Association of outdoor activity level and myopia among children and adolescents in Shanghai

WANG Yanjiao; WANG Jingjing; NI Zihan; QI Ziyi; CHEN Jun; LIU Sichen; YANG Jinliuxing; DU Linlin; HE Xiangui

doi:10.16835/j.cnki.1000-9817.2025012

Volume 46 Issue 1

Jan. 2025

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WANG Yanjiao, WANG Jingjing, NI Zihan, QI Ziyi, CHEN Jun, LIU Sichen, YANG Jinliuxing, DU Linlin, HE Xiangui. Association of outdoor activity level and myopia among children and adolescents in Shanghai[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(1): 18-23. doi: 10.16835/j.cnki.1000-9817.2025012

Citation:

WANG Yanjiao, WANG Jingjing, NI Zihan, QI Ziyi, CHEN Jun, LIU Sichen, YANG Jinliuxing, DU Linlin, HE Xiangui. Association of outdoor activity level and myopia among children and adolescents in Shanghai[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(1): 18-23. doi: 10.16835/j.cnki.1000-9817.2025012

Citation:

WANG Yanjiao, WANG Jingjing, NI Zihan, QI Ziyi, CHEN Jun, LIU Sichen, YANG Jinliuxing, DU Linlin, HE Xiangui. Association of outdoor activity level and myopia among children and adolescents in Shanghai[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(1): 18-23. doi: 10.16835/j.cnki.1000-9817.2025012

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Association of outdoor activity level and myopia among children and adolescents in Shanghai

doi: 10.16835/j.cnki.1000-9817.2025012

WANG Yanjiao¹,
WANG Jingjing^{2, 3, 4},
NI Zihan²,
QI Ziyi^{3, 4},
CHEN Jun^{3, 4},
LIU Sichen^{3, 4},
YANG Jinliuxing^{3, 4},
DU Linlin^{3, 4},
HE Xiangui^{1, 2, 3, 4
,
,}

1.
School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai (201203), China

Received Date: 2024-12-12
Rev Recd Date: 2024-12-22

Available Online: 2025-01-25

Publish Date: 2025-01-25

Abstract

Abstract

Objective To analyze the status of outdoor activities on weekends among children and adolescents of different educational stages in Shanghai and their impact on myopia, so as to provide a basis for formulating more specific prevention and control protocol of myopia. Methods From September to October 2022, a stratified cluster random sampling method was employed to select 84 schools (27 kindergartens, 21 primary schools, 15 junior high schools and 21 high schools) across Shanghai, enrolling a total of 28 654 children and adolescents aged 4 to 18 for the study. Ophthalmic examinations were conducted to ascertain the prevalence of myopia among children and adolescents. Additionally, a questionnaire survey was administered to collect data on outdoor activity duration and associated factors. Multivariate Logistic regression analysis was utilized to investigate the associated factors of outdoor activity levels on weekends. Results The overall myopia detection rate among children and adolescents was 58.4%, with a higher rate observed in girls (59.2%) compared to boys (57.6%). The myopia detection rates for children and adolescents with an average daily outdoor activity duration of ≥2 h and < 2 h on weekends were 54.6% and 68.8%, and the differences were statistically significant (χ²=8.12, 460.89, P < 0.01). Multivariable Logistic regression analysis revealed that girls (OR=0.80), those with a myopic parent (OR=0.68), schools from urban districts (OR=0.72), higher education stages (primary school: OR=0.65, junior high school: OR=0.24, high school: OR=0.14) and spending≥2 h/d on homework during weekends (OR=0.57) among children and adolescents were less likely to engage in outdoor activities for ≥2 h on weekends (P < 0.01). After incorporating gender, parental myopia status, educational stage, school location, average daily duration on weekends for spending on homework, electronic product usage and outdoor activities as dependent variables in a multivariate Logistic regression analysis, the results showed that children and adolescents with an average outdoor activity duration for ≥2 h on weekends had a lower risk of myopia (OR=0.86, P < 0.01). Conclusions The level of outdoor activity among children and adolescents on weekends needs to be improved. Outdoor activities on weekends is an associated factor for myopia among children and adolescents. Particularly, girls, those with myopic parents, schools from urban districts, and spending long hours on homework during weekends among children and adolescents require increased attention.
- Motor activity,
- Myopia,
- Regression analysis,
- Child,
- Adolescent

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References(42)

References

[1]	FLITCROFT D I, HE M, JONAS J B, et al. IMI-defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies[J]. Invest Ophthalmol Vis Sci, 2019, 60(3): M20-M30. doi: 10.1167/iovs.18-25957
[2]	HOLDEN B A, FRICKE T R, WILSON D A, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050[J]. Ophthalmology, 2016, 123(5): 1036-1042. doi: 10.1016/j.ophtha.2016.01.006
[3]	HAARMAN A E G, ENTHOVEN C A, TIDEMAN J W L, et al. The complications of myopia: a review and Meta-analysis[J]. Invest Ophthalmol Vis Sci, 2020, 61(4): 49. doi: 10.1167/iovs.61.4.49
[4]	NAIDOO K S, FRICKE T R, FRICK K D, et al. Potential lost productivity resulting from the global burden of myopia: systematic review, Meta-analysis, and modeling[J]. Ophthalmology, 2019, 126(3): 338-346. doi: 10.1016/j.ophtha.2018.10.029
[5]	健康中国行动推进委员会. 健康中国行动(2019—2030年)[EB/OL]. (2019-07-15)[2023-07-24]. http://www.nhc.gov.cn/guihuaxxs/s3585u/201907/e9275fb95d5b4295be8308415d4cd1b2.shtml.
[6]	ROSE K A, MORGAN I G, IP J, et al. Outdoor activity reduces the prevalence of myopia in children[J]. Ophthalmology, 2008, 115(8): 1279-1285. doi: 10.1016/j.ophtha.2007.12.019
[7]	WU P C, TSAI C L, WU H L, et al. Outdoor activity during class recess reduces myopia onset and progression in school children[J]. Ophthalmology, 2013, 120(5): 1080-1085. doi: 10.1016/j.ophtha.2012.11.009
[8]	徐可, 张晟, 卢次勇, 等. 广州市低年级小学生户外活动时间与近视关系[J]. 中国公共卫生, 2022, 38(6): 686-688. XU K, ZHANG S, LU C Y, et al. Relationship between outdoor activity time and myopia among elementary school students in lower grades in Guangzhou[J]. Chin J Public Health, 2022, 38(6): 686-688. (in Chinese)
[9]	HANSEN M H, LAIGAARD P P, OLSEN E M, et al. Low physical activity and higher use of screen devices are associated with myopia at the age of 16-17 years in the CCC2000 eye study[J]. Acta Ophthalmol, 2020, 98(3): 315-321. doi: 10.1111/aos.14242
[10]	HE M, XIANG F, ZENG Y, et al. Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial[J]. JAMA, 2015, 314(11): 1142-1148. doi: 10.1001/jama.2015.10803
[11]	XIONG S, SANKARIDURG P, NADUVILATH T, et al. Time spent in outdoor activities in relation to myopia prevention and control: a Meta-analysis and systematic review[J]. Acta Ophthalmol, 2017, 95(6): 551-566. doi: 10.1111/aos.13403
[12]	MCCARTHY D, LUERAS P, BHIDE P G. Elevated dopamine levels during gestation produce region-specific decreases in neurogenesis and subtle deficits in neuronal numbers[J]. Brain Res, 2007, 1182: 11-25. doi: 10.1016/j.brainres.2007.08.088
[13]	GUGGENHEIM J A, NORTHSTONE K, MCMAHON G, et al. Time outdoors and physical activity as predictors of incident myopia in childhood: a prospective cohort study[J]. Invest Ophthalmol Vis Sci, 2012, 53(6): 2856-2865. doi: 10.1167/iovs.11-9091
[14]	谭晖, 余惠琴, 汪玲, 等. 儿童视力保健相关行为评定量表的编制及信效度检验[J]. 中国学校卫生, 2009, 30(11): 1007-1010. TAN H, YU H Q, WANG L, et al. Development and reliability test of Scale for Children's Vision Care-related Behaviors[J]. Chin J Sch Health, 2009, 30(11): 1007-1010. (in Chinese)
[15]	WHO. Physical activity[EB/OL]. (2024-06-26)[2024-12-18]. https://www.who.int/news-room/fact-sheets/detail/physical-activity.
[16]	中华人民共和国国家卫生健康委员会. 中小学生屈光不正筛查规范: WS/T 662—2020[EB/OL]. (2020-01-11) [2025-01-02]. http://www.nhc.gov.cn/wjw/pqt/202002/f4f6810592984d3989324 203f86ac86b.shtml.
[17]	中华人民共和国国家卫生健康委办公厅关于印发0~6岁儿童眼保健及视力检查服务规范(试行)的通知[EB/OL]. (2021-06-17)[2025-01-11]. https://www.gov.cn/zhengce/zhengceku/2021-06/24/content_5620637.htm.
[18]	中华人民共和国国家卫生健康委办公厅关于印发近视防治指南(2024年版)的通知[EB/OL]. (2024-05-17)[2024-12-18]. https://www.gov.cn/zhengce/zhengceku/202406/content_6957665.htm.
[19]	国家疾病预防控制局. 我国儿童青少年近视率呈下降趋势[EB/OL]. (2024-03-13)[2025-01-05]. https://www.ndcpa.gov.cn/jbkzzx/c100010/common/content/content_1768152961235197952.html.
[20]	CAO K, WAN Y, YUSUFU M, et al. Significance of outdoor time for myopia prevention: a systematic review and Meta-analysis based on randomized controlled trials[J]. Ophthalmic Res, 2020, 63(2): 97-105. doi: 10.1159/000501937
[21]	HE X, SANKARIDURG P, WANG, et al. Time outdoors in reducing myopia: a school-based cluster randomized trial with objective monitoring of outdoor time and light intensity[J]. Ophthalmology, 2022, 129(11): 1245-1254. doi: 10.1016/j.ophtha.2022.06.024
[22]	DENG L, PANG Y. Effect of outdoor activities in myopia control: Meta-analysis of clinical studies[J]. Optom Vis Sci, 2019, 96(4): 276-282. doi: 10.1097/OPX.0000000000001357
[23]	HO C L, WU W F, LIOU Y M. Dose-response relationship of outdoor exposure and myopia indicators: a systematic review and Meta-analysis of various research methods[J]. Int J Environ Res Public Health, 2019, 16(14): 2595. doi: 10.3390/ijerph16142595
[24]	陈黎黎, 吴岩, 石荣兴, 等. 2018—2020年北京市丰台区儿童青少年近视筛查结果分析[J]. 中国健康教育, 2021, 37(6): 507-510. CHEN L L, WU Y, SHI R X, et al. Analysis of myopia screening results among children and adolescents in Fengtai District, Beijing, China, 2018-2020[J]. Chin J Health Educ, 2021, 37(6): 507-510. (in Chinese)
[25]	李兴洲, 姚嵩坡, 郭丽娇, 等. 佳木斯市郊区中小学生近视现况及影响因素分析[J]. 预防医学论坛, 2023, 29(12): 887-891. LI X Z, YAO S P, GUO L J, et al. Analysis of myopia status and influencing factors among primary and secondary school students in suburban areas of Jiamusi City[J]. Prev Med Trib, 2023, 29(12): 887-891. (in Chinese)
[26]	HUANG P C, HSIAO Y C, TSAI C Y, et al. Protective behaviours of near work and time outdoors in myopia prevalence and progression in myopic children: a 2-year prospective population study[J]. Br J Ophthalmol, 2020, 104(7): 956-961. doi: 10.1136/bjophthalmol-2019-314101
[27]	WU P C, CHEN C T, LIN K K, et al. Myopia prevention and outdoor light intensity in a school-based cluster randomized trial[J]. Ophthalmology, 2018, 125(8): 1239-1250. doi: 10.1016/j.ophtha.2017.12.011
[28]	LINGHAM G, YAZAR S, LUCAS R M, et al. Time spent outdoors in childhood is associated with reduced risk of myopia as an adult[J]. Sci Rep, 2021, 11(1): 6337. doi: 10.1038/s41598-021-85825-y
[29]	SHERWIN J C, HEWITT A W, CORONEO M T, et al. The association between time spent outdoors and myopia using a novel biomarker of outdoor light exposure[J]. Invest Ophthalmol Vis Sci, 2012, 53(8): 4363-4370. doi: 10.1167/iovs.11-8677
[30]	LIN Z, VASUDEVAN B, JHANJI V, et al. Near work, outdoor activity, and their association with refractive error[J]. Optom Vis Sci, 2014, 91(4): 376. doi: 10.1097/OPX.0000000000000219
[31]	WANG Y, LIU L, LU Z, et al. Rural-urban differences in prevalence of and risk factors for refractive errors among school children and adolescents aged 6-18 years in Dalian, China[J]. Front Public Health, 2022, 10: 917781. doi: 10.3389/fpubh.2022.917781
[32]	MA Y, LIN S, ZHU J, et al. Effect of parental myopia on change in refraction in Shanghai preschoolers: a 1-year prospective study[J]. Front Pediatr, 2022, 10: 864233. doi: 10.3389/fped.2022.864233
[33]	WANG J, LI S, HE S, et al. Regional disparities in the prevalence and correlated factors of myopia in children and adolescents in Gansu, China[J]. Front Med, 2024, 11: 1375080 doi: 10.3389/fmed.2024.1375080
[34]	DEMIR P, BASKARAN K, THEAGARAYAN B, et al. Refractive error, axial length, environmental and hereditary factors associated with myopia in Swedish children[J]. Clin Exp Optom, 2021, 104(5): 595-601. doi: 10.1080/08164622.2021.1878833
[35]	TANG S M, KAM K W, FRENCH A N, et al. Independent influence of parental myopia on childhood myopia in a dose-related manner in 2 055 trios: the Hong Kong children eye study[J]. Am J Ophthalmol, 2020, 218: 199-207. doi: 10.1016/j.ajo.2020.05.026
[36]	DEMIR P, BASKARAN K, RAMOS P L, et al. Incidence of myopia in Swedish schoolchildren: a longitudinal study[J]. Ophthalmic Physiol Opt, 2024, 44(6): 1301-1308. doi: 10.1111/opo.13359
[37]	GRZYBOWSKI A, KANCLERZ P, TSUBOTA K, et al. A review on the epidemiology of myopia in school children worldwide[J]. BMC Ophthalmol, 2020, 20(1): 27. doi: 10.1186/s12886-019-1220-0
[38]	PÄRSSINEN O, KAUPPINEN M. Risk factors for high myopia: a 22-year follow-up study from childhood to adulthood[J]. Acta Ophthalmol, 2019, 97(5): 510-518. doi: 10.1111/aos.13964
[39]	CHUA S Y L, SABANAYAGAM C, CHEUNG Y B, et al. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children[J]. Ophthalmic Physiol Opt, 2016, 36(4): 388-394. doi: 10.1111/opo.12305
[40]	唐文婷, 李佳倩, 李世贝, 等. 2018—2020年成都市新都区小学生近视流行病学研究[J]. 国际眼科杂志, 2022, 22(1): 148-152. TANG W T, LI J Q, LI S B, et al. Epidemiologic study of myopia among elementary school students in Xindu District, Chengdu City, China, from 2018 to 2020[J]. Int Eye Sci, 2022, 22(1): 148-152. (in Chinese)
[41]	YE B, LIU K, CAO S, et al. Discrimination of indoor versus outdoor environmental state with machine learning algorithms in myopia observational studies[J]. J Transl Med, 2019, 17(1): 314. doi: 10.1186/s12967-019-2057-2
[42]	CHEN J, WANG J, QI Z, et al. Smartwatch measures of outdoor exposure and myopia in children[J]. JAMA Network Open, 2024, 7(8): e2424595. doi: 10.1001/jamanetworkopen.2024.24595