{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:53:12Z","timestamp":1788177192828,"version":"build-2803163510"},"reference-count":77,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T00:00:00Z","timestamp":1603670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Today, the time spent actively is increasingly being replaced by screen-based media, although in some teenagers, a high level of physical activity (PA) and longer time spent in front of a screen (screen time, ST) may coexist as a mixed behavioral pattern. This study aimed to examine the association of the pattern created as activity (low\/high ST with high PA) and inactivity patterns (low\/high ST with low PA) with overweight, central obesity, and muscle strength in Polish teenagers taking into consideration socioeconomic and demographic factors. Cross-sectional data were collected from elementary school children (n = 1567), aged 11\u201313 years. Height, weight, waist circumference, and handgrip strength were measured. Body mass index (BMI) was calculated as the overweight measure, and the waist-to-height ratio (WHtR) was calculated as the central obesity measure. Data on ST, PA, socioeconomic status, demographics, and nutrition knowledge were collected by a questionnaire. Activity\u2013inactivity patterns were defined by an a priori approach. Multivariate logistic regression modelling was applied. The most active pattern (lowST-highPA) was found in 17% of the total sample. Teenagers with the most inactive pattern (highST-lowPA) had over four times higher chance of general overweight. No association between WHtR \u22650.5 and highST-highPA pattern was found. Higher muscle strength (&gt;1 SD) was associated only with high physical activity. Urban residence or lower socioeconomic status increased adherence to the most inactive pattern. From a public health perspective, implementing interventions promoting active patterns in 11\u201313-year-old teenagers is important for obesity prevention and enhanced physical fitness, especially in girls, teenagers living in urban areas, and from families with lower socio-economic status.<\/jats:p>","DOI":"10.3390\/ijerph17217842","type":"journal-article","created":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T10:38:35Z","timestamp":1603708715000},"page":"7842","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Activity\u2013Inactivity Patterns, Screen Time, and Physical Activity: The Association with Overweight, Central Obesity and Muscle Strength in Polish Teenagers. Report from the ABC of Healthy Eating Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8805-186X","authenticated-orcid":false,"given":"Magdalena","family":"G\u00f3rnicka","sequence":"first","affiliation":[{"name":"Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska Str 159C, 02-776 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4933-9016","authenticated-orcid":false,"given":"Jadwiga","family":"Hamulka","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska Str 159C, 02-776 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8571-9935","authenticated-orcid":false,"given":"Lidia","family":"Wadolowska","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition, Faculty of Food Sciences, University of Warmia and Mazury in Olsztyn, Pl. Cieszynski 1, 10-718 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1981-7320","authenticated-orcid":false,"given":"Joanna","family":"Kowalkowska","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition, Faculty of Food Sciences, University of Warmia and Mazury in Olsztyn, Pl. Cieszynski 1, 10-718 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8613-3733","authenticated-orcid":false,"given":"Eliza","family":"Kostyra","sequence":"additional","affiliation":[{"name":"Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska Str 159C, 02-776 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzena","family":"Tomaszewska","sequence":"additional","affiliation":[{"name":"Department of Food Gastronomy and Food Hygiene, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska Str 159C, 02-776 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Czeczelewski","sequence":"additional","affiliation":[{"name":"Faculty of Physical Education and Health in Bia\u0142a Podlaska, Josef Pi\u0142sudski University of Physical Education in Warsaw, Akademicka Str 2., 21-500 Bia\u0142a Podlaska, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2960-6981","authenticated-orcid":false,"given":"Monika","family":"Bronkowska","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wroclaw University of Environmental and Life Sciences, Chelmo\u0144skiego Str 37, 51-630 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1016\/S0140-6736(17)32129-3","article-title":"Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults","volume":"390","author":"Abdeen","year":"2017","journal-title":"Lancet"},{"key":"ref_2","unstructured":"(2020, February 05). OECD Obesity Update 2017. Available online: http:\/\/www.oecd.org\/health\/obesity-update.htm."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s00431-017-2938-4","article-title":"Central overweight and obesity in Polish schoolchildren aged 7\u201318 years: Secular changes of waist circumference between 1966 and 2012","volume":"176","author":"Suder","year":"2017","journal-title":"Eur. J. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s12966-018-0756-3","article-title":"Longitudinal analysis of physical activity, sedentary behaviour and anthropometric measures from ages 6 to 11 years","volume":"15","author":"Schwarzfischer","year":"2018","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Serrano-Sanchez, J.A., Mart\u00ed-Trujillo, S., Lera-Navarro, A., Dorado-Garc\u00eda, C., Gonz\u00e1lez-Henr\u00edquez, J.J., and Sanch\u00eds-Moysi, J. (2011). Associations between Screen Time and Physical Activity among Spanish Adolescents. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0024453"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1017\/S1368980016002640","article-title":"Perinatal, sociodemographic and lifestyle correlates of increased total and visceral fat mass levels in schoolchildren in Greece: The Healthy Growth Study","volume":"20","author":"Moschonis","year":"2017","journal-title":"Public Health Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1017\/S1368980009004881","article-title":"Screen time and adiposity in adolescents in Mexico","volume":"12","author":"Lajous","year":"2009","journal-title":"Public Health Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1001\/archpediatrics.2007.45","article-title":"A Randomized Trial of the Effects of Reducing Television Viewing and Computer Use on Body Mass Index in Young Children","volume":"162","author":"Epstein","year":"2008","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1017\/S136898001700372X","article-title":"Associations between sedentary behaviours and dietary intakes among adolescents","volume":"21","author":"Fletcher","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pearson, N., Griffiths, P., Biddle, S.J., Johnston, J.P., McGeorge, S., and Haycraft, E. (2017). Clustering and correlates of screen-time and eating behaviours among young adolescents. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4441-2"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1108\/NFS-04-2014-0036","article-title":"Behavioral and societal drivers of an obesogenic environment worldwide","volume":"45","author":"Abbade","year":"2015","journal-title":"Nutr. Food Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1249\/MSS.0b013e3181930355","article-title":"Sitting Time and Mortality from All Causes, Cardiovascular Disease, and Cancer","volume":"41","author":"Katzmarzyk","year":"2009","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/s12170-008-0054-8","article-title":"Too little exercise and too much sitting: Inactivity physiology and the need for new recommendations on sedentary behavior","volume":"2","author":"Hamilton","year":"2008","journal-title":"Curr. Cardio Risk. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jshs.2012.09.004","article-title":"Physical activity and obese children","volume":"1","author":"McManus","year":"2012","journal-title":"J. Sport Health Sci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"G\u0142\u0105bska, D., Guzek, D., Mellov\u00e1, B., Zadka, K., \u017bywczyk, K., and Gutkowska, K. (2019). The National After-School Athletics Program Participation as a Tool to Reduce the Risk of Obesity in Adolescents after One Year of Intervention: A Nationwide Study. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16030405"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.jadohealth.2008.10.142","article-title":"Patterns of Adolescent Physical Activity, Screen-Based Media Use, and Positive and Negative Health Indicators in the U.S. and Canada","volume":"44","author":"Iannotti","year":"2009","journal-title":"J. Adolesc. Health"},{"key":"ref_17","doi-asserted-by":"crossref","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":"ref_18","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1093\/eurheartj\/ehz774","article-title":"Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: A cohort study of 1 million men","volume":"41","author":"Henriksson","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e026275","DOI":"10.1136\/bmjopen-2018-026275","article-title":"Dietary intake, physical activity and muscle strength among adolescents: The Malaysian Health and Adolescents Longitudinal Research Team (MyHeART) study","volume":"9","author":"Ng","year":"2019","journal-title":"BMJ Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1111\/j.1600-0838.2009.01036.x","article-title":"Associations of physical activity with muscular fitness in adolescents: Physical activity and muscular fitness in adolescents","volume":"21","author":"Welk","year":"2011","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Jim\u00e9nez-Pav\u00f3n, D., Fern\u00e1ndez-V\u00e1zquez, A., Alexy, U., Pedrero, R., Cuenca-Garc\u00eda, M., Polito, A., Vanhelst, J., Manios, Y., Kafatos, A., and Molnar, D. (2013). Association of objectively measured physical activity with body components in European adolescents. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-667"},{"key":"ref_22","unstructured":"WHO (2010). Global Recommendations on Physical Activity for Health, World Health Organization."},{"key":"ref_23","unstructured":"(2020, April 18). Pyramid of Healthy Nutrition and Physical Activity for Children. (In Polish)."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics (2001). Committee on Public Education. American Academy of Pediatrics: Children, adolescents, and television. Pediatrics, 107, 423\u2013426.","DOI":"10.1542\/peds.107.2.423"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1111\/obr.12188","article-title":"Associations between sedentary behaviour and physical activity in children and adolescents: A meta-analysis: Active and sedentary behaviours in youth","volume":"15","author":"Pearson","year":"2014","journal-title":"Obes. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Hamulka, J., Wadolowska, L., Hoffmann, M., Kowalkowska, J., and Gutkowska, K. (2018). Effect of an Education Program on Nutrition Knowledge, Attitudes toward Nutrition, Diet Quality, Lifestyle, and Body Composition in Polish Teenagers. The ABC of Healthy Eating Project: Design, Protocol, and Methodology. Nutrients, 10.","DOI":"10.3390\/nu10101439"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Wadolowska, L., Hamulka, J., Kowalkowska, J., Ulewicz, N., Gornicka, M., Jeruszka-Bielak, M., Kostecka, M., and Wawrzyniak, A. (2019). Skipping Breakfast and a Meal at School: Its Correlates in Adiposity Context. Report from the ABC of Healthy Eating Study of Polish Teenagers. Nutrients, 11.","DOI":"10.3390\/nu11071563"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wadolowska, L., Hamulka, J., Kowalkowska, J., Kostecka, M., Wadolowska, K., Biezanowska-Kopec, R., Czarniecka-Skubina, E., Kozirok, W., and Piotrowska, A. (2018). Prudent-Active and Fast-Food-Sedentary Dietary-Lifestyle Patterns: The Association with Adiposity, Nutrition Knowledge and Sociodemographic Factors in Polish Teenagers\u2014The ABC of Healthy Eating Project. Nutrients, 10.","DOI":"10.3390\/nu10121988"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kowalkowska, J., Wadolowska, L., Hamulka, J., Wojtas, N., Czlapka-Matyasik, M., Kozirok, W., Bronkowska, M., Sadowska, J., Naliwajko, S., and Dziaduch, I. (2019). Reproducibility of a Short-Form, Multicomponent Dietary Questionnaire to Assess Food Frequency Consumption, Nutrition Knowledge, and Lifestyle (SF-FFQ4PolishChildren) in Polish Children and Adolescents. Nutrients, 11.","DOI":"10.3390\/nu11122929"},{"key":"ref_30","unstructured":"(2016). Council on Communications and Media Media Use in School-Aged Children and Adolescents. Pediatrics, 138, e20162592."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1136\/archdischild-2017-312969","article-title":"Media use in children: American Academy of Pediatrics recommendations 2016","volume":"103","author":"Guram","year":"2018","journal-title":"Arch. Dis. Child. Edu. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e0013","DOI":"10.1097\/pp9.0000000000000013","article-title":"Fitness and Fatness as Health Markers through the Lifespan: An Overview of Current Knowledge","volume":"3","author":"Ortega","year":"2018","journal-title":"Prog. Prev. Med."},{"key":"ref_33","unstructured":"(2019, December 10). Australian 24-Hour Movement Guidelines for Children and Young People (5\u201317 Years)\u2014An Integration of Physical Activity, Sedentary Behaviour and Sleep, Available online: https:\/\/www1.health.gov.au\/internet\/main\/publishing.nsf\/Content\/health-24-hours-phys-act-guidelines."},{"key":"ref_34","unstructured":"International Society for the Advancement of Kinanthropometry (ISAK) (2001). International Standards for Anthropometric Assessment, International Society for the Advancement of Kinanthropometry."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/j.2047-6310.2012.00064.x","article-title":"Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity: Extended international BMI cut-offs","volume":"7","author":"Cole","year":"2012","journal-title":"Pediatric Obes."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/j.1467-789X.2011.00952.x","article-title":"Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and meta-analysis: Waist-to-height ratio as a screening tool","volume":"13","author":"Ashwell","year":"2012","journal-title":"Obes. Rev."},{"key":"ref_37","first-page":"211","article-title":"Family Affluence Scale\u2014Validation study and suggested modification","volume":"48","author":"Mazur","year":"2013","journal-title":"Hygeia Public Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.nut.2004.09.011","article-title":"Development of a reliable and valid nutritional knowledge questionnaire for urban South African adolescents","volume":"21","author":"Whati","year":"2005","journal-title":"Nutrition"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Heshmat, R., Qorbani, M., Shahr Babaki, A.E., Djalalinia, S., Ataei-Jafari, A., Motlagh, M.E., Ardalan, G., Arefirad, T., Rezaei, F., and Asayesh, H. (2016). Joint Association of Screen Time and Physical Activity with Cardiometabolic Risk Factors in a National Sample of Iranian Adolescents: The CASPIANIII Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154502"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jshs.2018.03.004","article-title":"Cardiometabolic risk through an integrative classification combining physical activity and sedentary behavior in European adolescents: HELENA study","volume":"8","author":"Labayen","year":"2019","journal-title":"J. Sport Health Sci."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Throuvala, M.A., Griffiths, M.D., Rennoldson, M., and Kuss, D.J. (2020). The Role of Recreational Online Activities in School-Based Screen Time Sedentary Behaviour Interventions for Adolescents: A Systematic and Critical Literature Review. Int. J. Ment. Health Addict.","DOI":"10.1007\/s11469-019-00213-y"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12966-017-0497-8","article-title":"Sedentary behaviour and adiposity in youth: A systematic review of reviews and analysis of causality","volume":"14","author":"Biddle","year":"2017","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Yan, H., Zhang, R., Oniffrey, T., Chen, G., Wang, Y., Wu, Y., Zhang, X., Wang, Q., Ma, L., and Li, R. (2017). Associations among Screen Time and Unhealthy Behaviors, Academic Performance, and Well-Being in Chinese Adolescents. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14060596"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Xu, F., Adams, S.K., Cohen, S.A., Earp, J.E., and Greaney, M.L. (2019). Relationship between Physical Activity, Screen Time, and Sleep Quantity and Quality in US Adolescents Aged 16\u201319. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16091524"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1038\/ijo.2013.32","article-title":"Waist circumference-to-height ratio predicts adiposity better than body mass index in children and adolescents","volume":"37","author":"Brambilla","year":"2013","journal-title":"Int. J. Obes."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1111\/obr.12456","article-title":"Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: A meta-analysis: Screening cardio-metabolic risk factors","volume":"17","author":"Lo","year":"2016","journal-title":"Obes. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1038\/sj.ijo.0801401","article-title":"Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index","volume":"24","author":"Savva","year":"2000","journal-title":"Int. J. Obes."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"11158","DOI":"10.1038\/s41598-019-46971-6","article-title":"Heavy screen users are the heaviest among 10,000 children","volume":"9","author":"Engberg","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1519\/JSC.0b013e31817393b1","article-title":"Correlates of Upper and Lower Body Muscular Strength in Children","volume":"22","author":"Milliken","year":"2008","journal-title":"J. Strength Cond. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1007\/s00198-008-0595-1","article-title":"Relationship between grip strength and bone mineral density in healthy Hong Kong adolescents","volume":"19","author":"Chan","year":"2008","journal-title":"Osteoporos Int."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Edelson, L.R., Mathias, K.C., Fulgoni, V.L., and Karagounis, L.G. (2015). Screen-based sedentary behavior and associations with functional strength in 6\u201315 year-old children in the United States. BMC Public Health, 16.","DOI":"10.1186\/s12889-016-2791-9"},{"key":"ref_52","unstructured":"Kardefelt-Winther, D. (2020, April 23). How Does the Time Children Spend Using Digital Technology Impact Their Mental Well-Being, Social Relationships and Physical Activity? An Evidence-Focused Literature Review. Available online: https:\/\/www.unicefirc.org\/publications\/pdf\/Children-digital-technology-wellbeing.pdf."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.2105\/AJPH.2014.301874","article-title":"A Systematic Review of Effective Interventions for Reducing Multiple Health Risk Behaviors in Adolescence","volume":"104","author":"Hale","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/1479-5868-9-61","article-title":"Primary prevention of overweight in children and adolescents: A meta-analysis of the effectiveness of interventions aiming to decrease sedentary behaviour","volume":"9","author":"Ezendam","year":"2012","journal-title":"Int. J. Behav Nutr. Phys. Act."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.pmedr.2015.11.012","article-title":"Adherence to Canadian physical activity and sedentary behaviour guidelines among children 2 to 13 years of age","volume":"3","author":"Bayrampour","year":"2016","journal-title":"Prev. Med. Rep."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Garcia-Continente, X., Perez-Gimenez, A., Espelt, A., and Nebot Adell, M. (2013). Factors associated with media use among adolescents: A multilevel approach. Eur. J. Public Health, 24.","DOI":"10.1093\/eurpub\/ckt013"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1089\/g4h.2013.0055","article-title":"Active Screen Time Among, U.S. Youth Aged 9\u201318 Years, 2009","volume":"2","author":"Wethington","year":"2013","journal-title":"Games Health J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.amepre.2012.09.054","article-title":"Physical Activity and Screen Time in Adolescents and Their Friends","volume":"44","author":"Sirard","year":"2013","journal-title":"Am. J. Prev Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/21642850.2013.809313","article-title":"Physical activity and screen-based media use: Cross-sectional associations with health-related quality of life and the role of body satisfaction in a representative sample of German adolescents","volume":"1","author":"Finne","year":"2013","journal-title":"Health Psychol. Behav. Med."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Brophy, S., Crowley, A., Mistry, R., Hill, R., Choudhury, S., Thomas, N.E., and Rapport, F. (2011). Recommendations to improve physical activity among teenagers\u2014A qualitative study with ethnic minority and European teenagers. BMC Public Health, 11.","DOI":"10.1186\/1471-2458-11-412"},{"key":"ref_61","first-page":"23","article-title":"Levels of Physical Activity of Urban Adolescents According to Age and Gender","volume":"3","author":"Marques","year":"2013","journal-title":"Int. J. Sports Sci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1177\/0013916518806686","article-title":"Outdoor Time, Screen Time, and Connection to Nature: Troubling Trends Among Rural Youth?","volume":"51","author":"Larson","year":"2018","journal-title":"Environ. Behav."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Arundell, L., Salmon, J., Koorts, H., Contardo Ayala, A.M., and Timperio, A. (2019). Exploring when and how adolescents sit: Cross-sectional analysis of activPAL-measured patterns of daily sitting time, bouts and breaks. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-6960-5"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Haidar, A., Ranjit, N., Archer, N., and Hoelscher, D.M. (2019). Parental and peer social support is associated with healthier physical activity behaviours in adolescents: A cross-sectional analysis of Texas School Physical Activity and Nutrition (TX SPAN) data. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7001-0"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.rpped.2015.04.001","article-title":"Preval\u00eancia de tempo excessivo de tela e fatores associados em adolescentes","volume":"33","author":"Cheng","year":"2015","journal-title":"Rev. Paul. De Pediatr."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1479-5868-7-46","article-title":"Is spending time in screen-based sedentary behaviours associated with less physical activity: A cross national investigation","volume":"7","author":"Melkevik","year":"2010","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.1016\/j.jneb.2016.04.157","article-title":"Determining If Differences in Socioeconomic Status Are Associated With Screen Time Behavior and Physical Activity Levels","volume":"48","author":"Syed","year":"2016","journal-title":"J. Nutr. Educ. Behav."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Hankonen, N., Heino, M.T.J., Kujala, E., Hynynen, S.-T., Absetz, P., Ara\u00fajo-Soares, V., Borodulin, K., and Haukkala, A. (2017). What explains the socioeconomic status gap in activity? Educational differences in determinants of physical activity and screentime. BMC Public Health, 17.","DOI":"10.1186\/s12889-016-3880-5"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Drenowatz, C., Eisenmann, J.C., Pfeiffer, K.A., Welk, G., Heelan, K., Gentile, D., and Walsh, D. (2010). Influence of socio-economic status on habitual physical activity and sedentary behavior in 8- to 11-year old children. BMC Public Health, 10.","DOI":"10.1186\/1471-2458-10-214"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Lisinskiene, A., and Juskeliene, V. (2019). Links between Adolescents\u2019 Engagement in Physical Activity and Their Attachment to Mothers, Fathers, and Peers. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16050866"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Yi, X., Fu, Y., Burns, R.D., Bai, Y., and Zhang, P. (2019). Body mass index and physical fitness among Chinese adolescents from Shandong Province: A cross-sectional study. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-6420-2"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1590\/s1679-45082016ao3788","article-title":"Urban versus rural lifestyle in adolescents: Associations between environment, physical activity levels and sedentary behavior","volume":"14","author":"Regis","year":"2016","journal-title":"Einstein (S\u00e3o Paulo)"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1186\/1471-2458-14-1174","article-title":"Active and sedentary behaviours in children aged 7 to 10 years old: The urban and rural contexts, Brazil","volume":"14","author":"Neto","year":"2014","journal-title":"BMC Public Health"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1093\/heapro\/das054","article-title":"Urban-rural contrasts in fitness, physical activity, and sedentary behaviour in adolescents","volume":"29","author":"Mota","year":"2014","journal-title":"Health Promot. Inter."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Weinberg, D., Stevens, G.W.J.M., Bucksch, J., Inchley, J., and de Looze, M. (2019). Do country-level environmental factors explain cross-national variation in adolescent physical activity? A multilevel study in 29 European countries. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-6908-9"},{"key":"ref_76","unstructured":"Fija\u0142kowska, A. (2018). Current Evaluation of the Physical Activity Level Children and Teenagers Aged 3\u201319 Years in Poland."},{"key":"ref_77","first-page":"347","article-title":"Truth or consequences: The validity of self-report data in health services research on addictions","volume":"95","author":"Noll","year":"2000","journal-title":"Addiction"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/21\/7842\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:28:33Z","timestamp":1760178513000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/21\/7842"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,26]]},"references-count":77,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["ijerph17217842"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17217842","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,26]]}}}