NSCH-derived proxy measures of 24-hour movement guideline components and flourishing among u.s. children and adolescents with current asthma: a cross-sectional analysis of the 2023–2024 national survey of children’s health

Healthy movement behaviors are associated with flourishing in general pediatric populations, but the clinical novelty is evaluation of a proxy-operationalized 24-hour movement framework in a contemporary, nationally representative, post-pandemic sample of children with current asthma, a chronic respiratory condition. We analyzed the 2023–2024 National Survey of Children’s Health among children aged 6–17 years with current asthma. NSCH/CAHMI-derived proxy indicators represented physical activity on all 7 days of the past week, recreational screen time of 2 h/day or less on most weekdays, and age-specific minimum sleep duration. The component count ranged from 0 to 3. Flourishing required caregiver reports of usually or always meeting all three items for curiosity, task completion, and emotional self-control. Survey-weighted quasi-Poisson models estimated adjusted prevalence ratios (aPRs); logistic models provided secondary adjusted odds ratios (aORs). Six poverty implicates were combined using Rubin’s rules. Of 5,938 children with complete proxy-component data, 5,936 had flourishing data and 5,647 entered the primary adjusted model after 289 further exclusions for incomplete covariates; 6.1% met all three proxy criteria. Weighted flourishing prevalence was 40.1% with no component and 65.9% with all three. Each additional component was associated with higher flourishing prevalence (aPR, 1.19; 95% CI, 1.12–1.26; P < .001); the secondary aOR was 1.44 (95% CI, 1.27–1.64; P < .001). Standardized probabilities were 39.8% at score 0 and 65.8% at score 3 (RD, 26.0% points). The ratio of per-component aPRs for current versus no current asthma was 1.02 (95% CI, 0.96–1.08; P = .474). Asthma-stratified score 3-versus-0 RDs were 30.6 and 29.6% points; their difference was − 1.0% points (95% CI, − 10.7 to 8.8; P = .844). These nationally representative 2023–2024 post-pandemic data provide population-specific validation of the clinical relevance of the proxy-operationalized 24-hour movement framework for children with current asthma. More components met was associated with greater caregiver-reported flourishing. The PR- and RD-scale interaction analyses did not detect a difference by asthma status, a reassuring finding consistent with similar holistic associations in children with and without asthma; however, null tests do not establish equivalence, and cross-sectional associations do not demonstrate benefit or causality.