{"paper_id":"03702325-b8cb-4fc8-9ed2-beee859b4cc5","body_text":"Screen time as a health determinant for kindergarten children in the Australian Capital Territory (including a comparison of First Nations and non-Indigenous children): analysis of a cross-sectional complete enumeration survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Screen time as a health determinant for kindergarten children in the Australian Capital Territory (including a comparison of First Nations and non-Indigenous children): analysis of a cross-sectional complete enumeration survey Clair Bannerman, Kathleen O'Brien, Karen Ciszek, Kirsty A Douglas This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3871587/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Feb, 2025 Read the published version in BMC Public Health → Version 1 posted 21 You are reading this latest preprint version Abstract Background Australian First Nations children have poorer outcomes across a range of health measures. High levels of screen time are associated with a range of adverse health outcomes. Relatively little is known on the association between screen time and health outcomes for different demographic groups, including First Nations children. We aimed to describe the screen time behaviours of First Nations and non-Indigenous kindergarten children in the Australian Capital Territory (ACT), identify disparities in key health outcomes, and explore whether screen time was a risk factor for these outcomes. Methods 5,516 children participated in the cross-sectional population-based ACT Kindergarten Health Check (KHC) survey, including 146 First Nations children. The association between screen time of more than two hours per day and health outcomes (body mass index, respiratory health, development and wellbeing) was assessed for both First Nations and non-Indigenous cohorts using comparative statistics. Results Non-Indigenous children who had an average of more than two hours of screen time per day were 1.5 (95% CI, 1.3–1.7) times more likely to be overweight/obese, 1.2 (95% CI, 1.0-1.4) times more likely to have had a wheeze/whistle in their chest in the 12 months before the KHC, 1.5 (95% CI, 1.3–1.7) times more likely to have developmental concerns and 1.5 (95% CI, 1.3–1.8) times more likely to have reduced wellbeing measures compared to non-Indigenous children with screen time of two hours or less per day. None of these associations were statistically significant amongst First Nations children. Conclusions Screen time more than two hours per day is associated adverse health outcomes in non-Indigenous children, including overweight/obesity, respiratory problems, developmental concerns, and reduced wellbeing. Further analysis is required to enable a more robust assessment of the effect of screen time on health outcomes for First Nations children. Child health Child wellbeing Developmental disabilities Indigenous peoples Minority health Obesity Overweight Paediatric obesity Sedentary behaviour Screen time Social determinants of health vulnerable populations. Figures Figure 1 Background Management of screen time is one of the key challenges in childhood health for parents, educators, and policymakers alike [ 1 , 2 ]. The Australian 24-Hour Movement Guidelines for Children and Young People (‘the 24-hour movement guidelines’) were developed to support healthy physical activity and sleep habits across the day [ 3 ]. These guidelines recommend children aged 5–17 years have no more than two hours of recreational sedentary screen time per day. However, evidence suggests that most Australian children exceed these limits [ 4 ]. We know that high levels of screen time are associated with a range of adverse health outcomes, including overweight/obesity [ 5 , 6 ], reduced wellbeing [ 7 ], developmental delays [ 8 ] and respiratory problems [ 9 ]. Despite these ‘knowns’, there is relatively little available evidence regarding screen time habits and outcomes for different demographic groups, including First Nations children [ 10 ]. Meanwhile, First Nations children have poorer health outcomes across many of the measures associated with high levels of screen time, including overweight/obesity, wellbeing and respiratory disease [ 11 ]. In light of these disparities and the link between screen time and health outcomes, we sought to describe the screen time behaviours of First Nations children and non-Indigenous children in the Australian Capital Territory (ACT), identify differences in health outcomes between these cohorts and explore whether screen time was a risk factor for these outcomes. Methods Data source The ACT Kindergarten Health Check (KHC) is a cross-sectional population-based survey conducted as a part of the ACT Health Child, Youth and Women’s Health program. The KHC captures health measures for children in their first year of full-time primary education (i.e., kindergarten). All children enrolled in kindergarten in ACT public and private schools are invited to participate in the survey. In 2019, the KHC introduced questions exploring children’s screen time habits, including time spent engaging in screen time activities (including TV/video and computer/videogame) on typical weekdays and weekend days. We used this 2019 data-set as the basis for our study. The KHC is comprised of two components: a parental questionnaire collecting demographic data, physical activity, screen time behaviours, child development and wellbeing (see Supplement 1), and a nurse-led health screen of physical measures including body mass index (BMI). BMI was classified into weight categories based on Cole & Lobstein’s age- and sex-specific cutoffs [ 12 ]. To assess child development and wellbeing, the KHC includes a Parents’ Evaluation of Developmental Status (PEDS) questionnaire and a Strengths and Difficulties Questionnaire (SDQ). The PEDS questionnaire identifies children with clinically significant (Pathways A–B) and non-predictive (Pathway C–D) developmental concerns, as well as children with no developmental concerns (Pathway E). The SDQ categorises wellbeing scores as ‘close to average’, ‘slightly raised’ or ‘high risk’ of clinically significant concerns. To assess socio-educational disadvantage, we linked KHC data with the Australian Curriculum, Assessment and Reporting Authority (ACARA) Index of Community and Socio Educational Advantage (ICSEA). The ICSEA is a school-level measure that compares the average level of socio-educational advantage of a school’s student population to those of other schools, with a prescribed national median of 1000, where a higher score indicates higher socioeducational advantage [13]. Statistical analyses The study population included all children enrolled in kindergarten in the ACT in 2019. We excluded nonresponses/missing data from analyses, as well as responses with reported screen time in excess of 16 hours per day (comprised of no more than 8 hours of TV/video and 8 hours of computer/video games). We computed the total number of hours of screen time by weekday, weekend day and averaged across the week. We produced descriptive statistics for children stratified by Indigenous identification. Measures included demographic information (age, sex and socio-educational disadvantage), physical activity and screen time, and health outcomes (BMI, respiratory health, development and wellbeing). We created quintiles of socio-educational advantage by ranking KHC participant ICSEA scores and dividing them into five equal groups, with the top quintile representing children with relatively higher socio-educational advantage compared to their peers. These quintiles are specific to the 2019 ACT KHC cohort and differ from national ICSEA quintiles. We calculated comparative statistics for of the relationship between screen time of more than two hours per day with children’s BMI, respiratory problems, developmental concerns and wellbeing, using odds ratios (OR) for First Nations and non-Indigenous cohorts. Statistical analyses were conducted in IBM SPSS version 26. Results Demographics Detailed demographics are reported at Table 1 . Table 1 2019 KHC respondent characteristics by Indigenous identification Demographics Missing data First Nations children Non-Indigenous children Mean (SD) Proportion of cohort % (95% CI) Mean (SD) Proportion of cohort % (95% CI) Age in months at time of KHC health screen n = 15 69.1 (4.7) 69.5 (4.1) Gender Male n = 15 50.7 (42.6–58.7), n = 74 51.0 (49.7–52.3), n = 2,739 Female 49.3 (41.3–57.4), n = 72 49.0 (47.7–50.3), n = 2,631 First Nations children accounted for 2.6% (n = 146) of 2019 KHC participants for whom Indigenous identification was reported (n = 5,516). Children were an average of 5 years 9 months at the time of the health screen. There was no significant difference in the gender profile of First Nations and non-Indigenous children. The mean ICSEA score for First Nations and non-Indigenous children was above the national median of 1000, at 1054 (SD, 50) and 1089 (SD, 48) respectively. Significantly more First Nations than non-Indigenous children were in the most socio-educationally disadvantaged ICSEA quintile (42.5%, 95% CI, 34.7–50.6% (n = 62) compared to 17.5%, 95% CI, 16.5–18.5% (n = 940)) (Fig. 1). Similarly, a smaller proportion of First Nations children were in the most socio-educationally advantaged quintile compared to non-Indigenous children (8.2%, 95% CI, 4.6–13.5% (n = 12) compared to 23.0%, 95% CI, 21.9–24.1% (n = 1235)). Figure 1: 2019 KHC respondent socio-educational disadvantage by Indigenous identification †Quintile 5: ICSEA ≥ 1130; Quintile 4: ICSEA 1107 to 1129; Quintile 3: ICSEA 1072 to 1106; Quintile 2: ICSEA 1042 to 1071; Quintile 1: ICSEA < 1042. Missing: n = 15 Physical activity and screen time measures Both First Nations and non-Indigenous children were physically active for at least 60 minutes on most days of the week (Table 2 ). A higher proportion of First Nations children were physically active at this level on every day of the week compared to non-Indigenous children. Averaged across the week, daily screen time was 2.2 and 1.9 hours respectively for First Nations and non-Indigenous children. Weekend screen time averaged 3.1 hours for First Nation children and 2.7 hours for non-Indigenous children compared to 1.9 and 1.6 hours respectively on weekdays. Table 2 2019 KHC respondent modifiable risk factors by Indigenous identification Risk factor Missing data First Nations children Non-Indigenous children Mean (SD) Proportion of cohort % (95% CI) Mean (SD) Proportion of cohort % (95% CI) Physical activity Days in typical week with ≥ 60 minutes n = 86 6.0 (1.4) 5.7 (1.6) ≥ 60 minutes every day in typical week 56.6 (48.5–64.8), n = 81 44.3 (43.0-45.7), n = 2,351 Screen time Weekdays Total screen time per day n = 178 1.9 (1.3) 1.6 (1.2) Mean daily screen time > 2 hours 30.5 (23.4–38.4), n = 43 23.7 (22.6–24.9), n = 1,237 Weekends Total screen time per day n = 186 3.1 (1.9) 2.7 (1.7) Mean daily screen time > 2 hours 60.4 (52.2–68.3), n = 84 55.0 (53.6–56.4), n = 2,863 All days Total screen time per day n = 279 2.2 (1.3) 1.9 (1.2) Mean daily screen time > 2 hours 41.9 (33.9–50.3), n = 57 36.2 (34.9–37.6), n = 1,851 Health outcomes Table 3 sets out health and development outcomes by Indigenous identification. Three quarters of children were in the healthy weight range in both the First Nations and non-Indigenous cohorts. Table 3 2019 KHC respondent health and development outcomes by Indigenous identification Health outcome Missing data First Nations children Non-Indigenous children Proportion of cohort % (95% CI) Proportion of cohort % (95% CI) BMI category † Healthy weight n = 384 74.6 (66.7–81.5), n = 97 77.4 (76.2–78.5), n = 3,882 Overweight 15.4 (10.0-22.3), n = 20 12.4 (11.5–13.3), n = 621 Obese 9.2 (5.1–15.1), n = 12 7.5 (6.8–8.3), n = 377 Respiratory problems Chest wheeze/whistle (ever) n = 79 36.1 (28.6–44.2), n = 52 23.2 (22.0-24.3), n = 1,229 Chest wheeze/whistle (in past 12 months) n = 81 24.5 (18.0–32.0), n = 35 13.0 (12.1–13.9), n = 689 Parents’ Evaluation of Developmental Status (PEDS) pathway scores Pathway A n = 39 15.1 (10.0-21.5), n = 22 11.8 (10.9–12.7), n = 629 Pathway B 25.3 (18.8–32.8), n = 37 22.1 (21.0-23.2), n = 1,179 Pathway C–D (non-predictive concerns) 23.3 (17.0-30.6), n = 34 16.1 (15.1–17.1), n = 858 Pathway E (no concerns) 36.3 (28.8–44.3), n = 53 50.1 (48.8–51.4), n = 2,678 †Underweight excluded from table due to small numbers preventing adequate de-identification of data (included in analysis) More than one-third of First Nations children had ever had a wheeze/whistle in the chest compared to less than one quarter of non-Indigenous children. Likewise, a significantly higher proportion of First Nations children had respiratory problems in the 12-month period preceding the KHC. The proportion of children with developmental concerns was not significantly different for either cohort. However, only 36 per cent of First Nations children were identified as having no developmental concerns compared to more than half of non-Indigenous children. Table 4 sets out SDQ ‘total difficulties’ and ‘high-risk subscale’ wellbeing scores, all of which were within the expected range for both cohorts of children. Table 4 2019 KHC respondent Strengths and Development Questionnaire (SDQ) high-risk wellbeing scores by Indigenous identification SDQ measure Missing data Expected range First Nations children Non-Indigenous children Mean (SD) Mean (SD) Total difficulties n = 53 0–13 10.5 (6.7) 7.6 (5.0) Emotional difficulties n = 52 0–3 2.4 (2.3) 1.7 (1.8) Conduct problems n = 50 0–2 1.8 (1.7) 1.4 (1.4) Hyperactivity and inattention n = 51 0–5 4.5 (2.7) 3.3 (2.4) Peer problems n = 51 0–2 1.8 (1.9) 1.3 (1.6) Prosocial n = 52 6–10 8.1 (1.7) 8.2 (1.7) Health outcome associations with screen time Exposure to more than two hours of screen time per day was associated with a range of unfavourable health outcomes in non-Indigenous children; screen time was not significantly associated with any of the health outcomes examined through this study for First Nations children (Table 5 ). Table 5 Association between screen time over two hours per day (across all days of the week) and health outcomes by Indigenous identification Health measures Outcome Comparison Odds Ratio (95% CI) First Nations children Non-Indigenous children BMI† Overweight/obese Healthy weight 1.4 (0.6–3.1) 1.5 (1.3–1.7) Respiratory Chest wheeze/whistle (in past 12 months) No chest wheeze/whistle (in past 12 months) 1.0 (0.5–2.4) 1.2 (1.0-1.4) Development PEDS predictive concerns (any number) No PEDS predictive concerns 1.0 (0.5–2.1) 1.5 (1.3–1.7) Wellbeing ‘High-risk’ or ‘slightly raised’ range SDQ Total difficulties score Expected range SDQ Total difficulties score 1.1 (0.5–2.3) 1.5 (1.3–1.8) †Underweight children were excluded from OR analysis due to the small proportion in this BMI category within each cohort Non-Indigenous children who had an average of more than two hours of screen time per day were 1.5 times more likely to be overweight/obese, have at least one clinically significant developmental concern, or to have wellbeing measures outside of the ‘close to average’ range. They were also 1.2 times more likely to have had a wheeze/whistle in the chest in the 12 months before the KHC than children who had two hours or less daily screen time. Discussion Screen time behaviours Our analysis of the 2019 KHC showed that the screen time habits of most ACT kindergarten children were consistent with the 24-hour movement guidelines, regardless of Indigenous identification. Time spent using screens was higher on weekend days compared to weekdays for both First Nations and non-Indigenous children; this is comforting as recent evidence suggests that high levels of weekday screen time may be disproportionately detrimental to child health and development outcomes [ 4 ]. However, almost one-third of First Nations children and one-quarter of non-Indigenous children still reported more than two hours of screen time per weekday—alarming statistics given the robust body of evidence highlighting the association between high levels of weekday screen time and adverse health outcomes [ 5 ]. Notably, the 2019 KHC was completed prior to school and community closures related to the COVID-19 pandemic and the ACT’s transition to intermittent periods of online learning. Early research suggests that children’s use of recreational screen time markedly increased over the intervening period as a result of such closures [ 14 ]. Health outcomes and their association with screen time Overweight and obesity Overweight and obesity are nationally significant health concerns for all ages. Nearly one-quarter of First Nations children and one-fifth of non-Indigenous children in the 2019 KHC survey were overweight/obese. Of note, these proportions are higher than an analysis of KHC data from 2004–2008, which found that 18% of First Nations children and 14% of non-Indigenous children were overweight/obese [ 15 ]. This echoes a broader national trend of increasing adiposity among Australian children [ 14 ]. For non-Indigenous children, high BMI was associated with high levels of screen time. In this cohort, children with an average of more than two hours of screen time per day were 1.5 times more likely to be overweight/obese than peers with two hours or less daily screen time. Our data reinforces the established association between screen time and overweight/obesity in non-Indigenous children [ 5 , 6 ]; it did not, however, support the presence of such a relationship for First Nations children. Respiratory problems Respiratory diseases result in significantly greater burden in First Nations communities than among non-Indigenous children [ 11 ]. Our analysis confirmed this disparity, with 36% of First Nations children reporting ever having had wheeze/whistle in their chest compared to 23% of non-Indigenous children. International studies have suggested that children with respiratory conditions are more likely to engage in excessive use of screens than children with good respiratory function [ 9 ]. While our study cannot demonstrate causality, we found that non-Indigenous children were 1.2 times more likely to have respiratory problems if they had high levels of screen time. The association between screen time and respiratory problems for First Nations children was not statistically significant; additional analysis would be required to comment further on this relationship. Developmental concerns and wellbeing High levels of screen time have been linked with developmental delay in young children [ 8 ]. Similarly, a broad evidence base supports the association between high levels of screen time and reduced wellbeing, including anxiety, depression and peer problems [ 7 ]. Our analysis found that non-Indigenous children were 1.5 times more likely to have clinically significant developmental concerns or adverse wellbeing measures if they had more than two hours of screen time per day compared to lower levels. There was no comparable significant relationship between screen time and either developmental concerns or wellbeing for First Nations children despite a similar prevalence of clinically significant concerns in both cohorts. The role of demographics and physical activity Socio-educational disadvantage The ACT is a well-off area, with a mean level of socio-educational advantage significantly above the national median of 1000 [ 16 ]. At a macro level, our data appears to support this stereotype for both First Nations and non-Indigenous children, with a mean ICSEA of 1054 and 1089 respectively. However, a growing body of evidence has highlighted the ‘hidden disadvantage’ of certain sub-groups in the ACT [ 17 , 18 ] and the importance of considering disadvantage as a relative measure, considering family level variation in access to resources [ 19 ]. Our study found that First Nations children were significantly more likely than non-Indigenous children to be in the bottom quintile of socio-educational disadvantage relative to their peers. While we cannot infer causality from our analysis, socio-educational disadvantage is a known risk factor for a range of health outcomes, including overweight/obesity [ 6 ], respiratory health [ 20 ], child development [ 21 ] and wellbeing [ 22 ]. Additional analysis should be undertaken to further explore the association between relative socio-educational disadvantage and health outcomes in the study cohort, including the interaction between screen time, socio-educational disadvantage and health outcomes, to inform any potential interventions. Physical activity Physical activity promotes healthy growth and development [ 5 ] and has a protective effect on wellbeing [ 23 ]. For these reasons, the 24-hour movement guidelines recommend children do at least 60 minutes of physical activity per day [ 3 ]. Our study confirmed the trend highlighted in an analysis of 2014–2016 KHC data, which showed that First Nations children are more physically active than their non-Indigenous peers [ 18 ]. In 2019, 57%, of First Nations KHC participants were active for at least 60 minutes every day compared to 44% of non-Indigenous participants. While we cannot infer causality from our study, the higher level of physical activity amongst First Nations children compared to non-Indigenous children may have masked the deleterious associations observed for non-Indigenous children between screen time and BMI, respiratory problems, developmental concerns and wellbeing. Additional analysis should be undertaken to explore this interaction and any implications. Limitations and opportunities for future study The KHC provides a unique and robust opportunity to identify population-level outcomes and risk factors for kindergarten children in the ACT. With excellent response rates and well-validated questions, the KHC is a complete enumeration survey that provides a large representative sample for analysis and to inform evidence-based health policy design. The 2019 survey was the first iteration of the KHC to address children’s screen-time behaviours. These data will serve as a good basis to build longitudinal data on this important health risk factor in later years. The small population of First Nations children in our study meant that many of our findings were not statistically significant with large confidence intervals. It is also worth noting that missing data were excluded from the analyses; if the characteristics of these missing data differ from those children with complete data this has the potential to introduce bias. Repeating our analyses when multiple years of data are available would provide more robust findings and help to minimise this potential bias. Further, repeating the study analyses on 2020 and 2021 KHC data would provide valuable insight into changes in children’s screen time behaviour in the wake of the COVID-19 pandemic and effects on associated health outcomes. Conclusions Our study reinforced that screen time in excess of two hours per day is associated with a range of adverse health outcomes in non-Indigenous children, including overweight/obesity, respiratory problems, developmental concerns and reduced wellbeing. While our analysis did not explore causality, these findings suggest that interventions to support adherence to the screen time recommendations set out in the 24-hour movement guidelines may promote childhood health at a population level. This includes promoting healthy body weight, age-appropriate development and enhanced wellbeing amongst non-Indigenous children. We did not find any statistically significant association between screen time and adverse health outcomes for First Nations kindergarten children across any of the measures assessed in our study. Additional analysis with multiple years of pooled data and thus a larger cohort of First Nations children will enable a more robust assessment of the strength of the relationship between screen time and health outcomes for this cohort, and any interaction between screen time, socio-educational disadvantage and physical activity. If, indeed, screen time is an independent risk factor, interventions to support screen time management may help to close the health gap between First Nations and non-Indigenous children. Declarations Ethics approval and consent to participate The data collection and consent process for the KHC has been granted ethics approval through the ACT Health Human Research Ethics Committee (HREC; ETHLR.13.316). This includes informed consent from the parent/guardian for de-identified information collected in the KHC to be provided to researchers who have approval granted from the ACT HREC. Ethics approval for our study was granted by the ACT HREC (2020/ETH02679). Consent for publication Not applicable. Availability of data and materials Data may be obtained from a third party and are not publicly available. The Kindergarten Health Check is an ACT health database. Access can be applied for by emailing: [email protected] . Competing interests None declared. Funding No funding was received Authors’ contributions All authors were involved in the design of the study. Data were extracted by KC. Data analysis was done by CB and KOB; figures and tables were prepared by CB. CB drafted the manuscript. KOB, KD and KC contributed to the manuscript. All authors had final approval of the final manuscript. Acknowledgements We would like to thank the Narrabundah Early Childhood School and ACT Aboriginal and Torres Strait Islander Elected Body (ATSIEB) for their support of this project. References The Royal Children's Hospital National Child Health Poll. Top 10 child health problems: What Australian parents think. Poll Number 20 [Internet]. 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Supplementary Files Supplement12019KindergartenHealthCheckquestionnaire.pdf Cite Share Download PDF Status: Published Journal Publication published 04 Feb, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 06 Nov, 2024 Reviews received at journal 04 Nov, 2024 Reviews received at journal 01 Nov, 2024 Reviews received at journal 27 Oct, 2024 Reviewers agreed at journal 25 Oct, 2024 Reviews received at journal 22 Oct, 2024 Reviewers agreed at journal 21 Oct, 2024 Reviewers agreed at journal 21 Oct, 2024 Reviews received at journal 20 Oct, 2024 Reviews received at journal 16 Oct, 2024 Reviewers agreed at journal 15 Oct, 2024 Reviewers agreed at journal 15 Oct, 2024 Reviewers agreed at journal 14 Oct, 2024 Reviewers agreed at journal 13 Oct, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers agreed at journal 18 Feb, 2024 Reviewers invited by journal 14 Feb, 2024 Editor assigned by journal 14 Feb, 2024 Editor invited by journal 30 Jan, 2024 Submission checks completed at journal 30 Jan, 2024 First submitted to journal 16 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3871587\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":270017914,\"identity\":\"9af0f778-ffe4-4e24-8532-8a9a7e945d17\",\"order_by\":0,\"name\":\"Clair Bannerman\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"School of Medicine and Psychology, The Australian National University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Clair\",\"middleName\":\"\",\"lastName\":\"Bannerman\",\"suffix\":\"\"},{\"id\":270017915,\"identity\":\"71c0ecf2-7d6e-4d46-9fa0-d3c242cf6169\",\"order_by\":1,\"name\":\"Kathleen O'Brien\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIie2QsWrDMBCGLwTkxeD1TGmfQcFgAgl9Fh0GZzEmkMVDBk3u6DWPESh0NgTUxSVrxhRDJg95gJJUahtIqdqmWwd9068TH790AA7HPwQBGGzfYk8BcIDg/aL/g9JnIM6VUF6u6GDg9S9KeLdWW1GMc/Aka4vpOI8enxRCMSLpNdymXPmJx0WTzsCvvUHD01nc5ClCMyHpZ1blBhKGVK5IomCh5Ct6qLMYe2YC3yhBq5XD8aQc6b7qtHLQStDZH4amRdYnpaYlmhZpeu0t4aKNUaiESvMXyRNabLpoKNQkKnE3tSm4ph3u57dU6Y09yxcdqmyw2c9H11WQLO1r/oB9OokvE4fD4XD8hVe14lq8wiY1ogAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Academic Unit of General Practice, The Australian National University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Kathleen\",\"middleName\":\"\",\"lastName\":\"O'Brien\",\"suffix\":\"\"},{\"id\":270017916,\"identity\":\"e48df32d-6fcf-4235-b2db-81d9c284b7b5\",\"order_by\":2,\"name\":\"Karen Ciszek\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Academic Unit of General Practice, ACT Health\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Karen\",\"middleName\":\"\",\"lastName\":\"Ciszek\",\"suffix\":\"\"},{\"id\":270017917,\"identity\":\"b06fc2ab-f0ef-468f-8e6b-09e25be47efb\",\"order_by\":3,\"name\":\"Kirsty A Douglas\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Academic Unit of General Practice, ACT Health\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kirsty\",\"middleName\":\"A\",\"lastName\":\"Douglas\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-01-17 02:29:13\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-3871587/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-3871587/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12889-025-21611-z\",\"type\":\"published\",\"date\":\"2025-02-04T15:58:02+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":50508973,\"identity\":\"2b3fd4d4-ba4d-4050-a064-a7a91dc009f2\",\"added_by\":\"auto\",\"created_at\":\"2024-02-01 15:54:07\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":55076,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e2019 KHC respondent socio-educational disadvantage by Indigenous identification\\u003c/p\\u003e\\n\\u003cp\\u003e†Quintile 5: ICSEA ≥ 1130; Quintile 4: ICSEA 1107 to 1129; Quintile 3: ICSEA 1072 to 1106; Quintile 2: ICSEA 1042 to 1071; Quintile 1: ICSEA \\u0026lt; 1042. Missing: n=15\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3871587/v1/4bc912565e3861c7605bcf5a.png\"},{\"id\":75931215,\"identity\":\"4b1b65ca-31d7-4db7-b5fd-008e9569b61d\",\"added_by\":\"auto\",\"created_at\":\"2025-02-10 16:14:09\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":914666,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3871587/v1/05ea5e74-cef0-480d-be3a-4ff6c704f2c2.pdf\"},{\"id\":50508974,\"identity\":\"807c494d-6feb-4695-9dcd-acaf52b11969\",\"added_by\":\"auto\",\"created_at\":\"2024-02-01 15:54:07\",\"extension\":\"pdf\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":1344637,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplement12019KindergartenHealthCheckquestionnaire.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3871587/v1/f21866da78f702c82d4ec5b6.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Screen time as a health determinant for kindergarten children in the Australian Capital Territory (including a comparison of First Nations and non-Indigenous children): analysis of a cross-sectional complete enumeration survey\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eManagement of screen time is one of the key challenges in childhood health for parents, educators, and policymakers alike [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. The \\u003cem\\u003eAustralian 24-Hour Movement Guidelines for Children and Young People\\u003c/em\\u003e (‘the 24-hour movement guidelines’) were developed to support healthy physical activity and sleep habits across the day [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. These guidelines recommend children aged 5–17 years have no more than two hours of recreational sedentary screen time per day. However, evidence suggests that most Australian children exceed these limits [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eWe know that high levels of screen time are associated with a range of adverse health outcomes, including overweight/obesity [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e], reduced wellbeing [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e], developmental delays [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e] and respiratory problems [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. Despite these ‘knowns’, there is relatively little available evidence regarding screen time habits and outcomes for different demographic groups, including First Nations children [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Meanwhile, First Nations children have poorer health outcomes across many of the measures associated with high levels of screen time, including overweight/obesity, wellbeing and respiratory disease [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIn light of these disparities and the link between screen time and health outcomes, we sought to describe the screen time behaviours of First Nations children and non-Indigenous children in the Australian Capital Territory (ACT), identify differences in health outcomes between these cohorts and explore whether screen time was a risk factor for these outcomes.\\u003c/p\\u003e \"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eData source\\u003c/p\\u003e\\u003cp\\u003eThe ACT Kindergarten Health Check (KHC) is a cross-sectional population-based survey conducted as a part of the ACT Health Child, Youth and Women’s Health program. The KHC captures health measures for children in their first year of full-time primary education (i.e., kindergarten). All children enrolled in kindergarten in ACT public and private schools are invited to participate in the survey. In 2019, the KHC introduced questions exploring children’s screen time habits, including time spent engaging in screen time activities (including TV/video and computer/videogame) on typical weekdays and weekend days. We used this 2019 data-set as the basis for our study.\\u003c/p\\u003e\\u003cp\\u003eThe KHC is comprised of two components: a parental questionnaire collecting demographic data, physical activity, screen time behaviours, child development and wellbeing (see Supplement 1), and a nurse-led health screen of physical measures including body mass index (BMI). BMI was classified into weight categories based on Cole \\u0026amp; Lobstein’s age- and sex-specific cutoffs [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eTo assess child development and wellbeing, the KHC includes a Parents’ Evaluation of Developmental Status (PEDS) questionnaire and a Strengths and Difficulties Questionnaire (SDQ). The PEDS questionnaire identifies children with clinically significant (Pathways A–B) and non-predictive (Pathway C–D) developmental concerns, as well as children with no developmental concerns (Pathway E). The SDQ categorises wellbeing scores as ‘close to average’, ‘slightly raised’ or ‘high risk’ of clinically significant concerns.\\u003c/p\\u003e\\u003cp\\u003eTo assess socio-educational disadvantage, we linked KHC data with the Australian Curriculum, Assessment and Reporting Authority (ACARA) Index of Community and Socio Educational Advantage (ICSEA). The ICSEA is a school-level measure that compares the average level of socio-educational advantage of a school’s student population to those of other schools, with a prescribed national median of 1000, where a higher score indicates higher socioeducational advantage [13].\\u003c/p\\u003e\\u003cp\\u003eStatistical analyses\\u003c/p\\u003e\\u003cp\\u003eThe study population included all children enrolled in kindergarten in the ACT in 2019. We excluded nonresponses/missing data from analyses, as well as responses with reported screen time in excess of 16 hours per day (comprised of no more than 8 hours of TV/video and 8 hours of computer/video games). We computed the total number of hours of screen time by weekday, weekend day and averaged across the week.\\u003c/p\\u003e\\u003cp\\u003eWe produced descriptive statistics for children stratified by Indigenous identification. Measures included demographic information (age, sex and socio-educational disadvantage), physical activity and screen time, and health outcomes (BMI, respiratory health, development and wellbeing). We created quintiles of socio-educational advantage by ranking KHC participant ICSEA scores and dividing them into five equal groups, with the top quintile representing children with relatively higher socio-educational advantage compared to their peers. These quintiles are specific to the 2019 ACT KHC cohort and differ from national ICSEA quintiles.\\u003c/p\\u003e\\u003cp\\u003eWe calculated comparative statistics for of the relationship between screen time of more than two hours per day with children’s BMI, respiratory problems, developmental concerns and wellbeing, using odds ratios (OR) for First Nations and non-Indigenous cohorts.\\u003c/p\\u003e\\u003cp\\u003eStatistical analyses were conducted in IBM SPSS version 26.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eDemographics\\u003c/p\\u003e \\u003cp\\u003eDetailed demographics are reported at Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e2019 KHC respondent characteristics by Indigenous identification\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDemographics\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eMissing data\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eFirst Nations children\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e \\u003cp\\u003eNon-Indigenous children\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMean (SD)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProportion of cohort\\u003c/p\\u003e \\u003cp\\u003e% (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eMean (SD)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eProportion of cohort\\u003c/p\\u003e \\u003cp\\u003e% (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAge in months at time of KHC health screen\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e69.1 (4.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e69.5 (4.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eGender\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e50.7 (42.6\\u0026ndash;58.7), n\\u0026thinsp;=\\u0026thinsp;74\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e51.0 (49.7\\u0026ndash;52.3), n\\u0026thinsp;=\\u0026thinsp;2,739\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e49.3 (41.3\\u0026ndash;57.4), n\\u0026thinsp;=\\u0026thinsp;72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e49.0 (47.7\\u0026ndash;50.3), n\\u0026thinsp;=\\u0026thinsp;2,631\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eFirst Nations children accounted for 2.6% (n\\u0026thinsp;=\\u0026thinsp;146) of 2019 KHC participants for whom Indigenous identification was reported (n\\u0026thinsp;=\\u0026thinsp;5,516). Children were an average of 5 years 9 months at the time of the health screen. There was no significant difference in the gender profile of First Nations and non-Indigenous children.\\u003c/p\\u003e \\u003cp\\u003eThe mean ICSEA score for First Nations and non-Indigenous children was above the national median of 1000, at 1054 (SD, 50) and 1089 (SD, 48) respectively. Significantly more First Nations than non-Indigenous children were in the most socio-educationally disadvantaged ICSEA quintile (42.5%, 95% CI, 34.7\\u0026ndash;50.6% (n\\u0026thinsp;=\\u0026thinsp;62) compared to 17.5%, 95% CI, 16.5\\u0026ndash;18.5% (n\\u0026thinsp;=\\u0026thinsp;940)) (Fig.\\u0026nbsp;1). Similarly, a smaller proportion of First Nations children were in the most socio-educationally advantaged quintile compared to non-Indigenous children (8.2%, 95% CI, 4.6\\u0026ndash;13.5% (n\\u0026thinsp;=\\u0026thinsp;12) compared to 23.0%, 95% CI, 21.9\\u0026ndash;24.1% (n\\u0026thinsp;=\\u0026thinsp;1235)).\\u003c/p\\u003e \\u003cp\\u003eFigure 1: 2019 KHC respondent socio-educational disadvantage by Indigenous identification\\u003c/p\\u003e \\u003cp\\u003e\\u0026dagger;Quintile 5: ICSEA\\u0026thinsp;\\u0026ge;\\u0026thinsp;1130; Quintile 4: ICSEA 1107 to 1129; Quintile 3: ICSEA 1072 to 1106; Quintile 2: ICSEA 1042 to 1071; Quintile 1: ICSEA\\u0026thinsp;\\u0026lt;\\u0026thinsp;1042. Missing: n\\u0026thinsp;=\\u0026thinsp;15\\u003c/p\\u003e \\u003cp\\u003ePhysical activity and screen time measures\\u003c/p\\u003e \\u003cp\\u003eBoth First Nations and non-Indigenous children were physically active for at least 60 minutes on most days of the week (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). A higher proportion of First Nations children were physically active at this level on every day of the week compared to non-Indigenous children.\\u003c/p\\u003e \\u003cp\\u003eAveraged across the week, daily screen time was 2.2 and 1.9 hours respectively for First Nations and non-Indigenous children. Weekend screen time averaged 3.1 hours for First Nation children and 2.7 hours for non-Indigenous children compared to 1.9 and 1.6 hours respectively on weekdays.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e2019 KHC respondent modifiable risk factors by Indigenous identification\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"8\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" morerows=\\\"1\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eRisk factor\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eMissing data\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eFirst Nations children\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003eNon-Indigenous children\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMean (SD)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eProportion of cohort % (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eMean (SD)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eProportion of cohort % (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c8\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical activity\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eDays in typical week with \\u0026ge;\\u0026thinsp;60 minutes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6.0 (1.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5.7 (1.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;60 minutes every day in typical week\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e56.6 (48.5\\u0026ndash;64.8), n\\u0026thinsp;=\\u0026thinsp;81\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e44.3 (43.0-45.7), n\\u0026thinsp;=\\u0026thinsp;2,351\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c8\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eScreen time\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c8\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eWeekdays\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"7\\\" rowspan=\\\"8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eTotal screen time per day\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;178\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.9 (1.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.6 (1.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMean daily screen time\\u0026thinsp;\\u0026gt;\\u0026thinsp;2 hours\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e30.5 (23.4\\u0026ndash;38.4),\\u003c/p\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e23.7 (22.6\\u0026ndash;24.9), n\\u0026thinsp;=\\u0026thinsp;1,237\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c8\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eWeekends\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eTotal screen time per day\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;186\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.1 (1.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2.7 (1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMean daily screen time\\u0026thinsp;\\u0026gt;\\u0026thinsp;2 hours\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e60.4 (52.2\\u0026ndash;68.3),\\u003c/p\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;84\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e55.0 (53.6\\u0026ndash;56.4), n\\u0026thinsp;=\\u0026thinsp;2,863\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c8\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eAll days\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eTotal screen time per day\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;279\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.2 (1.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.9 (1.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMean daily screen time\\u0026thinsp;\\u0026gt;\\u0026thinsp;2 hours\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e41.9 (33.9\\u0026ndash;50.3),\\u003c/p\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;57\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e36.2 (34.9\\u0026ndash;37.6),\\u003c/p\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;1,851\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"8\\\"\\u003eHealth outcomes\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e sets out health and development outcomes by Indigenous identification. Three quarters of children were in the healthy weight range in both the First Nations and non-Indigenous cohorts.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e2019 KHC respondent health and development outcomes by Indigenous identification\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eHealth outcome\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eMissing data\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eFirst Nations children\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNon-Indigenous children\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eProportion of cohort % (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProportion of cohort % (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI category \\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHealthy weight\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;384\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e74.6 (66.7\\u0026ndash;81.5), n\\u0026thinsp;=\\u0026thinsp;97\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e77.4 (76.2\\u0026ndash;78.5), n\\u0026thinsp;=\\u0026thinsp;3,882\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOverweight\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15.4 (10.0-22.3), n\\u0026thinsp;=\\u0026thinsp;20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12.4 (11.5\\u0026ndash;13.3), n\\u0026thinsp;=\\u0026thinsp;621\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eObese\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.2 (5.1\\u0026ndash;15.1), n\\u0026thinsp;=\\u0026thinsp;12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7.5 (6.8\\u0026ndash;8.3), n\\u0026thinsp;=\\u0026thinsp;377\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eRespiratory problems\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChest wheeze/whistle (ever)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;79\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36.1 (28.6\\u0026ndash;44.2), n\\u0026thinsp;=\\u0026thinsp;52\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e23.2 (22.0-24.3), n\\u0026thinsp;=\\u0026thinsp;1,229\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChest wheeze/whistle (in past 12 months)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;81\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24.5 (18.0\\u0026ndash;32.0), n\\u0026thinsp;=\\u0026thinsp;35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13.0 (12.1\\u0026ndash;13.9), n\\u0026thinsp;=\\u0026thinsp;689\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eParents\\u0026rsquo; Evaluation of Developmental Status (PEDS) pathway scores\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePathway A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15.1 (10.0-21.5), n\\u0026thinsp;=\\u0026thinsp;22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e11.8 (10.9\\u0026ndash;12.7), n\\u0026thinsp;=\\u0026thinsp;629\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePathway B\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e25.3 (18.8\\u0026ndash;32.8), n\\u0026thinsp;=\\u0026thinsp;37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22.1 (21.0-23.2), n\\u0026thinsp;=\\u0026thinsp;1,179\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePathway C\\u0026ndash;D (non-predictive concerns)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23.3 (17.0-30.6), n\\u0026thinsp;=\\u0026thinsp;34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16.1 (15.1\\u0026ndash;17.1), n\\u0026thinsp;=\\u0026thinsp;858\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePathway E\\u003c/p\\u003e \\u003cp\\u003e(no concerns)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36.3 (28.8\\u0026ndash;44.3), n\\u0026thinsp;=\\u0026thinsp;53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e50.1 (48.8\\u0026ndash;51.4), n\\u0026thinsp;=\\u0026thinsp;2,678\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\u0026dagger;Underweight excluded from table due to small numbers preventing adequate de-identification of data (included in analysis)\\u003c/p\\u003e \\u003cp\\u003eMore than one-third of First Nations children had ever had a wheeze/whistle in the chest compared to less than one quarter of non-Indigenous children. Likewise, a significantly higher proportion of First Nations children had respiratory problems in the 12-month period preceding the KHC.\\u003c/p\\u003e \\u003cp\\u003eThe proportion of children with developmental concerns was not significantly different for either cohort. However, only 36 per cent of First Nations children were identified as having no developmental concerns compared to more than half of non-Indigenous children.\\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e sets out SDQ \\u0026lsquo;total difficulties\\u0026rsquo; and \\u0026lsquo;high-risk subscale\\u0026rsquo; wellbeing scores, all of which were within the expected range for both cohorts of children.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e2019 KHC respondent Strengths and Development Questionnaire (SDQ) high-risk wellbeing scores by Indigenous identification\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSDQ measure\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eMissing data\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eExpected range\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eFirst Nations children\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNon-Indigenous children\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMean (SD)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMean (SD)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal difficulties\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u0026ndash;13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.5 (6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7.6 (5.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEmotional difficulties\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;52\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u0026ndash;3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.4 (2.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.7 (1.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eConduct problems\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u0026ndash;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.8 (1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.4 (1.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHyperactivity and inattention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u0026ndash;5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.5 (2.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.3 (2.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePeer problems\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u0026ndash;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.8 (1.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.3 (1.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProsocial\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;52\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6\\u0026ndash;10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.1 (1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8.2 (1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eHealth outcome associations with screen time\\u003c/p\\u003e \\u003cp\\u003eExposure to more than two hours of screen time per day was associated with a range of unfavourable health outcomes in non-Indigenous children; screen time was not significantly associated with any of the health outcomes examined through this study for First Nations children (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eAssociation between screen time over two hours per day (across all days of the week) and health outcomes by Indigenous identification\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eHealth measures\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eOutcome\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eComparison\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eOdds Ratio (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eFirst Nations children\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNon-Indigenous children\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOverweight/obese\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eHealthy weight\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.4 (0.6\\u0026ndash;3.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.5 (1.3\\u0026ndash;1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRespiratory\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChest wheeze/whistle\\u003c/p\\u003e \\u003cp\\u003e(in past 12 months)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNo chest wheeze/whistle (in past 12 months)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.0 (0.5\\u0026ndash;2.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.2 (1.0-1.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDevelopment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePEDS predictive concerns\\u003c/p\\u003e \\u003cp\\u003e(any number)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNo PEDS predictive concerns\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.0 (0.5\\u0026ndash;2.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.5 (1.3\\u0026ndash;1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWellbeing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lsquo;High-risk\\u0026rsquo; or \\u0026lsquo;slightly raised\\u0026rsquo; range SDQ Total difficulties score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eExpected range SDQ Total difficulties score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.1 (0.5\\u0026ndash;2.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.5 (1.3\\u0026ndash;1.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\u0026dagger;Underweight children were excluded from OR analysis due to the small proportion in this BMI category within each cohort\\u003c/p\\u003e \\u003cp\\u003eNon-Indigenous children who had an average of more than two hours of screen time per day were 1.5 times more likely to be overweight/obese, have at least one clinically significant developmental concern, or to have wellbeing measures outside of the \\u0026lsquo;close to average\\u0026rsquo; range. They were also 1.2 times more likely to have had a wheeze/whistle in the chest in the 12 months before the KHC than children who had two hours or less daily screen time.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eScreen time behaviours\\u003c/p\\u003e \\u003cp\\u003e Our analysis of the 2019 KHC showed that the screen time habits of most ACT kindergarten children were consistent with the 24-hour movement guidelines, regardless of Indigenous identification.\\u003c/p\\u003e \\u003cp\\u003eTime spent using screens was higher on weekend days compared to weekdays for both First Nations and non-Indigenous children; this is comforting as recent evidence suggests that high levels of weekday screen time may be disproportionately detrimental to child health and development outcomes [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. However, almost one-third of First Nations children and one-quarter of non-Indigenous children still reported more than two hours of screen time per weekday\\u0026mdash;alarming statistics given the robust body of evidence highlighting the association between high levels of weekday screen time and adverse health outcomes [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eNotably, the 2019 KHC was completed prior to school and community closures related to the COVID-19 pandemic and the ACT\\u0026rsquo;s transition to intermittent periods of online learning. Early research suggests that children\\u0026rsquo;s use of recreational screen time markedly increased over the intervening period as a result of such closures [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eHealth outcomes and their association with screen time\\u003c/p\\u003e\\n\\u003ch3\\u003eOverweight and obesity\\u003c/h3\\u003e\\n\\u003cp\\u003eOverweight and obesity are nationally significant health concerns for all ages. Nearly one-quarter of First Nations children and one-fifth of non-Indigenous children in the 2019 KHC survey were overweight/obese. Of note, these proportions are higher than an analysis of KHC data from 2004\\u0026ndash;2008, which found that 18% of First Nations children and 14% of non-Indigenous children were overweight/obese [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. This echoes a broader national trend of increasing adiposity among Australian children [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eFor non-Indigenous children, high BMI was associated with high levels of screen time. In this cohort, children with an average of more than two hours of screen time per day were 1.5 times more likely to be overweight/obese than peers with two hours or less daily screen time. Our data reinforces the established association between screen time and overweight/obesity in non-Indigenous children [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]; it did not, however, support the presence of such a relationship for First Nations children.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRespiratory problems\\u003c/h2\\u003e \\u003cp\\u003eRespiratory diseases result in significantly greater burden in First Nations communities than among non-Indigenous children [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Our analysis confirmed this disparity, with 36% of First Nations children reporting ever having had wheeze/whistle in their chest compared to 23% of non-Indigenous children.\\u003c/p\\u003e \\u003cp\\u003eInternational studies have suggested that children with respiratory conditions are more likely to engage in excessive use of screens than children with good respiratory function [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. While our study cannot demonstrate causality, we found that non-Indigenous children were 1.2 times more likely to have respiratory problems if they had high levels of screen time. The association between screen time and respiratory problems for First Nations children was not statistically significant; additional analysis would be required to comment further on this relationship.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDevelopmental concerns and wellbeing\\u003c/h2\\u003e \\u003cp\\u003eHigh levels of screen time have been linked with developmental delay in young children [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Similarly, a broad evidence base supports the association between high levels of screen time and reduced wellbeing, including anxiety, depression and peer problems [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Our analysis found that non-Indigenous children were 1.5 times more likely to have clinically significant developmental concerns or adverse wellbeing measures if they had more than two hours of screen time per day compared to lower levels. There was no comparable significant relationship between screen time and either developmental concerns or wellbeing for First Nations children despite a similar prevalence of clinically significant concerns in both cohorts.\\u003c/p\\u003e \\u003cp\\u003eThe role of demographics and physical activity\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSocio-educational disadvantage\\u003c/h2\\u003e \\u003cp\\u003eThe ACT is a well-off area, with a mean level of socio-educational advantage significantly above the national median of 1000 [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. At a macro level, our data appears to support this stereotype for both First Nations and non-Indigenous children, with a mean ICSEA of 1054 and 1089 respectively. However, a growing body of evidence has highlighted the \\u0026lsquo;hidden disadvantage\\u0026rsquo; of certain sub-groups in the ACT [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e] and the importance of considering disadvantage as a relative measure, considering family level variation in access to resources [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. Our study found that First Nations children were significantly more likely than non-Indigenous children to be in the bottom quintile of socio-educational disadvantage relative to their peers. While we cannot infer causality from our analysis, socio-educational disadvantage is a known risk factor for a range of health outcomes, including overweight/obesity [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e], respiratory health [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e], child development [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e] and wellbeing [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. Additional analysis should be undertaken to further explore the association between relative socio-educational disadvantage and health outcomes in the study cohort, including the interaction between screen time, socio-educational disadvantage and health outcomes, to inform any potential interventions.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePhysical activity\\u003c/h2\\u003e \\u003cp\\u003ePhysical activity promotes healthy growth and development [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e] and has a protective effect on wellbeing [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. For these reasons, the 24-hour movement guidelines recommend children do at least 60 minutes of physical activity per day [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Our study confirmed the trend highlighted in an analysis of 2014\\u0026ndash;2016 KHC data, which showed that First Nations children are more physically active than their non-Indigenous peers [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. In 2019, 57%, of First Nations KHC participants were active for at least 60 minutes every day compared to 44% of non-Indigenous participants. While we cannot infer causality from our study, the higher level of physical activity amongst First Nations children compared to non-Indigenous children may have masked the deleterious associations observed for non-Indigenous children between screen time and BMI, respiratory problems, developmental concerns and wellbeing. Additional analysis should be undertaken to explore this interaction and any implications.\\u003c/p\\u003e \\u003cp\\u003eLimitations and opportunities for future study\\u003c/p\\u003e \\u003cp\\u003eThe KHC provides a unique and robust opportunity to identify population-level outcomes and risk factors for kindergarten children in the ACT. With excellent response rates and well-validated questions, the KHC is a complete enumeration survey that provides a large representative sample for analysis and to inform evidence-based health policy design. The 2019 survey was the first iteration of the KHC to address children\\u0026rsquo;s screen-time behaviours. These data will serve as a good basis to build longitudinal data on this important health risk factor in later years.\\u003c/p\\u003e \\u003cp\\u003eThe small population of First Nations children in our study meant that many of our findings were not statistically significant with large confidence intervals. It is also worth noting that missing data were excluded from the analyses; if the characteristics of these missing data differ from those children with complete data this has the potential to introduce bias. Repeating our analyses when multiple years of data are available would provide more robust findings and help to minimise this potential bias. Further, repeating the study analyses on 2020 and 2021 KHC data would provide valuable insight into changes in children\\u0026rsquo;s screen time behaviour in the wake of the COVID-19 pandemic and effects on associated health outcomes.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eOur study reinforced that screen time in excess of two hours per day is associated with a range of adverse health outcomes in non-Indigenous children, including overweight/obesity, respiratory problems, developmental concerns and reduced wellbeing. While our analysis did not explore causality, these findings suggest that interventions to support adherence to the screen time recommendations set out in the 24-hour movement guidelines may promote childhood health at a population level. This includes promoting healthy body weight, age-appropriate development and enhanced wellbeing amongst non-Indigenous children.\\u003c/p\\u003e \\u003cp\\u003eWe did not find any statistically significant association between screen time and adverse health outcomes for First Nations kindergarten children across any of the measures assessed in our study. Additional analysis with multiple years of pooled data and thus a larger cohort of First Nations children will enable a more robust assessment of the strength of the relationship between screen time and health outcomes for this cohort, and any interaction between screen time, socio-educational disadvantage and physical activity. If, indeed, screen time is an independent risk factor, interventions to support screen time management may help to close the health gap between First Nations and non-Indigenous children.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eEthics approval and consent to participate\\u003c/p\\u003e\\n\\u003cp\\u003eThe data collection and consent process for the KHC has been granted ethics approval through the ACT Health Human Research Ethics Committee (HREC; ETHLR.13.316). This includes informed consent from the parent/guardian for de-identified information collected in the KHC to be provided to researchers who have approval granted from the ACT HREC. Ethics approval for our study was granted by the ACT HREC (2020/ETH02679).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eConsent for publication\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003eAvailability of data and materials\\u003c/p\\u003e\\n\\u003cp\\u003eData may be obtained from a third party and are not publicly available. The Kindergarten Health Check is an ACT health database. Access can be applied for by emailing: augp@anu.edu.au.\\u003c/p\\u003e\\n\\u003cp\\u003eCompeting interests\\u003c/p\\u003e\\n\\u003cp\\u003eNone declared.\\u003c/p\\u003e\\n\\u003cp\\u003eFunding\\u003c/p\\u003e\\n\\u003cp\\u003eNo funding was received\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors\\u0026rsquo; contributions\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors were involved in the design of the study. Data were extracted by KC. Data analysis was done by CB and KOB; figures and tables were prepared by CB. CB drafted the manuscript. KOB, KD and KC contributed to the manuscript. All authors had final approval of the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003eAcknowledgements\\u003c/p\\u003e\\n\\u003cp\\u003eWe would like to thank the Narrabundah Early Childhood School and ACT Aboriginal and Torres Strait Islander Elected Body (ATSIEB) for their support of this project.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eThe Royal Children's Hospital National Child Health Poll. Top 10 child health problems: What Australian parents think. Poll Number 20 [Internet]. Melbourne: The Royal Children's Hospital. 2021 [cited 2021 Aug 16]. 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Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.racgp.org.au/afp/2013/july/indigenous-child-obesity/\\u003c/span\\u003e\\u003cspan address=\\\"https://www.racgp.org.au/afp/2013/july/indigenous-child-obesity/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSocio-economic advantage and disadvantage. 2091.0 \\u0026ndash; Census of Population and Housing: Reflecting Australia \\u0026ndash; Stories from the Census, 2016. [Internet]. Australian Bureau of Statistics. 2018 [cited 2021 Sep 7]. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Socio-Economic%20Advantage%20and%20Disadvantage~123\\u003c/span\\u003e\\u003cspan address=\\\"https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Socio-Economic%20Advantage%20and%20Disadvantage~123\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGoldie X, Kakuk I, Wood G. Two Tales of a City: detecting socio-economic disadvantage in an \\u0026lsquo;advantaged\\u0026rsquo; Australian urban centre. Aust Geogr. 2014;45(4):521\\u0026ndash;40.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eO'Brien K, Agostino J, Ciszek K, Douglas KA. Physical activity and risk of behavioural and mental health disorders in kindergarten children: analysis of a series of cross-sectional complete enumeration (census) surveys. BMJ Open. 2020;10(3):e034847.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAustralian Early Development Census. Hidden vulnerabilities in communities. [Internet]. Commonwealth of Australia. 2020 [cited 2021 Sep 7]. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.aedc.gov.au/Websilk/Handlers/ResourceDocument.ashx?id=f0312964-db9a-6d2b-9fad-ff0000a141dd\\u003c/span\\u003e\\u003cspan address=\\\"https://www.aedc.gov.au/Websilk/Handlers/ResourceDocument.ashx?id=f0312964-db9a-6d2b-9fad-ff0000a141dd\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRocha V, Soares S, Stringhini S, Fraga S. Socioeconomic circumstances and respiratory function from childhood to early adulthood: a systematic review and meta-analysis. BMJ Open. 2019;9(6):e027528.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCollier LR, Gregory T, Harman-Smith Y, et al. Inequalities in child development at school entry: A repeated cross-sectional analysis of the Australian Early Development Census 2009\\u0026ndash;2018. Lancet Reg Health - Western Pac. 2020;4:100057.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMoore GF, Anthony RE, Hawkins J, et al. Socioeconomic status, mental wellbeing and transition to secondary school: Analysis of the School Health Research Network/Health Behaviour in School-aged Children survey in Wales. Br Educ Res J. 2020;46:1111\\u0026ndash;30.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eUssher MH, Owen CG, Cook DG, Whincup PH. The relationship between physical activity, sedentary behaviour and psychological wellbeing among adolescents. Soc Psychiatry Psychiatr Epidemiol. 2007;42(10):851\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Child health, Child wellbeing, Developmental disabilities, Indigenous peoples, Minority health, Obesity, Overweight, Paediatric obesity, Sedentary behaviour, Screen time, Social determinants of health, vulnerable populations.\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3871587/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3871587/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eAustralian First Nations children have poorer outcomes across a range of health measures. High levels of screen time are associated with a range of adverse health outcomes. Relatively little is known on the association between screen time and health outcomes for different demographic groups, including First Nations children. We aimed to describe the screen time behaviours of First Nations and non-Indigenous kindergarten children in the Australian Capital Territory (ACT), identify disparities in key health outcomes, and explore whether screen time was a risk factor for these outcomes.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003e5,516 children participated in the cross-sectional population-based ACT Kindergarten Health Check (KHC) survey, including 146 First Nations children. The association between screen time of more than two hours per day and health outcomes (body mass index, respiratory health, development and wellbeing) was assessed for both First Nations and non-Indigenous cohorts using comparative statistics.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eNon-Indigenous children who had an average of more than two hours of screen time per day were 1.5 (95% CI, 1.3\\u0026ndash;1.7) times more likely to be overweight/obese, 1.2 (95% CI, 1.0-1.4) times more likely to have had a wheeze/whistle in their chest in the 12 months before the KHC, 1.5 (95% CI, 1.3\\u0026ndash;1.7) times more likely to have developmental concerns and 1.5 (95% CI, 1.3\\u0026ndash;1.8) times more likely to have reduced wellbeing measures compared to non-Indigenous children with screen time of two hours or less per day. None of these associations were statistically significant amongst First Nations children.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eScreen time more than two hours per day is associated adverse health outcomes in non-Indigenous children, including overweight/obesity, respiratory problems, developmental concerns, and reduced wellbeing. Further analysis is required to enable a more robust assessment of the effect of screen time on health outcomes for First Nations children.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Screen time as a health determinant for kindergarten children in the Australian Capital Territory (including a comparison of First Nations and non-Indigenous children): analysis of a cross-sectional complete enumeration survey\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-02-01 15:54:02\",\"doi\":\"10.21203/rs.3.rs-3871587/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision 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