Impact of increased educational screen exposure on adolescent overweight and the mediating role of physical activity and sleep quality: a natural experiment study from China

Li, Jiayi, Wu, Tianshi, Song, Fujian, Li, Shuju, Wang, Wenhui, Zhang, Qianqian and Peng, Xin (2026) Impact of increased educational screen exposure on adolescent overweight and the mediating role of physical activity and sleep quality: a natural experiment study from China. BMC Public Health. ISSN 1471-2458

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Abstract

Background: Globally, increasing numbers of adolescents use digital devices for learning, and this educational screen exposure may alter behavioral patterns and be associated with the rising prevalence of adolescent overweight. Limited research has examined the interrelationships among educational screen exposure, adolescent overweight, physical activity, and sleep quality. This study aims to assess the impact of educational screen exposure on adolescent overweight prevalence and to identify related mediating risk behaviors. Methods: Data on 41,157 adolescents from 16 cities in China were from the Database of Youth Health. Body mass and height were measured to estimate body mass index. Physical activity and sleep quality data were collected using a self-administered questionnaire. We drew data from two waves (2015 and 2017) of adolescent health surveys, which coincided with China’s online education policy since 2015. The implementation of this policy resulted in a substantial increase in adolescents’ educational screen exposure, with the intensity of the policy implementation influenced by local Internet infrastructure. We allocated adolescents into exposure and control groups based on the local Internet penetration rate. Leveraging this policy-driven natural experiment, a difference-in-differences approach was then applied to compare changes in overweight prevalence, physical activity, and sleep quality before and after the policy implementation between these two groups. Results: The increase in overweight prevalence of adolescents in the exposure group from 2015 to 2017 was 3.1% greater than those in the control group (Coef. 0.03, 95% CI: 0.01 to 0.05, p < 0.01). The exposure group showed significant reductions in physical activity frequency (Coef. -0.49, 95% CI: -0.52 to -0.45) and sleep quality (Coef. -0.06, 95% CI: -0.09 to -0.02). Mediation analyses suggested that reduced physical activity and sleep quality were plausible mediating variables linking educational screen exposure and overweight prevalence. Male adolescents experienced a greater increase in overweight associated with educational screen exposure compared to their peers (Coef. 0.026, 95% CI: 0.01 to 0.04). Conclusions: Educational screen exposure may contribute to increased overweight in adolescents by reducing physical exercise and impairing sleep quality. Educators, guardians, and policymakers should consider effective measures to minimize the adverse impacts of educational screen exposure by promoting physical activities among adolescents.

Item Type:	Article
Additional Information:	Data Availability: Data may be obtained from a third party and are not publicly available. These data are available from the Database of Youth Health (Shandong University) hosted by the National Population Health Data Center (PHDA) and can be accessed via DOI: https://doi.org/10.12213/11.A0031.202107.209.V1.0. (https://www.ncmi.cn/index.html.), subject to the repository’s terms of use. The authors had no special access permissions that others could not have. The data on socioeconomic indicators are available from the China City Statistical Yearbooks published annually by the National Bureau of Statistics of China (https://www.stats.gov.cn). All data generated or analyzed during this study are included in this manuscript and its additional files.
Uncontrolled Keywords:	adolescent health,overweight pandemic,educational screen exposure,natural experiment,difference-in-differences,mediation analyses
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Public Health
Depositing User:	LivePure Connector
Date Deposited:	24 Feb 2026 18:30
Last Modified:	28 Feb 2026 00:55
URI:	https://ueaeprints.uea.ac.uk/id/eprint/102051
DOI:	10.1186/s12889-026-26600-4

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