The awareness of the importance of physical literacy (PL) is globally increasing; however, knowledge of the applicability of PL measurement tools in southeastern Europe is limited. The aim of this study was to evaluate the reliability and validity of translated versions of the CAPL-2 and PLAYself questionnaires in 9- to 11-year-old elementary school children from Croatia, Bosnia and Herzegovina, and Montenegro. The participants were 303 children (141 girls; all 9 to 11 years of age) from Croatia (n = 71), Bosnia and Herzegovina (n = 162), and Montenegro (n = 70), enrolled in regular elementary school. The participants were tested throughout a test–retest procedure using two PL evaluation tools, i.e., the Canadian Assessment of Physical Literacy (shorter version, CAPL-2) and the Physical Literacy Assessment of Youth (PLAYself) questionnaires. With an intraclass correlation (ICC) of 0.70–0.80 for specific questionnaire subscales and 0.84 for the total score, PLAYself was found to be reliable. With Kappa values of 0.11–0.23 and a percentage of absolute agreement of less than 62%, CAPL-2 appeared to be less reliable. Factors related to sport participation were significantly positively associated with the PLAYself score, indicating its proper validity. In conclusion, we suggest the usage of the PLAYself questionnaire in further studies examining PL in children of a similar age in the region. Future studies in other age groups and languages are also warranted.

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

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

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

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

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