Associations of Passive and Mentally Active Screen Time With Perceived School Performance of 197,439 Adolescents Across 38 Countries

Published:August 22, 2022DOI:



      To examine the associations of passive (ie, television) and active (ie, electronic games, computer use) screen time (ST) with perceived school performance of adolescents across gender.


      Data were from the 2014 Health Behaviour in School-aged Children survey conducted across 38 European countries and Canada. Perceived school performance was assessed using an item and dichotomized as high (good/very good) versus the remainder (average/below-average as reference). Participants reported hours per day of time spent watching television, playing electronic games, and using a computer in their free time. Multilevel logistic regression was used to estimate the associations.


      A total of 197,439 adolescents (average age 13.6 [standard deviation 1.63] years; 51% girls) were analyzed. Multivariable modeling showed that engaging in >2 h/d of ST was progressively and adversely associated with high performance in both boys and girls. Adolescents reporting >4 h/d of television time (≤1 h/d as reference) had 32% lower odds in boys (odds ratio [OR] 0.68; 95% confidence interval [CI]: 0.65–0.71) and 39% lower odds in girls (OR 0.61; 95% CI, 0.58–0.65) of reporting high performance. Playing electronic games for >4 h/d was associated with high performance with odds being 38% lower in boys (OR 0.62; 95% CI, 0.59–0.66) and 45% lower in girls (OR 0.55; 95% CI, 0.52–0.57). Sex differences in the estimates were mixed.


      High screen use, whether active or passive, was adversely associated with perceived high school performance, with association estimates being slightly stronger in girls than boys, and for mentally active than passive screen use. Discouraging high levels of screen use of any type could be beneficial to school performance.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stiglic N
        • Viner RM.
        Effects of screen time on the health and well-being of children and adolescents: a systematic review of reviews.
        BMJ Open. 2019; 9e023191
        • Thomas G
        • Bennie JA
        • De Cocker K
        • et al.
        A descriptive epidemiology of screen-based devices by children and adolescents: a scoping review of 130 surveillance studies since 2000.
        Child Indic Res. 2020; 13: 935-950
        • WHO
        WHO Guidelines on Physical Activity and Sedentary Behaviour.
        World Health Organization, Geneva2020 (Licence: CC BY-NC-SA 3.0 IGO)
        • Carson V
        • Hunter S
        • Kuzik N
        • et al.
        Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update.
        Appl Physiol Nutr Metab. 2016; 41: S240-S265
        • Oswald TK
        • Rumbold AR
        • Kedzior SGE
        • et al.
        Psychological impacts of “screen time” and “green time” for children and adolescents: a systematic scoping review.
        PLoS One. 2020; 15e0237725
        • Eirich R
        • McArthur BA
        • Anhorn C
        • et al.
        Association of screen time with internalizing and externalizing behavior problems in children 12 years or younger: a systematic review and meta-analysis.
        JAMA Psychiatry. 2022; 79: 393-405
        • Khan A
        • Moni M
        • Khan S
        • et al.
        Different types of screen time are associated with low life satisfaction in adolescents across 37 European and North American countries.
        Scand J Pub Health. 2022; (Online ahead of print)
        • Canadian Society for Exercise Physiology
        Canadian 24-Hour Movement Guidelines for Children and Youth (5-17 Years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep.
        Canadian Society for Exercise Physiology, Ottawa2017
      1. Australian Government DoH. Australian 24-hour movement guidelines for children (5 to 12 years) and young people (13 to 17 years): An integration of physical activity, sedentary behaviour, and sleep. 2019. Available at: Accessed December 2, 1996.

        • Hale L
        • Guan S.
        Screen time and sleep among school-aged children and adolescents: a systematic literature review.
        Sleep Med Rev. 2015; 21: 50-58
        • Sweetser P
        • Johnson D
        • Ozdowska A
        • et al.
        Active versus passive screen time for young children.
        Aust J Early Child. 2012; 37: 94-98
        • Walsh JJ
        • Barnes JD
        • Tremblay MS
        • et al.
        Associations between duration and type of electronic screen use and cognition in US children.
        Comput Human Behav. 2020; 108106312
        • Veraksa N
        • Veraksa A
        • Gavrilova M
        • et al.
        Short- and long-term effects of passive and active screen time on young children's phonological memory.
        Front Educ. 2021; 6: 140
        • Kim S
        • Favotto L
        • Halladay J
        • et al.
        Differential associations between passive and active forms of screen time and adolescent mood and anxiety disorders.
        Soc Psychiatry Psychiatr Epidemiol. 2020; 55: 1469-1478
        • Khan A
        • Lee E
        • Janssen I
        • et al.
        Associations of passive and active screen time with psychosomatic complaints of adolescents.
        Am J Prev Med. 2022; 63: 24-32
        • Suhrcke M
        • de Paz
        • Nieves C.
        The Impact of Health and Health Behaviours on Educational Outcomes in High-Income Countries: A Review of the Evidence.
        WHO Regional Office for Europe, Copenhagen2011
        • Howie EK
        • Joosten J
        • Harris CJ
        • et al.
        Associations between meeting sleep, physical activity or screen time behaviour guidelines and academic performance in Australian school children.
        BMC Pub Health. 2020; 20: 520
        • Huang X
        • Zeng N
        • Ye S.
        Associations of sedentary behavior with physical fitness and academic performance among Chinese students aged 8-19 years.
        Int J Environ Res Pub Health. 2019; 16: 4494
        • Roberts DF
        • Henriksen L
        • Voelker DH
        • et al.
        Television and schooling: displacement and distraction hypotheses.
        Aust J Educ. 1993; 37: 198-211
        • Felder-Puig R
        • Griebler R
        • Samdal O
        • et al.
        Does the school performance variable used in the International Health Behavior in School-Aged Children (HBSC) study reflect students' school grades?.
        J Sch Health. 2012; 82: 404-409
        • Sanchez E
        • Buddin R
        How Accurate are Self-Reported High School Courses, Course Grades, and Grade Point Average?.
        ACT, Iowa City, IA2016
        • Sticca F
        • Goetz T
        • Bieg M
        • et al.
        Examining the accuracy of students’ self-reported academic grades from a correlational and a discrepancy perspective: evidence from a longitudinal study.
        PLoS One. 2017; 12e0187367
        • Lizandra J
        • Devís-Devís J
        • Pérez-Gimeno E
        • et al.
        Does sedentary behavior predict academic performance in adolescents or the other way round? A longitudinal path analysis.
        PLoS One. 2016; 11e0153272
        • Roberts C
        • Freeman J
        • Samdal O
        • et al.
        The Health Behaviour in School-aged Children (HBSC) study: methodological developments and current tensions.
        Int J Public Health. 2009; 54: 140-150
        • Badura P
        • Sigmund E
        • Madarasova GA
        • et al.
        Is participation in organized leisure-time activities associated with school performance in adolescence?.
        PLoS One. 2016; 11e0153276
        • Bobakova D
        • Hamrik Z
        • Badura P
        • et al.
        Test-retest reliability of selected physical activity and sedentary behaviour HBSC items in the Czech Republic, Slovakia and Poland.
        Int J Public Health. 2015; 60: 59-67
        • Khan A
        • Lee EY
        • Rosenbaum S
        • et al.
        Dose-dependent and joint associations between screen time, physical activity, and mental wellbeing in adolescents: an international observational study.
        Lancet Child Adolesc Health. 2021; 5: 729-738
        • He J
        • Chen X
        • Fan X
        • et al.
        Is there a relationship between body mass index and academic achievement? A meta-analysis.
        Public Health. 2019; 167: 111-124
        • Ng KW
        • Sudeck G
        • Marques A
        • et al.
        Associations between physical activity and perceived school performance of young adolescents in health behavior in school-aged children countries.
        J Phys Act Health. 2020; 17: 698-708
        • Currie C
        • Molcho M
        • Boyce W
        • et al.
        Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) Family Affluence Scale.
        Soc Sci Med. 2008; 66: 1429-1436
        • Shi Y
        • Yu H
        • Di S
        • et al.
        Body mass index and academic achievement among Chinese secondary school students: the mediating effect of inhibitory control and the moderating effect of social support.
        Front Psychol. 2022; 13835171
        • Prochaska JJ
        • Sallis JF
        • Long B.
        A physical activity screening measure for use with adolescents in primary care.
        Arch Pediatr Adolesc Med. 2001; 155: 554-559
        • White IR
        • Royston P
        • Wood AM
        Multiple imputation using chained equations: issues and guidance for practice.
        Stat Med. 2011; 30: 377-399
        • Ramírez S
        • Gana S
        • Garcés S
        • et al.
        Use of technology and its association with academic performance and life satisfaction among children and adolescents.
        Front Psychiatry. 2021; 12
        • Skvarc DR
        • Penny A
        • Harries T
        • et al.
        Type of screen time and academic achievement in children from Australia and New Zealand: interactions with socioeconomic status.
        J Child Media. 2021; 15: 509-525
        • Ferrar KE
        • Olds TS
        • Walters JL.
        All the stereotypes confirmed: differences in how Australian boys and girls use their time.
        Health Educ Behav. 2011; 39: 589-595
        • Stetsenko A
        • Little TD
        • Gordeeva T
        • et al.
        Gender effects in children's beliefs about school performance: a cross-cultural study.
        Child Dev. 2000; 71: 517-527
        • Vandewater EA
        • Bickham DS
        • Lee JH.
        Time well spent? Relating television use to children's free-time activities.
        Pediatrics. 2006; 117: e181-e191
        • Hale L
        • Kirschen GW
        • LeBourgeois MK
        • et al.
        Youth screen media habits and sleep: sleep-friendly screen behavior recommendations for clinicians, educators, and parents.
        Child Adolesc Psychiatr Clin N Am. 2018; 27: 229-245
        • Marciano L
        • Camerini AL.
        Recommendations on screen time, sleep and physical activity: associations with academic achievement in Swiss adolescents.
        Pub Health. 2021; 198: 211-217
        • Tapia-Serrano MA
        • García-Hermoso A
        • Sevil-Serrano J
        • et al.
        Is adherence to 24-hour movement guidelines associated with a higher academic achievement among adolescent males and females?.
        J Sci Med Sport. 2022; 25: 155-161
        • Rosen JA
        • Porter SR
        • Rogers J.
        Understanding student self-reports of academic performance and course-taking behavior.
        AERA Open. 2017; 3: 1-14
        • Parry DA
        • Davidson BI
        • Sewall CJR
        • et al.
        A systematic review and meta-analysis of discrepancies between logged and self-reported digital media use.
        Nat Hum Behav. 2021; 5: 1535-1547
        • Nagata JM
        • Cortez CA
        • Cattle CJ
        • et al.
        Screen time use among US adolescents during the COVID-19 pandemic: findings from the Adolescent Brain Cognitive Development (ABCD) study.
        JAMA Pediatrics. 2022; 176: 94-96