Influence of parental behavior on myopigenic behaviors and risk of myopia: analysis of nationwide survey data in children aged 3 to 18 years

Abstract

Background: Preventive parental behavior may play an important role in the outcomes of children's myopia. We investigated associations between parental behavior and children's myopia status and daily activities using data from the most recent myopia survey in Taiwan.

Methods: In total, 3845 children aged 3 to 18 years who completely responded to the questionnaire were included (total score ranging from 0 to 75). A score of ≥ 50 was considered to indicate beneficial parental behavior. Time allocation data for near-work activities, using electronic devices, and outdoor activities were collected using a separate self-reported questionnaire. Associations between beneficial parental behavior and children's myopia status and activity patterns were analyzed and stratified by school level.

Results: Beneficial parental behavior was positively associated with children's myopia in the overall samples [adj. odds ratio (OR): 1.31, 95% confidence interval (CI): 1.08-1.59, p = 0.006)] and at the elementary school level (adj. OR: 1.43, 95% CI: 1.11-1.83, p = 0.005). However, a negative association with high myopia was observed in the overall samples (adj. OR: 0.71, 95% CI: 0.50-0.99, p = 0.049) and high school level (adj. OR: 0.62, 95% CI: 0.41-0.92, p = 0.02). Beneficial parental behavior was associated with less time spent on near work (≥ 180 min/day) and electronic device use (≥ 60 min/day), but not with outdoor activities.

Conclusion: In Taiwan, children's myopia is associated with higher rate of parents' beneficial behaviors, which suggests that regular vision surveillance is necessary to promote better parental behavior toward children's eye care. Certain parental practices may influence children's behavior pattern and reduce the risk of children's high myopia development in the long run.

Keywords: Elementary school; Family; High myopia; High school; Kindergarten; Myopia; Near work activities; Parental behavior.

Fig. 1

Beneficial parental behavior rate (behavior score ≥ 50) in different school levels, stratified by schoolchildren's refractive status

Fig. 2

Heatmap of the weightings of all questions contributing to each component from principal component analyses in kindergarten, elementary school, and high school, respectively. All questions in the questionnaire on parental behavior in myopia control and parental attitude about children’s time distribution after class were included. Cells in black indicate that these questions were not asked at the kindergarten level. Multivariate logistic regression analyses for children’s myopia or high myopia were performed for all components at each school level, adjusted for age, parental myopia, parental education level, and SES. Components with significant associations in the analyses are marked with asterisks, daggers, and double daggers. * At the kindergarten level, a significant negative association was observed between component 5 and children’s myopia (adj. OR: 0.71, 95% CI: 0.51–0.98, P = 0.04). This component was majorly contributed by the parental attitude in regulating outdoor time and reading time. † At the elementary school level, a significant positive association was observed between component 1 and children’s myopia (adj. OR: 1.19, 95% CI: 1.05–1.34, P = 0.005), and a negative association was observed between component 3 and children’s myopia (adj. OR: 0.69, 95% CI: 0.61–0.77, P < 0.001). Component 3 was negatively affected by parental behavior in the medical control of myopia. ‡ At the high school level, no significant association was observed between the components and myopia in children. However, when we targeted moderate and high myopia (n = 963) subgroups, a negative association at a borderline significance level was observed between component 1 and children’s high myopia (adj. OR: 0.87, 95% CI: 0.75–1.0, P = 0.05)