The association between obesity and problematic smartphone use among school-age children and adolescents: a cross-sectional study in Shanghai.
BACKGROUND
The study aimed to investigate the association between content-based problematic smartphone use and obesity in school-age children and adolescents, including variations in the association by educational stage and sex.


METHODS
Two-stage non-probability sampling was used to recruit 8419 participants from nineteen primary schools, five middle schools, and thirteen high schools in Shanghai in December 2017. Obesity was identified by body mass index (BMI), which was obtained from the school physical examination record, while problematic smartphone use was measured by the Revised Problematic Smartphone Use Classification Scale as the independent variable.


RESULTS
The rates of obesity varied with educational stages, while problematic smartphone use increased with educational stages. Male students reported higher obesity rates (37.1%vs19.4%, P < 0.001) and greater problematic smartphone use scores (25.65 ± 10.37 vs 22.88 ± 8.94, P < 0.001) than female students. Problematic smartphone use for entertainment (smartphone users addicted to entertainment games, music, videos, novels and other applications) was positively associated to obesity status for primary school [odds ratio (OR), 1.030; 95% confidence interval (95% CI), 1.005-1.057] and high school students (OR, 1.031; 95% CI, 1.004-1.059). For female students, problematic smartphone use for entertainment was positively associated with obesity status (OR, 1.046; 95% CI, 1.018-1.075).


CONCLUSIONS
Problematic smartphone use may be associated with obesity in children and adolescents. The association differed based on the educational stage and sex, and the difference possessed dimensional specificity.
['Ma|Zhicong|Z|', 'Wang|Jiangqi|J|', 'Li|Jiang|J|', 'Jia|Yingnan|Y|0000-0001-9211-4061']
Obesity Problematic smartphone use Children Adolescents