Moderating effects of outdoor activity on infancy responsive caregiving trajectory and early child development level
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摘要:
目的 探讨户外活动在婴儿期回应性照护轨迹与儿童早期发育水平关联中起到的作用，为促进儿童早期发育提供理论依据。 方法 以上海亲子队列中任意完成2，6，12月龄一项回应性照护问卷随访的4 723名儿童及其母亲为研究对象。问卷调查回应性照护水平以及2岁时的每日平均户外活动时长，使用年龄与发育进程问卷第三版(ASQ-3)评估儿童2~5岁时的发育水平。采用轨迹模型拟合回应性照护轨迹，修正Poisson回归分析不同轨迹组与发育水平的关联，并检验户外活动时长的调节效应。 结果 婴儿期回应性照护轨迹分为一般组(3 871名)、下降组(160名)和波动组(646名)。调整父母教育水平、家庭年收入，母亲孕前体质量指数、孕期烟草暴露、孕期焦虑抑郁、分娩年龄、分娩孕周、分娩方式，儿童性别、出生体重，母乳喂养时长等混杂因素后，修正Poission回归分析结果表明，相比于一般组，下降组和波动组的儿童在2岁时出现沟通、粗大动作、精细动作、解决问题、个人-社会能区可疑发育迟缓的风险均增加(OR值分别为1.41，1.31，1.35，1.23，1.21；1.07，1.08，1.08，1.09，1.06)，但在3~5岁时仅出现下降组沟通(OR=1.08)、波动组个人-社会能区(OR=1.06)可疑发育迟缓的风险增加(P值均<0.05)。户外活动水平较低时，相比于一般组，波动组的儿童沟通(β=-1.41)、精细动作(β=-2.34)、解决问题(β=-1.11)和个人-社会能区(β=-1.99)得分降低，下降组儿童粗大动作能区得分降低(β=-4.78)(P值均<0.05)；户外活动水平较高时，并未发现波动组和下降组的儿童与一般组能区得分有差异(P值均>0.05)。 结论 长时间的户外活动可以减弱婴儿期回应性照护的下降和波动轨迹对儿童早期发育的不良效应。 Abstract:Objective To explore the role of outdoor activity in the relationship between infancy responsive caregiving trajectories and early childhood development, so as to provide a theoretical basis for the promotion of early child development. Methods The study participants were drawn from the Shanghai Maternal-Child Pairs Cohort and 4 723 mother-child pairs who completed responsive caregiving questionnaires at 2, 6 and 12 months old were included. Questionnaires were used to assess children's responsive caregiving and average daily hours of outdoor activity at 2 years of age. The Age-Stage Questionnaire, Third Edition (ASQ-3) was used to evaluate children's development problems at 2-5 years old. Group-based trajectory model was applied to fit infancy responsive caregiving trajectory. Modified Poisson regression was used to analyze associations between different responsive caregiving trajectory groups and child development, and moderating effects were tested for hours of outdoor activity. Results Infancy responsive caregiving trajectories were categorized into general group (n=3 871), declining group(n=160), and fluctuating group(n=646). After adjusting for confounding factors, such as parents' educational level, annual household income, maternal progestation body mass index, maternal tobacco exposure during pregnancy, maternal anxiety and depression during pregnancy, maternal age at delivery, maternal gestational age, maternal mode of delivery, children's gender, children's birth weight, and duration of breastfeeding, the results of modified Poission regression analysis showed that compared with the general group, children at the age of 2 in declining and fluctuating group had increased risks of suspected developmental delays in communication, gross motor, fine motor, problem solving, and personal-social scales (OR=1.41, 1.31, 1.35, 1.23, 1.21;1.07, 1.08, 1.08, 1.09, 1.06);but children only had increased risk of suspected developmental delays in communication of declining group (OR=1.08), personal-social scales of fluctuating group (OR=1.06) at 3-5 years of age (P<0.05). At lower levels of outdoor activity, children in fluctuating group had reduced scores in communication (β=-1.41), fine motor (β=-2.34), problem solving (β=-1.11) and personal-social scales (β=-1.99) as compared to general group; and children in declining group had reduced scores in gross motor (β=-4.78)(P<0.05). While at higher levels of outdoor activity, no differences were found between children in fluctuating, declining groups and those in general group in scores of different scales (P>0.05). Conclusion Prolonged outdoor activity attenuates the adverse effects of declining and fluctuating trajectories of infancy responsive caregiving on early childhood development. -
Key words:
- Motor activity /
- Responsive caregiving /
- Growth and development /
- Regression analysis /
- Child
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表 1 各特征构成在儿童不同婴儿期回应性照护轨迹组间比较
Table 1. Comparison of different characteristic composition between groups of different children's responsive caregiving trajectory in infancy
组别 选项 一般组(n=3 871) 下降组(n=160) 波动组(n=646) χ2值 P值 母亲教育水平 初中及以下 369(9.53) 7(4.38) 39(6.04) 54.09 <0.01 高中或中专 533(13.77) 9(5.62) 63(9.75) 大专 1 344(34.72) 43(26.88) 210(32.51) 大学及以上 1 625(41.98) 101(63.13) 334(51.70) 父亲教育水平 初中及以下 318(8.22) 9(5.63) 39(6.04) 38.71 <0.01 高中或中专 688(17.77) 11(6.87) 78(12.07) 大专 1 245(32.16) 47(29.37) 221(34.21) 大学及以上 1 620(41.85) 93(58.13) 308(47.68) 家庭年收入/万元 ＜10 959(24.77) 24(15.00) 145(22.45) 32.84 <0.01 10~20 1 843(47.61) 61(38.12) 293(45.35) >20 1 069(27.62) 75(46.88) 208(32.20) 母亲孕前BMI/(kg·m-2) ＜18.5 596(15.40) 26(16.25) 102(15.79) 3.95 0.41 18.5~<24 2 615(67.55) 116(72.50) 440(68.11) ≥24 660(17.05) 18(11.25) 104(16.10) 母亲孕期烟草暴露 是 2 418(62.46) 96(60.00) 390(60.37) 1.34 0.51 否 1 453(37.54) 64(40.00) 256(39.63) 母亲孕期焦虑 是 346(8.94) 10(6.25) 61(9.44) 1.62 0.44 否 3 525(91.06) 150(93.75) 585(90.56) 母亲孕期抑郁 是 418(10.80) 18(11.25) 86(13.31) 4.46 0.35 否 3 453(89.20) 142(88.75) 560(86.69) 母亲分娩年龄/岁 ＜30 2 326(60.09) 92(57.50) 374(57.89) 1.44 0.49 ≥30 1 545(39.91) 68(42.50) 272(42.11) 母亲分娩孕周 ＜37 356(9.20) 12(7.50) 64(9.91) 0.93 0.63 ≥37 3 515(90.80) 148(92.50) 582(90.09) 母亲分娩方式 顺产 1 800(46.50) 72(45.00) 305(47.21) 0.27 0.87 剖宫产 2 071(53.50) 88(55.00) 341(52.79) 儿童性别 男 1 969(50.87) 84(52.50) 342(52.94) 1.07 0.59 女 1 902(49.13) 76(47.50) 304(47.06) 儿童出生体重/g ＜2 500 124(3.20) 2(1.25) 14(2.17) 7.91 0.10 2 500~4 000 3 521(90.96) 153(95.63) 603(93.34) ＞4 000 226(5.84) 5(3.12) 29(4.49) 母乳喂养时长/月 ＜6 985(25.45) 30(18.75) 174(26.94) 17.59 <0.01 6~<12 2 272(58.69) 114(71.25) 394(60.99) ≥12 614(15.86) 16(10.00) 78(12.07) 儿童每日户外活动时长/h ＜1 1 335(34.49) 54(33.75) 223(34.52) 5.65 0.23 1~2 1 811(46.78) 84(52.50) 319(49.38) ＞2 725(18.73) 22(13.75) 104(16.10) 注： ()内数字为构成比/%。 
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表 2 不同回应性照护轨迹组不同年龄儿童可疑发育迟缓率比较
Table 2. Comparison of suspected developmental delays rates among different age children by different responsive caregiving trajectory groups
轨迹组 2岁 3~5岁 人数 沟通 粗大动作 精细动作 解决问题 个人-社会 人数 沟通 粗大动作 精细动作 解决问题 个人-社会 一般组 1 983 110(5.55) 88(4.44) 34(1.71) 38(1.92) 41(2.07) 2 715 104(3.83) 152(5.60) 166(6.11) 132(4.86) 131(4.83) 下降组 94 20(21.28) 11(11.70) 10(10.64) 4(4.26) 2(2.13) 109 5(4.59) 8(7.34) 11(10.09) 6(5.50) 5(4.59) 波动组 338 25(7.40) 21(6.21) 13(3.85) 11(3.25) 8(2.37) 481 21(4.37) 31(6.44) 33(6.86) 23(4.78) 28(5.82) 合计 2 415 155(6.42) 120(4.97) 57(2.36) 53(2.19) 51(2.11) 3 305 130(3.93) 191(5.78) 210(6.35) 161(4.87) 164(4.96) χ2值 37.57 11.32 34.78 4.34 0.12 0.44 1.04 3.03 0.10 0.89 P值 <0.01 <0.01 <0.01 0.11 0.94 0.80 0.59 0.22 0.95 0.64 注： ()内数字为检出率/%；数据存在缺失。
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表 3 户外活动在回应性照护轨迹与3~5岁儿童发育问题中的调节效应(n=4 723)
Table 3. Moderating effect of outdoor activity on responsive caregiving trajectories and developmental problems in children aged 3 to 5 years old(n=4 723)
自变量 沟通 粗大动作 精细动作 解决问题 个人-社会 β值 t值 β值 t值 β值 t值 β值 t值 β值 t值 下降组 -1.26 -1.70 -1.69 -1.66 -2.50 -2.03 -1.32 -1.85 -1.30 -1.80 波动组 -0.51 -1.40 -0.21 -0.41 -0.86 -1.42 -0.22 -0.62 -1.29 -3.62 户外活动 0.03 0.17 0.26 1.22 0.30 1.15 -0.02 -0.13 0.17 1.13 下降组×户外活动 0.47 0.48 3.44 2.53* -0.32 -0.20 -0.49 -0.51 0.08 0.08 波动组×户外活动 1.00 2.46* 0.65 1.17 1.65 2.45* 1.00 2.58* 0.79 2.00** R2值 0.04 0.03 0.06 0.04 0.04 F值 4.91** 4.00** 7.11** 4.41** 4.74** 注：** P<0.01, * P<0.05；自变量为轨迹组，以一般组为参照；因变量为儿童3~5岁能区发育得分；调整变量包括父母亲教育水平、家庭年收入，母亲孕前BMI、孕期烟草暴露、孕期焦虑抑郁、分娩年龄、分娩孕周、分娩方式，儿童性别、出生体重，母乳喂养时长。
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