016\/j.exer.2022.109202","article-title":"Near work induces myopia in Guinea pigs","volume":"224","author":"Fu","year":"2022","journal-title":"Exp Eye 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