Linking 24-hour movement behavior guidelines to academic engagement and social-emotional functioning among youth with chronic pain

Background: Growing evidence documents the health benefits of meeting the 24-h movement behavior (24-HMB) guidelines (including recommendations concerning physical activity [PA], screen time [ST], and sleep [SL]) regardless of age or health status. However, the association between meeting the 24-HMB guidelines and academic engagement, social functioning, and emotional functioning has not been investigated in children and adolescents (youth) with chronic pain. Therefore, this cross-sectional study examined the potential links between meeting the 24-HMB guidelines and indicators of the above-mentioned outcomes in a nationally representative sample of U.S. youth with chronic pain. Methods: Data from caregiver proxy reports for 7918 U.S. children and adolescents with chronic pain, aged between 6 and 17 years, were retrieved from the 2020 National Survey of Children's Health. Exposures of interest included the isolated and combined 24-HMB guidelines, while outcomes included measures of academic engagement, social functioning, and emotional functioning. To determine the association between the variables mentioned above, a logistic regression analysis was conducted using adjustment for confounding variables (e.g., age, sex, ethnicity, household federal poverty level [FPL] status, education level of primary caregivers, premature birth, and overweight). Results: A low (4.53 %) proportion of U.S. youth with chronic pain met the combined 24-HMB guidelines. As compared to the reference group (i.e., did not meet the 24-HMB guidelines), youth with chronic pain who met the combined 24-HMB guidelines (referring to PA + ST, PA + SL, PA + ST + SL) showed significantly better performance on our measures of interest (e.g., learning interest/curiosity, difficulty in making friends, resilience; p < 0.05 for all). Conclusions: In youth with chronic pain, meeting the 24-HMB guidelines is associated with better academic engagement, social functioning, and emotional functioning. However future intervention studies are necessary to provide more robust evidence before more firm conclusions can be drawn. Our results suggest that fostering a healthy lifestyle behavior in this vulnerable population might support their social-emotional and cognitive development (e.g., academic engagement).