Behavioral configurations of movement, screen exposure, and diet in school-aged children: a cross-sectional study

Abstract Background Citywide COVID-19 lockdowns compressed children’s daily lives into the home environment, concentrating physical activity, screen exposure, and dietary behaviors within domestic settings. This context provides an opportunity to examine physical activity, screen exposure, and diet using a clustering approach, allowing behavioral patterns to be identified that are not observable when these behaviors are analyzed individually. Results Sixty six children aged 5 to 9 years were included. Correlation analyses identified coherent co occurrence patterns within behavioral domains, with outdoor play positively associated with weekly structured physical activity (Spearman rho 0.35, q 0.040), fruits with vegetables (rho 0.39, q 0.025), and bread with fats and oils intake (rho 0.41, q 0.025). Associations involving screen exposure did not remain significant after false discovery rate correction. Based on these quantitative relationships, two interpretable behavioral configurations were identified. One configuration was characterized by higher screen exposure together with higher bread intake and lower outdoor play. The contrasting configuration showed greater outdoor play and higher intake of dairy products, vegetables, and fruits. Between configuration differences that remained significant after correction included outdoor play (Cliff’s delta minus 0.72), screen time (delta 0.62), bread intake (delta 0.51), and dairy intake (delta minus 0.43). In adjusted analyses, boys had higher odds of belonging to the screen centered configuration (odds ratio 3.46 with 95 percent confidence interval 1.16 to 10.30), whereas age, body mass index, household size, and number of rooms were not associated with configuration membership. Conclusions Under constrained home-based conditions, school-aged children’s physical activity, screen exposure, and dietary behaviors co-occurred in coherent and interpretable configurations that differed across both movement-related and dietary components. These findings describe how daily behaviors tended to co-organize in restricted environments and suggest that individual characteristics, particularly sex, may be more informative than aggregate household indicators when examining behavioral configurations in children.