ASSOCIATION OF SCREEN TIME WITH BMI AND ACADEMIC PERFORMANCE AMONG CHILDREN AGED 6-17 YEARS IN TIRANA

Abstract

Excessive engagement with screen-based devices has emerged as a significant behavioral risk factor in childhood, contributing to sedentary lifestyles and increasing rates of overweight and obesity. Although extensive international research has documented these associations, evidence from Balkan countries remains limited, particularly regarding the combined relationship between screen exposure, body mass index (BMI), and academic performance. The aim of this study was to assess the relationship of daily screen time with BMI status, and academic achievement in schoolchildren aged 6 to 17 years in Tirana, Albania. The research was a descriptive analytical, cross-sectional and observational study conducted in 2025, with 600 pupils selected through a multi-stage probabilistic sampling procedure from public schools. The data collection instrument was a structured questionnaire, designed based on international literature. Variables included socio-demographic characteristics, sleep duration, physical activity, BMI, academic performance, and screen exposure. Screen time was categorized as ≤2 hours/day and >2 hours per day, while BMI was determined in three categories: underweight, healthy weight, and overweight / obese. Nonparametric tests such as Chi-Square, Mann Whintey U and binary logistic regression were used in the analysis. The level of statistical significance was set at 0.05. Overall, 26.3% of participants reported more than two hours of daily screen exposure. Schoolchildren who spent more than 2 hours/ day on screens were significantly more likely to belong to higher BMI categories. Chi-square analysis demonstrated a significant relationship between daily digital use and BMI categories (χ² = 23.743, df = 2, p = 0.000). Watching TV during a meal was significantly related to higher BMI. (χ²=8.500; p=0.014). Pupils with normal BMI achieved significantly better academic results than their overweight/obese peers (p<0.001). Furthermore, prolonged screen time was independently associated with poorer academic outcomes (χ² = 35.033, df = 2, p<0.01). Binary logistic regression indicated that age (OR=1.323; 95%CI: 1.232-1.422; p=0.000) and male gender (OR=2.098; 95%CI: 1.377-3.196; p= 0.000) were associated with higher odds of excessive time spent using a device such as a computer, television, or iPad (>2 hours per day). An increased BMI was a risk factor (OR=1.059; 95%CI: 0.999-1.123; p=0.054). Longer sleep duration (≥9 hours/night) was a protective factor (OR=0.547; 95%CI: 0.352-0.848; p=0.007), and regular physical activity reduced the odds of excessive screen time (OR=1.681 for non-active participants; 95%CI: 1.002-2.818; p=0.049). These results emphasize interrelationship between sedentary behavior, weight status, sleep patterns, and educational attainment. Comprehensive public health strategies aimed at moderating screen exposure and promoting healthier daily routines are warranted to improve both physical health and academic performance among schoolchildren.