online homework for 4 year olds

Worksheets for 4-Year-Olds

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Introducing our innovative worksheets designed specifically for 4-Year-Olds! Crafted with the young, curious minds of preschoolers in mind, these worksheets are the perfect blend of fun and learning. Covering a range of essential skills such as basic math concepts, letter recognition, and early writing skills, each activity is tailored to engage and inspire four-year-olds. With vibrant illustrations and interactive tasks, our worksheets make learning an exciting adventure for your little one. Unlock your child’s potential and lay the foundation for academic success with our expertly designed worksheets for 4-Year-Olds. Start the journey of discovery and growth today!

Letter A Tracing Page

Geometry Worksheet

Christmas Tree Tracing Winter Words Worksheet

A Fox and Bird Coloring Page

Counting Cupcakes Worksheet

Snowflake Tracing Winter Words Worksheet

Which One Is Different Worksheet

Plural Nouns Practice Worksheet

Trace The Circles Worksheet

Who Is in a Family? Worksheet

Counting Backwards: Treasure Hunt Worksheet

Lowercase Letters Maze Worksheet

Desert Maze Worksheet

Let's Practice Plurals Word Structure Worksheet

Red and Blue Coloring Fun Worksheet

Number Match Up Worksheet

Physical Science: States of Matter Worksheet

Town or City? Worksheet

Rhyming Words: Assessment Worksheet

Months of the Year Worksheet

The Bingo Song: Coloring The Girl Worksheet

Mammals and Reptiles Worksheet

Letter Z Tracing Page

The Lion and The Mouse Sequencing Worksheet

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Worksheets designed specifically for 4-year-olds serve as a fundamental tool in early childhood education, offering numerous benefits that support a child's developmental milestones. These carefully crafted activities are instrumental in enhancing fine motor skills. As children engage with worksheets, they practice pencil grip and control, laying the groundwork for legible handwriting.

Moreover, worksheets for 4-year-olds are tailored to stimulate cognitive development. Through a variety of puzzles, matching games, and problem-solving tasks, these resources encourage critical thinking and the ability to focus, fostering an early love for learning. They also introduce basic concepts of math, language, and science in a fun and accessible manner, making education an enjoyable experience.

Social skills, too, receive a boost through the use of worksheets. Group activities promote teamwork, sharing, and communication among peers, essential competencies for kindergarten readiness. Additionally, completing worksheets gives young learners a sense of accomplishment and self-confidence, important aspects of emotional development.

Importantly, worksheets for 4-year-olds are designed to be engaging and age-appropriate, ensuring that learning aligns with their curiosity and capacity for understanding. They bridge the gap between play and structured learning, preparing children for a seamless transition into more formal education settings.

In conclusion, worksheets for 4-year-olds are a versatile educational tool, fostering not only academic but also social and emotional growth. They lay a solid foundation for lifelong learning.

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• Recognizing letter names and sounds
• Recognizing lowercase and uppercase letters
• Tracing letters and numbers
• Putting the letters of the alphabet in order
• Matching letter sounds to beginning word sounds
• Counting syllables
• Reading sight words
• Recognizing rhyming words
• Engaging in wordplay
• Understanding and contributing to a short narrative
• Counting to 10
• Recognizing written numbers from 1 to 10
• Sorting by color and number
• Tracing numbers
• Recognizing shapes and patterns
• Recognizing “more” and “less”
• Painting and coloring
• Illustrating a story
• Expressing themselves through art and design
• Recognizing and naming colors
• Recognizing shapes
• Comparing sizes
• Talking about weather
• Picking the right clothes for the weather
• Using a mouse, trackpad, or touchscreen

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Preschool Worksheets PDF FREE Printable

Here is a list of free preschool worksheets pdf you can download and print from Planes & Balloons. You’ll find activities and worksheets that strengthen fine motor skills, early literacy and math skills, thinking and reasoning skills, focus and attention, and so much more.

Coloring pages

Language arts

Preschool math

Cut and paste

Same or different

free preschool worksheets age 3-4 pdf

Pre-K to Kindergarten Review

Grab this book full of engaging activities to prepare your little one for kindergarten!

Or use them in your nursery or preschool lesson plans throughout the year.

Preschool Number worksheets

You can easily turn a bunch of these worksheets into a cute preschool workbook for teaching numbers!

Tracing the numbers 1-20

Number flashcards 1-20

Halloween counting 1-20

Spring color by number

Christmas count and match

Preschool alphabet worksheets.

Check out these fun and educational alphabet activities for your preschoolers!

Spot and dot uppercase alphabet

Alphabet tracing worksheets printable

Tracing lowercase letters

Hot chocolate letter matching

Alphabet coloring book

Preschool shapes worksheets.

Free printable preschool learning materials free download pdf for your 3-4 year olds and 4-5 year old preschoolers!

Do a dot shapes worksheets

Frog shapes cut and paste

My shape book free printablE

Free Printable Shapes Worksheets

Tracing shapes worksheets

Nursery worksheets pdf.

Let your preschoolers practice visual discrimination with these fun same and different worksheets in your home or daycare!

Spring same and different

Same and different worksheets for preschool

Visual discrimination practice

Ocean same and different

CActus same and different

Preschool tracing worksheets pdf.

Tracing is a great preschool pre-writing activity , especially when you need one quickly and without much prep work. There are many tracing activities for preschoolers here, including tracing shapes, horizontal and vertical lines, and tracing pictures.

Tracing lines spring worksheets

Tracing fall pictures for preschool

Valentine’s Day number tracing

Alphabet tracing worksheets.

Transportation tracing pages

Preschool cut and paste worksheets.

Preschool cut and paste worksheets to practice scissor skills and fine motor skills.

Cut and paste Apple Worksheets

Cut and paste Easter eggs

Cut and paste For preschool

Cut and paste hearts

HALLOWEEN CUT AND PASTE

Preschool mazes printable.

These printable mazes will be a fun addition to your preschool playgroup activities.

Christmas mazes

Back to school mazes

Easter mazes

Mazes for preschoolers

Number mazes

Coloring is popular with little ones, especially if the coloring pages are in sync with their favorite topics such as bugs, cars, fall, Christmas, and more.

Preschool worksheet packet PDF

If you need a little bit of everything all in one printable, then these preschool packets pdf will help you out.

• Farm animals worksheets for preschoolers
• 4th of July worksheets for preschool
• Free printable days of the week bundle
• Halloween monster worksheets for preschoolers
• Circle time calendar template
• Berry picking learning pack
• Silly socks preschool learning pack
• Free printable Christmas worksheets for preschoolers
• Summer worksheets for pre-k and kindergarten
• Fall preschool worksheets packet
• Dental health preschool worksheets packet
• Preschool space activities learning binder
• Spring preschool worksheets printable pack
• Valentine’s Day preschool worksheets bundle
• Thanksgiving worksheets for preschoolers

200+ Free Preschool Printables & Worksheets

Free preschool printables.

Letters & Letter Sounds

Name recognition puzzles, tracing, drawing & fine motor, other literacy printables, counting & numbers, other math printables, scissor skills, visual discrimination, science, geography, social studies, dot marker sheets, playdough mats, q-tip painting printables, seasonal & themed packs, 64 comments:.

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Missing: 3-Year-Old Boy With Autism Wanders Away From Home

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Oregon man convicted of sexually abusing 2 teen girls he met online gets 12 1/2 years in prison

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PORTLAND, Ore. (AP) — An Oregon man who met two 15-year-old girls on Snapchat, sexually abused them while traveling through three states and finally abandoned them at a park has been sentenced to more than a decade behind bars, prosecutors said Thursday.

Albert Wayne Johnson was sentenced Wednesday to 12 1/2 years in federal prison and 10 years of supervised release, the U.S. Attorney’s Office for the District of Oregon said Thursday in a statement.

On Aug. 8, 2022, Clackamas County Sheriff’s Office deputies responded to a call reporting two minors abandoned in a park outside Portland in Boring, Oregon, according to court documents.

The girls told deputies they met Johnson on Snapchat and that he drove them from Washington through Idaho and into Oregon. Johnson sexually abused both of them at a motel in Othello, Washington, and one of them at a campground near La Grande, Oregon, according to court documents.

After arriving in Boring, Johnson left the children at a campsite in Barton Park and never returned.

Johnson, 42, was arrested at his home in La Grande on an outstanding parole violation warrant Aug. 30, 2022. Surveillance video from the motel in Othello showed him with the two girls, documents said.

That November a federal grand jury in Portland returned a three-count indictment charging him with traveling across state lines to engage in a sexual act with a minor, transporting a minor with intent to engage in criminal sexual activity and commission of a sex offense by a registered sex offender.

As part of an agreement with prosecutors, Johnson pleaded guilty this year to transporting a minor with intent to engage in criminal sexual activity.

In court filings Johnson’s attorney, Elizabeth Daily, said he did not use physical force or coercion against the girls and suggested that a sentence of just over 11 years would be sufficient.

Johnson was previously convicted of luring a minor and attempt to commit sexual abuse in 2018 and was under state supervision in August 2022, according to prosecutors. He had also violated his conditions of release by changing his address without approval and failing to complete sex offender and substance abuse treatment, they said.

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• Published: 13 May 2024

The impact of the world’s first regulatory, multi-setting intervention on sedentary behaviour among children and adolescents (ENERGISE): a natural experiment evaluation

• Bai Li   ORCID: orcid.org/0000-0003-2706-9799 1 ,
• Selene Valerino-Perea 2 ,
• Weiwen Zhou 3 ,
• Yihong Xie 4 ,
• Keith Syrett 5 ,
• Remco Peters 1 ,
• Zouyan He 4 ,
• Yunfeng Zou 4 ,
• Frank de Vocht 6 , 7 &
• Charlie Foster 1  

International Journal of Behavioral Nutrition and Physical Activity volume  21 , Article number:  53 ( 2024 ) Cite this article

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Regulatory actions are increasingly used to tackle issues such as excessive alcohol or sugar intake, but such actions to reduce sedentary behaviour remain scarce. World Health Organization (WHO) guidelines on sedentary behaviour call for system-wide policies. The Chinese government introduced the world’s first nation-wide multi-setting regulation on multiple types of sedentary behaviour in children and adolescents in July 2021. This regulation restricts when (and for how long) online gaming businesses can provide access to pupils; the amount of homework teachers can assign to pupils according to their year groups; and when tutoring businesses can provide lessons to pupils. We evaluated the effect of this regulation on sedentary behaviour safeguarding pupils.

With a natural experiment evaluation design, we used representative surveillance data from 9- to 18-year-old pupils before and after the introduction of the regulation, for longitudinal ( n  = 7,054, matched individuals, primary analysis) and repeated cross-sectional ( n  = 99,947, exploratory analysis) analyses. We analysed pre-post differences for self-reported sedentary behaviour outcomes (total sedentary behaviour time, screen viewing time, electronic device use time, homework time, and out-of-campus learning time) using multilevel models, and explored differences by sex, education stage, residency, and baseline weight status.

Longitudinal analyses indicated that pupils had reduced their mean total daily sedentary behaviour time by 13.8% (95% confidence interval [CI]: -15.9 to -11.7%, approximately 46 min) and were 1.20 times as likely to meet international daily screen time recommendations (95% CI: 1.01 to 1.32) one month after the introduction of the regulation compared to the reference group (before its introduction). They were on average 2.79 times as likely to meet the regulatory requirement on homework time (95% CI: 2.47 to 3.14) than the reference group and reduced their daily total screen-viewing time by 6.4% (95% CI: -9.6 to -3.3%, approximately 10 min). The positive effects were more pronounced among high-risk groups (secondary school and urban pupils who generally spend more time in sedentary behaviour) than in low-risk groups (primary school and rural pupils who generally spend less time in sedentary behaviour). The exploratory analyses showed comparable findings.

Conclusions

This regulatory intervention has been effective in reducing total and specific types of sedentary behaviour among Chinese children and adolescents, with the potential to reduce health inequalities. International researchers and policy makers may explore the feasibility and acceptability of implementing regulatory interventions on sedentary behaviour elsewhere.

The growing prevalence of sedentary behaviour in school-aged children and adolescents bears significant social, economic and health burdens in China and globally [ 1 ]–[ 3 ]. Sedentary behaviour refers to any waking behaviour characterised by an energy expenditure equal or lower than 1.5 metabolic equivalents (METs) while sitting, reclining, or lying [ 3 ]. Evidence from systematic reviews, meta-analyses and longitudinal studies have shown that excessive sedentary behaviour, in particular recreational screen-based sedentary behaviour, affect multiple dimensions of children and adolescents’ wellbeing, spanning across mental health [ 4 ], cognitive functions/developmental health/academic performance [ 5 ], [ 6 ], quality of life [ 7 ], and physical health [ 8 ]. In China, over 60% of school pupils use part of their sleep time to play mobile phones/digital games and watch TV programmes, and 27% use their sleep time to do homework or other learning activities [ 9 ]. Screen-based, sedentary entertainment has become the leading cause for going to bed late, which is linked to detrimental consequences for children’s physical and mental health [ 10 ]. Notably, academic-related activities such as post-school homework and off campus tutoring also contribute to the increasing amounts of sedentary behaviour. According to the Organisation for Economic Co-operation and Development (OECD) report, China is the leading country in time spent on homework by adolescents (14 h/week on average) [ 11 ].

The COVID-19 pandemic exacerbated this global challenge, with children and adolescents reported to have been the most affected group [ 12 ]. Schools are a frequently targeted setting for interventions to reduce sedentary behaviour [ 13 ]. However, school-based interventions have had limited success when delivered under real-world conditions or at scale [ 14 ]. School-based interventions alone have also been unsuccessful in mitigating the trend of increasing sedentary behaviour that is driven by a complex system of interdependent factors across multiple sectors [ 13 ]. Even for parents and carers who intend to restrict screen-based sedentary behaviour and for children who wish to reduce screen-based sedentary behaviour, social factors including peer pressure often form barriers to changing behaviour [ 15 ]. In multiple public health fields such as tobacco control and healthy eating promotion, there has been a notable shift away from downstream (e.g., health education) towards an upstream intervention approach (e.g., sugar taxation). However, regulatory actions for sedentary behaviour are scarce [ 16 ]. World Health Organization (WHO) 2020 guidelines on sedentary behaviour encourage sustainable and scalable approaches for limiting sedentary behaviour and call for more system-wide policies to improve this global challenge [ 8 ]. Up-stream interventions can act on sedentary behaviour more holistically and have the potential to maximise reach and health impact [ 13 ]. In response to this pressing issue, and to widespread demands from many parents/carers, the Chinese government introduced nationwide regulations in 2021 to restrict (i) the amount of homework that teachers can assign, (ii) when (and for how long) online gaming businesses can provide access to young people, and (iii) when tutoring businesses can provide lessons [ 17 ], [ 18 ]. Consultations with WHO officials and reviewers of international health policy interventions confirmed that this is currently the only government-led, multi-setting regulatory intervention on multiple types of sedentary behaviour among school-aged children and adolescents. A detailed description of this programme is available in the Additional File 1 .

We evaluated the impact of this regulatory intervention on sedentary behaviour in Chinese school-aged children and adolescents. We also investigated whether and how intervention effects differed by sex, education stage, geographical area, and baseline weight status.

Study design

The introduction of the nationwide regulation provided a unique opportunity for a natural experiment evaluation where the pre-regulation comparator group data (Wave 1) was compared to the post-regulation group data (Wave 2). Multiple components of the intervention (see Additional File 1 ) were introduced in phases from July 2021 with all components being fully in place by September 2021 [ 17 ], [ 18 ]. This paper follows the STROBE reporting guidance [ 19 ], [ 20 ].

Data source, study population and sampling

We obtained regionally representative data on 99,947 pupils who are resident in the Chinese province of Guangxi as part of Guangxi Centre for Disease Control and Prevention’s (CDC) routine surveillance. The data, available from participants in grade 4 (aged between 9 and 10 years) and higher, were collected using a multi-stage random sampling design (Fig.  1 ) through school visits by trained health professionals following standardised protocols (see Supplementary Fig.  1 , Additional File 1 ). In Wave 1 (data collected from September to November 2020), pupils were randomly selected from schools in 31 urban/rural counties from 14 cities in Guangxi. At least eight schools, including primary, secondary, high schools, and ‘vocational high schools’, were selected from urban counties. Five schools were selected from rural counties. Approximately 80 students were randomly selected from each grade at the schools selected. The same schools were invited to participate in Wave 2 (data collected from September to November 2021), and new schools were invited to replace Wave 1 schools that no longer participated. Children with available data at both Wave 1 and Wave 2 represented approximately 10% of the sample ( n  = 7,587). Paper-based questionnaires were administrated to students by trained personnel or teachers. The questionnaires were designed and validated by China National Health Commission, and have been utilised in routine surveillance throughout the country.

Flow diagram of participants included in the ENERGISE study

We used data from the age groups 7–18 years for most analyses. For specific analyses of homework and out-of-campus tutoring, we excluded high school pupils (16–18 years) because the homework and out-of-campus tutoring regulations apply to primary (7–12 years) and middle (13–15 years) school pupils only. Furthermore, participants without socio-demographic data or those who reported medical history of disease, or a physical disability were excluded. This gave us a total sample of 7,054 eligible school-aged children and adolescents with matching data (longitudinal sample).

Outcomes and subgroups

Guangxi CDC used purposively designed questions for surveillance purposes to assess sedentary behaviour outcomes (Table  1 ).

The primary outcomes of interest included: (1) total sedentary behaviour time, (2) homework time, (3) out-of-campus learning (private tutoring) time, and (4) electronic device use time (Table  1 ). We considered electronic device use time, including mobile phones, handheld game consoles, and tablets, the most suitable estimator of online game time (estimand) in the surveillance programme since these are the main devices used for online gaming in China [ 23 ]. Secondary outcomes were: (1) total screen-viewing time, (2) internet-use time, (3) likelihood of meeting international screen-viewing time recommendations, and (4) likelihood of meeting the regulation on homework time (Table  1 ).

We calculated total sedentary behaviour time as the sum of total screen-viewing time (secondary outcome), homework time, and out-of-campus learning time (Table  1 ). Total screen-viewing time represents the sum of electronic device use time per day, TV/video game use time per day, and computer use time per day (Table  1 ). Total screen-viewing time was considered as an alternative estimator of online game time (estimand) since TV/videogame console use time and computer time could also capture the small proportion of children who use these devices for online gaming (Table  1 ). The international screen-viewing time recommendations were based on the American Academy of Paediatrics guidelines [ 21 ]. We did not include internet use time (secondary outcome) in total screen-viewing time, and total sedentary behaviour time, because this measure likely overlaps with other variables.

We defined subgroups by demographic characteristics, including the child’s sex (at birth: girls or boys), date of birth, education stage [primary school or secondary school [including middle school, high school, and ‘occupational schools’]), children’s residency (urban versus rural) and children’s baseline weight status (non-overweight versus overweight/obesity). Each sampling site selected for the survey was classified by the surveillance personnel as urban/rural and as lower-, medium-, or higher-economic level based on the area’s gross domestic product (GDP) per capita. The area’s GDP per capita was measured by the Chinese Centre for Disease Control and Prevention (CDC). Trained personnel also measured height, and weight using calibrated stadiometers and scales. Children’s weight/height were measured with light clothing and no shoes. Measurements during both waves were undertaken when students lived a normal life (no lockdowns, school were opened normally). We classified weight status (normal weight vs. overweight/obesity) according to the Chinese national reference charts [ 24 ].

Statistical analyses

We treated sedentary behaviour values that exceeded 24-hours per day as missing. We did not exclude extreme values for body mass index from the analyses 25 . Additional information, justifications, and results of implausible and missing values can be found in the Supplementary Table 1 , Additional File 1 .

The assumptions for normality and heteroscedasticity were assessed visually by inspecting residuals. We assessed multicollinearity via variance inflation factors. The outcome variables for linear regression outcomes were transformed using square roots to meet assumptions. We reported descriptive demographic characteristics (age, sex, area of residence, socioeconomic status), weight status, and outcome variables using means (or medians for non-normally distributed data) and proportions [ 26 ]

We ran multilevel models with random effects nested at the school and child levels to compare the outcomes in Wave 1 against Wave 2. We developed separate models for each sedentary behaviour outcome variable. We treated the introduction of the nationwide regulation as the independent binary variable (0 for Wave 1 and 1 for Wave 2). We ran linear models for continuous outcomes, logistic models for binary outcomes, and ordered logistic models for ordinal outcomes in a complete case analysis estimating population average treatment effects [ 27 ]. For the main analysis, in which participants had measurements in both Waves (longitudinal sample), only those with non-missing data at both time points were included.

We estimated marginal effects for each sedentary behaviour outcome. With a self-developed directed acyclic graph (DAG) we identified age (continuous), sex (male/female), area of residence (urban/rural), and socioeconomic status (high/medium/low) as confounders (see Supplementary Figs. 2–4, Additional File 1 ).

We evaluated subgroup effects defined by child’s sex at birth (boys versus girls), child’s stage of education (primary school versus secondary school [including middle school, high school, and ‘occupational schools’]), children’s residency (rural versus urban), and children’s baseline weight status (non-overweight versus overweight/obesity). We also repeated the covariate-adjusted model with interaction terms (between Wave and sex; Wave and child stage of education; Wave and residency; and Wave and weight status). We adjusted for multiple testing using Bonferroni correction ( p 0.05 divided by the number of performed tests for an outcome). The resulting cut-off point of p  < 0.005 was used to determine the presence of any interaction effects.

We also conducted exploratory analyses (including subgroup analyses) by evaluating the same models with a representative, cross-sectional sample of 99,947 pupils. This cross-sectional sample included different schools and children at Wave 1 and Wave 2. We therefore used propensity score (PS) weighting to account for sample imbalances in the socio-demographic characteristics. Propensity scores were calculated by conducting a logistic regression, which calculated the likelihood of each individual to be in Wave 2 (dependent variable). Individual’s age, sex, area of residence and the GDP per area were treated as independent variables. Subsequently, inverse probability of treatment weighting was applied to balance the demographic characteristics in the sample in Wave 1 (unexposed to the regulatory intervention) and Wave 2 (exposed to the regulatory intervention). The sample weight for individuals in Wave 1 were calculated using the Eq. 1/ (1-propensity score). The sample weight for individuals in Wave 2 were calculated using the Eq. 1/propensity score [ 28 ].

We only ran linear models for continuous outcomes since it was not possible to run PS-weighted multilevel models with this sample size in Stata. We conducted all statistical analyses in Stata version 16.0.

Participant sample

In our primary, longitudinal analyses, we analysed data from 7,054 children and adolescents. The mean age was 12.3 years (SD, 2.4) and 3,477 (49.3%) were girls (Table  2 ). More detailed information on characteristics of subgroups in the longitudinal sample are presented in the Supplementary Tables 2–5, Additional File 2 .

Primary outcomes

Children and adolescents reported a reduction in their daily mean total sedentary behaviour time by 13.8% (95% CI: -15.9 to -11.7), or 46 min, on average between Waves 1 and 2. Participants were also less likely to report having increased their time spent on homework (adjusted odd ratio/AOR: 0.39; 95% CI: 0.35–0.43) and in out-of-campus learning (AOR: 0.53; 95% CI: 0.47 to 0.59) in Wave 2 in comparison to Wave 1, respectively (Tables  3 and 4 ). We did not find any changes in electronic device use time.

Secondary outcomes

Participants reported reducing their mean daily screen-viewing time by 6.4% (95% CI: -9.6 to -3.3%), or 10 min, on average (Tables  3 and 4 ). Participants were also 20% as likely to meet international screen time recommendations (AOR: 1.20; 95% CI: 1.09 to 1.32) and were 2.79 times as likely to meet the regulatory requirement on homework time (95% CI: 2.47 to 3.14) compared to the reference group (before the introduction of the regulation).

Subgroup analyses

Most screen- and study-related sedentary behaviour outcomes differed by education stage ( p  < 0.005) (see Supplementary Tables 6–13, Additional File 2 ), with the reductions being larger in secondary school pupils than in primary school pupils (Tables  3 and 4 , and Table  5 ). Only secondary school pupils reduced their total screen-viewing time (-8.4%; 95% CI: -12.4 to -4.3) and were also 1.41 times as likely to meet screen-viewing recommendations (AOR: 1.41; 95% CI: 1.23 to 1.61) at Wave 2 compared to Wave 1.

Conversely, at Wave 2, primary school pupils reported a lower likelihood of spending more time doing homework (AOR: 0.30; 95%: 0.26 to 0.34) than secondary school pupils (AOR: 0.58; 95% CI: 0.50 to 0.67) compared to their counterparts at Wave 1. At Wave 2, primary school pupils also had a higher likelihood of reporting meeting homework time recommendations (AOR: 3.61; 95% CI: 3.09 to 4.22) than secondary school pupils (middle- and high school) (AOR: 2.11; 95% CI: 1.74 to 2.56) compared to their counterparts at Wave 1 (Table  5 ). There was also a residence interaction effect ( p  < 0.001) in total sedentary behaviour time, with participants in urban areas reporting larger reductions (-15.3%; 95% CI: -17.8 to -12.7) than those in rural areas (-11.2%; 95% CI: -15.0 to -7.4). There was no evidence of modifying effects by children’s sex or baseline weight status (Tables  4 and 5 ).

Findings from the exploratory repeated cross-sectional analyses were similar to the findings of the main longitudinal analyses including total sedentary behaviour time, electronic device use time, total screen-viewing time and internet use time (see Supplementary Tables 14–23, Additional File 2 ).

Principal findings

Our study evaluated the impact of the world’s first regulatory, multi-setting intervention on multiple types of sedentary behaviour among school-aged children and adolescents in China. We found that children and adolescents reduced their total sedentary behaviour time, screen-viewing time, homework time and out-of-campus learning time following its implementation. The positive intervention effects on total screen-viewing time (-8.4 vs. -2.3%), and the likelihood of meeting recommendations on screen-viewing time (1.41 vs. 1.02 AOR) were more pronounced in secondary school pupils compared with primary school pupils. Intervention effects on total sedentary behaviour time (-15.3 vs. -11.2%) were more pronounced among pupils living in the urban area (compared to pupils living in the rural area). These subgroup differences imply that the regulatory intervention benefit more the groups known to have a higher rate of sedentary behaviour [ 29 ].

Interestingly, the observed reduction in electronic device use itself did not reach statistical significance following implementation of regulation. This could be viewed as a positive outcome if this is correctly inferred and not the result of reporting bias or measurement error. International data indicated that average sedentary and total screen time have increased among children due to the COVID-19 pandemic [ 12 ]. However, such interesting finding might be explained by the absence of lockdowns in Guangxi during both surveillance waves when most school-aged students outside China were affected by pandemic mitigation measures such as online learning.

Strengths and weaknesses

Our study has several notable strengths. This is the first study to evaluate the impact of multi-setting nationwide regulations on multiple types of sedentary behaviour in a large and regionally representative sample of children and adolescents. Still, to gain a more comprehensive view of the regulatory intervention on sedentary behaviour across China, similar evaluation research should be conducted in other regions of China. Furthermore, access to a rich longitudinal dataset allowed for more robust claims of causality. The available data also allowed us to measure the effect of the intervention on multiple sedentary behaviours including recreational screen-time and academic-related behaviours. Lastly, the large data set allowed us to explore whether the effect of the regulatory intervention varied across important subgroups, suggesting areas for further research and development.

Some limitations need to be taken into consideration when interpreting our findings. First, a common limitation in non-controlled/non-randomised intervention studies is residual confounding. We aimed to limit this by adjusting our analysis for confounders known to impact the variables of interest, but it is impossible to know whether important confounding may still have been present. With maturation bias, it is possible that secular trends are the cause for any observed effects. However, this seems unlikely in our study as older children may spend more time doing homework [ 23 ] and engage more in screen-viewing activities [ 30 ]. In this study, we observed reductions in these outcomes. The use of self-reported outcomes (social desirability bias) was a limitation and might have led to the intervention effects being over-estimated [ 13 ]. However, since our data were collected as part of a routine surveillance programme, pupils were unaware of the evaluation. This might mitigate reporting bias. In addition, the data were collected in Guangxi which might not representative of the whole population in China. Another limitation is using electronic device use time as a proxy measure of online gaming time. It is possible that electronic devices can be used for other purposes. However, mobile phones, handheld game consoles and tablets are the main devices used for online gaming. In this study, electronic device use time provided a practical means of assessing the broad effects of regulatory measures on screen time behaviours, including online gaming, in a large (province level) surveillance programme. In the future, instruments specifically designed to capture online gaming behaviour should be used in surveillance and research work.

Comparisons with other studies

Neither China nor other countries globally have previously implemented and evaluated multi-setting regulatory interventions on multiple types of sedentary behaviour, which makes comparative discussions challenging. In general, results of health behaviour research over the past decades have shown that interventions that address structural and environmental determinants of multiple behaviours to be more effective in comparison with individual-focussed interventions [ 31 ]. Furthermore, the continuous and universal elements of regulatory interventions may be particularly important explanations for the observed reductions in sedentary behaviour. Standalone school and other institution-led interventions may struggle with financial and logistic costs which threaten long-term implementation [ 13 ]. In contrast, the universality element of regulatory intervention can reduce or remove peer pressures and potential stigmatisation among children and teachers that are often associated with more selective/targeted interventions [ 24 ]. Our findings support WHO guidelines for physical activity and sedentary behaviour that encourage sustainable and scalable approaches for limiting sedentary behaviour and call for more system-wide policies to improve this global challenge[ 8 ].

Implications for future policy and research

Our study has important implications for future research and practice both nationally and internationally. Within China, future research should focus on optimising the implementation of the regulatory intervention through implementation research and assess long-term effects of the regulation on both behavioral and health outcomes. Internationally, our findings also provide a promising policy avenue for other countries and communities outside of China to explore the opportunities and barriers to implement such programmes on sedentary behaviour. This exploratory process could start with assessing how key stakeholders (including school-aged children, parents/carers, schoolteachers, health professionals, and policy makers) within different country contexts perceive regulatory actions as an intervention approach for improving health and wellbeing in young people, and how they can be tailored to fit their own contexts. Within public health domains, including healthy eating promotion, tobacco and alcohol control, regulatory intervention approaches (e.g., smoking bans and sugar taxation) have been adopted. However, regulatory actions for sedentary behaviour are scarce [ 19 ]. Within the education sector, some countries recently banned mobile phone use in schools for academic purpose [ 25 ]. While this implies potential feasibility and desirability of such interventions internationally, there is little research on the demand for, and acceptability of, multi-faceted sedentary behaviour regulatory interventions for the purpose of improving health and wellbeing. It will be particularly important to identify and understand any differences in perceptions and feasibility both within (e.g., public versus policy makers) and across countries of differing socio-cultural-political environments.

This natural experiment evaluation indicates that a multi-setting, regulatory intervention on sedentary behaviour has been effective in reducing total sedentary behaviour, and multiple types of sedentary behaviour among Chinese school-aged children and adolescents. Contextually appropriate, regulatory interventions on sedentary behaviour could be explored and considered by researchers and policy makers in other countries.

Data availability

Access to anonymised data used in this study can be requested through the corresponding author BL, subject to approval by the Guangxi CDC. WZ and SVP have full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Abbreviations

Centre for disease control and prevention

Directed acyclic graph

Gross domestic product

Metabolic equivalents

Organisation for Economic Co-operation and Development

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Acknowledgements

We would like to acknowledge Dr Peter Green and Dr Ruth Salway for providing feedback on the initial data analysis plan, and Dr Hugo Pedder and Lauren Scott who provided feedback on the statistical analyses.

This work was funded by the Wellcome Trust through the Global Public Health Research Strand, Elizabeth Blackwell Institute for Health Research. The funder of our study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Bai Li, Remco Peters & Charlie Foster

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Selene Valerino-Perea

Department of Nutrition and School Health, Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China

Weiwen Zhou

School of Public Health, Guangxi Medical University, Nanning, Guangxi, China

Yihong Xie, Zouyan He & Yunfeng Zou

Centre for Health, Law, and Society, School of Law, University of Bristol, Bristol, UK

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Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

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BL conceived the study idea and obtained the funding with support from WZ, CF, KS, YX, YZ, ZH and RP. BL, CF, FdV and KS designed the study. WZ led data collection and provided access to the data. YX, SVP and ZH cleaned the data. SVP analysed the data with guidance from BL, FdV and CF. BL, SVP and RP drafted the paper which was revised by other authors. All authors read and approved the final manuscript for submission.

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Correspondence to Bai Li .

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Ethics approvals were granted by the School for Policy Studies Research Ethics Committee at the University of Bristol (reference number SPSREC/20–21/168) and the Research Ethics Committee at Guangxi Medical University (reference number 0136). Written informed consent was obtained from each participant, and a parent or guardian for participants aged < 20 years.

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Li, B., Valerino-Perea, S., Zhou, W. et al. The impact of the world’s first regulatory, multi-setting intervention on sedentary behaviour among children and adolescents (ENERGISE): a natural experiment evaluation. Int J Behav Nutr Phys Act 21 , 53 (2024). https://doi.org/10.1186/s12966-024-01591-w

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Received : 20 December 2023

Accepted : 04 April 2024

Published : 13 May 2024

DOI : https://doi.org/10.1186/s12966-024-01591-w

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• Sedentary behaviour
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