{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T12:59:16Z","timestamp":1790600356619,"version":"4.1.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Digital exclusion extends beyond access to whether digital participation is associated with health-promoting behavior and health-related outcomes. Physical exercise may form one behavioral link between digital participation and health, but the strength of this sequence may differ across sociodemographic groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We harmonized the 2013, 2018, and 2023 Chinese General Social Survey, including 29,295 adults across 31 provincial-level units. These waves were deliberately selected at approximately 5-year intervals to provide repeated cross-sectional snapshots across a 10-year period. Provincial digital development was measured using a 21-indicator province-year composite index. Survey-weighted population-average path models were supplemented by constrained-model comparisons, formal between-group heterogeneity tests, and multilevel structural equation models separating within- and between-province-year associations. The multilevel models used 87 observed province-year clusters and additionally adjusted for province-year sports-facility resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Provincial digital development increased from 0.117 in 2013 to 0.176 in 2018 and was 0.162 in 2023. Internet use increased from 2.132 to 3.593, while physical exercise increased from 2.091 to 2.537. In population-average models, digital development was positively associated with internet use, internet use with physical exercise, and exercise with all three health outcomes; the complete serial indirect associations were statistically supported but small. Multilevel decomposition showed robust within-cluster internet use \u2192 exercise \u2192 health indirect associations. At the between-cluster level, digital development \u2192 internet use and internet use \u2192 exercise were supported, whereas exercise \u2192 health and the complete digital development \u2192 internet use \u2192 exercise \u2192 health indirect associations were not. Formal heterogeneity tests indicated selective, stage-specific differences by age, hukou, marital status, and education, with weaker evidence for household economic position and no clear evidence for sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Digital expansion did not automatically correspond to comparable growth in physical exercise or multidimensional health. The findings support a use-to-benefit perspective while showing that the proposed sequence is level-dependent: individual internet use was consistently linked to exercise and health within province-year contexts, but the complete between-cluster serial association was not supported. Public-health strategies should connect inclusive digital participation with behaviorally specific support and accessible offline opportunities for physical activity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1976170","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T12:12:01Z","timestamp":1790597521000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Digital development and health in China: a serial pathway model through internet use and physical exercise in repeated cross-sectional surveys"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiaochu","family":"Yang","sequence":"first","affiliation":[{"name":"School of Physical Education, Hunan University of Technology","place":["Zhuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minmin","family":"Wei","sequence":"additional","affiliation":[{"name":"School of Physical Education, Hunan University of Technology","place":["Zhuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyu","family":"Fang","sequence":"additional","affiliation":[{"name":"School of Physical Education, Hunan University of Technology","place":["Zhuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengbiao","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Physical Education, Hunan University of Technology","place":["Zhuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","unstructured":"The 33rd Statistical Report on Internet Development in China\n          \n          2014"},{"key":"B2","unstructured":"The 53rd Statistical Report on China's Internet Development\n          \n          2024"},{"key":"B3","doi-asserted-by":"publisher","first-page":"i3857","DOI":"10.1136\/bmj.i3857","article-title":"Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013","volume":"354","author":"Kyu","year":"2016","journal-title":"BMJ"},{"key":"B4","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.maturitas.2017.09.003","article-title":"Exercise and mental health","volume":"106","author":"Mikkelsen","year":"2017","journal-title":"Maturitas"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br J Sports Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1097\/HCO.0000000000000437","article-title":"Health benefits of physical activity: a systematic review of current systematic reviews","volume":"32","author":"Warburton","year":"2017","journal-title":"Curr Opin Cardiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/S0140-6736(12)60646-1","article-title":"Global physical activity levels: surveillance progress, pitfalls, and prospects","volume":"380","author":"Hallal","year":"2012","journal-title":"Lancet"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e1077","DOI":"10.1016\/S2214-109X(18)30357-7","article-title":"Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1. 9 million participants","volume":"6","author":"Guthold","year":"2018","journal-title":"Lancet Glob Health"},{"key":"B9","unstructured":"Global Status Report on Physical Activity 2022\n          \n          2022"},{"key":"B10","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/S0140-6736(12)60735-1","article-title":"Correlates of physical activity: why are some people physically active and others not?","volume":"380","author":"Bauman","year":"2012","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1016\/S0140-6736(16)30370-1","article-title":"Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? 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