To explore the association between lifestyle factors (such as physical activity, outdoor light exposure, and sugar-sweetened beverage intake) and demographic characteristics with the onset and progression of myopia among adolescents in Chongqing, and to provide precise evidence for regional myopia prevention and control, this study used a stratified cluster sampling method to select 3745 baseline non-myopic adolescents (aged 6-15 years, including 2136 primary school students and 1609 junior high school students) from 12 primary and secondary schools in 6 administrative districts of Chongqing, conducted a 3-year prospective cohort study from September 2022 to September 2025 with data collected at 4 time points (baseline and annual follow-up), used international standardized scales (such as the IPAQ Short Form, OTR Record Sheet, and Simplified Food Frequency Questionnaire) to investigate the participants' demographic characteristics, physical activity (moderate-to-vigorous physical activity [MVPA] duration), daily outdoor light exposure time, and sugar-sweetened beverage intake frequency, performed standardized ophthalmic examinations (visual acuity, refraction, and axial length measurement), implemented quality control measures including pre-survey, investigator training, instrument calibration, double data entry, and follow-up of lost-to-follow-up participants, used SPSS 26.0 and Stata 18.0 software for descriptive statistics, Cox proportional hazards model (to analyze myopia onset risk), linear mixed model (to analyze axial length growth rate), and stratified analysis while adjusting for confounding factors such as gender and age with the significance level set at α=0.05; at baseline, the participants had an average age of (10.2±2.3) years, with males accounting for 52.4%, 42.5% of the participants had parents with a bachelor's degree or above, 30.4% engaged in MVPA for ≥150 minutes per week, 33.7% had outdoor exposure for ≥2 hours per day, 19.4% consumed sugar-sweetened beverages ≥4 times per week, with an average refraction of (+1.23±0.45) D and an average axial length of (22.15±0.82) mm; during the follow-up period, the 3-year cumulative myopia incidence was 42.24%, with the annual incidence showing an increasing trend year by year (11.36%-16.06%), and after adjusting for confounders, weekly MVPA ≥150 minutes (HR=0.69) and daily outdoor exposure ≥2 hours (HR=0.57) were protective factors against myopia onset, while weekly sugar-sweetened beverage intake ≥4 times (HR=1.28), non-only child status (HR=1.19), and parental binocular myopia (HR=2.45) were risk factors, with the myopia-inducing effect of sugar-sweetened beverages being more significant in primary school students (HR=1.89) and the annual axial length growth rate being significantly lower in the protective factor groups than in the risk factor groups; this study indicates that the incidence of myopia among adolescents in Chongqing is showing an increasing trend year by year, sufficient physical activity, adequate outdoor light exposure, and high parental education level are protective factors against myopia, while high-frequency sugar-sweetened beverage intake and non-only child status are risk factors, and targeted regional myopia prevention and control strategies should be formulated based on these findings.

Wu Xiangdong, Ren Lisha, Hao Zongji. Association between Myopia Onset and Progression and Lifestyle Factors among Adolescents in Chongqing: A 3-Year Cohort Analysis of 3745 Adolescents. Frontiers in Medical Science Research (2026), Vol. 8, Issue 3: 1-10. https://doi.org/10.25236/FMSR.2026.080301.

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