Objective  To explore individual eye health-related behaviors and their influencing factors among primary and middle school students and to provide evidences for prevention and control of myopia in the students.

  Methods  With multistage cluster sampling, we randomly selected 10 213 students at 12 primary and middle schools in Ningxiang city of Hunan province and conducted an anonymous questionnaire survey during October – November 2014.

  Results  Among the 8 391 students with valid responses, 58.15% reported a generally good eye health-related behavior; the proportions of the students reporting specific vision health behaviors were 78.24% for keeping a distance of 66 centimeters (cm) or more between an electronic screen and eyes, 75.32% for keeping a distance of more than 10 cm between chest and the table edge while studying, 72.43% for keeping a distance of more than 30 cm between eyes and book while reading, and 36.92% for keeping a distance of more than 3 cm between fingers and pen tip while writing, respectively. There were 64.01% of the students reporting a television or computer screen time of ≤ 2 hours per day, 55.13% reporting a time of ≥ 1 hour per day for outdoor activity, 37.39% spending a reasonable time to do homework, 44.53% reporting a sunlight exposure of ≥ 1 hour in a sunny day, and 56.57% reporting a sleeping time of 7 – 9 hours every day. The results of logistic regression analysis demonstrated that female gender (odds ratio OR = 1.166), aged ≥ 16 years (OR = 1.970), and maternal myopia (OR = 1.202) were associated with a high risk of poor vision health behavior among the students; while, aged 10 – 12 years (OR = 0.834) and high maternal education (OR = 0.779) were correlated to a low risk of poor vision health behavior.

  Conclusion  The prevalence of good eye health-related behaviors is low and influence by multiple factors among urban primary and secondary school students in Hunan province. The results suggest that interventions on vision health need to promoted in the students.