Gender-specific effects of exposure to maternal prenatal smoking on gross motor skills and movement behaviors in 3-5 year-old children: findings from the 2012 National Youth Fitness Survey

Gender-specific effects of exposure to maternal prenatal smoking on gross motor skills and movement behaviors in 3-5 year-old children: findings from the 2012 National Youth Fitness 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 Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gender-specific effects of exposure to maternal prenatal smoking on gross motor skills and movement behaviors in 3-5 year-old children: findings from the 2012 National Youth Fitness Survey Andrew Zhou, Zhengyuan Qiu, Chiyuan Amy Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4283363/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Dec, 2024 Read the published version in Discover Public Health → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Smoking during pregnancy has been associated with various health and behavioral problems in offspring throughout their lifespan. In addition, studies have shown that these health and behavioral problems following maternal prenatal smoking exposure (MPSE) are likely gender-dependent, i.e. the outcomes are divergent between male and female offspring. However, studies on whether MPSE affects gross motor skills in 3-5 year-old children in a gender-specific manner are lacking. The first aim of this project is to examine the effects of MPSE on gross motor skills in 3-5 year-old boys and girls. The second aim is to identify factors that are associated with gross motor skills in children with MPSE. Methods: The data used in this project are from the 2012 National Youth Fitness Survey (NNYFS) conducted by the Centers for Disease and Prevention National Center for Health Statistics (NCHS). Out of the 368 children aged 3-5 surveyed by NCHS, 329 had locomotor skills standard score (LSSS), object control skills standard score (OCSSS), and gross motor quotient (GMQ) along with demographic data, body measurement data early childhood questionnaire data movement behavior questionnaire data and were selected for this study. Results: Boys with MPSE had significantly lower LSSS, OCSSS, and GMQ compared to those without MPSE, while no significant differences in LSSS, OCSSSS, and GMQ for girls were detected, indicating a gender-specific effect of MPSE on GMQ in 3-5 year-old children. MPSE was associated with low ratio of family income to poverty (RFIP) in girls but not in boys, suggesting a gender-specific inverse relationship of MPSE with parity. MPSE was associated with having no physical activity outside of school for the past 7 days in boys but not in girls, watching TV for >2 hours in the past 30 days and having 2 or fewer days with physical activity at least 60 min in the past 7 days in girls but not in boys, suggest that MPSE is associated with movement behaviors that confer less physical activity in boys and more sedentary state in girls. Conclusion: MPSE negatively impacts gross motor skills in 3-5 year-old boys. maternal prenatal smoking exposure gross motor skills gender-specific movement behaviors parity NNYFS Figures Figure 1 Background Smoking during pregnancy has been associated with various health and behavioral problems in offspring, from low birth weight and high irritability in infants 1–3 , increased obesity and attention-deficit/hyperactivity disorder and delayed puberty in adolescence 4–6 , to increased risk of tobacco smoking/dependence and susceptibility to metabolic diseases in adulthood 7,8 . In addition, studies have shown that these health and behavioral problems following maternal prenatal smoking exposure (MPSE) are likely gender-dependent, i.e. the outcomes are divergent between male and female offsprings 9,10 . For example, multiple investigations demonstrated a greater reduction in lung function in boys with MPSE compared to girls aged from 6 to 13 years old 10 , while adolescent women whose mothers smoked during pregnancy display more pronounced deficits in visual and auditory attention than male counterparts 9 . However, findings on the gender-specific effects of MPSE in children aged 3–5 years old are inconsistent. For instance, some studies have demonstrated that boys with MPSE are more vulnerable to the development of conduct problems while others have found no gender differences 9 . More investigations are certainly needed to determine whether MPSE differentially affects the health and behavior of 3–5 year-old children. The age range of 3–5 years is considered as a critical period in developing and learning gross motor skills involving the large muscles of the body that enable major body movements including locomotor skills such as walking, running, and jumping and object control skills such as throwing, striking, and catching 11 . It is important to understand the factors that influence motor skill competence because adequate motor skills have been shown to be critical for cardiovascular fitness, healthy weight status, language development and academic performance in children 12–14 . In 2012, the National Youth Fitness Survey (NNYFS) was conducted on a representative sample of US children aged 3–15 years 15 . The survey provided the first nationally representative data on locomotor and object control skills among 3–5 year-old children together with demographic, health, physical activity, and nutrition information about the child, providing a unique opportunity to investigate factors that influence motor skill competence including the gender-specific effects of MPES on gross motor skills and movement behaviors in these children. Using the NNYFS data, Kit et al. reported that gross motor development among 3–5 year-old children generally did not differ by demographic or weight status 16 . In addition, neither the percentage of body fat nor sum of skinfolds was associated with gross motor skills 17 . Furthermore, neither lean muscle mass nor fat mass was related with any motor skill measure 17 . However, Kwon et al. found that 3–5 year-old children living below the poverty threshold were more likely to have a higher gross motor quotient (GMQ) determined using the Test of Gross Motor Development-Second Edition (TGMD-2) 18 , indicating an inverse association between family income and gross motor development in NNYFS participants. In addition, children engaging in gross motor-related physical activity or living with other child(ren) ≤ 5 years old had significantly higher GMQ 18 . Moreover, girls were more likely to have a higher locomotor score than boys, indicating a gender difference in locomotor skills in 3–5 year-old children 18 . In a more recent meta-analysis using data from 39 studies in children aged 3–6 years, Zheng et al. showed that boys had significantly higher proficiency in gross motor skills and object control skills than girls, while gender differences in locomotor skill proficiency approached significance, trending in favor of girls 19 . These studies revealed gender differences in gross motor skills including locomotor and object control skills in 3–5 year-old children. Studies on whether MPSE affects gross motor skills in 3–5 year-old children in a gender-specific manner are lacking. The first aim of this project is to examine the effects of MPSE on gross motor skills in 3–5 year-old boys and girls. The second aim is to identify factors that are associated with gross motor skills in children with MPSE. Methods Data collection: The data used in this project are from the 2012 NNYFS conducted by the Centers for Disease and Prevention National Center for Health Statistics (NCHS) and publicly available at https://wwwn.cdc.gov/nchs/nhanes/search/nnyfs12.aspx. Detailed survey design and methods including sampling strategy and measurement procedures are described elsewhere 15,20 . Out of the 368 children aged 3-5 surveyed by NCHS, 329 had locomotor skills standard score, object control skills standard score, and gross motor quotient available and were selected for this study. Three types of data were used in this study: 1. Demographics data included age, gender, race, the ratio of family income to poverty (RFIP), and the number of children 5 years or younger in household; 2. Questionnaire data included early childhood variables (mother smoked when pregnant (MPSE) and weight at birth (WAB)) and movement behavior variables (days physically active at least 60 mins for the past 7 days, days with physical activities outside of school for the past 7 days, hours watching TV or videos during the past 30 days); 3. Examination data included body mass index (BMI), locomotor skills standard score (LSSS), object control skills standard score (OCSSS), and gross motor quotient (GMQ) which is calculated using LSSS and OCSSS. In addition, individual scores for tests assessing different aspects of locomotor skills, i.e. run, gallop, hop, leap, horizontal jump, slide, and object control skills, i.e. striking a stationary ball, stationary dribble, kick, catch, overhand throw, and underhand roll, were also evaluated in these 329 children. All data were compiled into a single file available at https://docs.google.com/spreadsheets/d/11N54nUwBjtyVv3W07bOy1g3pHZzoFbh-/edit?usp=sharing&ouid=109765623934484658518&rtpof=true&sd=true Statistical analysis: All statistical analyses were performed using GraphPad Prism version 9.0.0 (GraphPad Software, San Diego, California USA, www.graphpad.com). For all analyses, the alpha value was set for 0.05 as statistically significant. For continuous variables including LSSS, OCSSS, GMQ, BMI, RFIP, and WAB, data were first stratified by gender and then by MPSE status. Data distribution and equality of variance of each group were then determined using Shapiro-Wilk normality test (SW test) and F-test, respectively. For data that are normally distributed with equal variance, two-sample t-test was performed to determine whether there is a significant difference in these variables between boys and girls. For data that are normally distributed but with unequal variance, Welch’s t-test was performed. For data that are not normally distributed, Mann-Whitney U test was incorporated to assess any significant between-groups differences. For categorical variables such as race, more than 2 days physically active at least 60 mins for the past 7 days, any physical activities outside of school for the past 7 days, and watching TV or videos for more than 2 hours during the past 30 days, data were stratified by MPSE into two groups for each gender and a contingency table was then constructed. Considering the sample sizes of some groups are small, two-sided Fisher’s exact test was performed to determine whether there is a significant association between either of these categorical variables with MPSE. For each gross motor skill tested, specific performance criteria in TGMD-2 procedures manual (https://www.cdc.gov/nchs/data/nnyfs/tgmd.pdf) were evaluated with two separate trials. The number of trials, i.e. 0, 1 or 2, that a child performed correctly based on the criteria was recorded. Finally, a multiple linear regression analysis was performed to determine the relationship between GMQ as a dependent variable and all other continuous variables except LSSS and OCSSS and categorical variables as independent variables. Specifically, analysis of variance (ANOVA) is used to determine the overall significance of the regression model, as well as the significance of each independent variable included in the model. Results MPSE is associated with low LSSS, OCSSS and GMQ in boys but not in girls Statistical tests based on data normality and equality of variance were chosen to compare the means of two groups as described in the methods section (Table 3 ). Boys exposed to maternal prenatal smoking had significant lower LSSS, OCSSSS, and GMQ compared to those without MPSE, while no significant differences in LSSS, OCSSSS, and GMQ for girls with or without MPSE were detected (Fig. 1 ), indicating a gender-specific effect of MPSE on GMQ in 3–5 year-old children. For other variables tested, MPSE only associated with low RFIP in girls (Table 3 and Fig. 1 ), suggesting a gender-specific inverse relationship of MPSE with parity. Table 1 Descriptive statistics, distribution and variance tests for LOSSS, OCSSS and GMQ Gender Boys (n = 166) Girls (n = 163) MPSE Status Yes (n = 17) No (n = 149) Yes (n = 17) No (n = 146) LSSS Mean (95% CI) 8.0 (6.2–9.3) 9.7 (9.3–10.3) 11.0 (10.1–11.9) 10.4 (9.9–10.9) Range (min-max) 11 ( 2 – 13 ) 18 ( 2 – 20 ) 8 ( 7 – 15 ) 17 ( 3 – 20 ) SD 3.0 3.3 1.8 3.2 SEM 0.7 0.3 0.4 0.3 SW Test p = 0.74 p = 0.03 p = 0.04 p = 0.17 F-test p = 0.69 p = 0.013 OCSSS Mean (95% CI) 7.1 (5.8–8.5) 8.8 (8.3–9.2) 8.5 (7.6–9.5) 8.6 (8.2-9.0) Range (min-max) 10 ( 2 – 12 ) 14 ( 1 – 15 ) 7 ( 5 – 12 ) 12 ( 3 – 15 ) SD 2.6 2.6 1.8 2.3 SEM 0.6 0.2 0.5 0.2 SW Test p = 0.84 p = 0.06 p = 0.73 p = 0.004 F-test p = 0.90 p = 0.36 GMQ Mean (95% CI) 84.6 (76.8–92.5) 95.5 (93.0-97.8) 98.2 (93.6-102.9) 96.9 (94.6–99.2) Range (min-max) 51 (61–112) 87 (49–136) 36 (85–121) 84 (61–145) SD 15.3 15.0 9.1 14.2 SEM 3.7 1.2 2.2 1.2 SW Test p = 0.77 p = 0.49 p = 0.46 p = 0.14 F-test p = 0.82 p = 0.04 Table 2 Descriptive statistics, distribution and variance tests for RFIP, WAB and BMI Gender Boys Girls RFIP MPSE Status Yes (n = 17) No (n = 139) Yes (n = 17) No (n = 129) Mean (95% CI) 1.34 (0.81–1.86) 2.05 (1.78–2.32) 0.85 (0.62–1.07) 2.19 (1.92–2.45) Range (min-max) 3.30 (0.00-3.30) 5.00 (0.00–5.00) 1.39 (0.43–1.82) 5.00 (0.00–5.00) SD 1.02 1.60 0.44 1.53 SEM 0.25 0.14 0.11 0.13 SW Test p = 0.22 p < 0.0001 p = 0.0047 p < 0.0001 F-test p = 0.13 p < 0.0001 WAB (oz) MPSE Status Yes (n = 17) No (n = 147) Yes (n = 16) No (n = 144) Mean (95% CI) 119 (106–133) 122 (119–125) 113 (104–121) 113 (109–116) Range (min-max) 103 (66–169) 134 (34–168) 59 (83–142) 140 (26–166) SD 26 20 16 21 SEM 6 2 4 2 SW Test p = 0.95 P = 0.0001 p = 0.99 p < 0.0001 F-test p = 0.11 p = 0.22 BMI MPSE Status Yes (n = 17) No (n = 149) Yes (n = 17) No (n = 146) Mean (95% CI) 16.7 (15.6–17.9) 16.6 (16.3–16.9) 16.9 (15.7–18.1) 16.2 (15.8–16.5) Range (min-max) 8.0 (13.6–21.6) 11.8 (13.4–25.2) 8.1 (13.7–21.8) 12.2 (11.9–24.1) SD 2.2 1.9 2.4 2.0 SEM 0.5 0.2 0.6 0.2 SW Test p = 0.090 p < 0.0001 p = 0.27 p < 0.0001 F-test p = 0.37 p = 0.29 Table 3 Detection of significant differences between means for LSSS, OCSSS, GMQ, RFIP, WAB, and BMI Variable Gender Test P Variable Gender Test P LSSS Boys Mann-Whitney U 0.022 RFIP Boys Mann-Whitney U 0.13 Girls Mann-Whitney U 0.29 Girls Mann-Whitney U 0.0002 OCSSS Boys Two sample t 0.015 WAB Boys Mann-Whitney U 0.49 Girls Mann-Whitney U 0.90 Girls Mann-Whitney U 0.82 GMQ Boys Two sample t 0.0054 BMI Boys Mann-Whitney U 0.71 Girls Welch's t 0.60 Girls Mann-Whitney U 0.18 Multiple gross motor skills were negatively affected by MPSE in boys but not in girls To determine the specific motor skills differentially affected by MPSE in boys and girls, we evaluated the distribution of test scores for 48 individual criteria measured in NNFYS, including run (4 criteria), gallop (4 criteria), hop (5 criteria), leap (3 criteria), horizontal jump (4 criteria) and slide (4 criteria) for locomotor skills and striking a stationary ball (5 criteria), stationary dribble (4 criteria), kick (4 criteria), catch (3 criteria), overhand throw (4 criteria), and underhand roll (4 criteria) for object control skills. Out of these criteria, 8 showed statistically significant lower frequencies of low scores in boys with MPSE compared to those without MPSE determined by Fisher’s exact test or chi-square test (Table 4 ). These criteria measure skills in hop, jump, leap, stationary dribble, catch, and underhand roll, suggesting that MPSE negatively affects different aspects of gross motor skills in boys. In contrast, the distribution of scores that correspond to these criteria were not statistically different in girls with MPSE compared with those without MPSE, suggesting that MPSE influences these individual motor skills in a gender-dependent manner. Table 4 Individual gross motor skills differentially affected by MPSE in boys and girls Gender Boys Girls MPSE Status Yes (n = 17) No (n = 149) Yes (n = 17) No (n = 146) Hop: Arms flexed and swing forward to produce force 0 or 1 correct trial 16 92 7 85 2 correct trials 1 57 10 61 Statistical test Two-sided Fisher Chi-square P value 0.0066 0.18 Hop: Takes off and lands 3 consecutive times on preferred foot 0 or 1 correct trial 13 62 5 54 2 correct trials 4 87 12 92 Statistical test Two-sided Fisher Two-sided Fisher P value 0.0089 0.60 Leap: for a period where both feet are off the ground longer than running 0 or 1 correct trial 10 48 5 55 2 correct trials 7 101 12 91 Statistical test Chi-square/Fisher Two-sided Fisher P value 0.029/0.057 > 0.99 Horizontal jump: Takes off and lands on both feet simultaneously 0 or 1 correct trial 12 52 4 36 2 correct trials 5 97 13 110 Statistical test Two-sided Fisher Two-sided Fisher P value 0.0071 > 0.99 Stationary dribble: Ball contacts surface in front of or to the outside of foot on the preferred side 0 or 1 correct trial 15 87 15 105 2 correct trials 2 62 2 41 Statistical test Two-sided Fisher Two-sided Fisher P value 0.018 0.24 Catch: Arms extend while reaching for the ball as it arrives 0 or 1 correct trial 14 77 11 91 2 correct trials 3 72 6 55 Statistical test Two-sided Fisher Chi-square P value 0.020 0.85 Catch: Ball is caught by hands only 0 or 1 correct trial 17 113 13 89 2 correct trials 0 36 4 39 Statistical test Two-sided Fisher Two-sided Fisher P value 0.022 0.78 Underhand roll: Bend knees to lower body 0 or 1 correct trial 10 47 8 50 2 correct trials 7 102 9 96 Statistical test Chi-square Chi-square P value 0.025 0.30 MPSE is differentially associated with movement behaviors in boys and girls To determine the association between MPSE and movement behaviors, contingency tables were constructed for days physically active at least 60 min in the past 7 days, hours watching TV or videos in the past 30 days, and days with any physical activity outside of school in the past 7 days (Table 5 ). MPSE was significantly associated with having no physical activity outside of school in boys but not in girls. In addition, MPSE was significantly associated with watching TV for more than 2 hours in the past 30 days and having 2 or fewer days with physical activity at least 60 min in the past 7 days in girls but not in boys (Table 5 ). These observations suggest that MPSE is associated with movement behaviors that confer less physical activity in boys and a more sedentary state in girls. Table 5 Determination of association between MPSE and movement behavior and race Days physically active at least 60 min Boys Girls MPSE Status Yes (n = 17) No (n = 149) Yes (n = 17) No (n = 146) 2days 17 139 13 137 Statistical test Two-sided Fisher Two-sided Fisher P value 0.61 0.033 Hours watch TV or videos past 30 days 2 hour 4 30 9 35 Statistical test Two-sided Fisher Chi-square P value 0.75 0.019 Any physical activities past 7 days Yes 10 126 12 125 No 7 22 5 21 Statistical test Chi-square Chi-square P value 0.014 0.15 Race/Hispanic origin Yes (n = 16) No (n = 139) Yes (n = 17) No (n = 128) non-Hispanic 15 90 13 89 Hispanic 1 49 4 39 Statistical test Two-sided Fisher Two-sided Fisher P value 0.022 0.78 MPSE is significantly associated with GMQ independent of other variables Our multiple linear regression on MPSE and GMQ models included age, race, BMI, RFIP, number of sibling(s) younger than 5 years old, and whether having any physical activities outside of school in the past 7 days. We chose these variables because either they are significantly associated with MPSE in boys based on our analyses above (race and any physical activities outside of school in the past 7 days) or they have been shown to significantly associated with gross motor skills in this cohort of children in a previous study by Kwon et al. (RFIP, number of sibling(s) younger than 5 years old) 18 or other pre-school cohorts in previous studies (age, BMI) 21,22 . The analysis revealed that both MPSE (β = -13.2, p = 0.0013) and RFIP (β = -1.965, p = 0.0306) were significant predictors of GMQ independent of other variables (Table 6 ), and the model has p-value of 0.037 accounting for 10% (R 2 = 0.10) of the variance in GMQ. Table 6 Multiple linear regression analysis of selected independent variables and GMQ Variable β SE 95% CI |t| P value Summary Intercept 97.6 15.1 67.8 to 127.4 6.5 < 0.0001 Rows in table 166 Physical activity 4.3 5.2 -5.9 to 14.5 0.8 0.41 Missing data (skipped) 11 Race -1.8 3.0 -7.8 to 4.1 0.6 0.54 Rows analyzed 155 Age -1.6 1.5 -4.6 to 1.4 1.0 0.3 Parameter Estimates 8 RFIP -2.0 0.9 -3.7 to -0.2 2.2 0.031 Degrees of freedom 147 BMI 0.4 0.7 -0.9 to 1.7 0.6 0.55 Regression P value 0.037 Sibling(s) -1.2 2.6 -6.2 to 3.9 0.5 0.65 R squared 0.10 MPSE -13.2 4.0 -21.1 to -5.3 3.3 0.0013 Adjusted R squared 0.05 Discussion Deficits in motor control have been reported in children with maternal prenatal exposure to smoking for more than two decades. For example, smoking in pregnancy was associated with a small, but demonstrable adverse effect on the child's balance at 5 years using the Peabody Developmental Motor Scales (PDMS) test in a cohort of 362 Scandinavian children 23 . In addition, prenatal tobacco exposure predicted significantly slower performance on the Grooved Pegboard task, a measure of eye-hand coordination, in 10-year-olds 24 and worse visual-motor coordination in 16-year-old adolescents in a computerized bimanual coordination test 25 . Moreover, heavy smoking during pregnancy was statistically significantly associated with poor coordination performance in 11-year-olds, particularly among boys 26 , suggesting a gender difference of maternal smoking on motor performance. Our study is the first to demonstrate the gender-specific effects of MPSE on gross motor development in 3–5 year-old children. MPSE is an independent predictor of low GMQ in boys when other confounders are adjusted, underscoring the importance of MPSE on the gross motor development of preschool-aged boys. A previous study showed that prenatal second-hand smoke exposure reduced gross motor development at 18 months of age in both boys and girls 27 , suggesting the gender-specific effects of MPSE may take 3–5 years to manifest. Mechanistically, prenatal smoke exposure may elicit adverse effects on children by altering offspring’s epigenetic and genetic profiles such as DNA methylation and telomere length 28–30 , resulting in weak muscle tone and reduced cardiovascular and lung functions as well as impaired neurodevelopment such as smaller brain volume 2,31–35 . The extent of alterations has been shown to be gender-dependent in some cases. For instance, prenatal second-hand smoke exposure was associated with shorter telomere length in boys than in girls 30 , indicating that similar molecular mechanisms may underlie the gender-specific effects of MPSE on GMQ observed in this study. Although there is robust evidence for DNA methylation alterations associated with maternal smoking during pregnancy, there are no conclusive studies about the effects of exposure to low doses of maternal smoking or smoking during the preconception period on DNA methylation 36 . In addition, studies using tissues other than the placenta and blood are scarce 36 . Moreover, further investigations are needed to better understand the biological consequences of DNA methylation and telomere length changes and how they affect motor development in children. Since the prevalence of maternal tobacco smoking during pregnancy is estimated to be 8% 37 and approximately 360,000-500,000 smoke-exposed infants are born yearly 38 , it is important to educate parents on the consequences of smoking during pregnancy and offer help to women to quit smoking before pregnancy or when pregnancy is known. A population-based study of 113 6–8 year-old children with MPSE and 113 age and gender-matched controls without MPSE found that brain development in offspring of mothers who quit smoking when pregnancy was known resembled that of nonexposed controls (no smaller brain volumes and no thinning of the cortex) 39 , suggesting that quit smoking will help protect brain development of offspring, which in turn, will potentially prevent reduced motor skill development and behavioral and emotional problems. The US Preventive Services Task Force has recommended that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco 40 . The results of this study provide further rationale to support this recommendation. The amount of variance in GMQ explained by the multiple linear regression model combining potential predictors including MSPE is low but significant and comparable with results from previous studies on the effects of smoking exposure on motor development. For instance, the R 2 for multivariant analysis between associations of fine and gross motor skill test scores with age, gender, BMI, blood lead, and magnesium levels as well as serum cotinine level that reflect recent exposure to nicotine in tobacco smoke ranges from 0.08 to 0.25 41 . The low R 2 in our study is partly due to the small sample size of MPSE children which can be attributed to the inherited limitations of questionnaire-based investigation, i.e. underreporting of smoking by mothers. The small sample size may also reduce the ability to detect small effects of MPSE on the health and behaviors of children 3–5 year-old. For example, lower birth weight associated with MPSE reported in other studies was not detected in this cohort. Another contributing factor to the low amount of variance explained by the potential predicting factors of GMQ is that the development of gross motor skills in children is a complex process that is affected by a variety of factors such as child’s sleeping time and position 42,43 , exposure to formal aquatic activities 44 , and maternal moderate-to-vigorous intensity physical activity during pregnancy 45 . Moreover, MPSE-associated factors such as duration of breastfeeding may also contribute to differential gross motor skills in children with or without MPSE 46 . Information on these factors is not available in the NNYES survey, making it impossible to take them into account for modeling. Further studies using biomarkers such as urine cotinine 27 may be helpful to accurately assess the prevalence of MPSE exposure and its effects on the health and development of preschool children including gross motor development. In addition, large-scale studies including as many factors that may affect gross motor development as possible will help to build robust predictive models for preschool children. Conclusions Smoking during pregnancy negatively impacts the gross motor skills of 3–5 year-old boys but not girls. It is also associated with movement behaviors that confer less physical activity in boys and a more sedentary state in girls. More efforts in educating parents on the consequences of smoking during pregnancy and helping women to quit smoking before and during pregnancy are needed to ensure the well-being of preschool-aged children, especially boys. Abbreviations ANOVA: Analysis of variance BMI: Body mass index GMQ: Gross motor quotient LSSS: Locomotor skills standard score MPSE: Maternal prenatal smoking exposure OCSSS: Object control skills standard score NCHS: National Center for Health Statistics NHANES: National Health and Examination Survey NNYFS: National Youth Fitness Survey RFIP: Ratio of family income to poverty SW: Shapiro-Wilk TGMD-2: Test of Gross Motor Development-Second Edition WAB: Weight at birth Declarations Ethical Approval and consent to participate No ethics approval and consent to participate is required for this study. Consent for Publication Not applicable Data Availability statement Raw data were downloaded from https://wwwn.cdc.gov/nchs/nhanes/search/nnyfs12.aspx. Compiled data file is available at https://docs.google.com/spreadsheets/d/11N54nUwBjtyVv3W07bOy1g3pHZzoFbh-/edit?usp=sharing&ouid=109765623934484658518&rtpof=true&sd=true Conflict of interest There are no competing interests from authors. Funding All authors are funded by the Department of Urology at Stanford University. Acknowledgment We thank Mr. Josh Kuo for helpful discussions on various topics related to this study. Author contribution A.Z and C.A.Z designed the study and developed the overall research plan. A.Z. and Z.Q collected the data and performed the statistical analyses. A.Z drafted the manuscript. Z.Q and C.A.Z revised the manuscript. References Dessì, A., Corona, L., Pintus, R. & Fanos, V. Exposure to tobacco smoke and low birth weight: from epidemiology to metabolomics. Expert Rev Proteomics 15 , 647-656 (2018). Froggatt, S., Covey, J. & Reissland, N. Infant neurobehavioural consequences of prenatal cigarette exposure: A systematic review and meta-analysis. Acta Paediatr 109 , 1112-1124 (2020). Pereira, P.P., Da Mata, F.A., Figueiredo, A.C., de Andrade, K.R. & Pereira, M.G. Maternal Active Smoking During Pregnancy and Low Birth Weight in the Americas: A Systematic Review and Meta-analysis. 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Int J Environ Res Public Health 15 (2018). Johnson, C.L. et al. National Health and Nutrition Examination Survey: National Youth Fitness Survey Estimation Procedures, 2012. Vital Health Stat 2 , 1-25 (2014). Kit, B.K., Akinbami, L.J., Isfahani, N.S. & Ulrich, D.A. Gross Motor Development in Children Aged 3-5 Years, United States 2012. Matern Child Health J 21 , 1573-1580 (2017). Wood, A.P., McMillan, A.G., Imai, S., Swift, D. & DuBose, K.D. Associations of Percent Body Fat and Motor Skill Development in Preschool-Aged Children: National Youth Fitness Survey. Child Obes 18 , 50-55 (2022). Kwon, S. & O'Neill, M. Socioeconomic and Familial Factors Associated with Gross Motor Skills among US Children Aged 3-5 Years: The 2012 NHANES National Youth Fitness Survey. Int J Environ Res Public Health 17 (2020). Zheng, Y., Ye, W., Korivi, M., Liu, Y. & Hong, F. Gender Differences in Fundamental Motor Skills Proficiency in Children Aged 3-6 Years: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 19 (2022). Borrud, L. et al. National Health and Nutrition Examination Survey: national youth fitness survey plan, operations, and analysis, 2012. Vital Health Stat 2 , 1-24 (2014). Duncan, M.J., Hall, C., Eyre, E., Barnett, L.M. & James, R.S. Pre-schoolers fundamental movement skills predict BMI, physical activity, and sedentary behavior: A longitudinal study. Scand J Med Sci Sports 31 Suppl 1 , 8-14 (2021). Ma, F.F. & Luo, D.M. Relationships between physical activity, fundamental motor skills, and body mass index in preschool children. Front Public Health 11 , 1094168 (2023). Trasti, N., Vik, T., Jacobsen, G. & Bakketeig, L.S. Smoking in pregnancy and children's mental and motor development at age 1 and 5 years. Early Hum Dev 55 , 137-47 (1999). Cornelius, M.D., Ryan, C.M., Day, N.L., Goldschmidt, L. & Willford, J.A. Prenatal tobacco effects on neuropsychological outcomes among preadolescents. J Dev Behav Pediatr 22 , 217-25 (2001). Willford, J.A., Chandler, L.S., Goldschmidt, L. & Day, N.L. Effects of prenatal tobacco, alcohol and marijuana exposure on processing speed, visual-motor coordination, and interhemispheric transfer. Neurotoxicol Teratol 32 , 580-8 (2010). Larsson, M. & Montgomery, S.M. Maternal smoking during pregnancy and physical control and coordination among offspring. J Epidemiol Community Health 65 , 1151-8 (2011). Evlampidou, I. et al. Prenatal Second-Hand Smoke Exposure Measured with Urine Cotinine May Reduce Gross Motor Development at 18 Months of Age. J Pediatr 167 , 246-52.e2 (2015). Braun, M., Klingelhöfer, D., Oremek, G.M., Quarcoo, D. & Groneberg, D.A. Influence of Second-Hand Smoke and Prenatal Tobacco Smoke Exposure on Biomarkers, Genetics and Physiological Processes in Children-An Overview in Research Insights of the Last Few Years. Int J Environ Res Public Health 17 (2020). Nakamura, A., François, O. & Lepeule, J. Epigenetic Alterations of Maternal Tobacco Smoking during Pregnancy: A Narrative Review. Int J Environ Res Public Health 18 (2021). Liu, B. et al. Prenatal second-hand smoke exposure and newborn telomere length. Pediatr Res 87 , 1081-1085 (2020). Nordenstam, F. Prenatal nicotine exposure was associated with long-term impact on the cardiovascular system and regulation—Review. Acta Paediatrica 110 , 2536-2544 (2021). Kuniyoshi, K.M. & Rehan, V.K. The impact of perinatal nicotine exposure on fetal lung development and subsequent respiratory morbidity. Birth Defects Res 111 , 1270-1283 (2019). Wehby, G.L., Prater, K., McCarthy, A.M., Castilla, E.E. & Murray, J.C. The Impact of Maternal Smoking during Pregnancy on Early Child Neurodevelopment. J Hum Cap 5 , 207-254 (2011). Chen, D. et al. The correlation between prenatal maternal active smoking and neurodevelopmental disorders in children: a systematic review and meta-analysis. BMC Public Health 23 , 611 (2023). Ekblad, M.O. et al. Maternal smoking during pregnancy negatively affects brain volumes proportional to intracranial volume in adolescents born very preterm. Frontiers in Human Neuroscience 16 (2023). Cosin-Tomas, M., Cilleros-Portet, A., Aguilar-Lacasaña, S., Fernandez-Jimenez, N. & Bustamante, M. Prenatal Maternal Smoke, DNA Methylation, and Multi-omics of Tissues and Child Health. Curr Environ Health Rep 9 , 502-512 (2022). Lange, S., Probst, C., Rehm, J. & Popova, S. National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis. The Lancet Global Health 6 , e769-e776 (2018). Scherman, A., Tolosa, J.E. & McEvoy, C. Smoking cessation in pregnancy: a continuing challenge in the United States. Ther Adv Drug Saf 9 , 457-474 (2018). El Marroun, H. et al. Prenatal Tobacco Exposure and Brain Morphology: A Prospective Study in Young Children. Neuropsychopharmacology 39 , 792-800 (2014). Force, U.P.S.T. Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement. JAMA 325 , 265-279 (2021). Yeramaneni, S. et al. Secondhand Tobacco Smoke Exposure and Neuromotor Function in Rural Children. J Pediatr 167 , 253-9.e1 (2015). Boonzaaijer, M. et al. Factors associated with gross motor development from birth to independent walking: A systematic review of longitudinal research. Child Care Health Dev 47 , 525-561 (2021). Kuzik, N., Naylor, P.J., Spence, J.C. & Carson, V. Movement behaviours and physical, cognitive, and social-emotional development in preschool-aged children: Cross-sectional associations using compositional analyses. PLoS One 15 , e0237945 (2020). Santos, C., Burnay, C., Button, C. & Cordovil, R. Effects of Exposure to Formal Aquatic Activities on Babies Younger Than 36 Months: A Systematic Review. Int J Environ Res Public Health 20 (2023). Jones, M.A. et al. Maternal Sedentary Behavior and Physical Activity across Pregnancy and Early Childhood Motor Development. Children 8 , 549 (2021). Moore, B.F. et al. Prenatal Exposure to Tobacco and Offspring Neurocognitive Development in the Healthy Start Study. J Pediatr 218 , 28-34.e2 (2020). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies 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-4283363","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":299561777,"identity":"1a7d61f1-e5d9-4ade-baf5-eb18081d33c3","order_by":0,"name":"Andrew Zhou","email":"","orcid":"","institution":"Stanford University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Zhou","suffix":""},{"id":299561779,"identity":"ae449bb3-1cb2-4756-be67-f448f25293e9","order_by":1,"name":"Zhengyuan Qiu","email":"","orcid":"","institution":"Stanford University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhengyuan","middleName":"","lastName":"Qiu","suffix":""},{"id":299561781,"identity":"9ae3be9a-0e5d-41d1-b0de-9a0889ec186f","order_by":2,"name":"Chiyuan Amy Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYFACHhBhIwdmVzAwMDYwMBgQoyXNmIENSJ0hQcuhxAaitfD3nz34ueDXgfT585ufPThQcU+2gb15mwQ+LRIHziVLz+y7k7vhGJu5wYEzxcYNPMfK8GoxYOwxkObteZa7gY3BTPpjW0Jig0SOGX4tzDzGv3l7DqfLt7F/kzgI0iL/hoAWNh4zaZ4fhxMYjvGYQbRI8ODXInGGx8yatyHNcMOxnDKJA2cSjNt40oot8Gnh7z9jfJvnj428fPPxbRIHKhJk+9kPb7yBTwsYMLYhcdgIKgeDP8QpGwWjYBSMghEKAInZSsIHBe3jAAAAAElFTkSuQmCC","orcid":"","institution":"Stanford University School of Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Chiyuan","middleName":"Amy","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-04-17 17:18:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4283363/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4283363/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-024-00337-0","type":"published","date":"2024-12-11T15:57:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":56477816,"identity":"a9c57fab-cbc4-4ec3-af2f-6ff577ebe354","added_by":"auto","created_at":"2024-05-14 17:49:12","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55735,"visible":true,"origin":"","legend":"\u003cp\u003eBox-whiskers plot of LSSS, OCSSS, GMQ and RFIP in boys and girls with or without MSPE. *p\u0026lt;0.05, ** p\u0026lt;0.01, ***p\u0026lt;0.001\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4283363/v1/2a3a09b002a7ba61031d2c1b.jpg"},{"id":71552536,"identity":"ac5dfd03-238e-4d6e-b3c2-61a58028dc93","added_by":"auto","created_at":"2024-12-16 16:07:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1041982,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4283363/v1/84ede862-8507-4880-8b97-b81658ec762c.pdf"},{"id":56477815,"identity":"8a53fbd8-4dc3-4a1d-98c0-907ac5d6d682","added_by":"auto","created_at":"2024-05-14 17:49:12","extension":"xlsx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":43059,"visible":true,"origin":"","legend":"","description":"","filename":"BMCsupplementaryfile.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4283363/v1/f5b03e65d5a7754e8ba73c83.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gender-specific effects of exposure to maternal prenatal smoking on gross motor skills and movement behaviors in 3-5 year-old children: findings from the 2012 National Youth Fitness Survey","fulltext":[{"header":"Background","content":"\u003cp\u003eSmoking during pregnancy has been associated with various health and behavioral problems in offspring, from low birth weight and high irritability in infants\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e, increased obesity and attention-deficit/hyperactivity disorder and delayed puberty in adolescence\u003csup\u003e4\u0026ndash;6\u003c/sup\u003e, to increased risk of tobacco smoking/dependence and susceptibility to metabolic diseases in adulthood\u003csup\u003e7,8\u003c/sup\u003e. In addition, studies have shown that these health and behavioral problems following maternal prenatal smoking exposure (MPSE) are likely gender-dependent, i.e. the outcomes are divergent between male and female offsprings\u003csup\u003e9,10\u003c/sup\u003e. For example, multiple investigations demonstrated a greater reduction in lung function in boys with MPSE compared to girls aged from 6 to 13 years old\u003csup\u003e10\u003c/sup\u003e, while adolescent women whose mothers smoked during pregnancy display more pronounced deficits in visual and auditory attention than male counterparts\u003csup\u003e9\u003c/sup\u003e. However, findings on the gender-specific effects of MPSE in children aged 3\u0026ndash;5 years old are inconsistent. For instance, some studies have demonstrated that boys with MPSE are more vulnerable to the development of conduct problems while others have found no gender differences\u003csup\u003e9\u003c/sup\u003e. More investigations are certainly needed to determine whether MPSE differentially affects the health and behavior of 3\u0026ndash;5 year-old children.\u003c/p\u003e \u003cp\u003eThe age range of 3\u0026ndash;5 years is considered as a critical period in developing and learning gross motor skills involving the large muscles of the body that enable major body movements including locomotor skills such as walking, running, and jumping and object control skills such as throwing, striking, and catching\u003csup\u003e11\u003c/sup\u003e. It is important to understand the factors that influence motor skill competence because adequate motor skills have been shown to be critical for cardiovascular fitness, healthy weight status, language development and academic performance in children\u003csup\u003e12\u0026ndash;14\u003c/sup\u003e. In 2012, the National Youth Fitness Survey (NNYFS) was conducted on a representative sample of US children aged 3\u0026ndash;15 years\u003csup\u003e15\u003c/sup\u003e. The survey provided the first nationally representative data on locomotor and object control skills among 3\u0026ndash;5 year-old children together with demographic, health, physical activity, and nutrition information about the child, providing a unique opportunity to investigate factors that influence motor skill competence including the gender-specific effects of MPES on gross motor skills and movement behaviors in these children.\u003c/p\u003e \u003cp\u003eUsing the NNYFS data, Kit et al. reported that gross motor development among 3\u0026ndash;5 year-old children generally did not differ by demographic or weight status\u003csup\u003e16\u003c/sup\u003e. In addition, neither the percentage of body fat nor sum of skinfolds was associated with gross motor skills\u003csup\u003e17\u003c/sup\u003e. Furthermore, neither lean muscle mass nor fat mass was related with any motor skill measure\u003csup\u003e17\u003c/sup\u003e. However, Kwon et al. found that 3\u0026ndash;5 year-old children living below the poverty threshold were more likely to have a higher gross motor quotient (GMQ) determined using the Test of Gross Motor Development-Second Edition (TGMD-2)\u003csup\u003e18\u003c/sup\u003e, indicating an inverse association between family income and gross motor development in NNYFS participants. In addition, children engaging in gross motor-related physical activity or living with other child(ren)\u0026thinsp;\u0026le;\u0026thinsp;5 years old had significantly higher GMQ\u003csup\u003e18\u003c/sup\u003e. Moreover, girls were more likely to have a higher locomotor score than boys, indicating a gender difference in locomotor skills in 3\u0026ndash;5 year-old children\u003csup\u003e18\u003c/sup\u003e. In a more recent meta-analysis using data from 39 studies in children aged 3\u0026ndash;6 years, Zheng et al. showed that boys had significantly higher proficiency in gross motor skills and object control skills than girls, while gender differences in locomotor skill proficiency approached significance, trending in favor of girls\u003csup\u003e19\u003c/sup\u003e. These studies revealed gender differences in gross motor skills including locomotor and object control skills in 3\u0026ndash;5 year-old children.\u003c/p\u003e \u003cp\u003eStudies on whether MPSE affects gross motor skills in 3\u0026ndash;5 year-old children in a gender-specific manner are lacking. The first aim of this project is to examine the effects of MPSE on gross motor skills in 3\u0026ndash;5 year-old boys and girls. The second aim is to identify factors that are associated with gross motor skills in children with MPSE.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cu\u003eData collection:\u003c/u\u003e The data used in this project are from the 2012 NNYFS conducted by the Centers for Disease and Prevention National Center for Health Statistics (NCHS) and publicly available at https://wwwn.cdc.gov/nchs/nhanes/search/nnyfs12.aspx. Detailed survey design and methods including sampling strategy and measurement procedures are described elsewhere\u003csup\u003e15,20\u003c/sup\u003e. Out of the 368 children aged 3-5 surveyed by NCHS, 329 had locomotor skills standard score, object control skills standard score, and gross motor quotient available and were selected for this study. Three types of data were used in this study: 1. Demographics data included age, gender, race, the ratio of family income to poverty (RFIP), and the number of children 5 years or younger in household; 2. Questionnaire data included early childhood variables (mother smoked when pregnant (MPSE) and weight at birth (WAB)) and movement behavior variables (days physically active at least 60 mins for the past 7 days, days with physical activities outside of school for the past 7 days, hours watching TV or videos during the past 30 days); 3. Examination data included body mass index (BMI), locomotor skills standard score (LSSS), object control skills standard score (OCSSS), and gross motor quotient (GMQ) which is calculated using LSSS and OCSSS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, individual scores for tests assessing different aspects of locomotor skills, i.e. run, gallop, hop, leap, horizontal jump, slide, and object control skills, i.e. striking a stationary ball, stationary dribble, kick, catch, overhand throw, and underhand roll, were also evaluated in these 329 children. All data were compiled into a single file available at https://docs.google.com/spreadsheets/d/11N54nUwBjtyVv3W07bOy1g3pHZzoFbh-/edit?usp=sharing\u0026amp;ouid=109765623934484658518\u0026amp;rtpof=true\u0026amp;sd=true\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStatistical analysis:\u003c/u\u003e All statistical analyses were performed using GraphPad Prism version 9.0.0 (GraphPad Software, San Diego, California USA, www.graphpad.com). For all analyses, the alpha value was set for 0.05 as statistically significant.\u003c/p\u003e\n\u003cp\u003eFor continuous variables including LSSS, OCSSS, GMQ, BMI, RFIP, and WAB, data were first stratified by gender and then by MPSE status. \u0026nbsp;Data distribution and equality of variance of each group were then determined using Shapiro-Wilk normality test (SW test) and F-test, respectively. For data that are normally distributed with equal variance, two-sample t-test was performed to determine whether there is a significant difference in these variables between boys and girls. For data that are normally distributed but with unequal variance, Welch\u0026rsquo;s t-test was performed. For data that are not normally distributed, Mann-Whitney U test was incorporated to assess any significant between-groups differences. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor categorical variables such as race, more than 2 days physically active at least 60 mins for the past 7 days, any physical activities outside of school for the past 7 days, and watching TV or videos for more than 2 hours during the past 30 days, data were stratified by MPSE into two groups for each gender and a contingency table was then constructed. Considering the sample sizes of some groups are small, two-sided Fisher\u0026rsquo;s exact test was performed to determine whether there is a significant association between either of these categorical variables with MPSE. For each gross motor skill tested, specific performance criteria in TGMD-2 procedures manual (https://www.cdc.gov/nchs/data/nnyfs/tgmd.pdf) were evaluated with two separate trials. The number of trials, i.e. 0, 1 or 2, that a child performed correctly based on the criteria was recorded.\u003c/p\u003e\n\u003cp\u003eFinally, a multiple linear regression analysis was performed to determine the relationship between GMQ as a dependent variable and all other continuous variables except LSSS and OCSSS and categorical variables as independent variables. Specifically, analysis of variance (ANOVA) is used to determine the overall significance of the regression model, as well as the significance of each independent variable included in the model.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMPSE is associated with low LSSS, OCSSS and GMQ in boys but not in girls\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStatistical tests based on data normality and equality of variance were chosen to compare the means of two groups as described in the \u003cspan refid=\"Sec2\" class=\"InternalRef\"\u003emethods\u003c/span\u003e section (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Boys exposed to maternal prenatal smoking had significant lower LSSS, OCSSSS, and GMQ compared to those without MPSE, while no significant differences in LSSS, OCSSSS, and GMQ for girls with or without MPSE were detected (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), indicating a gender-specific effect of MPSE on GMQ in 3\u0026ndash;5 year-old children. For other variables tested, MPSE only associated with low RFIP in girls (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), suggesting a gender-specific inverse relationship of MPSE with parity.\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\u003eDescriptive statistics, distribution and variance tests for LOSSS, OCSSS and GMQ\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eBoys (n\u0026thinsp;=\u0026thinsp;166)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eGirls (n\u0026thinsp;=\u0026thinsp;163)\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\u003eMPSE Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;149)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eLSSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0 (6.2\u0026ndash;9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.7 (9.3\u0026ndash;10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.0 (10.1\u0026ndash;11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.4 (9.9\u0026ndash;10.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSEM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSW Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eF-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eOCSSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1 (5.8\u0026ndash;8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.8 (8.3\u0026ndash;9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.5 (7.6\u0026ndash;9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.6 (8.2-9.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSEM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSW Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eF-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eGMQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.6 (76.8\u0026ndash;92.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.5 (93.0-97.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.2 (93.6-102.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.9 (94.6\u0026ndash;99.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (61\u0026ndash;112)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87 (49\u0026ndash;136)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (85\u0026ndash;121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84 (61\u0026ndash;145)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSEM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSW Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eF-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.04\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 \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\u003eDescriptive statistics, distribution and variance tests for RFIP, WAB and BMI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eRFIP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMPSE Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;139)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;129)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.34 (0.81\u0026ndash;1.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.05 (1.78\u0026ndash;2.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85 (0.62\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.19 (1.92\u0026ndash;2.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.30 (0.00-3.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.00 (0.00\u0026ndash;5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.39 (0.43\u0026ndash;1.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.00 (0.00\u0026ndash;5.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSEM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSW Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eF-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eWAB\u003c/p\u003e \u003cp\u003e(oz)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMPSE Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;147)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;144)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (106\u0026ndash;133)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122 (119\u0026ndash;125)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e113 (104\u0026ndash;121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e113 (109\u0026ndash;116)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (66\u0026ndash;169)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (34\u0026ndash;168)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59 (83\u0026ndash;142)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e140 (26\u0026ndash;166)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSEM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSW Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eF-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMPSE Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;149)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7 (15.6\u0026ndash;17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.6 (16.3\u0026ndash;16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.9 (15.7\u0026ndash;18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.2 (15.8\u0026ndash;16.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0 (13.6\u0026ndash;21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.8 (13.4\u0026ndash;25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.1 (13.7\u0026ndash;21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.2 (11.9\u0026ndash;24.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSEM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSW Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eF-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.29\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 \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\u003eDetection of significant differences between means for LSSS, OCSSS, GMQ, RFIP, WAB, and BMI\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\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLSSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRFIP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOCSSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTwo sample t\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWAB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGMQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTwo sample t\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWelch's t\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.18\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 \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMultiple gross motor skills were negatively affected by MPSE in boys but not in girls\u003c/h2\u003e \u003cp\u003eTo determine the specific motor skills differentially affected by MPSE in boys and girls, we evaluated the distribution of test scores for 48 individual criteria measured in NNFYS, including run (4 criteria), gallop (4 criteria), hop (5 criteria), leap (3 criteria), horizontal jump (4 criteria) and slide (4 criteria) for locomotor skills and striking a stationary ball (5 criteria), stationary dribble (4 criteria), kick (4 criteria), catch (3 criteria), overhand throw (4 criteria), and underhand roll (4 criteria) for object control skills. Out of these criteria, 8 showed statistically significant lower frequencies of low scores in boys with MPSE compared to those without MPSE determined by Fisher\u0026rsquo;s exact test or chi-square test (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). These criteria measure skills in hop, jump, leap, stationary dribble, catch, and underhand roll, suggesting that MPSE negatively affects different aspects of gross motor skills in boys. In contrast, the distribution of scores that correspond to these criteria were not statistically different in girls with MPSE compared with those without MPSE, suggesting that MPSE influences these individual motor skills in a gender-dependent manner.\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\u003eIndividual gross motor skills differentially affected by MPSE in boys and girls\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\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMPSE Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;149)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eHop: Arms flexed and swing forward to produce force\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 or 1 correct trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 correct trials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.0066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eHop: Takes off and lands 3 consecutive times on preferred foot\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 or 1 correct trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 correct trials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.0089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eLeap: for a period where both feet are off the ground longer than running\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 or 1 correct trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 correct trials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eChi-square/Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.029/0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eHorizontal jump:\u0026nbsp;Takes off and lands on both feet simultaneously\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 or 1 correct trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 correct trials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.0071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eStationary dribble:\u0026nbsp;Ball contacts surface in front of or to the outside of foot on the preferred side\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 or 1 correct trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 correct trials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCatch:\u0026nbsp;Arms extend while reaching for the ball as it arrives\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 or 1 correct trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 correct trials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCatch:\u0026nbsp;Ball is caught by hands only\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 or 1 correct trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 correct trials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eUnderhand roll:\u0026nbsp;Bend knees to lower body\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 or 1 correct trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 correct trials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.30\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 \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMPSE is differentially associated with movement behaviors in boys and girls\u003c/h2\u003e \u003cp\u003eTo determine the association between MPSE and movement behaviors, contingency tables were constructed for days physically active at least 60 min in the past 7 days, hours watching TV or videos in the past 30 days, and days with any physical activity outside of school in the past 7 days (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). MPSE was significantly associated with having no physical activity outside of school in boys but not in girls. In addition, MPSE was significantly associated with watching TV for more than 2 hours in the past 30 days and having 2 or fewer days with physical activity at least 60 min in the past 7 days in girls but not in boys (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). These observations suggest that MPSE is associated with movement behaviors that confer less physical activity in boys and a more sedentary state in girls.\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\u003eDetermination of association between MPSE and movement behavior and race\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=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDays physically active at least 60 min\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBoys\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eGirls\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMPSE Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;149)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;=2days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eHours watch TV or videos past 30 days\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;=2 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAny physical activities past 7 days\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eRace/Hispanic origin\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;139)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;128)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enon-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTwo-sided Fisher\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.78\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 \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMPSE is significantly associated with GMQ independent of other variables\u003c/h2\u003e \u003cp\u003eOur multiple linear regression on MPSE and GMQ models included age, race, BMI, RFIP, number of sibling(s) younger than 5 years old, and whether having any physical activities outside of school in the past 7 days. We chose these variables because either they are significantly associated with MPSE in boys based on our analyses above (race and any physical activities outside of school in the past 7 days) or they have been shown to significantly associated with gross motor skills in this cohort of children in a previous study by Kwon et al. (RFIP, number of sibling(s) younger than 5 years old)\u003csup\u003e18\u003c/sup\u003e or other pre-school cohorts in previous studies (age, BMI)\u003csup\u003e21,22\u003c/sup\u003e. The analysis revealed that both MPSE (β = -13.2, p\u0026thinsp;=\u0026thinsp;0.0013) and RFIP (β = -1.965, p\u0026thinsp;=\u0026thinsp;0.0306) were significant predictors of GMQ independent of other variables (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e), and the model has p-value of 0.037 accounting for 10% (R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.10) of the variance in GMQ.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression analysis of selected independent variables and GMQ\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e|t|\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eSummary\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\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.8 to 127.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRows in table\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePhysical activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-5.9 to 14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMissing data (skipped)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-7.8 to 4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRows analyzed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-4.6 to 1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eParameter Estimates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRFIP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.7 to -0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDegrees of freedom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.9 to 1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRegression P value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSibling(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-6.2 to 3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eR squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMPSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-21.1 to -5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdjusted R squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.05\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 \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDeficits in motor control have been reported in children with maternal prenatal exposure to smoking for more than two decades. For example, smoking in pregnancy was associated with a small, but demonstrable adverse effect on the child's balance at 5 years using the Peabody Developmental Motor Scales (PDMS) test in a cohort of 362 Scandinavian children\u003csup\u003e23\u003c/sup\u003e. In addition, prenatal tobacco exposure predicted significantly slower performance on the Grooved Pegboard task, a measure of eye-hand coordination, in 10-year-olds\u003csup\u003e24\u003c/sup\u003e and worse visual-motor coordination in 16-year-old adolescents in a computerized bimanual coordination test\u003csup\u003e25\u003c/sup\u003e. Moreover, heavy smoking during pregnancy was statistically significantly associated with poor coordination performance in 11-year-olds, particularly among boys\u003csup\u003e26\u003c/sup\u003e, suggesting a gender difference of maternal smoking on motor performance. Our study is the first to demonstrate the gender-specific effects of MPSE on gross motor development in 3\u0026ndash;5 year-old children. MPSE is an independent predictor of low GMQ in boys when other confounders are adjusted, underscoring the importance of MPSE on the gross motor development of preschool-aged boys. A previous study showed that prenatal second-hand smoke exposure reduced gross motor development at 18 months of age in both boys and girls\u003csup\u003e27\u003c/sup\u003e, suggesting the gender-specific effects of MPSE may take 3\u0026ndash;5 years to manifest.\u003c/p\u003e \u003cp\u003eMechanistically, prenatal smoke exposure may elicit adverse effects on children by altering offspring\u0026rsquo;s epigenetic and genetic profiles such as DNA methylation and telomere length\u003csup\u003e28\u0026ndash;30\u003c/sup\u003e, resulting in weak muscle tone and reduced cardiovascular and lung functions as well as impaired neurodevelopment such as smaller brain volume\u003csup\u003e2,31\u0026ndash;35\u003c/sup\u003e. The extent of alterations has been shown to be gender-dependent in some cases. For instance, prenatal second-hand smoke exposure was associated with shorter telomere length in boys than in girls\u003csup\u003e30\u003c/sup\u003e, indicating that similar molecular mechanisms may underlie the gender-specific effects of MPSE on GMQ observed in this study. Although there is robust evidence for DNA methylation alterations associated with maternal smoking during pregnancy, there are no conclusive studies about the effects of exposure to low doses of maternal smoking or smoking during the preconception period on DNA methylation\u003csup\u003e36\u003c/sup\u003e. In addition, studies using tissues other than the placenta and blood are scarce\u003csup\u003e36\u003c/sup\u003e. Moreover, further investigations are needed to better understand the biological consequences of DNA methylation and telomere length changes and how they affect motor development in children.\u003c/p\u003e \u003cp\u003eSince the prevalence of maternal tobacco smoking during pregnancy is estimated to be 8%\u003csup\u003e37\u003c/sup\u003e and approximately 360,000-500,000 smoke-exposed infants are born yearly\u003csup\u003e38\u003c/sup\u003e, it is important to educate parents on the consequences of smoking during pregnancy and offer help to women to quit smoking before pregnancy or when pregnancy is known. A population-based study of 113 6\u0026ndash;8 year-old children with MPSE and 113 age and gender-matched controls without MPSE found that brain development in offspring of mothers who quit smoking when pregnancy was known resembled that of nonexposed controls (no smaller brain volumes and no thinning of the cortex)\u003csup\u003e39\u003c/sup\u003e, suggesting that quit smoking will help protect brain development of offspring, which in turn, will potentially prevent reduced motor skill development and behavioral and emotional problems. The US Preventive Services Task Force has recommended that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco\u003csup\u003e40\u003c/sup\u003e. The results of this study provide further rationale to support this recommendation.\u003c/p\u003e \u003cp\u003eThe amount of variance in GMQ explained by the multiple linear regression model combining potential predictors including MSPE is low but significant and comparable with results from previous studies on the effects of smoking exposure on motor development. For instance, the R\u003csup\u003e2\u003c/sup\u003e for multivariant analysis between associations of fine and gross motor skill test scores with age, gender, BMI, blood lead, and magnesium levels as well as serum cotinine level that reflect recent exposure to nicotine in tobacco smoke ranges from 0.08 to 0.25\u003csup\u003e41\u003c/sup\u003e. The low R\u003csup\u003e2\u003c/sup\u003e in our study is partly due to the small sample size of MPSE children which can be attributed to the inherited limitations of questionnaire-based investigation, i.e. underreporting of smoking by mothers. The small sample size may also reduce the ability to detect small effects of MPSE on the health and behaviors of children 3\u0026ndash;5 year-old. For example, lower birth weight associated with MPSE reported in other studies was not detected in this cohort. Another contributing factor to the low amount of variance explained by the potential predicting factors of GMQ is that the development of gross motor skills in children is a complex process that is affected by a variety of factors such as child\u0026rsquo;s sleeping time and position\u003csup\u003e42,43\u003c/sup\u003e, exposure to formal aquatic activities\u003csup\u003e44\u003c/sup\u003e, and maternal moderate-to-vigorous intensity physical activity during pregnancy\u003csup\u003e45\u003c/sup\u003e. Moreover, MPSE-associated factors such as duration of breastfeeding may also contribute to differential gross motor skills in children with or without MPSE\u003csup\u003e46\u003c/sup\u003e. Information on these factors is not available in the NNYES survey, making it impossible to take them into account for modeling. Further studies using biomarkers such as urine cotinine\u003csup\u003e27\u003c/sup\u003e may be helpful to accurately assess the prevalence of MPSE exposure and its effects on the health and development of preschool children including gross motor development. In addition, large-scale studies including as many factors that may affect gross motor development as possible will help to build robust predictive models for preschool children.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSmoking during pregnancy negatively impacts the gross motor skills of 3\u0026ndash;5 year-old boys but not girls. It is also associated with movement behaviors that confer less physical activity in boys and a more sedentary state in girls. More efforts in educating parents on the consequences of smoking during pregnancy and helping women to quit smoking before and during pregnancy are needed to ensure the well-being of preschool-aged children, especially boys.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANOVA: Analysis of variance\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMI: Body mass index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGMQ: Gross motor quotient\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLSSS: Locomotor skills standard score\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMPSE: Maternal prenatal smoking exposure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOCSSS: Object control skills standard score\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNCHS: National Center for Health Statistics\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNHANES: National Health and Examination Survey\u003c/p\u003e\n\u003cp\u003eNNYFS: National Youth Fitness Survey\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRFIP: Ratio of family income to poverty\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSW: Shapiro-Wilk\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTGMD-2: Test of Gross Motor Development-Second Edition\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWAB: Weight at birth\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo ethics approval and consent to participate is required for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRaw data were downloaded from https://wwwn.cdc.gov/nchs/nhanes/search/nnyfs12.aspx. Compiled data file is available at https://docs.google.com/spreadsheets/d/11N54nUwBjtyVv3W07bOy1g3pHZzoFbh-/edit?usp=sharing\u0026amp;ouid=109765623934484658518\u0026amp;rtpof=true\u0026amp;sd=true\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no competing interests from authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors are funded by the Department of Urology at Stanford University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Mr. Josh Kuo for helpful discussions on various topics related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.Z and C.A.Z designed the study and developed the overall research plan. A.Z. and Z.Q collected the data and performed the statistical analyses. \u0026nbsp;A.Z drafted the manuscript. Z.Q and C.A.Z revised the manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDess\u0026igrave;, A., Corona, L., Pintus, R. \u0026amp; Fanos, V. Exposure to tobacco smoke and low birth weight: from epidemiology to metabolomics. \u003cem\u003eExpert Rev Proteomics\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, 647-656 (2018).\u003c/li\u003e\n\u003cli\u003eFroggatt, S., Covey, J. \u0026amp; Reissland, N. Infant neurobehavioural consequences of prenatal cigarette exposure: A systematic review and meta-analysis. \u003cem\u003eActa Paediatr\u003c/em\u003e \u003cstrong\u003e109\u003c/strong\u003e, 1112-1124 (2020).\u003c/li\u003e\n\u003cli\u003ePereira, P.P., Da Mata, F.A., Figueiredo, A.C., de Andrade, K.R. \u0026amp; Pereira, M.G. 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In addition, studies have shown that these health and behavioral problems following maternal prenatal smoking exposure (MPSE) are likely gender-dependent, i.e. the outcomes are divergent between male and female offspring. However, studies on whether MPSE affects gross motor skills in 3-5 year-old children in a gender-specific manner are lacking. The first aim of this project is to examine the effects of MPSE on gross motor skills in 3-5 year-old boys and girls. The second aim is to identify factors that are associated with gross motor skills in children with MPSE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The data used in this project are from the 2012 National Youth Fitness Survey (NNYFS) conducted by the Centers for Disease and Prevention National Center for Health Statistics (NCHS). Out of the 368 children aged 3-5 surveyed by NCHS, 329 had locomotor skills standard score (LSSS), object control skills standard score (OCSSS), and gross motor quotient (GMQ) along with demographic data, body measurement data early childhood questionnaire data movement behavior questionnaire data and were selected for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Boys with MPSE had significantly lower LSSS, OCSSS, and GMQ compared to those without MPSE, while no significant differences in LSSS, OCSSSS, and GMQ for girls were detected, indicating a gender-specific effect of MPSE on GMQ in 3-5 year-old children. MPSE was associated with low ratio of family income to poverty (RFIP) in girls but not in boys, suggesting a gender-specific inverse relationship of MPSE with parity. MPSE was associated with having no physical activity outside of school for the past 7 days in boys but not in girls, watching TV for \u0026gt;2 hours in the past 30 days and having 2 or fewer days with physical activity at least 60 min in the past 7 days in girls but not in boys, suggest that MPSE is associated with movement behaviors that confer less physical activity in boys and more sedentary state in girls.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e MPSE negatively impacts gross motor skills in 3-5 year-old boys.\u003c/p\u003e","manuscriptTitle":"Gender-specific effects of exposure to maternal prenatal smoking on gross motor skills and movement behaviors in 3-5 year-old children: findings from the 2012 National Youth Fitness Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-14 17:49:07","doi":"10.21203/rs.3.rs-4283363/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-16T07:00:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-13T12:04:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67412718917396549327808495514649897199","date":"2024-07-13T11:37:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-05T02:08:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272528698929933083015225609523071249829","date":"2024-06-05T01:47:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-03T20:32:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-06T11:40:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-06T11:19:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2024-04-17T17:17:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"154d38ea-3a67-4332-b2c7-03e128e4f21b","owner":[],"postedDate":"May 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-16T16:04:08+00:00","versionOfRecord":{"articleIdentity":"rs-4283363","link":"https://doi.org/10.1186/s12982-024-00337-0","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2024-12-11 15:57:17","publishedOnDateReadable":"December 11th, 2024"},"versionCreatedAt":"2024-05-14 17:49:07","video":"","vorDoi":"10.1186/s12982-024-00337-0","vorDoiUrl":"https://doi.org/10.1186/s12982-024-00337-0","workflowStages":[]},"version":"v1","identity":"rs-4283363","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4283363","identity":"rs-4283363","version":["v1"]},"buildId":"zQwnuV7TCBrMSSSToR1PI","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}