Intersectional Identities and 24-hr Movement Behavior Recommendation Adherence Among U.S. Children and Adolescents

Individual characteristics and social drivers of health (SDOH) likely interact to shape 24-hr movement behaviors (24HMB), yet most research has focused on single factors. We identified intersectional subgroups and examined disparities in meeting physical activity (PA), sedentary behavior (SB), sleep, and combined 24HMB recommendations. We performed a cross-sectional latent class analysis of 2022-2023 National Survey of Children's Health data (n = 68,000, ages 6-17) using sex, race/ethnicity, caregiver education, household language, and food sufficiency. Survey-weighted logistic regression estimated class differences. Five classes emerged, with labels emphasizing the indicators that most differentiated profiles: Class 1 (52% of the population; high education, non-Hispanic [NH] White), Class 2 (10%; high education, NH Asian), Class 3 (5%; low education, NH White), Class 4 (20%; low education, Hispanic/Black), and Class 5 (12%; non-English, low education, Hispanic). The prevalence of meeting PA recommendations (19.48%) was lower than meeting SB recommendations (49.93%) and sleep recommendations (64.52%). Compared with Class 1, odds were lower in Classes 2 and 5 (ORs = 0.56-0.64) for meeting PA recommendations, lower in Classes 3-5 (ORs = 0.56-0.72) for meeting SB recommendations, and lower in all other classes (ORs = 0.49-0.76) for meeting sleep recommendations. Relative to Class 1, disadvantaged classes had higher odds of meeting none (ORs = 1.39-2.05) and lower odds of meeting all three (ORs = 0.48-0.63) recommendations. Findings highlight the need to consider combinations of individual characteristics and SDOH rather than one-size-fits-all approaches to improve 24HMB adherence across diverse groups.