Differential associations between Quantity, content, and context of screen time, and Children's health-related quality of life: A two-wave study

Existing literature suggests that lengthy durations of screen time (ST) are associated with lower levels of healthrelated quality of life (HRQoL) and other negative outcomes in children. Nonetheless, the current available evidence largely relies on cross-sectional studies. In addition, data on the content and context (parent -child couse and solitary use) of ST are scarce. We set out to conduct a one-year, two -wave longitudinal study to investigate the association between exposure to different types of ST and HRQoL among primary school children in Hong Kong, from 2021 to 2022. A population representative random sample (N = 1428) participated in the study. Results from pooled ordinary least squares regressions showed children 's ST duration was significantly associated with worse HRQoL ( beta = -1.101, p < 0.0001). However, interactions of ST content and context, including parent -child co -use x TV viewing ( beta = 1.305, p < 0.0001), parent -child co -use x video gaming ( beta = 0.280, p < 0.0001), solitary use x video gaming ( beta = 0.198, p < 0.0001), and solitary use x social media use ( beta = 0.454, p < 0.0001) were significantly associated with better HRQoL. Our findings suggest that increased overall durations of ST are associated with worse HRQoL in children, but this association is impacted by the types of ST content and context.