Prevalence and Correlates of Healthy Behaviors Among Children Age 3-5 Years.

Introduction: This study examined the prevalence and correlates of 6 healthy behaviors among preschool-age children in the United States.

Methods: Data from the 2021 and 2022 National Survey of Children's Health were used to examine daily fruit consumption, daily vegetable consumption, no sugary beverage consumption in the past week, frequent outdoor play (≥2 hours/day), limited screen time (≤1 hour/weekday), and adequate sleep (≥10 hours/day) among children ages 3-5 years (N=23,123). Relationships between healthy behaviorss and child, family, community characteristics, and state of residence were examined using logistic regression modeling, accounting for the complex survey design. Analyses were conducted in 2024 using SAS-callable SUDAAN.

Results: Prevalence of healthy behaviors varied from 32.4% having no sugary drinks in the past week to 65.3% eating fruit daily. Only 20% engaged in all or nearly all (5-6) healthy behaviors. After adjustment, children engaging in 5-6 HBs were more likely to be younger, non-Hispanic White, have parents with higher education and income, excellent/very good parental mental health, frequent family meals, household food sufficiency, and live in safe neighborhoods, yet prevalence rose to only 30% across any characteristic. The proportion of children engaging in 5-6 healthy behaviors ranged from 6.5% in Mississippi to 46.4% in Vermont, with child, family, and community factors accounting for 43% of the variance between states.

Conclusions: There is a need to increase healthy behaviors among preschool-age children and address disparities. Family and community factors associated with healthy behaviors can inform pediatric care, public policy, programmatic investments, and additional research to foster improvement.