ABSTRACT Background The preschool years are a crucial period for development. Stable environments and responsive caregivers support children's cognitive and motor development, two interrelated and essential domains. Caregiver smartphone use in front of children may reduce attention and responsiveness, which have been negatively associated with young children's health and development. We examined associations between the frequency of caregiver smartphone use in a child's presence and motor skills and executive functions, and whether these associations vary by country income level. Methods We analysed cross‐sectional data from 27 countries participating in the SUNRISE International Study. Caregivers reported the frequency of smartphone use in the child's presence across five scenarios: mealtime, playtime, travel, walk and bedtime routines. Children's motor skills were assessed using four established tests. Early Years Toolbox games were used to assess children's visual–spatial working memory and inhibition. Mixed‐effects linear regression models were used to assess the associations, including interaction terms to test variation by country income level. Models were adjusted for the child's sex, age, daily screen time, time spent outdoors, sleep duration and the caregiver's highest level of education. Results The analytical sample included 2232 preschoolers (mean age = 4.2 ± 0.6 years, 50.9% girls). In fully adjusted models, the frequency of caregiver smartphone use in a child's presence was not associated with gross motor skills, fine motor skills, visual–spatial working memory or inhibition (all p > 0.05). Results did not differ by country income level. Conclusions Findings suggest that the frequency of caregiver smartphone use in a child's presence alone may not be associated with performance on motor skills and executive function. There is a need for more sensitive measures that capture the frequency, duration and context of interruptions and more longitudinal studies that examine motor development and cognition. Future research should also account for socioeconomic and demographic diversity, environmental factors and cultural context when assessing such associations.

OBJECTIVES To estimate the proportion of children who meet the restrained sitting guidelines (i.e. <1 h in continuous restrained sedentary). The secondary aim was to determine which factors contribute to the probability a child will meet the restrained sitting guidelines. DESIGN Secondary data analysis of 32 countries participating in the SUNRISE International Study. METHODS Parent surveys were used to collect child demographic information and total restrained sitting. Physical activity was assessed with an accelerometer (ActiGraph wGT3X-BT). A generalized linear mixed model was used to determine the probability of a child meeting the restrained sitting guidelines based on sex, age, geographic region, time spent in a vehicle, and hours of total physical activity. Separate models were run by country income level. RESULTS Final analysis included 2647 children (4.3 ± 0.5 years, 50.6% girls, 49.0% rural). Overall, 81.9% of participants met the restrained sitting guidelines. Odds of meeting the guidelines were 35% lower for children in urban areas and 71% lower for spending 60 min or more in a vehicle. Every additional hour of physical activity increased the odds of meeting the guidelines by a factor of 1.25. These relationships differed when stratified by country income level. CONCLUSIONS While most children meet the guidelines, a focus on children living in urban areas, spending more time in vehicles, and those who engage in less physical activity is warranted.

ABSTRACT Background Early childhood and education centres (ECECs) are key settings in the promotion of healthy levels of outdoor play and napping among young children. Aim This study aimed to examine the associations between environmental factors and preschoolers' outdoor play and napping in ECECs across an international sample. Methods Data from 187 ECECs in 27 countries (22 low‐ and middle–income countries) that participated in the third pilot phase (January 2021–April 2025) of the SUNRISE International Study were analysed. The director of each ECEC completed a questionnaire which asked if children participating in the SUNRISE Study were unable to participate in outdoor play and nap time due to a range of environmental barriers. Results Forty‐six percent (n = 86) of ECECs reported at least one environmental factor that prevented preschoolers' outdoor play, and 20% (n = 37) reported at least one factor that disrupted naptime. Hot and cold temperatures, rain and other factors were observed as barriers to outdoor play across regions and country income levels. Indoor noise, extreme temperatures, brightness and lack of space were reported as disrupting preschoolers' naptime across regions and country income levels. For rural ECECs, hot temperatures and lack of space were barriers for outdoor play and napping, respectively. Conclusions Context‐specific strategies are required to create climate‐resilient outdoor play spaces and more restful napping environments to optimise early childhood development within ECECs.

ABSTRACT Objective To examine the associations between parent perceived environmental factors, nighttime sleep duration and 24-h sleep duration among an international sample of preschool-aged children. Methods Secondary analyses of cross-sectional data from preschoolers across 23 countries (19 LMICs), collected during the third pilot phase (January 2021–August 2024) of the SUNRISE Study. Parents completed a questionnaire which asked about their child’s sleep patterns and environmental factors that impacted their child’s sleep in the previous 3 days. Results Data from 2,219 children were analyzed. A significant difference was observed between nighttime sleep (F = 14.27, p = <0.0001) and nap duration (F = 9.10, p = 0.0004) across country income level. Environmental factors such as heat (−12.87, 95% CI: −11.54, −0.61) and cold (−17.70, 95% CI: −34.53, −0.85) were negatively associated with nighttime sleep duration. Conclusions Public health researchers and professionals should prioritize context-specific strategies to minimize the impact of weather conditions on sleep to promote healthy levels of sleep among preschoolers from diverse settings.

BACKGROUND Few questionnaires with established measurement properties can globally measure sleep in preschoolers and sleep-related family practices. OBJECTIVE To examine (1) concurrent validity of the SUNRISE parent questionnaire against an accelerometer for measuring sleep in preschoolers and (2) test-retest reliability of the questionnaire for sleep and related family practices. METHODS Sleep was measured using the questionnaire and Actigraph GTX3+ accelerometer using a decision-tree algorithm and the Sadeh algorithm in 1737 preschoolers (4.4±0.6years) from 30 countries. Concurrent validity was examined using correlation analysis (duration, timing, and quality), paired t test or the Wilcoxon signed-rank test, Bland-Altman plot (duration, timing), and analysis of sensitivity, specificity, and accuracy (variability). Test-retest variability was examined for sleep and family practice variables in a subsample of 163 participants (4.3±0.6years) from eight countries. RESULTS Questionnaire measures of sleep timing and duration were correlated with the accelerometer measures (r=0.43-0.75; p<.001). Although statistically significant mean differences were observed between questionnaire and accelerometer measures of sleep timing and duration variables, the difference in nighttime sleep duration had a small effect size (-14 min/d; Cohen's d=-0.2). The questionnaire was less able to provide adequate measurement for sleep quality and variability. High levels of reliability were observed for sleep (ICC=0.63-0.83; Kappa=0.53-0.62) and family practice (ICC=0.81-0.94; Kappa=0.73-0.86) variables. CONCLUSION The SUNRISE questionnaire appears reliable in assessing preschooler sleep characteristics and related family practices, particularly in disadvantaged settings. It could be used in global surveillance of nighttime sleep duration and in studies examining associations of sleep timing and duration with health indicators in preschoolers.

BACKGROUND Environmental factors influence children's development. However, their impact on outdoor play among children from international settings remains understudied. This study examined associations between parent perceptions of environmental factors and outdoor play among an international sample of preschool-aged children. METHODS Data were sourced from the pilot phases of the SUNRISE International Study of Movement Behaviors in the Early Years. Parents completed a questionnaire about their child's outdoor play and environmental factors that influenced their child's participation in outdoor play in the past 3 days. RESULTS 1855 children from 19 countries (16 low- and middle-income countries) were examined. Heat (-25.6; 95% CI, -44.6 to -6.6), cold (-26.9; 95% CI, -45.9 to -8.4), and rain (-24.8; 95% CI, -43.3 to -6.6) were negatively associated with weekday outdoor play. Cold (-41.2; 95% CI, -62.4 to -20.0) and social instability (-40.7; 95% CI, -61.5 to -20.3) were negatively associated with weekend outdoor play. Playing at friend's or relative's homes (29.5 [95% CI, 18.6 to 40.5]; 37.9 [25.6 to 50.4]), greenspaces (23.1 [95% CI, 9.6 to 36.6]; 30.4 [95% CI, 15.1 to 45.8]), and on the street (41.4 [95% CI, 26.9 to 55.7]; 34.9 [95% CI, 18.2 to 51.3]) were associated with weekday and weekend day outdoor play, respectively. Playing on the family's property was also associated with weekend day outdoor play (25.5 [95% CI, 18.2 to 51.3]). CONCLUSIONS The environmental context is important to consider when developing interventions to promote outdoor play in young children across diverse international settings. Future research from representative populations is needed to confirm these findings.

Abstract Study Objectives To examine (1) multidimensional sleep profiles in preschoolers (3–6 years) across geocultural regions and (2) differences in sleep characteristics and family practices between Majority World regions (Pacific Islands, Sub-Saharan Africa, Eastern Europe, Northeast Asia, Southeast Asia, South Asia, the Middle East and North Africa, and Latin America) and the Minority World (the Western world). Methods Participants were 3507 preschoolers from 37 countries. Nighttime sleep characteristics and nap duration (accelerometer: n = 1950) and family practices (parental questionnaire) were measured. Mixed models were used to estimate the marginal means of sleep characteristics by region and examine the differences. Results Geocultural region explained up to 30% of variance in sleep characteristics. A pattern of short nighttime sleep duration, low sleep efficiency, and long nap duration was observed in Eastern Europe, Northeast Asia, and Southeast Asia. The second pattern, with later sleep midpoints and greater night-to-night sleep variability, was observed in South Asia, the Middle East and North Africa, and Latin America. Compared to the Minority World, less optimal sleep characteristics were observed in several Majority World regions, with medium-to-large effect sizes (∣d∣=0.48–2.35). Several Majority World regions reported more frequent parental smartphone use during bedtime routines (Northeast Asia, Southeast Asia: 0.77–0.99 units) and were more likely to have electronic devices in children’s bedroom (Eastern Europe, Latin America, South Asia: OR = 5.97–16.57) and co-sleeping arrangement (Asia, Latin America: OR = 7.05–49.86), compared to the Minority World. Conclusions Preschoolers’ sleep profiles and related family practices vary across geocultural regions, which should be considered in sleep health promotion initiatives and policies.

There is little knowledge about within- and between-referee variation (WBRV) in cardiovascular responses (CVR) and locomotor game demands (LMD). Thus, the primary aim of this study was to assess the WBRV of CVR and LMD in male basketball referees during elite international games in preparation [e.g., warm-up (WU) and re-warm-up (R-WU)] and active game phases. The secondary aim was to explore quarter-by-quarter differences in CVR and LMD. Thirty-five international male referees took part in this study (age, 40.4 ± 5.4 years; body height, 184.9 ± 5.7 cm; body weight, 85.1 ± 7.5 kg; BMI, 24.0 ± 1.7 kg × m−2; fat%, 18.8 ± 4.7% and VO2max, 50.4 ± 2.2 L × kg−1 × min−1. In total, 76 games (e.g., 228 officiating cases) were analyzed during the FIBA elite men’s competition. They officiated 4.5 games on average (range 3–9 games). Each referee used the Polar Team Pro system to measure CVR [e.g., heart rate (HR), time spent in different HR intensity categories] and LMD (e.g., distance covered, maximal and average velocity, and number of accelerations). Results showed that the referees had bigger WBRV during the active and preparation (e.g., W-U than R-WU) phase when variables of higher CVR and LMD intensity were observed (e.g., time spent at higher HR zones, distance covered in higher speed zones). The WBRV, CVR, and LMD were higher during WU than R-WU. Moreover, the referees had a lower CVR and LMD in the second half. In conclusion, the referees should establish and follow consistently a game-to-game preparation routine and attempt to spread their on-court preparation time equally within the crew. A half-time preparation routine should be improved to re-establish a sufficient activation level similar to that achieved in pre-game preparation.

The actions required to achieve higher-quality and harmonised global surveillance of child and adolescent movement behaviours (physical activity, sedentary behaviour including screen time, sleep) are unclear. To identify how to improve surveillance of movement behaviours, from the perspective of experts. This Delphi Study involved 62 experts from the SUNRISE International Study of Movement Behaviours in the Early Years and Active Healthy Kids Global Alliance (AHKGA). Two survey rounds were used, with items categorised under: (1) funding, (2) capacity building, (3) methods, and (4) other issues (e.g., policymaker awareness of relevant WHO Guidelines and Strategies). Expert participants ranked 40 items on a five-point Likert scale from ‘extremely’ to ‘not at all’ important. Consensus was defined as > 70% rating of ‘extremely’ or ‘very’ important. We received 62 responses to round 1 of the survey and 59 to round 2. There was consensus for most items. The two highest rated round 2 items in each category were the following; for funding (1) it was greater funding for surveillance and public funding of surveillance; for capacity building (2) it was increased human capacity for surveillance (e.g. knowledge, skills) and regional or global partnerships to support national surveillance; for methods (3) it was standard protocols for surveillance measures and improved measurement method for screen time; and for other issues (4) it was greater awareness of physical activity guidelines and strategies from WHO and greater awareness of the importance of surveillance for NCD prevention. We generally found no significant differences in priorities between low-middle-income (n = 29) and high-income countries (n = 30) or between SUNRISE (n = 20), AHKGA (n = 26) or both (n = 13) initiatives. There was a lack of agreement on using private funding for surveillance or surveillance research. This study provides a prioritised and international consensus list of actions required to improve surveillance of movement behaviours in children and adolescents globally.