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The role and potential impact of digital screen technology in the lives of children is heavily debated. Current evidence is limited by the weakness of measures typically used to characterise screen use, predominantly proxy- or self-reports with known inaccuracy and bias. However, robust and detailed evidence is needed to provide practical trustworthy guidance to families and professionals working with families. The purpose of this paper is to support researchers to select measurement method(s) that will provide robust and detailed evidence. The paper outlines the challenges in measuring contemporary screen use by children, using a child–technology interaction model to organise considerations. A range of different methods used to measure digital screen technology use in children and adolescents (i.e., questionnaires, diaries, electronically prompted sampling, direct observation, fixed room cameras, wearable/portable cameras, audio recorders, screen-device onboard logging, remote digital trace logging and proximity logging) are described along with examples of their use and constructs typically measured as well as a summary of the advantages and disadvantages of each method. A checklist and worked examples are provided to support researchers determining the best methods or combination of methods for a research project. [ABSTRACT FROM AUTHOR]

Aim: Sleep behaviour is correlated and causally related to physical and mental health. Limited longitudinal data exist on the associations of poor sleep behaviour in childhood and adolescence with adult health. Parent‐reported sleep behaviours from 1993 participants of the Raine Study (at ages 5, 8, 10, 14, 17) were used to determine sleep trajectories (using latent class growth analysis). Methods: Measures of physical and mental health were compared between sleep trajectories using generalised linear models (at age 20). Results: Three sleep trajectories were identified as follows: 43% of participants belonged to a trajectory with 'consistently minimal' sleep problems, 49% showed some 'declining' in reporting of sleep problems incidence and 8% had 'persistent' sleep problems. Participants in the 'consistently minimal' trajectory had better physical and mental health outcomes at age 20 compared to those in the 'declining' and 'persistent' trajectories. For example, 'consistently minimal' participants had significantly lower body fat percentage (mean difference: −3.89% (95% CI: −7.41 to −0.38)) and a higher (better) SF‐12 mental component score (mean difference: 4.78 (95% CI: 2.35–7.21)) compared to participants in the 'persistent' trajectory. Conclusion: Poor sleep behaviour across childhood and adolescent years is related to poorer physical and mental health in young adulthood. [ABSTRACT FROM AUTHOR]

Abstract Background There is a high prevalence of mental health problems amongst adolescents. In addition there is a high prevalence of spinal pain in this population. Evidence suggests that these conditions are related. This study sought to extend earlier findings by examining the relationship between mental health problems as measured by the Child Behaviour Check List (CBCL) and the experience of back and neck pain in adolescents. Methods One thousand five hundred and eighty participants (mean age 14.1 years) from the Western Australian Pregnancy (Raine) Study provided cross-sectional spinal pain and CBCL data. Results As predicted, there was a high prevalence of back and neck pain in this cohort. On the whole, females reported more mental health difficulties than males. There were strong relationships between the majority of symptom scales of the CBCL and back and neck pain. Scores on the CBCL were associated with higher odds of comorbid back and neck pain. Conclusions These findings strongly support the need to consider both psychological and pain symptoms when providing assessments and treatment for adolescents. Further research is required to inform causal models.

Objective The purpose of this study was to determine whether sagittal neck sitting posture subgroup membership in late adolescence was a risk factor for persistent neck pain (PNP) in young adults. Methods There were 686 participants enrolled in the Raine Study at the 17- and 22-year follow-ups. At 17 years of age, posture was measured by photographs, and 4 subgroups of sitting neck posture were determined by cluster analysis. Height and weight were measured, and exercise frequency, depression, and PNP were assessed by questionnaire. At 22 years of age, participants answered questions about neck pain and occupation type. Logistic regression examined if neck posture subgroups at 17 years of age were a risk factor for PNP at 22 years of age, taking into account other factors. Results Female sex (odds ratio [OR] = 1.75, 95% CI = 1.16–2.65) and PNP at 17 years of age (OR = 3.78, 95% CI = 2.57–5.57) were associated with PNP at 22 years of age. In females, neck posture subgroup at 17 years of age was a risk factor for PNP at 22 years of age. Compared with the upright subgroup, both the slumped thorax/forward head subgroup groups and the intermediate subgroup had decreased odds for PNP at 22 years of age (OR = 0.24, 95% CI = 0.08–0.76; OR = 0.38, 95% CI = 0.15–0.99, respectively). No association was found in males. Conclusion After taking into account PNP at 17 years, sitting neck posture at 17 was not a risk factor for PNP at 22 years of age in males, whereas in females, more relaxed postures (slumped thorax/forward head and Intermediate postures) were protective of neck pain compared with upright posture. Impact Females in late adolescence who sat in slumped thorax/forward head or intermediate posture rather than upright sitting posture had a lower risk of PNP as a young adult. The practice of generic public health messages to sit up straight to prevent neck pain needs rethinking. [ABSTRACT FROM AUTHOR]

* SYNOPSIS: Low back pain (LBP) is the leading cause of disability worldwide. It often begins in adolescence, setting a course for later in life. We have tracked the course of LBP in the Raine Study cohort from the age of 14 years into early adulthood. Our work has found that LBP is already prevalent in individuals at 14 years of age and increases throughout adolescence and into early adulthood. It is often comorbid with other musculoskeletal pain. For some adolescents, LBP has little impact; for others, its impact includes care seeking, taking medication, taking time off from school and work, as well as modifying physical and functional activity. Of concern is the increasing prevalence of LBP with impact across adolescence, reaching adult rates by 22 years of age. The predictors of disabling LBP in adolescence are multidimensional. They include female sex, negative back pain beliefs, poor mental health status, somatic complaints, involvemerit in sports, and altered stress responses. Genetics also plays a role. Ironically, the factors that we have historically thought to be important predictors of LBP, such as "poor" spinal posture, scoliosis, carrying school bags, joint hypermobility, and poor back muscle endurance, are not strong predictors. This challenges our clinical beliefs and highlights that adolescent LBP needs a flexible and targeted multidimensional approach to assessment and management. In most cases, we recommend a cognitive functional approach that challenges negative LBP beliefs, educates adolescents regarding factors associated with their LBP, restores functional capacity where it is impaired, and encourages healthy lifestyle habits. [ABSTRACT FROM AUTHOR]

* STUDY DESIGN: Prospective cohort study of the Western Australian Pregnancy Cohort (Raine) Study. * BACKGROUND: Low back pain (LBP) commonly develops in adolescence and is a significant risk factor for adult LBP. A broad range of factors have been associated with the development of adolescent LBP, but prior literature has limitations related to characterization of LBP and the scope of risk factors considered. * OBJECTIVE: This study aimed to identify potential factors contributing to the development of LBP, with and without impact, at 17 years of age, utilizing a broad range of exposures at 14 years of age. * METHODS: Data from 1088 participants (52,1% female) with "no LBP," "LBP with minimal impact," and "LBP with impact" at 17 years of age and a range of measures from multiple domains, including spinal pain, physical, psychological, social, and lifestyle, at 14 years of age were collected for the study. Multivariable multinomial logistic regression was used to estimate the association of potential mechanistic factors at 14 years of age with LBP at 17 years of age. * RESULTS: Female sex and back pain at 14 years of age were strongly associated with LBP at 17 years of age. Potential mechanistic factors for LBP outcomes at 17 years of age included exposures from the pain (neck/shoulder pain) and physical domains (standing posture subgroup membership, back muscle endurance, throwing distance), psychological domain (somatic complaints, aggressive behavior), social domain (socioeconomic area), and lifestyle domain (exercise out of school). * CONCLUSION: The findings support the multidimensional nature of adolescent LBP and highlight the challenge this presents for epidemiological research, clinical practice, and prevention initiatives in the general population. * LEVEL OF EVIDENCE: Prognosis, level lb. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Recent figures indicate that nearly a quarter of Australian adolescents are overweight or obese. Despite the well-established role of physical activity and healthy eating in reducing prevalence of obesity, there remains a lack of effective interventions that promote sustained behavior engagement. This paper aims to describe the theory-based integration and implementation of self-determination theory and goal setting theory in a family-based lifestyle intervention. Although these theories have been shown to independently predict motivation for behavior, a limited number of studies have described behavior-change techniques at a level to allow for effective evaluation and replication, and no studies have combined the theories in a healthy lifestyle behavior intervention. Methods: Behavior change techniques and the associated change mediators are described in relation to need-supportive environments provided by instructors and extended to parents in the home environment. Methods for motivating and promoting sustained engagement in adolescent physical activity and healthy eating and parent behaviors to support these lifestyle changes are discussed within the context of need-satisfaction and goal setting. Conclusions: This study will contribute to understanding processes for developing and implementing behavior-change techniques based on the integration of two theories of motivation. Future interventions aimed at promoting maintenance of physical activity and healthy eating behaviors in overweight and obese adolescents will benefit by being informed of which techniques are effective at enhancing motivation within the intervention context and home environment. [Copyright &y& Elsevier]

Abstract: Objective: To identify differences in repositioning error in adolescents with and without non-specific chronic low back pain (NSCLBP), sub-groups of NSCLBP and in different spinal regions. Methods: Spinal repositioning error was measured during a seated task. Variables were constant error (CE), absolute error (AE) and variable error (VE) for lower lumbar, upper lumbar and lumbar angles. 28 subjects with NSCLBP were sub-classified using O'Sullivans system and compared to 28 healthy controls. Results: Significant differences were noted for AE between adolescents with and without NSCLBP, but no differences were found for CE or VE. When sub-grouped there was a pattern for lower AE and higher VE in the flexion sub-group. This group also displayed a tendency to undershoot the criterion position in the lower lumbar spine. Greater VE was noted in the extension sub-group and those with no NSCLBP in the upper lumbar compared to the lower lumbar spine. Conclusions: Differences in spinal repositioning errors were noted between adolescents with and without NSCLBP and sub-groups of NSCLBP. Those with flexion-pattern NSCLBP had the lowest levels of spinal repositioning ability. Individuals with no-LBP (low-back pain) or extension-pattern NSCLBP displayed greater variability in the upper lumbar spine. [Copyright &y& Elsevier]

Background. Disability in adults with low back pain (LBP) is associated with negative back pain beliefs (BPBs). Adult BPBs can be positively influenced with education, resulting in reduced LBP disability. By late adolescence, the prevalence of LBP reaches adult levels. The relationship among LBP experience, LBP impact, and BPBs has not been investigated in late adolescence. Objective. The aim of this study was to document unknown relationships among LBP experience, LBP impact, and BPBs in 17-year-olds. Design. A cross-sectional study design was used. Methods. Adolescents (n= 1,126) in the Raine Study provided full information on LBP, LBP impact (sought professional advice or treatment, taken medication, missed school or work, interfered with normal activities, interfered with physical activities), BPBs, and a number of covariates. Results. Back pain beliefs were more positive in participants with experience of LBP (X=30.2, SD=5.6) than in those without experience of LBP (X=28.5, SD=5.1). Individuals with LBP without activity modification impacts had more positive BPBs than those with activity modification impacts, even after adjustment for mental well-being and sex. The adjusted difference in BPBs between participants with experience of LBP but no activity modification impacts and those reporting all 3 activity modification impacts was 2.9 points (95% confidence interval=1.7 to 4.2). Participants with no activity modification impacts had more positive BPBs than those with no experience of LBP (adjusted difference=2.2 points, 95% confidence interval 1.4 to 2.9). More positive BPBs also were associated with female sex, lower body mass index, higher family income, better 36-Item Short-Form Health Survey (SF-36) Mental Health scale scores, and more positive primary caregiver beliefs. Limitations. Cause and effect cannot be ascertained with the cross-sectional design. Conclusion. Differences in BPBs are associated with different levels of LBP impact at 17 years of age. This finding provides a potential target for intervention early during the life course. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Comorbidities in adults negatively affect the course of low back pain (LBP). Little is known of the presence and/or impact of LBP comorbidities in adolescents. Methods: Subjects from the Raine Study cohort at age 17 years (n = 1,391) provided self-report of diagnosed medical conditions/health complaints, health-related quality of life (36-Item Short Form Health Survey [SF-36]), lifetime experience of LBP, and specific LBP impacts (taking medication, missing school/work, interference with normal/physical activities). Latent class analysis was used to estimate clusters of comorbidities based on diagnosed disorders. Profiles of SF-36 and impact were examined between clusters. Results: Four distinct comorbidity clusters were identified: cluster 1: Low probability of diagnosed LBP or any other medical condition (79.7%); cluster 2: High probability of diagnosed LBP and neck/shoulder pain, but a low probability of other diagnosed health conditions (9.6%); cluster 3: Moderate probability of diagnosed LBP and high probability of diagnosed anxiety and depression (6.9%); cluster 4: Moderate probability of diagnosed LBP and high probability of diagnosed behavioral and attention disorders (3.8%). The clusters had different SF-36 and LBP impact profiles, with clusters 3 and 4 having poorer SF-36 scores, and clusters 2 to 4 having greater risk for specific LBP impacts, than cluster 1. Conclusions: Identified comorbidity clusters support adolescent and adult studies reporting associations between LBP, other pain areas, psychological disorders, and disability. Tracking these clusters into adulthood may provide insight into health care utilization in later life, whereas identification of these individuals early in the life span may help optimize intervention opportunities. [Copyright &y& Elsevier]

Objectives. To identify distinct age-related trajectory classes of body mass index (BMI) z-scores from childhood to adolescence, and to examine the association of these trajectories with measures of standing sagittal spinal alignment at 14 years of age. Methods. Adolescents participating in the Western Australian Pregnancy Cohort (Raine) Study contributed data to the study (n=1 373). Age- and gender-specific z-scores for BMI were obtained from height and weight at the ages of 3, 5, 10 and 14 years. Latent class group analysis was used to identify six distinct trajectory classes of BMI z-score. At the age of 14 years, adolescents were categorised into one of four subgroups of sagittal spinal posture using k-means cluster analysis of photographic measures of lumbar lordosis, thoracic kyphosis and trunk sway. Regression modeling was used to assess the relationship between postural angles and subgroups, and different BMI trajectory classes, adjusting for gender. Results. Six trajectory classes of BMI z-score were estimated: Very Low (4%), Low (24%), Average (34%), Ascending (6%), Moderate High (26%) and Very High (6%). The proportions of postural subgroups at age 14 were; Neutral (29%), Flat (22%), Sway (27%) and Hyperlordotic (22%). BMI trajectory class was strongly associated with postural subgroup, with significantly higher proportions of adolescents in the Very High, High and Ascending BMI trajectory classes displaying a Hyperlordotic or Sway posture than a Neutral posture at age 14. Conclusions. This prospective study provides evidence that childhood obesity, and how it develops, is associated with standing sagittal postural alignment in adolescence. [ABSTRACT FROM AUTHOR]

Background. Conflicting evidence exists regarding relationships among sitting posture, factors that influence sitting posture, and back pain. This conflicting evidence may partially be due to the presence of multiple and overlapping factors associated with both sitting posture and back pain.Objective. The purpose of this study was to determine whether the degree ofslump in sitting was associated with sex and other physical, lifestyle, or psychosocial factors. Additionally, the relationship between the report of back pain made worse by sitting and the degree of slump in sitting and other physical, lifestyle, or psychosocial factors was investigated. Design. This was a cross-sectional study. Methods. Adolescents (n1,596) completed questionnaires to determine lifestyle and psychosocial profiles and the experience of back pain. Sagittal sitting posture, body mass index (BMI), and back muscle endurance (BME) were recorded. Standing posture subgroup categorization was determined. Results. Multivariate analysis revealed that the most significant factor associated with the degree of slump in sitting was male sex, followed by non-neutral standing postures, lower perceived self-efficacy, lower BME, greater television use, and higher BMI. Multivariable analysis indicated poorer Child Behaviour Checklist scores were the strongest correlate of report of back pain made worse by sitting, whereas degree of slump in sitting, female sex, and BME were more weakly related. Limitations. Causality cannot be determined from this cross-sectional study, and 60% of sitting posture variation was not explained by the measured variables. Conclusions. Slump in sitting was associated with physical correlates, as well as sex, lifestyle, and psychosocial factors, highlighting the complex, multidimensional nature of usual sitting posture in adolescents. Additionally, this study demonstrated that a greater degree of slump in sitting was only weakly associated with adolescent back pain made worse by sitting after adjustment for other physical and psychosocial factors. [ABSTRACT FROM AUTHOR]

Background: There is a high prevalence of mental health problems amongst adolescents. In addition there is a high prevalence of spinal pain in this population. Evidence suggests that these conditions are related. This study sought to extend earlier findings by examining the relationship between mental health problems as measured by the Child Behaviour Check List (CBCL) and the experience of back and neck pain in adolescents. Methods: One thousand five hundred and eighty participants (mean age 14.1 years) from the Western Australian Pregnancy (Raine) Study provided cross-sectional spinal pain and CBCL data. Results: As predicted, there was a high prevalence of back and neck pain in this cohort. On the whole, females reported more mental health difficulties than males. There were strong relationships between the majority of symptom scales of the CBCL and back and neck pain. Scores on the CBCL were associated with higher odds of comorbid back and neck pain. Conclusions: These findings strongly support the need to consider both psychological and pain symptoms when providing assessments and treatment for adolescents. Further research is required to inform causal models. [ABSTRACT FROM AUTHOR]

Purpose: Artery dysfunction is an early, integral stage in atherogenesis that predicts future cardiovascular events. Sedentary behavior, such as TV watching, is highly prevalent and associated with increased risk of developing cardiovascular diseases. This study investigated whether patterns of TV watching throughout childhood and adolescence were associated with artery function in adulthood. Methods: TV watching data were collected when participants of the Raine Study were aged 5, 8, 10, 14, 17, and 20 yr. Previous latent class analysis indicated three trajectory groups of TV watching: low TV (<14 h·wk−1), high TV (>14 h·wk−1), and increasing TV (change from low TV to high TV). At age 28 yr, participants were invited to undergo tests of brachial and femoral artery function by flow-mediated dilation (FMD). General linear models examined differences in artery function between TV trajectory groups for men and women. Results: Five hundred sixty participants (n = 261 women, n = 299 men) were included in the study. In women, the low TV group had significantly greater femoral artery FMD (10.8 ± 1.6%) than both High TV (9.0 ± 1.3%, P = 0.005) and Increasing TV groups (8.5 ± 1.3%, P < 0.001); these results were maintained following mediation analysis, including contemporaneous risk factors. There were no significant differences in femoral artery FMD between TV trajectory groups in men (P = 0.955). Conclusions: This study suggests that TV watching behaviors during childhood and adolescence may have legacy impacts on artery function at age 28 yr, particularly in women. This may increase the risk of atherosclerotic vascular pathologies in later life. [ABSTRACT FROM AUTHOR]

The article presents a cross-sectional comparative study which examines the spinal kinematic and truck muscle activity in adolescents with or without nonspecific chronic low back pain (NSCLBP). The study involved 28 adolescents suffering from NSCLBP and 28 pain-free subjects. Researchers found that the spinal posture of adolescents in usual and slump sitting were the same for adolescents with and without NSCLBP. They also found that trunk muscle activity is not a sensitive indicator for determining subgroups of NSCLBP during adolescence.

Objectives: This study investigated spinal pain-related absenteeism at age 17 as a potential precursor to work presenteeism at age 23. Methods: A longitudinal study was performed with Raine Study Gen2 participants (n = 451). Spinal pain-related absenteeism from school/work was collected at the 17 year follow-up. Presenteeism (due to ill-health or any other reason) was collected quarterly during one year around the age of 23. Zero-inflated binominal regression analysis was conducted. Results: Participants with adolescent spinal pain-related absenteeism reported higher work presenteeism in early adulthood than those without pain (155.7 h/y compared to 77.7 h/y), with an incident rate ratio (95% confidence interval) of 1.41 (1.04 to 1.92) after adjusting for sex, occupational class and multimorbidity count. Conclusions: Targeting factors associated with absenteeism behaviours during early life may have significant benefits for future work productivity. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to identify unique organized sport trajectories from early childhood to late adolescence in an Australian pregnancy cohort, the Raine Study. Methods: Participation in organized sport was assessed at ages 5, 8, 10,14, and 17 yr. Physical activity, body composition, and self-rated physical and mental health were assessed at the age of 20 yr. Latent class analysis was used to identify patterns of sport participation. To assess the internal validity of the trajectory classes, differences in health characteristics between trajectories were analyzed using generalized linear models. Results: For girls, three trajectory classes were identified: consistent sport participators (47.5%), sport dropouts (34.3%), and sport nonparticipators (18.1%). For boys, three trajectory classes were identified: consistent sport participators (55.2%), sport dropouts (36.9%), and sport joiners (8.1%). For girls, there were overall differences across trajectory classes in lean body mass (P = 0.003), lean mass index (P = 0.06), and physical health (P = 0.004). For boys, there were differences across classes in physical activity (P = 0.018), percent body fat (P = 0.002), lean body mass (P < 0.001), lean mass index (P < 0.001), physical health (P = 0.06), and depression scores (P = 0.27). Conclusion: This study identified unique, sex-specific trajectories of organized sport participation. The differences in health outcomes between trajectory classes, such as participants with consistent sport participation having more preferable health outcomes at the age of 20 yr, support the internal validity of the trajectories. Strategies are needed to identify and encourage those in the dropout trajectory to maintain their participation and those in the nonparticipator or joiner trajectories to join sport earlier. Specifically, interventions to encourage early sport participation in girls and help nonparticipating boys to join sport during adolescence may help more children receive the benefits of sport participation. [ABSTRACT FROM AUTHOR]

Early life stress exposures may cause dysregulation of the Hypothalamic Pituitary Adrenal (HPA)-axis and cortisol production, with timing and sex-specific effects. Studies examining the impact of early life stress on cortisol responses to stress have focused on severe trauma and have produced inconsistent results. The aim of this study was to investigate whether common early life stressors, experienced prenatally or throughout childhood and adolescence, play a role in the dysregulation of the HPA-axis in early adulthood. Exposures to common life stress events were examined prenatally and as longitudinal trajectories of stress exposure from birth to age 17 in males and females from Gen2 of the Raine Study. At age 18 years, 986 participants were assessed for their salivary cortisol response to a psychosocial stressor - the Trier Social Stress Test (TSST). In males there was an association between high prenatal stress exposure at 18 weeks gestation and a heightened TSST response. We found evidence for sex-specific associations with increasing stress exposure during adolescence (the ascending trajectory) whereby males were more likely to be non-responders to the TSST and females were more likely to be responders. Our results point to sex differences in how stress exposure in-utero and exposure increasing during adolescence may affect regulation of the HPA-axis later in life. However, overall common life stress events experienced in-utero, during childhood and adolescence show limited impact on the HPA-axis stress response in early adulthood. • Effects of early life stress exposure on cortisol reactivity are sex-dependent. • In males, high stress in early pregnancy increased cortisol reactivity to stress at age 18. • Increasing stress around adolescence has opposing effects on cortisol reactivity in males and females. • Common early life stress events have a limited overall effect on cortisol reactivity at age 18. [ABSTRACT FROM AUTHOR]