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Health Hazards of Homework

March 18, 2014 | Julie Greicius Pediatrics .

A new study by the Stanford Graduate School of Education and colleagues found that students in high-performing schools who did excessive hours of homework “experienced greater behavioral engagement in school but also more academic stress, physical health problems, and lack of balance in their lives.”

Those health problems ranged from stress, headaches, exhaustion, sleep deprivation, weight loss and stomach problems, to psycho-social effects like dropping activities, not seeing friends or family, and not pursuing hobbies they enjoy.

In the Stanford Report story about the research, Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of the  study published in the  Journal of Experimental Education , says, “Our findings on the effects of homework challenge the traditional assumption that homework is inherently good.”

The study was based on survey data from a sample of 4,317 students from 10 high-performing high schools in California communities in which median household income exceeded $90,000. Of the students surveyed, homework volume averaged about 3.1 hours each night.

“It is time to re-evaluate how the school environment is preparing our high school student for today’s workplace,” says Neville Golden, MD , chief of adolescent medicine at Stanford Medicine Children’s Health and a professor at the School of Medicine. “This landmark study shows that excessive homework is counterproductive, leading to sleep deprivation, school stress and other health problems. Parents can best support their children in these demanding academic environments by advocating for them through direct communication with teachers and school administrators about homework load.”

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More than two hours of homework may be counterproductive, research suggests.

A Stanford education researcher found that too much homework can negatively affect kids, especially their lives away from school, where family, friends and activities matter.   "Our findings on the effects of homework challenge the traditional assumption that homework is inherently good," wrote Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of a study published in the Journal of Experimental Education .   The researchers used survey data to examine perceptions about homework, student well-being and behavioral engagement in a sample of 4,317 students from 10 high-performing high schools in upper-middle-class California communities. Along with the survey data, Pope and her colleagues used open-ended answers to explore the students' views on homework.   Median household income exceeded $90,000 in these communities, and 93 percent of the students went on to college, either two-year or four-year.   Students in these schools average about 3.1 hours of homework each night.   "The findings address how current homework practices in privileged, high-performing schools sustain students' advantage in competitive climates yet hinder learning, full engagement and well-being," Pope wrote.   Pope and her colleagues found that too much homework can diminish its effectiveness and even be counterproductive. They cite prior research indicating that homework benefits plateau at about two hours per night, and that 90 minutes to two and a half hours is optimal for high school.   Their study found that too much homework is associated with:   • Greater stress : 56 percent of the students considered homework a primary source of stress, according to the survey data. Forty-three percent viewed tests as a primary stressor, while 33 percent put the pressure to get good grades in that category. Less than 1 percent of the students said homework was not a stressor.   • Reductions in health : In their open-ended answers, many students said their homework load led to sleep deprivation and other health problems. The researchers asked students whether they experienced health issues such as headaches, exhaustion, sleep deprivation, weight loss and stomach problems.   • Less time for friends, family and extracurricular pursuits : Both the survey data and student responses indicate that spending too much time on homework meant that students were "not meeting their developmental needs or cultivating other critical life skills," according to the researchers. Students were more likely to drop activities, not see friends or family, and not pursue hobbies they enjoy.   A balancing act   The results offer empirical evidence that many students struggle to find balance between homework, extracurricular activities and social time, the researchers said. Many students felt forced or obligated to choose homework over developing other talents or skills.   Also, there was no relationship between the time spent on homework and how much the student enjoyed it. The research quoted students as saying they often do homework they see as "pointless" or "mindless" in order to keep their grades up.   "This kind of busy work, by its very nature, discourages learning and instead promotes doing homework simply to get points," said Pope, who is also a co-founder of Challenge Success , a nonprofit organization affiliated with the GSE that conducts research and works with schools and parents to improve students' educational experiences..   Pope said the research calls into question the value of assigning large amounts of homework in high-performing schools. Homework should not be simply assigned as a routine practice, she said.   "Rather, any homework assigned should have a purpose and benefit, and it should be designed to cultivate learning and development," wrote Pope.   High-performing paradox   In places where students attend high-performing schools, too much homework can reduce their time to foster skills in the area of personal responsibility, the researchers concluded. "Young people are spending more time alone," they wrote, "which means less time for family and fewer opportunities to engage in their communities."   Student perspectives   The researchers say that while their open-ended or "self-reporting" methodology to gauge student concerns about homework may have limitations – some might regard it as an opportunity for "typical adolescent complaining" – it was important to learn firsthand what the students believe.   The paper was co-authored by Mollie Galloway from Lewis and Clark College and Jerusha Conner from Villanova University.

Clifton B. Parker is a writer at the Stanford News Service .

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Education scholar Denise Pope has found that too much homework has negative effects on student well-being and behavioral engagement. (Image credit: L.A. Cicero)

A Stanford researcher found that too much homework can negatively affect kids, especially their lives away from school, where family, friends and activities matter.

“Our findings on the effects of homework challenge the traditional assumption that homework is inherently good,” wrote Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of a study published in the Journal of Experimental Education .

The researchers used survey data to examine perceptions about homework, student well-being and behavioral engagement in a sample of 4,317 students from 10 high-performing high schools in upper-middle-class California communities. Along with the survey data, Pope and her colleagues used open-ended answers to explore the students’ views on homework.

Median household income exceeded $90,000 in these communities, and 93 percent of the students went on to college, either two-year or four-year.

Students in these schools average about 3.1 hours of homework each night.

“The findings address how current homework practices in privileged, high-performing schools sustain students’ advantage in competitive climates yet hinder learning, full engagement and well-being,” Pope wrote.

Pope and her colleagues found that too much homework can diminish its effectiveness and even be counterproductive. They cite prior research indicating that homework benefits plateau at about two hours per night, and that 90 minutes to two and a half hours is optimal for high school.

Their study found that too much homework is associated with:

* Greater stress: 56 percent of the students considered homework a primary source of stress, according to the survey data. Forty-three percent viewed tests as a primary stressor, while 33 percent put the pressure to get good grades in that category. Less than 1 percent of the students said homework was not a stressor.

* Reductions in health: In their open-ended answers, many students said their homework load led to sleep deprivation and other health problems. The researchers asked students whether they experienced health issues such as headaches, exhaustion, sleep deprivation, weight loss and stomach problems.

* Less time for friends, family and extracurricular pursuits: Both the survey data and student responses indicate that spending too much time on homework meant that students were “not meeting their developmental needs or cultivating other critical life skills,” according to the researchers. Students were more likely to drop activities, not see friends or family, and not pursue hobbies they enjoy.

A balancing act

The results offer empirical evidence that many students struggle to find balance between homework, extracurricular activities and social time, the researchers said. Many students felt forced or obligated to choose homework over developing other talents or skills.

Also, there was no relationship between the time spent on homework and how much the student enjoyed it. The research quoted students as saying they often do homework they see as “pointless” or “mindless” in order to keep their grades up.

“This kind of busy work, by its very nature, discourages learning and instead promotes doing homework simply to get points,” Pope said.

She said the research calls into question the value of assigning large amounts of homework in high-performing schools. Homework should not be simply assigned as a routine practice, she said.

“Rather, any homework assigned should have a purpose and benefit, and it should be designed to cultivate learning and development,” wrote Pope.

High-performing paradox

In places where students attend high-performing schools, too much homework can reduce their time to foster skills in the area of personal responsibility, the researchers concluded. “Young people are spending more time alone,” they wrote, “which means less time for family and fewer opportunities to engage in their communities.”

Student perspectives

The researchers say that while their open-ended or “self-reporting” methodology to gauge student concerns about homework may have limitations – some might regard it as an opportunity for “typical adolescent complaining” – it was important to learn firsthand what the students believe.

The paper was co-authored by Mollie Galloway from Lewis and Clark College and Jerusha Conner from Villanova University.

Media Contacts

Denise Pope, Stanford Graduate School of Education: (650) 725-7412, [email protected] Clifton B. Parker, Stanford News Service: (650) 725-0224, [email protected]

Homework could have an impact on kids’ health. Should schools ban it?

Professor of Education, Penn State

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Gerald K. LeTendre has received funding from the National Science Foundation and the Spencer Foundation.

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Reformers in the Progressive Era (from the 1890s to 1920s) depicted homework as a “sin” that deprived children of their playtime . Many critics voice similar concerns today.

Yet there are many parents who feel that from early on, children need to do homework if they are to succeed in an increasingly competitive academic culture. School administrators and policy makers have also weighed in, proposing various policies on homework .

So, does homework help or hinder kids?

For the last 10 years, my colleagues and I have been investigating international patterns in homework using databases like the Trends in Mathematics and Science Study (TIMSS) . If we step back from the heated debates about homework and look at how homework is used around the world, we find the highest homework loads are associated with countries that have lower incomes and higher social inequality.

Does homework result in academic success?

Let’s first look at the global trends on homework.

Undoubtedly, homework is a global phenomenon ; students from all 59 countries that participated in the 2007 Trends in Math and Science Study (TIMSS) reported getting homework. Worldwide, only less than 7% of fourth graders said they did no homework.

TIMSS is one of the few data sets that allow us to compare many nations on how much homework is given (and done). And the data show extreme variation.

For example, in some nations, like Algeria, Kuwait and Morocco, more than one in five fourth graders reported high levels of homework. In Japan, less than 3% of students indicated they did more than four hours of homework on a normal school night.

TIMSS data can also help to dispel some common stereotypes. For instance, in East Asia, Hong Kong, Taiwan and Japan – countries that had the top rankings on TIMSS average math achievement – reported rates of heavy homework that were below the international mean.

In the Netherlands, nearly one out of five fourth graders reported doing no homework on an average school night, even though Dutch fourth graders put their country in the top 10 in terms of average math scores in 2007.

Going by TIMSS data, the US is neither “ A Nation at Rest” as some have claimed, nor a nation straining under excessive homework load . Fourth and eighth grade US students fall in the middle of the 59 countries in the TIMSS data set, although only 12% of US fourth graders reported high math homework loads compared to an international average of 21%.

So, is homework related to high academic success?

At a national level, the answer is clearly no. Worldwide, homework is not associated with high national levels of academic achievement .

But, the TIMSS can’t be used to determine if homework is actually helping or hurting academic performance overall , it can help us see how much homework students are doing, and what conditions are associated with higher national levels of homework.

We have typically found that the highest homework loads are associated with countries that have lower incomes and higher levels of social inequality – not hallmarks that most countries would want to emulate.

Impact of homework on kids

TIMSS data also show us how even elementary school kids are being burdened with large amounts of homework.

Almost 10% of fourth graders worldwide (one in 10 children) reported spending multiple hours on homework each night. Globally, one in five fourth graders report 30 minutes or more of homework in math three to four times a week.

These reports of large homework loads should worry parents, teachers and policymakers alike.

Empirical studies have linked excessive homework to sleep disruption , indicating a negative relationship between the amount of homework, perceived stress and physical health.

What constitutes excessive amounts of homework varies by age, and may also be affected by cultural or family expectations. Young adolescents in middle school, or teenagers in high school, can study for longer duration than elementary school children.

But for elementary school students, even 30 minutes of homework a night, if combined with other sources of academic stress, can have a negative impact . Researchers in China have linked homework of two or more hours per night with sleep disruption .

Even though some cultures may normalize long periods of studying for elementary age children, there is no evidence to support that this level of homework has clear academic benefits . Also, when parents and children conflict over homework, and strong negative emotions are created, homework can actually have a negative association with academic achievement.

Should there be “no homework” policies?

Administrators and policymakers have not been reluctant to wade into the debates on homework and to formulate policies . France’s president, Francois Hollande, even proposed that homework be banned because it may have inegaliatarian effects.

However, “zero-tolerance” homework policies for schools, or nations, are likely to create as many problems as they solve because of the wide variation of homework effects. Contrary to what Hollande said, research suggests that homework is not a likely source of social class differences in academic achievement .

Homework, in fact, is an important component of education for students in the middle and upper grades of schooling.

Policymakers and researchers should look more closely at the connection between poverty, inequality and higher levels of homework. Rather than seeing homework as a “solution,” policymakers should question what facets of their educational system might impel students, teachers and parents to increase homework loads.

At the classroom level, in setting homework, teachers need to communicate with their peers and with parents to assure that the homework assigned overall for a grade is not burdensome, and that it is indeed having a positive effect.

Perhaps, teachers can opt for a more individualized approach to homework. If teachers are careful in selecting their assignments – weighing the student’s age, family situation and need for skill development – then homework can be tailored in ways that improve the chance of maximum positive impact for any given student.

I strongly suspect that when teachers face conditions such as pressure to meet arbitrary achievement goals, lack of planning time or little autonomy over curriculum, homework becomes an easy option to make up what could not be covered in class.

Whatever the reason, the fact is a significant percentage of elementary school children around the world are struggling with large homework loads. That alone could have long-term negative consequences for their academic success.

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Homework as a Mental Health Concern It's time for an in depth discussion about homework as a major concern for those pursuing mental health in schools. So many problems between kids and their families, the home and school, and students and teachers arise from conflicts over homework. The topic is a long standing concern for mental health practitioners, especially those who work in schools. Over the years, we have tried to emphasize the idea that schools need to ensure that homework is designed as "motivated practice," and parents need to avoid turning homework into a battleground. These views are embedded in many of the Center documents. At this time, we hope you will join in a discussion of what problems you see arising related to homework and what you recommend as ways to deal with such problems, what positive homework practices you know about, and so forth. Read the material that follows, and then, let us hear from you on this topic. Contact: [email protected] ######################### As one stimulus, here's a piece by Sharon Cromwell from Education World prepared for teachers " The Homework Dilemma: How Much Should Parents Get Involved? " http://www.education-world.com/a_curr/curr053.shtml . What can teachers do to help parents help their children with homework? Just what kind of parental involvement -- and how much involvement -- truly helps children with their homework? The most useful stance parents can take, many experts agree, is to be somewhat but not overly involved in homework. The emphasis needs to be on parents' helping children do their homework themselves -- not on doing it for them. In an Instructor magazine article, How to Make Parents Your Homework Partner s, study-skills consultant Judy Dodge maintains that involving students in homework is largely the teacher's job, yet parents can help by "creating a home environment that's conducive to kids getting their homework done." Children who spend more time on homework, on average, do better academically than children who don't, and the academic benefits of homework increase in the upper grades, according to Helping Your Child With Homework , a handbook by the Office of Education Research and Improvement in the U.S. Department of Education. The handbook offers ideas for helping children finish homework assignments successfully and answers questions that parents and people who care for elementary and junior high school students often ask about homework. One of the Goals 2000 goals involves the parent/school relationship. The goal reads, "Every school will promote partnerships that will increase parental involvement and participation in promoting the social, emotional, and academic growth of children." Teachers can pursue the goal, in part, by communicating to parents their reasons for assigning homework. For example, the handbook states, homework can help children to review and practice what they have learned; prepare for the next day's class; use resources, such as libraries and reference materials; investigate topics more fully than time allows in the classroom. Parents can help children excel at homework by setting a regular time; choosing a place; removing distractions; having supplies and resources on hand; monitoring assignments; and providing guidance. The handbook cautions against actually doing the homework for a child, but talking about the assignment so the child can figure out what needs to be done is OK. And reviewing a completed assignment with a child can also be helpful. The kind of help that works best depends, of course, partly on the child's age. Elementary school students who are doing homework for the first time may need more direct involvement than older students. HOMEWORK "TIPS" Specific methods have been developed for encouraging the optimal parental involvement in homework. TIPS (Teachers Involve Parents in Schoolwork) Interactive Homework process was designed by researchers at Johns Hopkins University and teachers in Maryland, Virginia, and the District of Columbia to meet parents' and teachers' needs, says the Phi Delta Kappa Research Bulletin . The September 1997 bulletin reported the effects of TIPS-Language Arts on middle-grade students' writing skills, language arts report card grades, and attitudes toward TIPS as well as parents' reactions to interactive homework. TIPS interactive homework assignments involve students in demonstrating or discussing homework with a family member. Parents are asked to monitor, interact, and support their children. They are not required to read or direct the students' assignments because that is the students' responsibility. All TIPS homework has a section for home-to-school communication where parents indicate their interaction with the student about the homework. The goals of the TIPS process are for parents to gain knowledge about their children's school work, students to gain mastery in academic subjects by enhancing school lessons at home, and teachers to have an understanding of the parental contribution to student learning. "TIPS" RESULTS Nearly all parents involved in the TIPS program said TIPS provided them with information about what their children were studying in school. About 90 percent of the parents wanted the school to continue TIPS the following year. More than 80 percent of the families liked the TIPS process (44 percent a lot; 36% a little). TIPS activities were better than regular homework, according to 60 percent of the students who participated. About 70 percent wanted the school to use TIPS the next year. According to Phi Delta Kappa Research Bulletin , more family involvement helped students' writing skills increase, even when prior writing skills were taken into account. And completing more TIPS assignments improved students' language arts grades on report cards, even after prior report card grades and attendance were taken into account. Of the eight teachers involved, six liked the TIPS process and intended to go on using it without help or supplies from the researchers. Furthermore, seven of the eight teachers said TIPS "helps families see what their children are learning in class." OTHER TIPS In "How to Make Parents Your Homework Partners," Judy Dodge suggests that teachers begin giving parent workshops to provide practical tips for "winning the homework battle." At the workshop, teachers should focus on three key study skills: Organizational skills -- Help put students in control of work and to feel sure that they can master what they need to learn and do. Parents can, for example, help students find a "steady study spot" with the materials they need at hand. Time-management skills -- Enable students to complete work without feeling too much pressure and to have free time. By working with students to set a definite study time, for example, parents can help with time management. Active study strategies -- Help students to achieve better outcomes from studying. Parents suggest, for instance, that students write questions they think will be on a test and then recite their answers out loud. Related Resources Homework Without Tears by Lee Canter and Lee Hauser (Perennial Library, 1987). A down-to-earth book by well-known experts suggests how to deal with specific homework problems. Megaskills: How Families Can Help Children Succeed in School and Beyond by Dorothy Rich (Houghton Mifflin Company, 1992). Families can help children develop skills that nurture success in and out of school. "Helping Your Student Get the Most Out of Homework" by the National PTA and the National Education Association (1995). This booklet for teachers to use with students is sold in packages of 25 through the National PTA. The Catalog item is #B307. Call 312-549-3253 or write National PTA Orders, 135 South LaSalle Street, Dept. 1860, Chicago, IL 60674-1860. Related Sites A cornucopia of homework help is available for children who use a computer or whose parents are willing to help them get started online. The following LINKS include Internet sites that can be used for reference, research, and overall resources for both homework and schoolwork. Dr. Internet. The Dr. Internet Web site, part of the Internet Public Library, helps students with science and math homework or projects. It includes a science project resource guide Help With Homework. His extensive listing of Internet links is divided into Language Art Links, Science Links, Social Studies Links, Homework Help, Kids Education, and Universities. If students know what they are looking for, the site could be invaluable. Kidz-Net... Links to places where you can get help with homework. An array of homework help links is offered here, from Ask Dr. Math (which provides answers to math questions) to Roget's Thesaurus and the White House. Surfing the Net With Kids: Got Questions? Links to people -- such as teachers, librarians, experts, authors, and other students -- who will help students with questions about homework. Barbara J. Feldman put together the links. Kidsurfer: For Kids and Teens The site, from the National Children's Coalition, includes a Homework/Reference section for many subjects, including science, geography, music, history, and language arts. Homework: Parents' Work, Kid's Work, or School Work? A quick search of this title in the Education Week Archives and you'll find an article presenting a parent's viewpoint on helping children with homework. @#@#@#@@# As another stimulus for the discussion, here is an excerpt from our online continuing education module Enhancing Classroom Approaches for Addressing Barriers to Learning ( https://smhp.psych.ucla.edu ) Turning Homework into Motivated Practice Most of us have had the experience of wanting to be good at something such as playing a musical instrument or participating in a sport. What we found out was that becoming good at it meant a great deal of practice, and the practicing often was not very much fun. In the face of this fact, many of us turned to other pursuits. In some cases, individuals were compelled by their parents to labor on, and many of these sufferers grew to dislike the activity. (A few, of course, commend their parents for pushing them, but be assured these are a small minority. Ask your friends who were compelled to practice the piano.) Becoming good at reading, mathematics, writing, and other academic pursuits requires practice outside the classroom. This, of course, is called homework. Properly designed, homework can benefit students. Inappropriately designed homework, however, can lead to avoidance, parent-child conflicts, teacher reproval, and student dislike of various arenas of learning. Well-designed homework involves assignments that emphasize motivated practice. As with all learning processes that engage students, motivated practice requires designing activities that the student perceives as worthwhile and doable with an appropriate amount of effort. In effect, the intent is to personalize in-class practice and homework. This does not mean every student has a different practice activity. Teachers quickly learn what their students find engaging and can provide three or four practice options that will be effective for most students in a class. The idea of motivated practice is not without its critics. I don't doubt that students would prefer an approach to homework that emphasized motivated practice. But �� that's not preparing them properly for the real world. People need to work even when it isn't fun, and most of the time work isn't fun. Also, if a person wants to be good at something, they need to practice it day in and day out, and that's not fun! In the end, won't all this emphasis on motivation spoil people so that they won't want to work unless it's personally relevant and interesting? We believe that a great deal of learning and practice activities can be enjoyable. But even if they are not, they can be motivating if they are viewed as worthwhile and experienced as satisfying. At the same time, we do recognize that there are many things people have to do in their lives that will not be viewed and experienced in a positive way. How we all learn to put up with such circumstances is an interesting question, but one for which psychologists have yet to find a satisfactory answer. It is doubtful, however, that people have to experience the learning and practice of basic knowledge and skills as drudgery in order to learn to tolerate boring situations. Also in response to critics of motivated practice, there is the reality that many students do not master what they have been learning because they do not pursue the necessary practice activities. Thus, at least for such individuals, it seems essential to facilitate motivated practice. Minimally, facilitating motivated practice requires establishing a variety of task options that are potentially challenging -- neither too easy nor too hard. However, as we have stressed, the processes by which tasks are chosen must lead to perceptions on the part of the learner that practice activities, task outcomes, or both are worthwhile -- especially as potential sources of personal satisfaction. The examples in the following exhibit illustrate ways in which activities can be varied to provide for motivated learning and practice. Because most people have experienced a variety of reading and writing activities, the focus here is on other types of activity. Students can be encouraged to pursue such activity with classsmates and/or family members. Friends with common interests can provide positive models and support that can enhance productivity and even creativity. Research on motivation indicates that one of the most powerful factors keeping a person on a task is the expectation of feeling some sense of satisfaction when the task is completed. For example, task persistence results from the expectation that one will feel smart or competent while performing the task or at least will feel that way after the skill is mastered. Within some limits, the stronger the sense of potential outcome satisfaction, the more likely practice will be pursued even when the practice activities are rather dull. The weaker the sense of potential outcome satisfaction, the more the practice activities themselves need to be positively motivating. Exhibit � Homework and Motivated Practice Learning and practicing by (1) doing using movement and manipulation of objects to explore a topic (e.g., using coins to learn to add and subtract) dramatization of events (e.g., historical, current) role playing and simulations (e.g., learning about democratic vs. autocratic government by trying different models in class; learning about contemporary life and finances by living on a budget) actual interactions (e.g., learning about human psychology through analysis of daily behavior) applied activities (e.g., school newspapers, film and video productions, band, sports) actual work experience (e.g., on-the-job learning) (2) listening reading to students (e.g., to enhance their valuing of literature) audio media (e.g., tapes, records, and radio presentations of music, stories, events) listening games and activities (e.g., Simon Says; imitating rhymes, rhythms, and animal sounds) analyzing actual oral material (e.g., learning to detect details and ideas in advertisements or propaganda presented on radio or television, learning to identify feelings and motives underlying statements of others) (3) looking directly observing experts, role models, and demonstrations visual media visual games and activities (e.g., puzzles, reproducing designs, map activities) analyzing actual visual material (e.g., learning to find and identify ideas observed in daily events) (4) asking information gathering (e.g., investigative reporting, interviewing, and opinion sampling at school and in the community) brainstorming answers to current problems and puzzling questions inquiry learning (e.g., learning social studies and science by identifying puzzling questions, formulating hypotheses, gathering and interpreting information, generalizing answers, and raising new questions) question-and-answer games and activities (e.g., twenty questions, provocative and confrontational questions) questioning everyday events (e.g., learning about a topic by asking people about how it effects their lives) O.K. That's should be enough to get you going. What's your take on all this? What do you think we all should be telling teachers and parents about homework? Let us hear from you ( [email protected] ). Back to Hot Topic Home Page Hot Topic Home Page --> Table of Contents Home Page Search Send Us Email School Mental Health Project-UCLA Center for Mental Health in Schools WebMaster: Perry Nelson ([email protected])

When Is Homework Stressful? Its Effects on Students’ Mental Health

Are you wondering when is homework stressful? Well, homework is a vital constituent in keeping students attentive to the course covered in a class. By applying the lessons, students learned in class, they can gain a mastery of the material by reflecting on it in greater detail and applying what they learned through homework. 

However, students get advantages from homework, as it improves soft skills like organisation and time management which are important after high school. However, the additional work usually causes anxiety for both the parents and the child. As their load of homework accumulates, some students may find themselves growing more and more bored.

Students may take assistance online and ask someone to do my online homework . As there are many platforms available for the students such as Chegg, Scholarly Help, and Quizlet offering academic services that can assist students in completing their homework on time. 

Negative impact of homework

There are the following reasons why is homework stressful and leads to depression for students and affect their mental health. As they work hard on their assignments for alarmingly long periods, students’ mental health is repeatedly put at risk. Here are some serious arguments against too much homework.

No uniqueness

Homework should be intended to encourage children to express themselves more creatively. Teachers must assign kids intriguing assignments that highlight their uniqueness. similar to writing an essay on a topic they enjoy.

Moreover, the key is encouraging the child instead of criticizing him for writing a poor essay so that he can express himself more creatively.

Lack of sleep

One of the most prevalent adverse effects of schoolwork is lack of sleep. The average student only gets about 5 hours of sleep per night since they stay up late to complete their homework, even though the body needs at least 7 hours of sleep every day. Lack of sleep has an impact on both mental and physical health.

No pleasure

Students learn more effectively while they are having fun. They typically learn things more quickly when their minds are not clouded by fear. However, the fear factor that most teachers introduce into homework causes kids to turn to unethical means of completing their assignments.

Excessive homework

The lack of coordination between teachers in the existing educational system is a concern. As a result, teachers frequently end up assigning children far more work than they can handle. In such circumstances, children turn to cheat on their schoolwork by either copying their friends’ work or using online resources that assist with homework.

Anxiety level

Homework stress can increase anxiety levels and that could hurt the blood pressure norms in young people . Do you know? Around 3.5% of young people in the USA have high blood pressure. So why is homework stressful for children when homework is meant to be enjoyable and something they look forward to doing? It is simple to reject this claim by asserting that schoolwork is never enjoyable, yet with some careful consideration and preparation, homework may become pleasurable.

No time for personal matters

Students that have an excessive amount of homework miss out on personal time. They can’t get enough enjoyment. There is little time left over for hobbies, interpersonal interaction with colleagues, and other activities. 

However, many students dislike doing their assignments since they don’t have enough time. As they grow to detest it, they can stop learning. In any case, it has a significant negative impact on their mental health.

Children are no different than everyone else in need of a break. Weekends with no homework should be considered by schools so that kids have time to unwind and prepare for the coming week. Without a break, doing homework all week long might be stressful.

How do parents help kids with homework?

Encouraging children’s well-being and health begins with parents being involved in their children’s lives. By taking part in their homework routine, you can see any issues your child may be having and offer them the necessary support.

Set up a routine

Your student will develop and maintain good study habits if you have a clear and organized homework regimen. If there is still a lot of schoolwork to finish, try putting a time limit. Students must obtain regular, good sleep every single night.

Observe carefully

The student is ultimately responsible for their homework. Because of this, parents should only focus on ensuring that their children are on track with their assignments and leave it to the teacher to determine what skills the students have and have not learned in class.

Listen to your child

One of the nicest things a parent can do for their kids is to ask open-ended questions and listen to their responses. Many kids are reluctant to acknowledge they are struggling with their homework because they fear being labelled as failures or lazy if they do.

However, every parent wants their child to succeed to the best of their ability, but it’s crucial to be prepared to ease the pressure if your child starts to show signs of being overburdened with homework.

Talk to your teachers

Also, make sure to contact the teacher with any problems regarding your homework by phone or email. Additionally, it demonstrates to your student that you and their teacher are working together to further their education.

Homework with friends

If you are still thinking is homework stressful then It’s better to do homework with buddies because it gives them these advantages. Their stress is reduced by collaborating, interacting, and sharing with peers.

Additionally, students are more relaxed when they work on homework with pals. It makes even having too much homework manageable by ensuring they receive the support they require when working on the assignment. Additionally, it improves their communication abilities.

However, doing homework with friends guarantees that one learns how to communicate well and express themselves. 

Review homework plan

Create a schedule for finishing schoolwork on time with your child. Every few weeks, review the strategy and make any necessary adjustments. Gratefully, more schools are making an effort to control the quantity of homework assigned to children to lessen the stress this produces.

Bottom line

Finally, be aware that homework-related stress is fairly prevalent and is likely to occasionally affect you or your student. Sometimes all you or your kid needs to calm down and get back on track is a brief moment of comfort. So if you are a student and wondering if is homework stressful then you must go through this blog.

While homework is a crucial component of a student’s education, when kids are overwhelmed by the amount of work they have to perform, the advantages of homework can be lost and grades can suffer. Finding a balance that ensures students understand the material covered in class without becoming overburdened is therefore essential.

Zuella Montemayor did her degree in psychology at the University of Toronto. She is interested in mental health, wellness, and lifestyle.

Psychreg is a digital media company and not a clinical company. Our content does not constitute a medical or psychological consultation. See a certified medical or mental health professional for diagnosis.

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Is Homework Necessary? Education Inequity and Its Impact on Students

The Problem with Homework: It Highlights Inequalities

How much homework is too much homework, when does homework actually help, negative effects of homework for students, how teachers can help.

Schools are getting rid of homework from Essex, Mass., to Los Angeles, Calif. Although the no-homework trend may sound alarming, especially to parents dreaming of their child’s acceptance to Harvard, Stanford or Yale, there is mounting evidence that eliminating homework in grade school may actually have great benefits , especially with regard to educational equity.

In fact, while the push to eliminate homework may come as a surprise to many adults, the debate is not new . Parents and educators have been talking about this subject for the last century, so that the educational pendulum continues to swing back and forth between the need for homework and the need to eliminate homework.

One of the most pressing talking points around homework is how it disproportionately affects students from less affluent families. The American Psychological Association (APA) explained:

“Kids from wealthier homes are more likely to have resources such as computers, internet connections, dedicated areas to do schoolwork and parents who tend to be more educated and more available to help them with tricky assignments. Kids from disadvantaged homes are more likely to work at afterschool jobs, or to be home without supervision in the evenings while their parents work multiple jobs.”

[RELATED] How to Advance Your Career: A Guide for Educators >> 

While students growing up in more affluent areas are likely playing sports, participating in other recreational activities after school, or receiving additional tutoring, children in disadvantaged areas are more likely headed to work after school, taking care of siblings while their parents work or dealing with an unstable home life. Adding homework into the mix is one more thing to deal with — and if the student is struggling, the task of completing homework can be too much to consider at the end of an already long school day.

While all students may groan at the mention of homework, it may be more than just a nuisance for poor and disadvantaged children, instead becoming another burden to carry and contend with.

Beyond the logistical issues, homework can negatively impact physical health and stress — and once again this may be a more significant problem among economically disadvantaged youth who typically already have a higher stress level than peers from more financially stable families .

Yet, today, it is not just the disadvantaged who suffer from the stressors that homework inflicts. A 2014 CNN article, “Is Homework Making Your Child Sick?” , covered the issue of extreme pressure placed on children of the affluent. The article looked at the results of a study surveying more than 4,300 students from 10 high-performing public and private high schools in upper-middle-class California communities.

“Their findings were troubling: Research showed that excessive homework is associated with high stress levels, physical health problems and lack of balance in children’s lives; 56% of the students in the study cited homework as a primary stressor in their lives,” according to the CNN story. “That children growing up in poverty are at-risk for a number of ailments is both intuitive and well-supported by research. More difficult to believe is the growing consensus that children on the other end of the spectrum, children raised in affluence, may also be at risk.”

When it comes to health and stress it is clear that excessive homework, for children at both ends of the spectrum, can be damaging. Which begs the question, how much homework is too much?

The National Education Association and the National Parent Teacher Association recommend that students spend 10 minutes per grade level per night on homework . That means that first graders should spend 10 minutes on homework, second graders 20 minutes and so on. But a study published by The American Journal of Family Therapy found that students are getting much more than that.

While 10 minutes per day doesn’t sound like much, that quickly adds up to an hour per night by sixth grade. The National Center for Education Statistics found that high school students get an average of 6.8 hours of homework per week, a figure that is much too high according to the Organization for Economic Cooperation and Development (OECD). It is also to be noted that this figure does not take into consideration the needs of underprivileged student populations.

In a study conducted by the OECD it was found that “after around four hours of homework per week, the additional time invested in homework has a negligible impact on performance .” That means that by asking our children to put in an hour or more per day of dedicated homework time, we are not only not helping them, but — according to the aforementioned studies — we are hurting them, both physically and emotionally.

What’s more is that homework is, as the name implies, to be completed at home, after a full day of learning that is typically six to seven hours long with breaks and lunch included. However, a study by the APA on how people develop expertise found that elite musicians, scientists and athletes do their most productive work for about only four hours per day. Similarly, companies like Tower Paddle Boards are experimenting with a five-hour workday, under the assumption that people are not able to be truly productive for much longer than that. CEO Stephan Aarstol told CNBC that he believes most Americans only get about two to three hours of work done in an eight-hour day.

In the scope of world history, homework is a fairly new construct in the U.S. Students of all ages have been receiving work to complete at home for centuries, but it was educational reformer Horace Mann who first brought the concept to America from Prussia. 

Since then, homework’s popularity has ebbed and flowed in the court of public opinion. In the 1930s, it was considered child labor (as, ironically, it compromised children’s ability to do chores at home). Then, in the 1950s, implementing mandatory homework was hailed as a way to ensure America’s youth were always one step ahead of Soviet children during the Cold War. Homework was formally mandated as a tool for boosting educational quality in 1986 by the U.S. Department of Education, and has remained in common practice ever since.  

School work assigned and completed outside of school hours is not without its benefits. Numerous studies have shown that regular homework has a hand in improving student performance and connecting students to their learning. When reviewing these studies, take them with a grain of salt; there are strong arguments for both sides, and only you will know which solution is best for your students or school. 

Homework improves student achievement.

• Source: The High School Journal, “ When is Homework Worth the Time?: Evaluating the Association between Homework and Achievement in High School Science and Math ,” 2012. 
• Source: IZA.org, “ Does High School Homework Increase Academic Achievement? ,” 2014. **Note: Study sample comprised only high school boys. 

Homework helps reinforce classroom learning.

• Source: “ Debunk This: People Remember 10 Percent of What They Read ,” 2015.

Homework helps students develop good study habits and life skills.

• Sources: The Repository @ St. Cloud State, “ Types of Homework and Their Effect on Student Achievement ,” 2017; Journal of Advanced Academics, “ Developing Self-Regulation Skills: The Important Role of Homework ,” 2011.
• Source: Journal of Advanced Academics, “ Developing Self-Regulation Skills: The Important Role of Homework ,” 2011.

Homework allows parents to be involved with their children’s learning.

• Parents can see what their children are learning and working on in school every day. 
• Parents can participate in their children’s learning by guiding them through homework assignments and reinforcing positive study and research habits.
• Homework observation and participation can help parents understand their children’s academic strengths and weaknesses, and even identify possible learning difficulties.
• Source: Phys.org, “ Sociologist Upends Notions about Parental Help with Homework ,” 2018.

While some amount of homework may help students connect to their learning and enhance their in-class performance, too much homework can have damaging effects. 

Students with too much homework have elevated stress levels. 

• Source: USA Today, “ Is It Time to Get Rid of Homework? Mental Health Experts Weigh In ,” 2021.
• Source: Stanford University, “ Stanford Research Shows Pitfalls of Homework ,” 2014.

Students with too much homework may be tempted to cheat. 

• Source: The Chronicle of Higher Education, “ High-Tech Cheating Abounds, and Professors Bear Some Blame ,” 2010.
• Source: The American Journal of Family Therapy, “ Homework and Family Stress: With Consideration of Parents’ Self Confidence, Educational Level, and Cultural Background ,” 2015.

Homework highlights digital inequity. 

• Sources: NEAToday.org, “ The Homework Gap: The ‘Cruelest Part of the Digital Divide’ ,” 2016; CNET.com, “ The Digital Divide Has Left Millions of School Kids Behind ,” 2021.
• Source: Investopedia, “ Digital Divide ,” 2022; International Journal of Education and Social Science, “ Getting the Homework Done: Social Class and Parents’ Relationship to Homework ,” 2015.
• Source: World Economic Forum, “ COVID-19 exposed the digital divide. Here’s how we can close it ,” 2021.

Homework does not help younger students.

• Source: Review of Educational Research, “ Does Homework Improve Academic Achievement? A Synthesis of Researcher, 1987-2003 ,” 2006.

To help students find the right balance and succeed, teachers and educators must start the homework conversation, both internally at their school and with parents. But in order to successfully advocate on behalf of students, teachers must be well educated on the subject, fully understanding the research and the outcomes that can be achieved by eliminating or reducing the homework burden. There is a plethora of research and writing on the subject for those interested in self-study.

For teachers looking for a more in-depth approach or for educators with a keen interest in educational equity, formal education may be the best route. If this latter option sounds appealing, there are now many reputable schools offering online master of education degree programs to help educators balance the demands of work and family life while furthering their education in the quest to help others.

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Is it time to get rid of homework? Mental health experts weigh in.

It's no secret that kids hate homework. And as students grapple with an ongoing pandemic that has had a wide range of mental health impacts, is it time schools start listening to their pleas about workloads?

Some teachers are turning to social media to take a stand against homework. 

Tiktok user @misguided.teacher says he doesn't assign it because the "whole premise of homework is flawed."

For starters, he says, he can't grade work on "even playing fields" when students' home environments can be vastly different.

"Even students who go home to a peaceful house, do they really want to spend their time on busy work? Because typically that's what a lot of homework is, it's busy work," he says in the video that has garnered 1.6 million likes. "You only get one year to be 7, you only got one year to be 10, you only get one year to be 16, 18."

Mental health experts agree heavy workloads have the potential do more harm than good for students, especially when taking into account the impacts of the pandemic. But they also say the answer may not be to eliminate homework altogether.

Emmy Kang, mental health counselor at Humantold , says studies have shown heavy workloads can be "detrimental" for students and cause a "big impact on their mental, physical and emotional health."

"More than half of students say that homework is their primary source of stress, and we know what stress can do on our bodies," she says, adding that staying up late to finish assignments also leads to disrupted sleep and exhaustion.

Cynthia Catchings, a licensed clinical social worker and therapist at Talkspace , says heavy workloads can also cause serious mental health problems in the long run, like anxiety and depression. 

And for all the distress homework  can cause, it's not as useful as many may think, says Dr. Nicholas Kardaras, a psychologist and CEO of Omega Recovery treatment center.

"The research shows that there's really limited benefit of homework for elementary age students, that really the school work should be contained in the classroom," he says.

For older students, Kang says, homework benefits plateau at about two hours per night. 

"Most students, especially at these high achieving schools, they're doing a minimum of three hours, and it's taking away time from their friends, from their families, their extracurricular activities. And these are all very important things for a person's mental and emotional health."

Catchings, who also taught third to 12th graders for 12 years, says she's seen the positive effects of a no-homework policy while working with students abroad.

"Not having homework was something that I always admired from the French students (and) the French schools, because that was helping the students to really have the time off and really disconnect from school," she says.

The answer may not be to eliminate homework completely but to be more mindful of the type of work students take home, suggests Kang, who was a high school teacher for 10 years.

"I don't think (we) should scrap homework; I think we should scrap meaningless, purposeless busy work-type homework. That's something that needs to be scrapped entirely," she says, encouraging teachers to be thoughtful and consider the amount of time it would take for students to complete assignments.

The pandemic made the conversation around homework more crucial 

Mindfulness surrounding homework is especially important in the context of the past two years. Many students will be struggling with mental health issues that were brought on or worsened by the pandemic , making heavy workloads even harder to balance.

"COVID was just a disaster in terms of the lack of structure. Everything just deteriorated," Kardaras says, pointing to an increase in cognitive issues and decrease in attention spans among students. "School acts as an anchor for a lot of children, as a stabilizing force, and that disappeared."

But even if students transition back to the structure of in-person classes, Kardaras suspects students may still struggle after two school years of shifted schedules and disrupted sleeping habits.

"We've seen adults struggling to go back to in-person work environments from remote work environments. That effect is amplified with children because children have less resources to be able to cope with those transitions than adults do," he explains.

'Get organized' ahead of back-to-school

In order to make the transition back to in-person school easier, Kang encourages students to "get good sleep, exercise regularly (and) eat a healthy diet."

To help manage workloads, she suggests students "get organized."

"There's so much mental clutter up there when you're disorganized. ... Sitting down and planning out their study schedules can really help manage their time," she says.

Breaking up assignments can also make things easier to tackle.

"I know that heavy workloads can be stressful, but if you sit down and you break down that studying into smaller chunks, they're much more manageable."

If workloads are still too much, Kang encourages students to advocate for themselves.

"They should tell their teachers when a homework assignment just took too much time or if it was too difficult for them to do on their own," she says. "It's good to speak up and ask those questions. Respectfully, of course, because these are your teachers. But still, I think sometimes teachers themselves need this feedback from their students."

More: Some teachers let their students sleep in class. Here's what mental health experts say.

More: Some parents are slipping young kids in for the COVID-19 vaccine, but doctors discourage the move as 'risky'

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Does Homework Cause Stress? Exploring the Impact on Students’ Mental Health

How much homework is too much?

Jump to: The Link Between Homework and Stress | Homework’s Impact on Mental Health | Benefits of Homework | How Much Homework Should Teacher’s Assign? | Advice for Students | How Healium Helps

Homework has become a matter of concern for educators, parents, and researchers due to its potential effects on students’ stress levels. It’s no secret students often find themselves grappling with high levels of stress and anxiety throughout their academic careers, so understanding the extent to which homework affects those stress levels is important. 

By delving into the latest research and understanding the underlying factors at play, we hope to curate insights for educators, parents, and students who are wondering  is homework causing stress in their lives?

The Link Between Homework and Stress: What the Research Says

Over the years, numerous studies investigated the relationship between homework and stress levels in students. 

One study published in the Journal of Experimental Education found that students who reported spending more than two hours per night on homework experienced higher stress levels and physical health issues . Those same students reported over three hours of homework a night on average.

This study, conducted by Stanford lecturer Denise Pope, has been heavily cited throughout the years, with WebMD eproducing the below video on the topic– part of their special report series on teens and stress : 

Additional studies published by Sleep Health Journal found that long hours on homework on may be a risk factor for depression while also suggesting that reducing workload outside of class may benefit sleep and mental fitness .

Lastly, a study presented by Frontiers in Psychology highlighted significant health implications for high school students facing chronic stress, including emotional exhaustion and alcohol and drug use.

Homework’s Potential Impact on Mental Health and Well-being

Homework-induced stress on students can involve both psychological and physiological side effects. 

1. Potential Psychological Effects of Homework-Induced Stress:

• Anxiety: The pressure to perform academically and meet homework expectations can lead to heightened levels of anxiety in students. Constant worry about completing assignments on time and achieving high grades can be overwhelming.

• Sleep Disturbances : Homework-related stress can disrupt students’ sleep patterns, leading to sleep anxiety or sleep deprivation, both of which can negatively impact cognitive function and emotional regulation.

• Reduced Motivation: Excessive homework demands could drain students’ motivation, causing them to feel fatigued and disengaged from their studies. Reduced motivation may lead to a lack of interest in learning, hindering overall academic performance.

2. Potential Physical Effects of Homework-Induced Stress:

• Impaired Immune Function: Prolonged stress could weaken the immune system, making students more susceptible to illnesses and infections.

• Disrupted Hormonal Balance : The body’s stress response triggers the release of hormones like cortisol, which, when chronically elevated due to stress, can disrupt the delicate hormonal balance and lead to various health issues.

• Gastrointestinal Disturbances: Stress has been known to affect the gastrointestinal system, leading to symptoms such as stomachaches, nausea, and other digestive problems.

• Cardiovascular Impact: The increased heart rate and elevated blood pressure associated with stress can strain the cardiovascular system, potentially increasing the risk of heart-related issues in the long run.

• Brain impact: Prolonged exposure to stress hormones may impact the brain’s functioning , affecting memory, concentration, and cognitive abilities.

The Benefits of Homework

It’s important to note that homework also offers many benefits that contribute to students’ academic growth and development, such as: 

• Development of Time Management Skills: Completing homework within specified deadlines encourages students to manage their time efficiently. This valuable skill extends beyond academics and becomes essential in various aspects of life.

• Preparation for Future Challenges : Homework helps prepare students for future academic challenges and responsibilities. It fosters a sense of discipline and responsibility, qualities that are crucial for success in higher education and professional life.

• Enhanced Problem-Solving Abilities: Homework often presents students with challenging problems to solve. Tackling these problems independently nurtures critical thinking and problem-solving skills.

While homework can foster discipline, time management, and self-directed learning, the middle ground may be to  strike a balance that promotes both academic growth and mental well-being .

How Much Homework Should Teachers Assign?

As a general guideline, educators suggest assigning a workload that allows students to grasp concepts effectively without overwhelming them . Quality over quantity is key, ensuring that homework assignments are purposeful, relevant, and targeted towards specific objectives. 

Advice for Students: How to balance Homework and Well-being

Finding a balance between academic responsibilities and well-being is crucial for students. Here are some practical tips and techniques to help manage homework-related stress and foster a healthier approach to learning:

• Effective Time Management : Encourage students to create a structured study schedule that allocates sufficient time for homework, breaks, and other activities. Prioritizing tasks and setting realistic goals can prevent last-minute rushes and reduce the feeling of being overwhelmed.

• Break Tasks into Smaller Chunks : Large assignments can be daunting and may contribute to stress. Students should break such tasks into smaller, manageable parts. This approach not only makes the workload seem less intimidating but also provides a sense of accomplishment as each section is completed.

• Find a Distraction-Free Zone : Establish a designated study area that is free from distractions like smartphones, television, or social media. This setting will improve focus and productivity, reducing time needed to complete homework.

• Be Active : Regular exercise is known to reduce stress and enhance mood. Encourage students to incorporate physical activity into their daily routine, whether it’s going for a walk, playing a sport, or doing yoga.

• Practice Mindfulness and Relaxation Techniques : Encourage students to engage in mindfulness practices, such as deep breathing exercises or meditation, to alleviate stress and improve concentration. Taking short breaks to relax and clear the mind can enhance overall well-being and cognitive performance.

• Seek Support : Teachers, parents, and school counselors play an essential role in supporting students. Create an open and supportive environment where students feel comfortable expressing their concerns and seeking help when needed.

How Healium is Helping in Schools

Stress is caused by so many factors and not just the amount of work students are taking home.  Our company created a virtual reality stress management solution… a mental fitness tool called “Healium” that’s teaching students how to learn to self-regulate their stress and downshift in a drugless way. Schools implementing Healium have seen improvements from supporting dysregulated students and ADHD challenges to empowering students with body awareness and learning to self-regulate stress . Here’s one of their stories. 

By providing students with the tools they need to self-manage stress and anxiety, we represent a forward-looking approach to education that prioritizes the holistic development of every student. 

To learn more about how Healium works, watch the video below.

About the Author

Sarah Hill , a former interactive TV news journalist at NBC, ABC, and CBS affiliates in Missouri, gained recognition for pioneering interactive news broadcasting using Google Hangouts. She is now the CEO of Healium, the world’s first biometrically powered immersive media channel, helping those with stress, anxiety, insomnia, and other struggles through biofeedback storytelling. With patents, clinical validation, and over seven million views, she has reshaped the landscape of immersive media.

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Excessive homework, inadequate sleep, physical inactivity and screen viewing time are major contributors to high paediatric obesity

1 School of Sport Sciences, Beijing Sport University, Beijing, China

Zhixiong Zhou

2 School of Physical Education and Coaching Science, Capital University of Physical Education and Sports, Beijing, China

Wenxi (Kevin) Liu

3 Department of Kinesiology, Health, and Nutrition, University of Texas at San Antonio, San Antonio, TX, USA

Xiujiang Wang

4 Children's Center of China, Beijing, China

Associated Data

Table S2 . Means (M), standard deviations ( SD ) of afterschool EBRB s by grade level.

This study examined the relationships between energy balance‐related behaviours (EBRBs) outside school hours and obesity in Chinese primary school students. We also explored the influence of gender on those relationships.

The study sample was a cross‐sectional cohort of 5032 Chinese children who were enrolled in grades 1–6 in primary schools in five Chinese cities and whose mean ages ranged from seven years and three months to 11.9 years. The children's parents completed a survey on their child's height, weight and EBRBs outside school hours.

The response rate was 97%, and the reported rates of overweight and obesity were 13.6% and 13.8%, respectively. The obesity rates were higher in boys and lower grade children. Most EBRBs varied between boys and girls and with increased grade levels. The amount of time spent on academic‐related activities, screen viewing, outdoor activities and sleep was mostly associated with obesity on weekdays and varied by gender.

Rate of obesity was alarmingly high in the primary school Chinese children in this cohort, especially in younger children. Excessive time spent on academic‐related activities outside school hours, inadequate sleep, physical inactivity and higher levels of screen viewing were major contributors to obesity in these Chinese children.

Abbreviations

• This study examined the relationships between energy balance‐related behaviours outside school hours and obesity in Chinese primary school students.
• Rates of obesity were alarmingly high in the children in this cohort, especially in younger children, with some notable age and gender differences.
• Excessive time spent on academic‐related activities outside school hours, inadequate sleep, physical inactivity and higher levels of screen viewing were major contributors to obesity levels.

Introduction

Childhood obesity has been rising rapidly in China, following the trends in developed countries 1 , and the increase is more dramatic in large urban regions 1 , 2 . According to the Chinese National Surveys on Students Constitution and Health, the prevalence of obesity in children aged 7–19 increased from 0.2% in 1985 to 8.1% in 2010. The Survey reported that obesity levels were highest among children aged seven to nine years, at 15.7% for boys and 8% for girls, and lowest in the 16–18 age group, at 6.8% for boys and 2.25% for girls 2 . While this increase has far exceeded those found in American and European children, the gender differences and high prevalence among the youngest children are particularly alarming and indicate a secular trend that could have serious health and economic implications for China in the near future 2 .

Energy balance‐related behaviours (EBRBs) refer to behaviours that influence energy intake and expenditure 3 , and the essence of obesity is dysregulation of EBRBs, leading to a positive energy balance. The links between obesity and EBRBs have been observed in preschool and primary school children 4 . Because activities at school are highly regulated and focused on academic pursuits, the study of EBRBs outside school hours – before and after school and during weekends and school holidays – provides additional insights for combating childhood obesity. Participation in outdoor activities, especially moderate‐to‐vigorous physical activity (MVPA) has been positively associated with lower body mass index (BMI), while increases in sedentary activities, such as sitting for lengthy periods of time, watching TV and playing computer games, have been associated with higher BMIs in children 4 , 5 . Epidemiological studies have also showed a close association between sleep deficiency and increases in childhood obesity 5 . However, it is not clear whether time spent on homework and other academic remedial activities outside school hours is associated with obesity in children.

From a young age, Chinese children are exposed to a fiery competitive system to prepare them for admission to universities 6 . Children start school in China at the age of 6 or 7, and primary school students are expected to spend at least three hours a day on academic‐related work, which includes homework assignments from their teachers and additional academic remedial and enrichment activities offered by external providers. This is in addition to a long school day that lasts eight to nine hours. These extra activities are paid tutoring programmes that enhance the children's academic achievement and aptitude. Little is known about the health effects of dedicating such a large amount of time to academic‐related studies on obesity in children of this age group 3 . An emerging body of research has related obesity with physical activity, sedentary behaviour and diet in Chinese children, similar to those conducted in developed countries 7 , 8 . However, a few studies have examined the effects of EBRBs outside school hours on obesity by age and gender in Chinese children.

This study reports the findings of a multicity parent survey on children's engagement in a broad range of EBRBs outside school hours in Chinese primary school students. The aims of this study were to examine the rate of obesity, the levels and patterns of EBRBs outside school hours and the relationships between engaging in EBRBs and obesity in a large sample of Chinese primary school students. Understanding children's activities outside school hours can facilitate a balanced development that promotes children's health and well‐being.

Study sample and data collection procedure

The study was conducted from March 1 to March 15, 2012 and included primary school students in five large metropolitan cities in five geographical regions of China: Beijing in Northern China, Guangzhou in Southern China, Hefei in Central China, Shanghai in Eastern Costal China and Xi'an in Western China. Four to five schools were selected from various areas of the city that were representative of the schools in the city. In each school, one classroom was randomly chosen from each of the six class grade levels to participate in the study. The parents of 5517 students were invited to complete a survey, and 5339 surveys were returned, providing a 97% response rate. Students who participated in sport teams or clubs were not asked not to complete the survey. The parents were informed that they could opt out of the study without any repercussions, and no financial incentive was provided for participating in the survey. The response rates were similar for all class grade levels and cities. After excluding the surveys with incomplete data on gender, age, grade, height and weight, 5032 students – 91% of the initial sample – were included in the data analysis. The study protocol was approved by the Research Review Committee of Beijing Sport University.

Parents were asked to complete a survey on their children's participation in five categories of leisure and nonleisure activities outside school hours on weekdays and at weekends, including three of the most common outdoor activities in children 9 . Parents talked to their children and estimated the number of hours that they spent on outdoor activities, homework assignments screen viewing – covering television and playing games on computers – remedial academic work to supplement and enrich their academic activities and sleep outside school hours on weekdays and at weekends. The students were not permitted to complete the surveys by themselves regardless of their ages. Parents were asked to report their child's current height and weight based on results from their most recent clinic visit or latest physical examination. Information was also requested on the students’ age, gender, grade levels, average school grades – with A being the best grade and F the lowest – for all subject areas (excluding physical education) and physical education. They were also asked about their own education levels and the monthly family income in renminbi, which is the Chinese currency. The students brought the completed surveys back to school the following day. The surveys were screened for completeness and entered into a database for quality checking by six research staff. These staff re‐entered 10% of the surveys to check for accuracy and the error rate was <0.0002%. Information on the children's attitudes towards outdoor activities, hygiene practices such as hand washing during outdoor activities and parent and peer support were also collected, but not included in this study.

Data analysis

The children's BMI, BMI Z‐score and standard deviations of BMI for age were calculated with the free AnthroPlus software from the World Health Organization (WHO) and using WHO Child Growth Standards 10 . The classification of obesity was based on the reference developed by the Working Group on Obesity in China (WGOC) 11 . We also classified obesity using the WHO age‐specific and sex‐specific BMI cut‐off points that were based on the WHO Child Growth Standards 12 . We used the BMI Z‐score as the continuous measure of obesity in this study, but performed the analyses on BMI as well. Associations between categorical variables were analysed with chi‐square ( χ 2 ) statistics, and associations between categorical and ordinal variables were analysed with Somer's d. Spearman's correlation was used to examine the relation between ordinal and continuous variables. The one‐way F‐test was used to test group differences or trends on continuous variables. Generalised estimation equations were used to estimate the independent associations between the BMI Z‐score as the response variable and EBRBs outside school hours as the explanatory variables. The city where the school data collection sites were based was included as a random term to control the clustering effect. The children's age, gender, grade levels, average school grades, average physical education grade, father's and mother's education levels and monthly family income were included as covariates. The analysis was repeated with stratification by gender to examine gender‐specific relationships between obesity and EBRBs outside school hours. To produce a parsimonious model, only significant covariates were kept in the final model. SPSS Statistics version 22 (IBM Corp., New York, NY, USA) was used in data analysis, with significance set at p = 0.05 based on a two‐sided test.

The study comprised 5032 students from six years and one month to 14.1 years, with a mean age of 9.70 and standard deviation of 1.72. Grades 1–6 normally cover students up to the age of 12, but sometimes they contain a few older students who are behind with their education for some reason. Table  1 shows the student characteristics and associations with obesity status. In general, the students in the study came from educated families, as 50.1% of the fathers and 46.2% of the mothers had attended college or higher education. More than two‐thirds of the families had a monthly income of <10 000 RMB, which was comparable to the 2012 national average family income of 13 000 RMB or 2100 US dollars per month. Students had a wide range of school grades in academic subject areas and physical education. Similar proportions of students from the five cities and across school grade levels were presented in the study sample (data not shown). Finally, higher levels of parent education and family income were associated with higher levels of obesity.

Student characteristics (n = 5032) and unadjusted correlations a with obesity status

A = The best grade; Grade F = Poorest grade; RMB = Renminbi (Chinese currency).

*p > 0.05, **p > 0.001, two‐sided test.

Table  2 shows the rate of overweight and obesity based on the Chinese WGOC reference in the overall student sample and by the cities included in the data collection. Boys were more likely to be overweight ( χ 2  = 115.48, df = 1, p < 0.001) and obese ( χ 2  = 80.43, df = 1, p < 0.001) than girls, and the patterns were similar across all five cities. The highest prevalence was observed in Beijing and Shanghai, two of the largest and most developed cities in China. Obesity rates based on the WHO Child Growth Standards are also presented. The rate for overweight was higher in the WHO reference than the WGOC reference, but the levels were similar for obesity. There was a significant inverse relationship for the total sample and by gender between the level of obesity and the students’ class grade level in school (p < 0.001 for trend) (Table  3 ). The inverse trend with age was particularly striking, with a difference of more than 10 percentage points between students in the first grade (19.6%) and the sixth grade (6.8%).

Rates of overweight and obesity in the overall student sample and broken down by gender

WGOC = Working Group on Obesity in China; WHO = World Health Organization child growth charts.

Unadjusted correlations between school grade level and obesity status a

Chinese primary students dedicated more time to academic‐related work outside school hours, namely homework and remedial academic work, and this reached almost three hours on weekdays and more than four hours on weekend days (Table S1). The time they spent on screen viewing and outdoor activities was rather limited on weekdays, at approximately one hour per day. On weekdays, boys spent more time on homework, screen viewing and sleep than girls. Girls spent more time on remedial academic work on both weekdays and weekend days than boys. Boys also spent more time on outdoor play on weekend days. Finally, children in higher grades spent more time on academic‐related activities and less time on nonacademic‐related activities and sleep, especially on weekdays (Table S2). Overall, there was a limited amount of discretionary time, approximately two to three hours per day, left for children to engage in other essential daily routine activities, such as travelling to and from school, eating meals, going to the toilet and washing (data not shown). A higher class grade level was significantly correlated with more time spent on homework and remedial academic work on weekdays and weekend days. Higher grades were also significantly correlated with less time spent on screen viewing and outdoor activities on weekend days and less sleep on weekdays.

In general, weekday afterschool EBRBs were associated more closely with obesity status as shown in Table  4 . Weekday homework, screen viewing and outdoor activities were positively associated with obesity status, while weekend day remedial academic work and weekday sleep were inversely associated (p < 0.05). Finally, obesity status was positively correlated with time spent on homework on weekdays, screen viewing on weekdays and weekend days and outdoor activities on weekdays. It was also inversely correlated with time spent on remedial academic work on weekend days and sleep on weekdays.

Means, standard deviations (SD) of out of school EBRB s and their correlations a with obesity status

EBRB = Energy balance‐related behaviour.

After controlling for significant covariates, the BMI Z‐score in the model that combined all the students was significantly and positively associated with hours of homework and screen viewing, inversely associated with hours of sleeping on weekdays and marginally and negatively associated with hours of outdoor activities on weekend days (Table  5 ). In the boys’ model, the BMI Z‐score was significantly and positively associated with hours spent on homework and negatively associated with hours of sleep on weekdays and was not related to EBRBs on weekend days. In the girls’ model, the BMI Z‐score was significantly and positively associated with hours of screen viewing on weekdays and was significantly and negatively associated with hours of outdoor activities on weekend days. The results were similar when we performed the analysis with BMI as the outcome variable (result not shown).

Results from generalised estimation equations analysis on the relationships between the children's body mass index Z‐score and energy balanced‐related behaviours outside school

B = Regression coefficient; SE = Standard error; p = Level of significance; ns = Not significant.

*Weekday model and † weekend day model both adjusted for intercept, gender and grade level.

‡ Weekday model and § weekend day model both adjusted for intercept, grade level and physical education grade.

¶ Weekday model and **weekend day model both adjusted for intercept, grade level and father's education level.

Findings from this survey study revealed that levels of overweight (13.7%) and obesity (13.6%) in primary school students living in large metropolitan cities were alarmingly high, continuing a secular trend that has emerged since the 2000s in Chinese children 2 , 13 . It is particularly worrying to see the gender disparity in obesity that emerged in this study, with the rate in boys nearly doubling and disproportional obesity at lower grade levels. Higher levels of parental education and family income were associated with higher levels of obesity in this sample of urban Chinese children, and this was consistent with studies conducted in the United States and other Western countries. The associations disappeared in the multivariate analysis, except for in the models for just girls, where the father's education remained a significant covariate. However, class grades and gender remained as significant covariates, suggesting the important role they play in understanding the obesity epidemic in Chinese students. Finally, there was evidence that time spent on academic‐related activities, screen viewing, outdoor activities and sleep was closely associated with obesity and that this varied by gender between weekdays and weekend days.

The rate of obesity in our study sample was consistent with recent studies based on the Chinese WGOC reference that used height and weight measured directly by trained research staff 2 , 13 . The prevalence of childhood obesity in China has doubled over the past 10 years according to a report published by the National Health and Family Planning Commission of the People's Republic of China in 2014 14 . It is not a surprise that the prevalence of childhood obesity has approached those observed in the United States and other developed countries in less than two decades, in the light of the alarming temporal increase in rate of obesity since the 1980s 8 , 13 . For instance, Ma et al. reported that the obesity rates were 0.10%, 0.30%, 0.23% and 0.23% in 1985–1995, 1995–2000, 2000–2005 and 2005–2010, respectively, using data from the Chinese National Survey on Students Constitution and Health 15 .

While some studies, including our study, have showed that time for academic‐related activity and screen viewing increased with age, while sleep duration decreased with age 8 , 16 , other studies have reported that older children and adolescents were more physically active and spent less on screen viewing 7 . A study of 2163 Chinese children aged nine years to 17 years from 11 cities measured daily physical activity and sedentary behaviour using accelerometry 17 . As the children got older, they had higher levels of moderate and vigorous physical activity (MVPA) and sedentary behaviour. However, levels of MVPA and sedentary behaviour were not correlated with children's obesity status in the study sample. The same was also observed in a sample of Australian girls 18 . These findings suggest that other EBRBs influenced the energy balance and obesity in children as well.

Concern has been raised about the faster increase in obesity in lower‐level primary school students (grades 1–3) than upper‐level students (grades 4–6) that have been found in studies of Chinese children 8 , 19 , and these were also found in our study. A similar trend has also been reported in other developing countries in recent years 20 . Although there is no clear explanation for this secular trend of obesity, Yang and Huffman speculated that the introduction of formula feeding, increased consumption of foods with high protein levels and added sugar, reduced access to physical activities and poor maternal prenatal diets might have contributed to the higher prevalence of obesity among younger children in developing countries 21 .

However, it is still unclear why the prevalence of obesity in boys in our study was nearly twice as high as the girls who took part. This gender disparity has also been reported by others studies of Chinese children 8 , 19 . As nutritious foods are in plentiful supply and food insecurity is not an issue in Chinese urban cities 1 , 13 , one plausible explanation is that boys consumed a more energy‐dense diet than girls and that led to a positive energy balance. However, food consumption or eating unhealthy foods has not been associated with a particular gender and cannot explain the differences in obesity in Chinese children reported in the current literature 7 . This means that we are left with the other parameter in the energy balance equation, namely the energy expenditure. Although we could not quantify which gender was more sedentary based on the reported EBRBs, there were clear differences in EBRBs between boys and girls that suggested that boys were more sedentary on weekdays. Furthermore, the stratified analyses showed differential associations of EBRBs with obesity: the boys’ obesity was influenced by more time spent on homework and less sleep on weekdays while the girls’ obesity was associated with more screen viewing on weekdays and less outdoor activity on weekend days. While the increased sedentary time and decreased sleep in boys can be explained by a displacement effect due to increase time spent on academic‐related work on weekdays, girls have been reported to prefer sedentary activities 17 , 22 .

Higher pressure for academic excellence from society, schools and parents has been linked to increased time spent on homework and lack of sleep and may contribute to the limited time spent on screen viewing by Chinese students, as suggested by cross‐cultural studies 8 . Chinese students spend more time on homework and other academic‐related work outside school hours and less time on screen viewing and sleep, compared to students of the same age from Western countries. However, less is known about the differences in physical activity and diet between Chinese and Western students. Although academic pressure has been related to childhood obesity in some developing countries 23 , it has not become the focus of studies in China. Our findings showed that academic‐related activities outside school hours displaced time for physical activity and sleep in primary school students 24 . This should serve as a warning to parents, schools, policy makers and ultimately the Chinese education system to re‐examine and modify the current practices and expectations of children in primary schools 7 . It should be noted that the amount of time spent on homework, screen viewing and sleep based on the parental reports in this study was similar to those reported in large national surveys in China 8 , 22 .

Childhood obesity prevention in China has generally focused on promoting physical activity and healthy eating 25 . Recently studies have identified that sedentary behaviours, such as watching TV and playing on computers, high level of life stress and lack of sleep were independently associated with obesity in Western children 5 , 26 . Findings from our study suggest that sedentary behaviour from an excessive amount of time spent on academic‐related work and inadequate sleep, in addition to a lack of physical activity and excessive screen viewing, may be responsible for increased obesity in Chinese children 7 . An examination of childhood obesity intervention studies in China revealed that focusing interventions on physical activity and unhealthy diets, commonly regarded as two primary contributors to the current obesity epidemic, produced marginally effective outcomes, suggesting additional factors may also play roles 25 . Therefore, all EBRBs need to be considered in order to prevent childhood obesity and interventions should specifically target the relevant EBRBs to be effective for different genders and age groups.

We found a positive association between obesity status and outdoor activity time on weekdays, but not on weekend days, in the study sample. Because of the ongoing school‐based national Sunshine Activity campaign, which has encouraged Chinese children to play outside in the sunshine since 2007, we assessed the time spent on outdoor activities rather than on MVPA in this study. However, it is not appropriate to equate the outdoor activities reported in this study with MVPA. The three most commonly reported outdoor activities in this study were as follows: (i) exercises and sport activities involving moderate and vigorous intensity, such as jumping with ropes, soccer, swimming, jogging and exercise stations; (ii) games and play activities involving light and moderate intensity, such as hide‐and‐seek and playing in the park; and (iii) outdoor leisure activities involving light intensity, such as leisurely strolls with friends and walking the dog. High‐intensity exercises and sports activities were less common in our cohort. When we examined these three reported activities in the study sample, we found that overweight and obese students engaged more frequently in light‐ and moderate‐intensity activities and less frequently in higher‐intensity exercises and sport activities than normal weight students on weekdays (data not shown). Therefore, the positive correlation between obesity and outdoor activities on weekdays could be due to the measurement method used. However, this cannot be directly examined in this study.

There were several limitations to the study. First, because this study used a cross‐sectional design, the findings relating to relationships between responses and explanatory variables should not be interpreted as causal. Future studies should examine the findings further using longitudinal study designs. Second, all of the data, including height and weight, were self‐reported and subject to bias in self‐reports and inaccurate recalls. Although parental reports of children's health information is regularly used in population‐based health studies, the use of such data tends to overestimate weight and that lead to overestimation of obesity rates in children 27 . Therefore, study findings based on parent‐reported height and weight should be interpreted with caution. Similarly, parental reports of the time that their children spend on various activities outside school hours on weekdays and weekend days are also subject to recall errors. Nonetheless, the obesity rates and how the school‐aged children in this study used their time were similar to studies based on directly measured height and weight or observational studies from the same period. Third, because the study data were not collected from a nationally representative sample and did not include children from small cities or rural regions, the findings should not be overgeneralised. Fourth, the use of the Chinese WGOC cut‐off reference for obesity tends to overestimate obesity for boys aged 6–16 and underestimate obesity for girls aged 3–18 and that may have exacerbated the gender disparity 28 . Finally, the study only focused on EBRBs outside school hours and did not collect data on diet and physical activity at school. Future studies need to examine EBRBs that occur both inside and outside school, including diet, to establish a full picture of the relationships between obesity and EBRBs in children.

The rate of obesity was high in Chinese primary school children, especially among boys and children in lower grades, and there were differential associations between obesity status and EBRBs in Chinese boys and girls outside school hours. Accordingly, obesity prevention programmes that only focus on physical activity, screen viewing and diet may not produce expected outcomes without addressing excessive time spent on academic‐related activity and inadequate sleep in Chinese children 25 . The design of interventions should also take into account the differences between EBRBs on weekdays and weekend days 17 . Finally, there is a need to conduct cross‐cultural studies of obesity and EBRBs that can help us to understand the underlying causes of the gender differences and the increased rates of obesity in younger children. These will enable us to develop culturally relevant lifestyle interventions for different population groups in China.

This study was partly funded by the Children's Center of China. The funder had no role in any part of the study.

Conflict of interest

The authors have no conflict of interests to disclose.

Supporting information

Table S1. Means, standard deviations ( SD ) of non‐school EBRB s for all students and comparison by gender.

Acknowledgements

We would like to thank the Children's Centers in Shanghai, Anhui Provence, Shanxi Provence and Guangdong Provence for their help in the collection, entry and quality checking of the study data and the students, parents and school teachers whose participation and cooperation made this study possible.

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3 Surprising Health Risks of Working From Home

 Alex Dos Diaz / Verywell

Key Takeaways

• More people are working from home amid the COVID-19 pandemic. While avoiding the office and staying socially distant is crucial to stopping the spread of the virus, working from home can bring about other health concerns.
• A recent study found that 41.2% of at-home workers report low back pain and 23.5% experience neck pain.
• Experts say that many of these health issues can be prevented or alleviated by taking simple measures to improve your work-from-home environment.

Since the beginning of the COVID-19 pandemic , more people around the world are working remotely. While the measure has been critical to helping control the spread of the virus, it hasn't come without compromise. As the number of people working from home has increased, healthcare providers have seen a rise in work-related injuries that are unique to the home environment.

That said, experts are hoping to reassure the remote workforce that many of these problems can be prevented or alleviated by taking simple steps to improve your at-home workspace.

Early Research

A small study conducted by researchers in Itlay has provided early insight into the potential impact that the increase in working from home amid the COVID-19 could have.  

The study, published in the International Journal of Environmental Research and Public Health, surveyed 51 at-home workers in Italy. The results showed that 41.2% of at-home workers reported low back pain, while 23.5% reported neck pain. About half of the respondents said that their neck pain (50%) had gotten worse since they started working from home.

While the study was small and limited in scope, it asks some important questions for employees who are trying to minimize the physical and emotional toll of their new work life. The good news is, there are some practical solutions that most workers can benefit from.

What This Means For You

If you're working from home, there are a few proactive steps you can take to help protect your physical and mental wellbeing. Take frequent breaks (set a reminder alarm if you need to), try to reduce your screen time when you can, get regular exercise, avoid eating at your desk or workspace, and stick to defined working hours.

When you aren't working, look for safe and socially distant ways to connect with others. If you notice any new or worsening health issues, be sure to talk to your provider.

Musculoskeletal Pain

Musculoskeletal pain from a not-quite-right desk set-up, unsupportive chair, or just long hours sitting down is a common problem among workers—both in an office setting and at home.

Meredith Christiansen, DPT, PhD , specializes in ergonomics at Fern Health , where she is a clinical scientist for the at-home musculoskeletal pain care program.

Christiansen recommends placing your computer monitor about arms' length away and keeping your hips and knees at a 90-degree angle. It also helps to avoid sitting on the couch or in bed for prolonged periods.

While proper ergonomic alignment matters, Christiansen tells Verywell that it's even more important to get up and move or change positions every hour of your workday. For example, try alternating between sitting at the dining room table and standing at the kitchen counter (which could serve as a standing desk).

If you're still uncomfortable, don't ignore it. "If you are in pain, it’s important to get it managed right away, so it doesn’t become a more chronic issue," Christiansen says.

After hours at your computer, you've probably felt your vision going a little blurry or even developed a slight headache. Eye strain is a common complaint, but one that is on the rise in remote workers.

Danielle Richardson, OD , optometrist, a consultant for Johnson & Johnson Vision, and the founder of Fierce Clarity (a holistic lifestyle and wellness company), tells Verywell that sustained focus on screens is the main reason people working at home experience increased eye strain.

"There are eye muscles that contract when we look up close, and when we look away they relax," Richardson says. "Everything we are doing is on a screen right now, and so there are fewer visual breaks. Meetings are happening via Zoom, people are sending emails instead of speaking to co-workers, and eating lunch in front of the screen."

Richardson recommends adjusting the angle of your computer screen to be 15 to 20 degrees below the horizontal eye level.

Another contributor to eye straight is the " blue light " emitted from screens, which can disrupt vision. "Blue light focuses in front of the retina, so the eye has to work harder to focus on the screen with that wavelength," Richardson says. "Wearing glasses that filter out the blue light will make digital devices more comfortable.

Richardson recommends following the 20-20-20 Rule: Every 20 minutes, take a screen break and focus on an object that's 20 feet away from you for at least 20 seconds.

Getting up and moving can also help. "I encourage my patients to go for a walk, or have a cup of coffee or tea and look outside," Richardson says.

Glasses and Contact Lenses

If you try making these changes but eye strain and headaches persist, it might be time to make an appointment with an optometrist to see if glasses would help.

"We are prescribing a lot more 'computer glasses,' prescription glasses specifically to relax the muscles while they look at the computer screen," Richardson says. "Even that little bit of extra work can trigger migraines."

If you prefer contact lenses to glasses, she says "daily disposable contact lenses are thinner and more breathable than monthly or two-week lenses. We’ve been switching a lot of patients to make them more comfortable."

If you decide to go the contact lens route, Richardson recommends using a hydrogen peroxide-based contact lens cleaning solution to prevent the build-up of debris.

Richardson also recommends using a lubricant for dry eyes . "Whenever you are doing sustained near work you blink less, so I recommend over the counter artificial tears."

Mental Health

Jagdish Khubchandani, PhD , a professor of public health at New Mexico State University, is currently researching the mental health effects of working from home.

Khubchandani has identified several commonalities among those who work from home and have increased health risks. “American homes were not designed to be offices," Khubchandani tells Verywell. "Indoor environmental parameters are not well examined in the home office setting." Khubchandani's study shows how a poor indoor environment can lead to headaches and pain disorders.  

“More people are working a greater number of hours, and there are no office time boundaries,” he says. “The lack of scheduled work times will take away from leisure time and as is, people are socializing less and there is lesser human contact, which is a big risk for mental health issues.”

In addition to the effects on mental health, isolation and a sedentary lifestyle also contribute to weight gain and obesity. In some cases, a lack of workplace-related health services might allow preexisting health issues to get worse, and preventative care could suffer as well.

On the upside, some participants in Khubchandani's study reported better health since they began working remotely. “Some individuals are now less likely to skip meals, fast, or eat unhealthy due to having more control over their lives, such as saved commute time."

Beyond physical health, the benefits of being at home more can extend to emotional wellbeing and even productivity. “More opportunities to stay with children and family means greater cooking at home as well and improved diet and sleep and social bonding for some,” Khubchandani says. “Studies have shown greater productivity in remote work, another health benefiting impact for some workers.”

Moretti A, Menna F, Aulicino M, Paoletta M, Liguori S, Iolascon G. Characterization of home working population during COVID-19 emergency: A cross-sectional analysis .  Int J Environ Res Public Health . 2020;17(17):6284. doi:10.3390/ijerph17176284

Tietjen GE, Khubchandani J, Ghosh S, Bhattacharjee S, Kleinfelder J. Headache symptoms and indoor environmental parameters: Results from the EPA BASE study .  Ann Indian Acad Neurol . 2012;15(Suppl 1):S95-S99. doi:10.4103/0972-2327.100029

By Cyra-Lea Drummond, BSN, RN Drummond is a registered nurse and a writer specializing in heart health, cardiac care, pediatric health, and more.

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May 23, 2024

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Children exposed to SARS-CoV-2 in womb or as newborns may face increased social and respiratory problems

by University of Bristol

Children who were exposed to SARS-CoV-2 (COVID-19) while in the womb or as newborn babies may face greater difficulties with social skills and have more respiratory symptoms than non-exposed children, according to a new University of Bristol-led study published in eClinicalMedicine .

Previous research suggests that infants exposed to SARS-CoV-2 infection during pregnancy may have poorer lung growth and delayed early development before 12 months of age, particularly when compared with those born before the COVID-19 pandemic. However, until now, longer-term outcomes of children born during the COVID-19 pandemic, with and without exposure to SARS-CoV-2 during pregnancy or in the newborn period, remained unclear.

In this new study, in collaboration with the University of Oxford, Imperial College London and the University of Leicester, researchers sought to understand whether SARS-CoV-2 exposure during pregnancy impacted the longer-term development and breathing of babies, and whether they suffered more health problems than children who were not exposed.

To investigate this, researchers approached families looked after in 87 NHS hospitals in England and Wales to complete surveys on their child's development and respiratory health. Participants included 96 babies who were born to mothers in the SARS-CoV-2 exposed group, and 243 babies in the non-exposed comparison group. Parents were asked to complete a survey about the development and breathing problems of their children and their child's use of health care services up to their second birthday.

The team found that overall development at two years of age did not differ between the children who were exposed and not-exposed to SARS-CoV-2. However, on a group level, the exposed cohort were at greater risk of slightly delayed social-emotional development.

Importantly, children exposed to the virus in the perinatal period also had more problems with breathing and used health care services more, including more inpatient, outpatient and GP attendances by two years of age when compared with the non-exposed cohort.

Dr. Ela Chakkarapani, one of the study's lead authors, Associate Professor of Neonatal Neuroscience and Director of the Centre for Academic Child Health at Bristol Medical School explained, "Our study indicates that antenatal or neonatal exposure to SARS-CoV-2 is associated with an increased risk of social-emotional difficulties in early childhood . Social-emotional delay in infancy poses a risk for difficulties later in childhood, and may impact children's ability to develop positive peer relationships and achieve academic success.

"We can only say that children with perinatal exposure to SARS-CoV-2 might develop difficulties with social emotional development. We need larger studies and longer-term follow-up to confirm and understand this risk. If parents are concerned about their child's development after exposure to SARS-CoV-2 during pregnancy, then they should see their GP.

"Children's lung function and health care usage also needs to be monitored longer term to identify whether there is improvement as they grow older. These findings inform the health care policy for monitoring children's health with perinatal SARS-CoV-2 infection and safeguarding their health in future pandemics."

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HHS Secretary Xavier Becerra Issues Statement on the National Institutes of Health Request for Information

Seeking Input on Draft Policy Involving NIH-Owned Inventions: Promoting Equity Through Access Planning

The Biden-Harris Administration is committed to lowering health care costs, promoting innovation, and making sure that taxpayer investments result in advancements in biomedical research that are accessible to everyone across the country.

Today, the National Institutes of Health (NIH) issued a first of its kind draft policy proposal to promote equitable access to products stemming from NIH-owned inventions. By requiring organizations partnering with the NIH through patent license agreements to outline detailed plans for patient access to drugs, biologics, vaccines, or devices developed from NIH-owned inventions, we are accelerating how breakthroughs in medical research originating from the NIH’s Intramural Research Program can translate into affordable and sustainable solutions for patients across the country. NIH has released a request for information and welcomes public input to inform this new policy.

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Increasing rates of teen sexual assault could be contributing to rising adolescent mental health problems

By the time she was 19, Rikki Hoyland had already been sexually assaulted twice.

The first time was when she was just 15, and grieving the loss of a father figure. She had turned to alcohol to cope, and was assaulted by a teenaged peer while unconscious at a party.

Four years later she had put her life back together when another teen she trusted coerced her into sex.

"It's pretty tough. I have nightmares every night," she said.

"I feel uncomfortable in my skin every day. I genuinely just think that all I'm good for is to be used and abused and left.

"I definitely have a lot of anxiety, a lot of depression."

The Queensland youth worker represents a new generation of adolescents experiencing sexual assault at rates never seen before.

Figures from the landmark Australian Child Maltreatment study show peer-on-peer sexual assault is on the rise with nearly one in five young people aged 16 to 24 having been sexually assaulted by another teen.

• 13.2 per cent were abused by another teen they knew
• 5.7 per cent were assaulted by a current or former romantic partner

Those aged 16 to 24 were three times more likely to report being sexually assaulted by a current or former partner as teens than those aged over 45.

It is backed up by data from the Australian Survey of Secondary Students and Sexual Health which shows that between 2002 and 2021, the percentage of Year 10 and 12 sexually active students who had unwanted sexual experiences rose from 25 per cent to 41 per cent.

Unwanted sexual experiences included being too drunk or high to consent, peer pressure, partner pressure or being too frightened to say no.

Lead Author of the Australian Child Maltreatment Study, Professor Ben Mathews, said the structure of the study meant this was a genuine rise, because it highlighted people's lived experiences, rather than anything they had reported through the justice system.

"We're talking about very, very substantial numbers of adolescents who are now experiencing sexually abusive behaviour at the hands of their peers, who in former generations were not," he said.

"It does demand some concerted action."

Researchers say there are clear links between the trauma of sexual assault and mental health issues which often first emerge in adolescence, with ABS data showing a nearly 50 per cent spike in mental health issues among young people in the past 15 years.

"There's a general, well-established body of evidence that sexual abuse is extremely harmful for mental health and for health risk behaviours," Professor Mathews said.

"Our study found…[sexual assaults] were also consistently the most strongly associated with health risk behaviours — things like cannabis dependence, smoking, self-harm and suicide attempt."

For Rikki Hoyland, the first assault set her on this exact course.

"After everything went down, I stopped talking to everyone. I isolated myself," she said.

"I was doing a lot of drugs, and I was drinking a lot. I would do anything to try and numb the pain."

The assaults happened after what had already been a rocky family life leading into adolescence and she was suicidal and self-harmed from an early age.

"I was a very angry kid. I would often fight people just because they looked at me funny. I would throw chairs and desks at teachers.

"I was so, so vulnerable."

What's behind the rise?

Academics theorise the rise in sexual assault rates is being caused by social media and access to hardcore pornography.

"Some kids might feel extra pressure to have sexual experiences or sexual encounters so that they feel a sense of status and a sense of peer acceptance," Professor Mathews said.

Figures from the Australian Survey of Secondary Students and Sexual Health showed 14.1 per cent of 14-to-18-year-old Australians viewed pornography daily or almost daily.

Another study from Macquarie University found more than half of boys reported their first exposure to porn between the ages of 12 and 14 and more than one quarter between the ages of 9 and 11.

"There is some evidence that consumption of violent pornography can influence aggressive and coercive sexual behaviour," Professor Mathews said.

'Mano-sphere' shaping violent views

The concern about porn and social media is supported by youth-led advocacy group Teach Us Consent, which heard from more than 7,000 Australian teens who were victims of sexual violence, many of them girls.

Tess Fuller from the group said many teens spoke candidly about the mental health impacts of their assault and that it was associated with higher rates of depression and anxiety.

"It stifled their sexual and social growth. A lot of them found it really difficult to keep attending school and being around that perpetrator."

She said social media was playing a crucial role in shaping teen attitudes.

"There's a radicalisation happening online in the so-called 'manosphere' that is encouraging boys and men to hold increasingly violent and misogynistic views."

One study from the United States found that 9 in 10 of the most popular mainstream pornography videos display violence against women, and, in almost all cases, the women featured respond with pleasure or neutrally.

"It's sending them the message that women should grin and bear (it) or even enjoy violence," Ms Fuller said.

"That men should assume these domineering and violent positions in bedrooms, which is really a norm that lots of boys that we speak to a deeply uncomfortable with.

"We're clearly missing a bunch of healthy male role models for boys to look up to."

Poor mental health drives violence

Ms Fuller said there was also evidence that poor mental health could be a driver of violence towards women, with men who ascribe misogynistic views eight times more likely to have frequent suicidal ideation.

"These forms of masculinity that encourage you to suppress your emotions, not talk about your problems with your friends, and sort of deal with everything by yourself, is in turn encouraging you to lash out on other people and to potentially commit sexual violence."

The Australian Childhood Maltreatment study found overall sexual abuse of minors is still widespread, but there was overall a downward trend, especially among boys as victims, and a reduction in perpetration by adults like family members and institutional carers.

The area that trended up most significantly was teen-on-teen abuse.

Rikki Hoyland now works at Youth InSearch, an early intervention service she relied on heavily in the wake of her assaults.

"It definitely saved my life," she said.

These days she takes comfort in the small things like her dog, Rasty.

"I'm just dealing with it through counselling. I am back on my anxiety medication," she said.

Rikki urged any teens who experienced what she did to ask for help.

"It doesn't make you weak. It makes you stronger and it helps you understand yourself a lot better."

Mental health disorders among young people have soared by nearly 50 per cent in 15 years. The ABC is talking to youth, parents, and researchers about what's driving this pattern, and what can be done to turn things around.

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