Reducing social disparities in child emotional and behavioral problems by hypothetical physical activity and screen time interventions

Purpose To estimate how social disparities in child psychiatric symptoms might change following hypothetical interventions targeting sports, outdoor play, and screen time at age 10. Methods We used data from 9,778 children of the Generation R Study, a prospective population-based cohort in Rotterdam, the Netherlands. Social inequality variables included sex, maternal education, and migration background. Primary caregivers filled out the validated Child Behavior Checklist to report on children's internalizing and externalizing symptoms at the age of 13. The hypothetical interventions (i.e., outdoor play, sports participation, and screen time) were parent-reported at age 10. We used sequential G-estimation to estimate the inequality with and without the hypothetical intervention. Results Children with migration backgrounds (46.3%) and low maternal education (53.3%) were associated with relatively more internalizing and externalizing symptoms than peers, with disparities of 0.125 and 0.177 standard deviations, respectively. Girls had more internalizing symptoms (0.106 SD), while boys had more externalizing symptoms (0.154 SD). Increasing sports participation reduced disparities in internalizing symptoms linked to maternal education (β = -0.014; 95% CI: -0.024, -0.003), while outdoor play and screen time interventions showed limited effects. None of the hypothetical interventions significantly reduced any of the social disparities in externalizing symptoms. Conclusions This study underscores the persistence of sex, cultural, and socioeconomic disparities in youth mental health. While sports participation showed a potential effect in reducing disparities in internalizing symptoms, its impact on externalizing symptoms and other interventions was negligible. Future efforts should focus on identifying more effective strategies for addressing these inequalities.