Jpah 2015-0514

“Screen-Based Behaviours of Adolescents in Bangladesh” by Khan A, Burton NW
Journal of Physical Activity & Health

© 2016 Human Kinetics, Inc.
Note: This article will be published in a forthcoming issue of

the Journal of Physical Activity & Health. This article appears
here in its accepted, peer-reviewed form, as it was provided
by the submitting author. It has not been copy edited, proofed,
or formatted by the publisher.
Section: Original Research
Article Title: Screen-Based Behaviours of Adolescents in Bangladesh
Authors: Asaduzzaman Khan1 and Nicola W. Burton2
Affiliations: 1School of Health and Rehabilitation Sciences, The University of Queensland,

Australia. 2School of Human Movement & Nutrition Sciences, The University of
Queensland, Australia.
Running Head: Screen time of adolescents
Journal: Journal of Physical Activity & Health
Acceptance Date: June 9, 2016
©2016 Human Kinetics, Inc.
DOI: http://dx.doi.org/10.1123/jpah.2015-0514
Screen-based behaviours of adolescents in Bangladesh
Running head: Screen time of adolescents
Keywords: recreational screen-time, sedentary behaviour, children, adolescents, Bangladesh.

Downloaded by Washington Univ In St Louis on 09/19/16, Volume 0, Article Number 0
Manuscript type: Original research
Asaduzzaman Khan1¥, Nicola W Burton2

1
School of Health and Rehabilitation Sciences, The University of Queensland, Australia
2
School of Human Movement & Nutrition Sciences, The University of Queensland, Australia
Australia
¥
Corresponding autor (AK)
School of Health and Rehabilitation Sciences
The University of Queensland
Brisbane, QLD 4072
Australia
Phone: +61 7 3346 7456
Fax: +61 7 3365 1877
Email: a.khan2@uq.edu.au
Word count
 Abstract: 200
 Manuscript: 5561 [excluding title and abstract]
Abstract
Background: Screen-time of adolescents has been associated with obesity and other adverse
health outcomes; however, little is known about screen-based behaviours in Asian
adolescents. The purpose of this study was to describe the prevalence, patterns and correlates
of recreational screen-based behaviours among adolescents in Bangladesh. Methods: A total
of 758 students, aged 13-16 years and 52% girls, from eight secondary schools of Dhaka city,
Bangladesh completed a survey where the Adolescent Sedentary Activity Questionnaire was
used to collect information on screen-time. Total screen-time was categorised as ≤2 h/day

(low) or >2 h/day (high). Results: About 79% of the adolescents had high recreational
screen-time, with similar proportions between boys (78%) and girls (80%). Median reported
recreational screen-time was 4.0 h/day with longer times among boys (4.3 h/day) than girls
(3.6 h/day). Multivariable analyses showed that high screen-time was more common among
boys than girls, and positively associated with commuting to school by car, consumption of
fast food >3 times/week, having sleep disturbance, and high family income. Conclusions:
This study identified high rates of recreational screen-time among urban adolescents in
Bangladesh and specific correlates of prolonged screen-time, and underscores the needs for
developing pragmatic strategies to reduce sedentariness among adolescents in Bangladesh.
Keywords: recreational screen-time, sedentary behaviour, children, adolescents, media use,
Bangladesh.
Introduction
Sedentary behaviour refers to sitting or reclining during waking when energy

[1]
expenditure is 1.5 metabolic equivalents or less . Although there are different types of
sedentary behaviours, screen-time (e.g., watching television, computer use) is the most
[2]
common, and often used as a proxy measure of sedentariness among young people .
Screen-based behaviours of adolescents have been adversely associated with obesity and
[3]
obesity-related health problems . Sedentary behaviour during adolescence can track into
[4]
adult life and contribute to the development of chronic disease in later life . It is therefore
imperative to understand the screen-based behaviour of adolescents to inform preventive-
health measures and promote active lifestyles.
Screen-based behaviour of adolescents has been primarily studied in developed
countries, with a widely used screen-time recommendation of ≤2 h/day by the American

[5]
Academy of Pediatrics (AAP) . A cross national investigation of 39 North American and
European countries reported that 41% of adolescents aged 11-15 years spent >2 h/day on
screen-based activities [6]. However, little is known about sedentary behaviour of adolescents
in developing countries. In China, the proportion of adolescents engaging in >2 h/day of

[7]
screen-based activities increased between 1997 and 2006, from 10% to 40% . Research
[8, 9, 7]
from Asia suggests that high adolescent screen-time is associated with being male ;
having a television in the bedroom [10, 7]; living in urban areas [8]; studying in a private school,
[9]
commuting to school by car, no provision of extra-curricular activities ; being younger
(aged 6-12 years as opposed to 13-18 years) and watching television with parents [7]; and high
[11]
BMI, frequent fast food consumption and having a mother working in paid employment .
Evidence is mixed about the relationship between parental education, socio-economic status
and adolescent screen-time [10, 8, 12].

As yet, no studies have looked at sedentary behaviour of Bangladeshi adolescents.
Bangladesh is undergoing rapid socio-economic growth and increasing urbanization, which
can be associated with increases in sedentary behaviour in occupational and domestic
contexts, and modes of transportation (i.e., increased access to automobiles). In parallel with
the socio-economic development of the country, contemporary Bangladeshi adolescents are
increasingly engaging in technological interaction (e.g., social networking via Facebook,
Twitter) and screen-based activities (e.g., television, smartphone), which are sedentary in
nature. In addition, the high expectations of Asian societies on academic performance has the
[7]
potential to increase sedentary behaviour via prolonged study . It is, therefore, crucial to
gather epidemiological information on the sedentary behaviour of adolescents in Bangladesh.
The purpose of this study was, therefore, to describe the prevalence, patterns and correlates of
recreational screen-time among adolescents in Bangladesh in order to inform interventions to
reduce sedentariness.
Methods
A self-administered written survey was conducted among students in grades 7-10
from eight secondary schools of Dhaka city, Bangladesh. Individual written informed consent
was obtained from students and one parent of each student prior to administering the survey.
Students completed the survey in a classroom setting with the principal investigator (AK)
present. A section of the survey was completed at home by one parent of the participating
student and returned by the student on the following day. The survey was available in English
and Bengali [local language], and took approximately 45-50 min to complete. Data for this
study were collected during the winter season (November 2012 – January 2013) of
Bangladesh. This study was approved by the Behavioural Social Sciences Ethics Review
Committee at The University of Queensland, Australia. Each of the participating schools
approved the survey prior to its administration.

Outcome measures
Students completed the Adolescent Sedentary Activity Questionnaire (ASAQ), which

[13]
has demonstrated reliability and satisfactory reproducibility . Research on the validity of
similar sedentary behaviour questionnaires with adolescents suggests self-report data can
have acceptable criterion and concurrent validity [14] but may be vulnerable to over reporting
[15]
. To assess recreational screen-time, students were asked to report time (hours/minutes)
spent sitting on (i) a usual school day and (ii) a usual weekend day to do each of watching
television, watching DVD's/videos, and using the computer for fun. An additional item was
included to assess time spent on social media (e.g., Facebook, Twitter). Recreational screen-
time for a usual school day and recreational screen-time for a usual weekend day was
computed by summing the time spent across the four screen-based activities. A total
recreational screen-time measure was derived by taking the weighted average: i.e. (school
day screen time x 5 + weekend day screen time x 2)/7 [16]. Total recreational screen-time was
dichotomized as ≤2 h/day (low) or >2 h/day (high), reflecting a widely used screen-time
[5]
recommendation . A separate category was developed to identify those with excessive
screen-time of >4 hours per day, as used elsewhere [17, 18]. A total of 758 students aged 13 to
16 years completed the ASAQ, which forms the analytical sample for this paper.
Other measures
Survey items were also used to assess demographics, health, and school, dietary and
life-style factors. Students were asked about access to resources for physical activities (e.g.,
sports equipment), health (e.g., general physical health, sleep disturbance and duration),
dietary behaviour (e.g., frequency of consumption of fast food, chocolate, ice-cream,
carbonated soft-drink during the past 7 days). School related items assessed include school
type (mainstream Bangla medium and English medium school), mode of travel to school
(e.g., walk, car), time taken to travel to school, participation in physical education classes,
involvement in team and non-team sports at school, and school facilities (e.g., playing field).
The 10-item Center for Epidemiologic Studies Depression Scale (CES-D 10) was used to
assess depressive symptoms. Parents provided household/family level data (e.g., family
income, family support for physical activity or sports) as well as personal information (e.g.,
parent age, occupation, height, weight).
Students’ height and weight were measured by the research team members. Centers
for Disease Control and Prevention (CDC) growth charts were used to determine the
corresponding body mass index (BMI) for-age and sex percentile [19]. Obesity was defined as
a BMI at or above the 95th percentile for adolescents of the same age and sex; overweight
was a BMI between the 85th and 95th percentiles, normal weight was a BMI less than the
85th percentile but at or above the 5th percentile, and underweight was a BMI less than the
5th percentile. Parental BMI was computed using their self-reported height and weight (BMI
= Weight in kg/Height in meters2), and categorised as normal (BMI<25), overweight
(25≤BMI<30) or obese (BMI≥30).
Statistical analysis
Total recreational screen-time was examined to check normality and presence of
outliers. Descriptive statistics such as gender-specific median screen-time (by schooldays and
weekend days), percentage of adolescents exceeding the AAP guidelines (≤2 h/day),
percentage of adolescents with excessive screen use (>4 h/day), and participation in various
forms of screen-based activities were computed.
Based on available evidence, an initial set of 22 explanatory variables were
considered to identify potential correlates of high (>2 h/day) and excessive (>4 h/day) screen-
time (with reference being low screen-time of ≤2 h/day), including: gender, age, BMI,
walking to school, travel to school by car, physical education class at school, involvement in
team and non-team sports at school, school type, current physical health, depressive
symptoms, sleep disturbance, sleep duration, frequency of consumption of (a) fast food (b)
carbonated soft-drinks (c) chocolate and (d) ice-cream; sports equipment at home, father’s
occupation, mother’s occupation, parental BMI, family income, and family support for
physical activity or sports.
The collinearity of the explanatory variables was examined prior to examining the
correlates. School type was significantly associated with having a playing field in the school
(p<0.001) and as such, a decision was made to exclude school type from any further analyses.
Given the significant association between father’s occupation and family income (p<0.001),
walking to school and car travel to school (p<0.001), and consumption of carbonated drinks
and fast food consumption (p<0.001), the former of each of these variable pairs was dropped
from the analyses.
As the aims of this study were to identify correlates of high and excessive recreational
screen-time when the students’ screen-based behaviours were nested within their schools,
generalized estimating equation (GEE) regression modelling with binomial family and logit
link was implemented under exchangeable correlation structure. The GEE approach
accounted for clustering at the school level since a number of students shared similar school
environments.
Bivariate analyses were carried out by using GEE regression to assess crude
associations between binary (high vs. low; excessive vs. low) screen-time and each of the
explanatory variables. Only variables found to be associated with high or excessive screen-
time at p<0.10 at the bivariate level and were free from multicollinearity were considered for
multivariable GEE analyses. The logit link function of the GEE facilitates the computation of
exponentiated fixed-effect regression coefficients, which are interpretable as odds ratios
(ORs) with OR>1 representing positive association and OR<1 representing negative
association. Only the variables significantly associated, at 5% level of significance, with high
and excessive screen-time at the multivariable GEE analyses were presented in the form of
odds ratios and their 95% confidence intervals. The analyses were carried out using the
statistical package Stata V13.0 [20].
Results:
The average age of the participating students was 14.3 years (SD 1.14) with 52%
being girls. A summary of the demographics of the participating students are presented in
Table 1. On average, the participating students had a median reported recreational screen-
time of 4 h/day (interquartile range: 2.1 to 6.2 h/day) with longer times among boys (4.3
h/day) than girls (3.6 h/day). Median screen-time was much higher during weekend days (5.2
h/day) than schooldays (3.1 h/day).
Figure 1 shows the median recreational screen-time (mins/day) of different media by
gender and weekend vs school day. Watching television was the main source of recreational
screen-time on both weekend- and school-days with no gender difference (median = 90
mins/school days and 180 mins/weekend day). Computer use for fun and watching videos
were considerably higher for boys (e.g., median 60 mins/weekend day) than girls (e.g., 10
mins/weekend day), irrespective of weekend vs school day. Use of social media was 35 mins
for boys and 30 mins for girls during a weekend day.
Figure 2 shows the percentage of boys and girls engaging in high recreational screen-
time by weekend vs school day. About 79% of the adolescents (78% of boys, 80% of girls)
reported high (>2 h/day) recreational screen-time, with higher rates on weekend days (89%)
than schooldays (75%). Almost half (48%) of the adolescents had excessive screen-time (>4
h/day) with a higher proportion of boys (53%) than girls (43%). Excessive screen-time during
weekend days (61%) was nearly double that of schooldays (34%). About 65% of the boys
and 57% of the girls engaged in excessive screen-time during weekend days (Figure 2).
Bivariate analyses demonstrated no significant association between recreational
screen time and BMI; however, the proportion of participants with high screen time (>
2h/day) was slightly higher for overweight (83.1%) and obese (82.7%) children than their
counterparts with healthy (78%) or underweight (73%) BMI. Similarly, excessive screen time
(>4 h/day) was more common among children categorised as overweight (75.0%) or obese
(74.3%) than children who were categorised as healthy (68.7%) or underweight 60.5%) BMI;
these differences were also not statistically significant.
Multivariable analyses showed that high recreational screen-time (>2 h/day) was more
common among boys than girls, and positively associated with commuting to school by car,
consumption of fast food >3 times/week, having sleep disturbance, and high family income
(Table 2). As shown in Table 3, the odds of having had excessive screen-time (>4 h/day)
were significantly higher for boys than girls, and positively associated with consuming fast
food >2 times/week and having sleep disturbance, and high family income. Having physical
education classes at school was inversely associated with excessive recreational screen-time
(Table 3).
Discussion
The prevalence of prolonged recreational screen-based behaviours in the present study
of Bangladeshi adolescents was high, with 79% exceeding the AAP recommended screen-
time guidelines (≤2 h/day). This is much higher than reported in previous studies in other
[21]
countries: 31% in India, 34% in China, 45% in Canada, and 59% in the US ; and slightly
higher than studies in the Asia-Pacific region: 63% in Australia [22] and 68% in Malaysia [23].
The present study found that almost half (48%) of the adolescents spent >4 h/day on
recreational screen-time, which is much higher than what has previously been reported in
[18] [17]
Spain (35%) and the US (16%) . With increased accessibility and availability of
[24]
electronic devices, adolescents are likely to spend more time on screen-based activities .
The finding that 4 in 5 adolescents in Bangladesh exceeded the AAP recommendations for
screen-time is alarming, especially when obesity and other inactivity-related non-

[25, 26]
communicable diseases are on the rise in Bangladesh . The present study, therefore,
underscores the need for strategies aimed at reducing these sedentary behaviours in
Bangladeshi adolescents.
Median time spent on recreational screen-based activities by Bangladeshi adolescents
was 4.0 h/day with 3.6 h/day for girls and 4.3 h/day for boys. This is much higher than in
[7]
China with girls engaging in 1.3 h/day and boys engaging in 1.7 h/day , and in Malaysia
[23]
with 2.8 h/day for girls and 3.3 h/day for boys . The findings of the present study are
similar to Portuguese adolescents with an average screen-time of 3.5 h/day for girls and 4.3
[27]
h/day for boys and to Australian adolescents with 3.0 h/day for girls and 4.3 h/day for
boys [28].
Watching television was the predominant recreational screen-based activity for
Bangladeshi adolescents (90 mins/school day and 180 mins/weekend day for both boys and
girls), which is consistent with data from recent Indian studies with 82 mins/school day and
[10]
203 mins/weekend day , and 119 mins/day for female and 112 mins/day for male
[29]
adolescents . Besides watching television, Bangladeshi adolescents spent a considerable
amount of time using the computers for fun and playing video games. Although there was no
gender difference in time spent watching television, boys were more likely to play video
games and use computers (for fun) than girls, as has been found elsewhere [27].
[27, 23, 12, 7]
In agreement with previous studies , the present study found that boys were
more likely to have prolonged recreational screen-time than girls. This could be due to boys’
extended use of computer and video games, as found in the present study. The gender
difference may also be partly explained by girls being more likely to do other types of
activities (e.g., household chores, extracurricular activities such as music, arts) than screen-
[30]
based activities, as reported elsewhere . Although age was found to be positively
associated with screen-time among Asian adolescents [7, 12], the present study did not find any
significant association between age and screen-time. One possibility could be that the present
study involved adolescents in a narrow age bracket of 13-16 years, which may not have been
sufficient to capture variability in sedentariness by age.
Family income was positively associated with prolonged recreational screen-time.
There is evidence to suggest that family socio-economic status (SES), when measured as
perceived or assessed with indicators of education, occupation or income, is positively

[8, 12, 10]

associated with high screen-time in Asian adolescents . This could partly be due to
children from high income families in developing countries have more access to screen-time
technology (e.g., more options to buy tablets, smartphone) and therefore, more opportunities
to engage in screen-based activities such as social media, games. Bangladesh has recently
become a lower-middle income country with a rapid increase in the ownership of electronic
devices (e.g., televisions, Xbox) in families with high income, which might explain, at least
partially, the high prevalence of screen-time among adolescents from high income families.
However, these findings are in contrast to that of developed countries where children of low
[31]
SES are likely to have high screen-time , and highlight an interesting difference between
developed and developing countries.

[11, 8, 32, 33]
Consistent with the findings of previous studies , the present study found
that more frequent consumption of fast food was significantly associated with high
recreational screen-time. This finding may have public health implications as prolonged
[34, 35]
sedentary behaviour and high energy intake may promote visceral fat in adolescents ,
[36, 37]
which in turn increases the risk of insulin resistance and cardiovascular diseases .
However, other research indicates no association between prolonged sedentary behaviour and
[38]
increased visceral fat accumulation in adults . Television and other screen-based devices
have become an important environmental exposure that could potentially promote unhealthy
[32] [39]
eating among adolescents either from exposure to fast food advertisements , snacking ,
distraction and a lack of awareness of actual food consumption, or overlooking food cues that
[40]
may lead to overconsumption . In recent years, high-energy foods/snacks have become
readily accessible to the majority of Bangladeshi adolescents because of increased

[41]
commercial supply outlets and a variety of options for fast food . Additional research is
therefore needed to develop better understanding about the relationship between the use of
screens and food choices among adolescents, especially in developing countries. Restriction
on fast food advertising on television, applying high taxes on energy-dense foods and use of
[42]
appropriate food labelling have been found useful in developed countries ; however,
further research is needed to examine whether such interventions are effective in developing
countries. No association was found between screen-time and the frequency of consumption
of fruits and vegetables, and the available evidence about such a relationship is mixed [33].
The present study found that disturbed sleep was significantly associated with high
recreational screen-time among adolescents, which is in accordance with the finding of a
recent large population based study that reported an inverse dose-response relationship
[43]
between sleep duration and media use . Those authors argued that electronic devices have
become an integral part of adolescent life, not only for entertainment but also for social
purposes. Active use of electronic media has been consistently associated with shortened
[44]
sleep, sleep problems, and delayed bedtime and wake-up time . However, the mechanism
behind such relationships is not well established. It has been argued that media use may
directly affect sleep by replacing it due to its time consuming nature, or it may interfere with
sleep through increased psychophysiological arousal caused by the stimulating content of the
[43]
material, or through bright light exposure inherent in most electronic media devices .
However, it may be also argued that as the need for sleep varies between individuals,
adolescents who need less sleep may spend more time on electronic devices. Therefore, more
research is needed to understand the temporality of this relationship, especially in the context
of developing countries like Bangladesh where screen-based devices are becoming
increasingly accessible to adolescents.
Access to physical education (PE) classes at school was inversely associated with
recreational screen-time. No comparable data are available to support this finding, although
other research has underscored the importance of attractive PE courses to promote physical
[18]
activity at schools . PE is an integral part of the Bangladesh National Curriculum for
[45]
secondary schools , which is followed in mainstream Bangla medium schools; however,
English medium schools, which do not follow the National Curriculum, may offer some
unstructured physical education. PE classes at school can be an opportunity to promote

[46]
activity, and potentially decrease sedentary time . The present study warrants further
exploration about how PE classes are delivered at Bangladeshi schools [both national
curricula and English medium] and how revisiting the curriculum of PE may help minimize
sedentariness through promoting a physically active lifestyle.
Use of a vehicle to travel to school was significantly associated with excessive

[9]
recreational screen-time, which is in agreement with findings in Nepal where commuting
to school by vehicles was positively associated with sitting time of female adolescents. In the
present study, no association was found between recreational screen-time and physical
activity, which is consistent with a review of the correlates of physical activity in children
[47]
and adolescents . This is in accordance with the view that sedentary behaviour and
physical activity are independent behaviours in adolescents [48].
The present study is the first of its kind to report on screen-based behaviours of
Bangladeshi adolescents, and was based on a large urban sample with a balanced
representation of gender and school type. Data on sedentary behaviours were collected via
self-report using the ASAQ which provides information on three screen-based behaviours
(e.g., television, computer and video games), in addition to time spent on social media, which
are important to characterize contemporary patterns of sedentary behaviours. Although the

[13]
ASAQ has demonstrated reliability and good face validity , this has not been validated in
Bangladeshi adolescents. Self-report measures are however vulnerable to recall bias. Many
other variables not examined in the present study (e.g., television in the bedroom, rules about
program content, provision of extra-curricular activities at school) could also be potential
correlates of adolescents’ screen-based behaviours. Participants were from eight purposively

selected schools of Dhaka city, which limits the generalization of the study findings to other
settings, including regional areas. Only interested students of the participating schools
completed in the survey, which may have resulted in volunteer bias. Despite these limitations,
the present study provides valuable data on an important public health issue that warrants
more attention.
In summary, the present study identified high rates of recreational screen-time use and
identified specific correlates of high and excessive screen-time. Prolonged screen-time is a
cause of concern given that access to screen-based devices has increased considerably in
recent years in Bangladesh. Since sedentary behaviour plays a key role in adolescent and later
adult health, the findings of the present study should be taken into consideration when
developing public health strategies to combat obesity and obesity-related health conditions in
Bangladesh. Longitudinal studies using objective measures of sedentary behaviours are
needed to better understand these behaviours and their predictors in order to formulate
pragmatic interventions to reduce sedentariness and promote an active lifestyle among
adolescents in Bangladesh.
Acknowledgements
We are very grateful to all students and their parents who participated in the study. We also
thank teachers/headmasters/principals of the participating schools for their support in the
implementation of this project. Special thanks are due to Mahfuzul Kabir of Data Analysis
and Technical Assistance (DATA), Bangladesh for painstakingly helping with data entry. We
also acknowledge the contribution of Stewart G Trost for his guidance in designing the
survey. Our thanks also go to Parveen A Khanum, Shuhana Sultana, Nazneen A Khanum,
Shanchita R Khan and Areebah S Khan for their assistance with data collection.
Funding source:
None to declare
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353
Screen-time on WE 290
210
Screen-time on SCH 180
180
Television on WE 180
90
Television on SCH 90
35
Social media on WE 30 Boys
20
Social media on SCH 14 Girls
70
Computer for fun on WE 60
45
Computer for fun on SCH 30
60
Video on WE 20
30
Video on SCH
15
0 25 50 75 100 125 150 175 200 225 250 275 300 325 350 375
Screen time: mins/day
Figure 1: Median adolescent screen-time [mins/day] of different media by gender and the day of the
week, Dhaka city, Bangladesh [WE=weekend days and SCH=schooldays]
> 4hr/day >2 ≤4hr/day

Overall 47.6% 31.4% 79.0%
WE 60.8% 28.5% 89.3%
SCH 33.8% 41.0% 74.8%
Boys 53.0% 24.9% 77.9%
Girls 42.6% 37.5% 80.1%
Boys-WE 65.4% 24.6% 90.0%
Girls-WE 56.6% 32.2% 88.8%
Boys-SCH 37.1% 39.2% 76.3%
Girls-SCH 30.8% 42.6% 73.4%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Figure 2: Percentage of adolescent boys and girls who engaged in high screen-time by the day of the
week, Dhaka city, Bangladesh [WE=weekend days and SCH=schooldays]
Table 1: Demographics of participating adolescents of Dhaka city, Bangladesh (n=758)
Characteristics n¥ %
Gender
Girl 392 51.7%
Boy 366 48.3%
Age in years
13 185 24.4%
14 249 32.9%
15 213 28.1%
16 111 14.6%
Body mass index
Underweight 62 8.5%
Healthy 494 68.0%

Overweight 118 16.3%
Obese 52 7.2%
Mother’s education
Up-to primary or equivalent 73 9.9%
Secondary or equivalent 101 13.6%
Higher secondary or equivalent 141 19.0%
Graduation or post-graduation 426 57.5%
Mother’s occupation
House wife – not in paid employment 508 76.3%
ψ
In paid Employment 158 23.7%
Father’s education
Up-to primary or equivalent 52 7.1%
Secondary or equivalent 50 6.8%
Higher secondary or equivalent 80 10.8%
Graduation or post-graduation 556 75.3%
Father’s occupation
Public service 161 24.7%
Professionals 93 14.3%
Private service 204 31.3%
Business-trade 193 29.7%
Family income (BDT in 000)* per month
< 30 160 22.7%
30 – <50 163 23.1%
50 – <100 211 29.9%
100 or more 172 24.4%
¥ Total for each variable may not be equal to n=758 due to missing values
* 1000 BDT = 12.61 USD
ψ due to small numbers, all paid work categories were combined to ‘Employed’
Table 2: Factors associated with adolescents’ recreational screen time > 2 hours per day¥, Dhaka city,
Bangladesh (n=637)
Characteristics Odds ratio 95% Conf. Intv. P-value

Sex (Girl=Ref)
Boy 1.71 1.04 2.82 0.035
Commuting to school by car

(No=Ref)
Yes 1.63 1.02 2.64 0.045
Consumption of fast food

during the last 7 days
(None=Ref)
Once 1.12 0.70 1.78 0.639

Twice 2.05 0.96 4.37 0.063
Three times or more 2.13 1.02 4.46 0.045
Sleep disturbance or poor

sleep during the past week
(No=Ref)
Yes 2.09 1.06 4.10 0.032
Total family income per

month (<30K=Ref)
30 - 50K 1.70 0.94 3.06 0.080
50 - 100K 2.03 1.13 3.63 0.017
100K+ 2.07 1.05 4.08 0.035
¥
compared to screen time ≤ 2 h/day
NB: Variables being significant at bivariate but not at multivariable GEE regression include: physical education class at
school, sleep duration, consumption of chocolate, sport equipment at home, and one parent’s BMI.
Table 3: Factors associated with adolescents’ recreational screen time > 4 hours per day¥, Dhaka city,
Bangladesh (n=431)
Characteristics Odds ratio 95% Conf. Intv. P-value

Sex (Girl=Ref)
Boy 2.45 1.50 3.99 <0.001
Physical education class

(No=Ref)
Yes 0.58 0.37 0.90 0.016
Consumption of fast food

during the last 7 days
(None=Ref)
Once 1.13 0.68 1.89 0.643
Twice 2.25 1.04 4.87 0.039
Three times or more 2.34 1.11 4.94 0.026
Sleep disturbance or poor

sleep during the past week
(No=Ref)
Yes 2.29 1.10 4.77 0.027
Total family income per

month (<30K=Ref)
30 - 50K 1.88 0.98 3.51 0.064
50 - 100K 2.06 1.10 3.86 0.024
100K+ 2.61 1.26 5.44 0.010
¥
compared to screen time ≤ 2 h/day
NB: Variables being significant at bivariate but not at multivariable GEE regression include: playing field, sleep duration,
consumption of chocolate and ice-cream , sport equipment at home, and one parent’s BMI.

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“Screen-Based Behaviours of Adolescents in Bangladesh” by Khan A, Burton NW

Journal of Physical Activity & Health

Note: This article will be published in a forthcoming issue of

Section: Original Research

Article Title: Screen-Based Behaviours of Adolescents in Bangladesh

Authors: Asaduzzaman Khan1 and Nicola W. Burton2

Affiliations: 1School of Health and Rehabilitation Sciences, The University of Queensland,

Running Head: Screen time of adolescents

Journal: Journal of Physical Activity & Health

Acceptance Date: June 9, 2016

©2016 Human Kinetics, Inc.

Screen-based behaviours of adolescents in Bangladesh

Running head: Screen time of adolescents

Keywords: recreational screen-time, sedentary behaviour, children, adolescents, Bangladesh.

Manuscript type: Original research

Asaduzzaman Khan1¥, Nicola W Burton2

health outcomes; however, little is known about screen-based behaviours in Asian

of recreational screen-based behaviours among adolescents in Bangladesh. Methods: A total

used to collect information on screen-time. Total screen-time was categorised as ≤2 h/day

developing pragmatic strategies to reduce sedentariness among adolescents in Bangladesh.

Keywords: recreational screen-time, sedentary behaviour, children, adolescents, media use,

Sedentary behaviour refers to sitting or reclining during waking when energy

imperative to understand the screen-based behaviour of adolescents to inform preventive-

health measures and promote active lifestyles.

Screen-based behaviour of adolescents has been primarily studied in developed

countries, with a widely used screen-time recommendation of ≤2 h/day by the American

in developing countries. In China, the proportion of adolescents engaging in >2 h/day of

and adolescent screen-time [10, 8, 12].

As yet, no studies have looked at sedentary behaviour of Bangladeshi adolescents.

Bangladesh is undergoing rapid socio-economic growth and increasing urbanization, which

can be associated with increases in sedentary behaviour in occupational and domestic

the socio-economic development of the country, contemporary Bangladeshi adolescents are

increasingly engaging in technological interaction (e.g., social networking via Facebook,

gather epidemiological information on the sedentary behaviour of adolescents in Bangladesh.

recreational screen-time among adolescents in Bangladesh in order to inform interventions to

A self-administered written survey was conducted among students in grades 7-10

Committee at The University of Queensland, Australia. Each of the participating schools

approved the survey prior to its administration.

Students completed the Adolescent Sedentary Activity Questionnaire (ASAQ), which

dietary behaviour (e.g., frequency of consumption of fast food, chocolate, ice-cream,

parent age, occupation, height, weight).

= Weight in kg/Height in meters2), and categorised as normal (BMI<25), overweight

(25≤BMI<30) or obese (BMI≥30).

Total recreational screen-time was examined to check normality and presence of

forms of screen-based activities were computed.

Based on available evidence, an initial set of 22 explanatory variables were

physical activity or sports.

from the analyses.

exponentiated fixed-effect regression coefficients, which are interpretable as odds ratios

statistical package Stata V13.0 [20].

h/day) than schooldays (3.1 h/day).

Figure 1 shows the median recreational screen-time (mins/day) of different media by

screen-time on both weekend- and school-days with no gender difference (median = 90

for boys and 30 mins for girls during a weekend day.

Bivariate analyses demonstrated no significant association between recreational

these differences were also not statistically significant.

The prevalence of prolonged recreational screen-based behaviours in the present study

screen-time is alarming, especially when obesity and other inactivity-related non-

Median time spent on recreational screen-based activities by Bangladeshi adolescents

Watching television was the predominant recreational screen-based activity for

sufficient to capture variability in sedentariness by age.

Family income was positively associated with prolonged recreational screen-time.

perceived or assessed with indicators of education, occupation or income, is positively