Two studies involving a researcher from the National Institute for Health Development (TAI) examine children’s health from different perspectives. Toomas Veidebaum, a senior researcher at TAI’s department of chronic diseases, is a co-author of both research papers.
The studies are based on the international IDEFICS/I.Family longitudinal study, which followed European children from early childhood through adolescence. Researchers repeatedly collected data on the children’s health, body weight, diet, physical activity, sleep, screen use and living environment.
A child’s entire day affects their well-being
A study published in the International Journal of Obesity examined how children’s well-being is associated with three daily habits: physical activity, sleep and screen time.
The analysis included 7,359 observations of European children ages 2 to 16. The data was collected over six years in three waves. Researchers assessed how well the children followed age-specific recommendations for physical activity, sleep and screen time.
Psychosocial well-being was lower among children who followed these recommendations less often. The association was stronger among boys and children and young people who were overweight or obese. Body mass index and waist circumference were used to assess body weight. Both measures affected the strength of the association between physical activity, sleep and screen time and well-being.
The study’s observational design makes it possible to describe associations that developed over a longer period, but the findings cannot establish that one factor directly causes another.
“Physical activity, sleep and screen time together make up a child’s day. If screens take up a large part of the evening, there may be less time for sleep. In turn, too little sleep affects energy levels, mood and the desire to be active. When supporting a child’s health, it is therefore worth looking at their entire daily routine rather than just one habit,” Veidebaum said.
Children with smartphones. Source: Ken Mürk/ERR
Psychosocial well-being refers to a child’s emotional and social well-being. It is influenced by factors including relationships with family and friends, the school environment, self-esteem and the ability to cope with everyday life.
The study’s findings suggest that the daily pattern combining physical activity, sleep and screen use may be particularly important for the well-being of children with excess weight.
“A child with excess weight may face more physical and social barriers to being active. At the same time, regular physical activity supports self-confidence, social interaction and well-being. The right activity should give the child a sense of achievement and take their abilities and interests into account,” Veidebaum said.
Only a little over half of young people exercise regularly
The National Institute for Health Development’s population health yearbook helps put the international study’s findings into an Estonian context. According to a 2022 school-aged children’s health behavior survey cited in the yearbook, 57 percent of Estonian children ages 11 to 15 took part in sports, dance or another organized physical activity at least twice a week. The figure was 60 percent among boys and 54 percent among girls.
Regular exercise was also associated with how young people rated their health. Among 11-year-olds who exercised regularly, 91 percent rated their health as good. The figure was 81 percent among those who exercised less often or irregularly.
Active young people were more likely to report greater life satisfaction and to enjoy going to school, and were less likely to experience depressive episodes.
Differences were also seen in health complaints. Around 40 percent of young people who exercised infrequently experienced feeling low, irritability, nervousness or difficulty falling asleep. Among those who exercised at least twice a week, fewer than one-third reported these complaints.
Among young people who exercised regularly, 17 percent were overweight or obese, compared with 24 percent of those who exercised once a week or less.
These findings show that physical activity, well-being and body weight are also closely associated among children in Estonia. However, it is important to bear in mind that the data shows associations and does not establish that regular exercise directly causes better mental or physical health.
Effects evaluated six years later
A study published in the European Journal of Preventive Cardiology focused on the long-term impact of the IDEFICS program. Researchers examined whether a health program implemented during childhood was associated with participants’ cardiovascular and metabolic health later in life.
Cardiometabolic health refers to the health of the cardiovascular system and metabolism. It can be assessed using measures such as blood pressure, blood glucose metabolism, blood lipid levels, waist circumference and body weight.
The IDEFICS study began during the 2007-2008 school year. A total of 16,229 children ages 2 to 9 in eight European countries took part in health assessments. Around half lived in areas where a community-based health program was implemented. The remaining children lived in comparison areas with similar socioeconomic backgrounds.
The program focused on three areas: nutrition, physical activity and stress management. Children, families, preschools, schools and local communities were all involved in the activities.
School. Source: Ken Mürk/ERR
The program aimed to encourage water and fruit and vegetable consumption, daily physical activity, sufficient sleep, moderate screen time and health-promoting activities for families to do together.
The children’s health indicators were measured at the start of the study, two years later and six years after the program began. The latest analysis included 1,159 children from Belgium, Estonia, Germany, Hungary, Italy and Sweden who had blood-based measurements available both at the start of the study and six years later. Of these, 685 were in the intervention group and 474 in the comparison group.
Biggest differences in blood pressure
Researchers calculated a metabolic syndrome risk score for each participant. The score combined blood pressure, waist circumference, insulin sensitivity and blood lipid measures, allowing researchers to assess changes in these indicators as a whole.
Over six years, the metabolic risk score improved somewhat more among participants in the health program than in the comparison group. The finding remained after researchers accounted for participants’ age, sex, country of origin, body weight and parents’ level of education.
Systolic and diastolic blood pressure contributed most to the difference. Among boys, the more favorable change in metabolic risk in the intervention group was most pronounced.
Changes in body mass index were similar in the intervention and comparison groups over the six-year period. This means that the health program’s potential benefits may have been reflected in blood pressure and other metabolic indicators even without a clear difference in body weight.
“Body weight is one easily visible indicator of health, but the changes taking place in a child’s body go beyond that. Blood pressure, blood glucose regulation and blood lipid levels provide early information about cardiovascular and metabolic health,” Veidebaum said.
Playground. Source: Priit Mürk/ERR
He said the findings also demonstrate the importance of long-term follow-up. “The effects of a prevention program may develop gradually and show up in different health indicators at different ages. A longitudinal study makes it possible to track which changes that begin in childhood carry over into adolescence and which require more sustained support,” Veidebaum said.
The study’s authors described the finding as modest but potentially significant from a public health perspective. More favorable development of blood pressure and metabolic indicators beginning in childhood could affect the later risk of cardiovascular disease and Type 2 diabetes.
Communities were selected as intervention and comparison areas for practical reasons and matched according to socioeconomic background. The six-year analysis included participants from whom fasting blood samples were collected both at the start of the study and six years later.
Health-supporting environment must be maintained for years
The studies highlight two complementary perspectives. A child’s daily physical activity, sleep and screen time habits are associated with their well-being. In turn, a program involving families, schools and communities may affect health indicators associated with the risk of chronic diseases years later.
“Children develop their habits within environments created by adults. Safe opportunities for physical activity, daily routines, the way schools are organized, extracurricular activities and shared family habits largely determine how easy it is for a child to live a healthy lifestyle,” Veidebaum said.
TAI’s population health yearbook also emphasizes that risk factors for chronic diseases develop throughout a person’s life and often begin in childhood. Early prevention means creating opportunities that support health at home, in preschool, at school and in the community.
Longitudinal studies help researchers understand how habits and health indicators established in childhood change over time and at what stage of life their development can be most effectively influenced.
The Population Health Yearbook 2026 provides an overview of the health of people in Estonia and the factors that affect it. This year’s yearbook focuses on the development of risk factors for chronic diseases from the perspective of longitudinal studies. It includes data on life expectancy, healthy life years, leading causes of death, cancer, cardiovascular diseases, excess weight, mental health, health behavior and access to health care services, among other topics.
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