Modifiable behavioral factors associated with myopia among school-aged children.

Abstract

This study aimed to examine behavioral factors associated with myopia among school-aged children. School physical examination records and parent-administered questionnaire data were collected from nine schools in Haizhu District, Guangzhou. Least absolute shrinkage and selection operator (LASSO) regression was used to reduce multicollinearity and select candidate predictors, followed by univariate and multivariate logistic regression analyses. Non-behavioral factors were included as adjustment covariates. A total of 4957 students were included in the analysis, with a mean age of 10.7 ± 2.42 years; 2661 students were boys and 2296 were girls. After adjustment for demographic, familial, anthropometric, and parental educational covariates, homework time 2-4 h per day was associated with higher odds of myopia [odds ratio (OR) = 1.24; 95% confidence interval (CI) = 1.07-1.44, P = .004]. In contrast, an eye-to-screen distances ≥30 cm (OR = 0.77; 95% CI = 0.65-0.92, P = .004), an eye-to-book distance ≥30 cm (OR = 0.82; 95% CI = 0.71-0.95, P = .008), and daily outdoor activity >30 min (OR = 0.87; 95% CI: 0.77-0.98; P = .026) were associated with lower odds of myopia. Several modifiable behavioral factors were associated with myopia among school-aged children. Maintaining an appropriate near-work distance, limiting prolonged after-school homework or reading time, and increasing outdoor activity may provide practical targets for school- and family-based myopia prevention. Key messages What is already known on this topic: Previous studies have shown that prolonged near work and limited outdoor time are associated with myopia in children. However, evidence remains inconsistent regarding specific daily visual behaviors, such as eye-to-screen distance, eye-to-book distance, and homework duration. What this study adds: This study adds evidence that several feasible daily behaviors, including maintaining a near-work distance of >30 cm, limiting prolonged homework time, and spending ˃30 min outdoors per day, were associated with lower odds of myopia in school-aged children. How this study might affect research, practice, or policy: In practice, these findings suggest that schools and families may consider promoting appropriate near-work distance, regular breaks during homework or reading, and more opportunities for outdoor activity during the school day. Further evidence from longitudinal and interventional studies is needed before these thresholds are incorporated into formal guidelines or policy recommendations.