Background: The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. Objective: The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children’s anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic. Methods: In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality. Results: On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root–transformed self-reported anxiety scores was greater in the intervention (–0.23, 95% CI –0.27 to –0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference –0.36, 95% CI –0.63 to –0.08; P=.02). There was a significant reduction in square-root–transformed eye strain in the intervention group (–0.08, 95% CI –0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference –0.15, 95% CI –0.26 to –0.03; P=.02). Change in sleep quality was similar between the two groups. Conclusions: This digital behavior change intervention reduced children’s anxiety and eye strain during COVID-19–associated online schooling. Trial Registration: ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097

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中文翻译：

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在COVID-19在家上学期间为儿童进行对等实时流式干预，以促进体力活动并减少焦虑和眼睛疲劳：群集随机对照试验

背景：COVID-19大流行导致全球学校停课，数百万儿童被限制在家中进行在线学习。结果，儿童可能容易出现焦虑症和数位眼疲劳，这突出表明需要进行人口干预。目的：我们的研究目的是调查旨在促进体育锻炼的数字行为改变干预措施是否可以减少在COVID-19大流行期间接受长时间家庭学习时儿童的焦虑和数字眼疲劳。方法：在该整群随机对照试验中，通过当地学校招募了华南地区12所中学的7年级在家上学的学生，并由学校随机分配以接受（1：1分配）：（1）促进运动和眼力的健康教育信息松弛，并通过实时流式传输和同伴共享推广活动（干预）或（2）仅接受健康教育信息（控制）来访问数字行为改变干预措施。主要结局是自我报告的焦虑评分改变。次要结果包括自我报告的眼疲劳和睡眠质量的变化。结果：2020年3月16日，对1009名儿童进行了评估，并将954名（94.5％）符合条件的同意家庭的儿童纳入了治疗意向分析。干预组（n = 485，6所学校）和对照组（n = 469，6所学校）中的儿童年龄为13.5（SD 0.5）岁，男性为52.3％（n = 499）。分配的干预措施由896名儿童完成（干预：n = 467，96.3％；对照组：n = 429，91.5％）。干预后平方根变换的自我报告的焦虑评分的2周变化更大（–0。23、95％CI –0.27至–0.20）与对照组（0.12，95％CI 0.09-0.16；未调整差–0.36，95％CI –0.63至–0.08； P = .02）。与对照组（0.07，95％CI 0.05-0.09；相差–0.15，95％CI –）相比，干预组的平方根转化眼疲劳显着减少（–0.08，95％CI –0.10至0.06）。 0.26至–0.03； P = .02）。两组的睡眠质量变化相似。结论：这种数字化行为改变干预措施减少了与COVID-19相关的在线教育期间儿童的焦虑和眼睛疲劳。试用注册：ClinicalTrials.gov NCT04309097；http://clinicaltrials.gov/ct2/show/NCT04309097 与对照组（0.07，95％CI 0.05-0.09；相差–0.15，95％CI –）相比，干预组的平方根转化眼疲劳显着减少（–0.08，95％CI –0.10至0.06）。 0.26至–0.03； P = .02）。两组的睡眠质量变化相似。结论：这种数字化行为改变干预措施减少了与COVID-19相关的在线教育期间儿童的焦虑和眼睛疲劳。试用注册：ClinicalTrials.gov NCT04309097；http://clinicaltrials.gov/ct2/show/NCT04309097 与对照组（0.07，95％CI 0.05-0.09；相差–0.15，95％CI –）相比，干预组的平方根转化眼疲劳显着减少（–0.08，95％CI –0.10至0.06）。 0.26至–0.03； P = .02）。两组的睡眠质量变化相似。结论：这种数字化行为改变干预措施减少了与COVID-19相关的在线教育期间儿童的焦虑和眼睛疲劳。试用注册：ClinicalTrials.gov NCT04309097；http://clinicaltrials.gov/ct2/show/NCT04309097 这种数字行为改变干预措施减少了与COVID-19相关的在线教育期间儿童的焦虑和眼睛疲劳。试用注册：ClinicalTrials.gov NCT04309097；http://clinicaltrials.gov/ct2/show/NCT04309097 这种数字行为改变干预措施减少了与COVID-19相关的在线教育期间儿童的焦虑和眼睛疲劳。试用注册：ClinicalTrials.gov NCT04309097；http://clinicaltrials.gov/ct2/show/NCT04309097

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