Differential associations between passive and active forms of screen time and adolescent mood and anxiety disorders

Prospective association of screen time with binge-eating disorder among adolescents in the United States: The mediating role of depression

OBJECTIVE

Screen time has been reported to be associated with binge-eating disorder (BED) among adolescents in the US; however, potential mediators remain unclear. This study aimed to evaluate depression symptoms as a mediator of the prospective association between screen time and BED.

METHOD

We utilized data from 9465 children (aged 9-11 years at baseline) from the Adolescent Brain Cognitive Development (ABCD) study (2016-2021). A generalized structural equation model was used to examine the prospective association between average daily screen time at baseline and BED at year 2, adjusting for baseline BED diagnosis, and other potential covariates (e.g., age, sex, and income). Mediation was examined using bias-corrected (BC) 95% confidence intervals for the indirect effect of baseline screen time on year 2 BED through depression symptoms (change from baseline to year 1).

RESULTS

One hundred and one participants (42.7% male, 49.4% racial/ethnic minority) met the criteria for BED in year 2. Participants were 9.9 years of age on average at baseline, 51.3% identified as male, and 43.1% identified as a racial/ethnic minority. Adjusting for covariates, screen time was prospectively associated with BED (OR = 1.09, 95% CI [1.03, 1.14], p = .005). Depression symptoms (B = .19, BC 95% CI [0.10, 0.28]) partially mediated (9.2%) the prospective association between screen time and BED.

DISCUSSION

Among US adolescents, higher baseline screen time was prospectively associated with BED diagnosis at year 2, and this relationship was partially mediated by increased depression symptoms. Preventive approaches targeting high screen use may have utility for reducing BED risk among adolescents.

PUBLIC SIGNIFICANCE

Among U.S. adolescents, higher screen time was prospectively associated with the incidence of BED. This association was partially mediated by the change in depressive symptoms. Preventive approaches targeting high screen use may have utility for reducing BED risk among adolescents.

Shared Genetic Risk in the Association of Screen Time With Psychiatric Problems in Children

Importance

Children's exposure to screen time has been associated with poor mental health outcomes, yet the role of genetic factors remains largely unknown.

Objective

To assess the extent of genetic confounding in the associations between screen time and attention problems or internalizing problems in preadolescent children.

Design, Setting, and Participants

This cohort study analyzed data obtained between 2016 and 2019 from the Adolescent Brain Cognitive Development Study at 21 sites in the US. The sample included children aged 9 to 11 years of genetically assigned European ancestry with self-reported screen time. Data were analyzed between November 2021 and September 2023.

Exposure

Child-reported daily screen time (in hours) was ascertained from questionnaires completed by the children at baseline.

Main Outcomes and Measures

Child psychiatric problems, specifically attention and internalizing problems, were measured with the parent-completed Achenbach Child Behavior Checklist at the 1-year follow-up. Genetic sensitivity analyses model (Gsens) was used, which incorporated polygenic risk scores (PRSs) of both exposure and outcomes as well as either single-nucleotide variant (SNV; formerly single-nucleotide polymorphism)-based heritability or twin-based heritability to estimate genetic confounding.

Results

The 4262 children in the sample included 2269 males (53.2%) with a mean (SD) age of 9.9 (0.6) years. Child screen time was associated with attention problems (β = 0.10 SD; 95% CI, 0.07-0.13 SD) and internalizing problems (β = 0.03 SD; 95% CI, 0.003-0.06 SD). The television time PRS was associated with child screen time (β = 0.18 SD; 95% CI, 0.14-0.23 SD), the attention-deficit/hyperactivity disorder PRS was associated with attention problems (β = 0.13 SD; 95% CI, 0.10-0.16 SD), and the depression PRS was associated with internalizing problems (β = 0.10 SD; 95% CI, 0.07-0.13 SD). These PRSs were associated with cross-traits, suggesting genetic confounding. Estimates using PRSs and SNV-based heritability showed that genetic confounding accounted for most of the association between child screen time and attention problems and for 42.7% of the association between child screen time and internalizing problems. When PRSs and twin-based heritability estimates were used, genetic confounding fully explained both associations.

Conclusions and Relevance

Results of this study suggest that genetic confounding may explain a substantial part of the associations between child screen time and psychiatric problems. Genetic confounding should be considered in sociobehavioral studies of modifiable factors for youth mental health.

Associations between screen-time, physical activity and depressive symptoms differ based on gender and screen-time mode

Higher levels of physical activity (PA) and screen time (ST) are associated with positive and negative mental health outcomes among adolescents, respectively. Research is needed to determine the interrelationship between ST and PA with depressive symptoms and the influence of ST modes. This study examines the associations between ST and PA level with depressive symptoms among 1756 adolescents (15.2 ± 1.6y; 995 female) in Ireland. Participants completed the Quick Inventory of Depressive Symptomatology and self-reported weekly ST (TV, computer, and phone use) and PA level (low, moderate, and high). Linear regressions examined associations between ST mode, PA level and relevant covariates with depressive symptoms in the full sample by gender, and in a sample stratified by PA level. Chi-square tests and one-way ANOVA examined gender differences in hours of ST, PA levels, and depressive symptoms. Differential associations were observed depending on the gender and ST mode. Higher levels of computer (β  =  0.106, p  ≤  0.000) and phone use (β  =  0.138, p  ≤  0.000) showed the strongest associations with depressive symptoms. PA level was inversely associated with depressive symptoms (β  =  - 0.175, p  ≤  0.000). When the sample was stratified by PA level, only associations between phone use and depressive symptoms were moderated by PA level for males and females. These findings highlight the complex interrelationships between ST, PA, and depressive symptoms, and that associations may vary based on gender and ST mode. This may have implications for future interventions. Increasing PA and reducing ST should be targeted concurrently with consideration given to different media and genders. Future research should explore longitudinal and prospective associations.

Association of Screen Time with Anxiety and Depressive Symptoms in College Students During COVID-19 Outbreak in Shanghai: Mediation Role of Sleep Quality

The study aimed to investigate the associations between different types of screen time (ST) and anxiety and depressive symptoms in college students during the Coronavirus disease 2019 (COVID-19) outbreak in Shanghai, China; the potential mediation role of sleep quality was also examined. A total of 1,550 college students completed an online survey in May 2022. ST, Self-rating Anxiety Scale (SAS) score, Self-rating Depression Scale (SDS) score, Pittsburgh Sleep Quality Index (PSQI) score, and physical activity were self-reported. Multiple linear regression and mediation analysis were conducted. The results showed that more time spent in TV/movie viewing (>2 h/day) and recreational reading (>1 h/day) was associated with higher levels of anxiety, while more time spent in online social media (>2 h/day) was associated with a higher level of depressive symptoms. In contrast, time spent in online social media (1-2 h/day) was associated with a lower level of anxiety. Meanwhile, recreational reading (2-3 h/day) had a significant indirect effect on anxiety and depressive symptoms through sleep quality. During the COVID-19 outbreak, the associations of ST with anxiety and depressive symptoms varied by the type of screen viewing in college students. The associations of slightly excessive time spent on recreational reading with higher levels of anxiety and depressive symptoms were partially mediated by sleep quality.

Different types of screen time are associated with low life satisfaction in adolescents across 37 European and North American countries

AIMS

Prolonged screen time (ST) is a potential concern for poor wellbeing. This study aimed to examine the associations of different types of ST with life satisfaction among adolescents.

METHODS

Data were from 380,446 adolescents (aged 11-15 years, 51% girls) across 37 European and North American countries who completed the 2010 and 2014 Health Behaviour in School-Aged Children surveys. Participants reported h/day during free time spent on television, electronic games, and computer/other devices. Life satisfaction was assessed using a 10-point scale (low life satisfaction ⩽5).

RESULTS

Generalized additive modelling showed non-linear associations for each ST type, with low life satisfaction increasing monotonically for >1 h/day of electronic gaming or computer/other device and >2 h/day of watching television. Multilevel multivariable modelling showed that >4 h/day of watching television was associated with 26% higher odds for boys (OR 1.26; 95% CI:1.21-1.32) and 52% higher odds for girls (1.52; 1.46-1.59) of low life satisfaction than for ⩽1 h/day of television. Electronic gaming >4 h/day was associated with low life satisfaction with odds 42% higher in boys (1.42, 1.36-1.48) and 69% higher in girls (1.69, 1.61-1.76). A similar association was found for >4 h/day of computer/other device for boys (1.43, 1.37-1.49) and girls (1.71, 1.65-1.77).

CONCLUSIONS

Low levels of ST may be beneficial; however, prolonged periods are associated with low life satisfaction among adolescents, in particular among girls. Results support ⩽2 h/day restriction of ST and highlight research is needed to understand underlying mechanisms of ST and wellbeing, which may not reflect active versus passive content.

Media screen time use and mental health in school aged children during the pandemic

BACKGROUND

Children's screen time activity has increased significantly during the pandemic. Extended school closures and heightened parent stress are associated with children's behavioural difficulties and time spent watching screens. The primary aim of this study was to determine which school and household factors were associated with challenging behaviours in Canadian schoolchildren during the COVID-19 pandemic.

METHODS

This longitudinal survey study examined the association amongst screen time, internalizing and externalizing behaviours in school-aged children at two time points over the 2020-2021 academic school year. Parents completed survey measures on their parental involvement, stress levels, and their child's screen time use as well as their emotional and behavioural difficulties.

RESULTS

Children's average daily screen time was 4.40 h (SE = 18.45) at baseline and 3.89 h (SE = 16.70) at 1-year follow up, with no significant change across the school year (p = .316). Increased screen time use was associated with a greater incidence of internalizing behaviours in children (p = .03). Children who spent more time on screens and who were in households with parents reporting higher stress levels had increased internalizing behaviours (p < .001). No association between screen time use and externalizing behaviours was evident; however, parent stress was positively associated with children's externalizing behaviours (p < .001).

CONCLUSIONS

Children's screen time use has remained high during the pandemic and is associated with anxious and depressive symptoms. Children who spent more time on screens and who were in households with parents reporting higher stress levels had increased internalizing behaviours. Parent stress was positively associated with children's externalizing behaviours. Targeted family intervention plans focused on reducing parent stress and screen time use may aid in improving children's mental health during the ongoing pandemic.

Screen-based and non-screen-based sedentary behaviors are differentially associated with affective states in older adults

Excessive sedentary behavior (SB) contributes to poor affective and physical feeling states, which is particularly concerning for older adults who are the most sedentary sector of the population. Specific types of SB have been shown to differentially impact health in cross-sectional and longitudinal studies, with screen-based SB more negatively impacting aspects of mental health. This study used Ecological Momentary Assessment (EMA), a real-time, intensive longitudinal data capture methodology, to examine the differential impact of screen-based behaviors on momentary affective responses during SB in naturalistic settings. A diverse sample of older adults (pooled across 2 studies) completed an EMA protocol for 8-10 days with six randomly delivered, smartphone assessments per day. At each EMA prompt, participants reported their current activity, whether they were sitting while doing that activity, and affective states. Multilevel models assessed whether screen-based (vs. non-screen-based) behavior moderated affective response during SB. At the within-person level, older adults experienced less positive affect during SB when engaged in a screen-based behavior compared to a non-screen-based SB (B = -0.10, p < 0.01). At the between-person level, positive associations between SB and negative affect (B = 0.79, p = 0.03) were stronger if participants reported engaging in screen-based behaviors for a greater proportion of prompts. Among older adults, screen-based SB may lead to poorer affective states compared to non-screen-based SB. Interventions aiming to reduce SB in this population should consider targeting reductions in screen-based SB as means to improve affective states.

The associations between screen time and mental health in adolescents: a systematic review

BACKGROUND

Adolescents have extensive use of screens and, they have common complains related to mental health. Here a systematic review was done to understand the association between screen time and adolescent's mental health.

METHOD

This review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA. An update search was performed in January 2023 with the following keywords: "screen time," "adolescent," and "mental health" on PubMed, PsycINFO and Scopus databases.

RESULTS

50 articles were included, most have found associations between screen exposure and mental health in adolescents. The most used device by adolescents was the smartphone and the use on weekdays was associated with diminished mental well-being. Social media use was negatively associated with mental well-being and, in girls, associated at higher risk for depression.

CONCLUSION

Excessive screen time in adolescents seems associated with mental health problems. Given the profusion and disparity of the results, additional studies are needed to clarify elements such as the screen content or the interaction of adolescents with different screen devices.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022302817.

The relationship between neuroticism and passive use of mobile social networks among Chinese young adults: The mediating role of fear of missing out and online social support

Many studies have shown that passive use of mobile social networks affects people's physical and mental health. However, few studies have explored the association between neuroticism and passive use of social networks, and the mediating factors that may indirectly contribute to this relationship. Therefore, the present study sought to investigate the relationship between neuroticism and passive use of mobile social networks and explore the sequential mediating role of fear of missing out (FOMO) and online social support. In the present study, data from a total of 531 Chinese undergraduates were collected by using the Chinese Big Five Personality Inventory, Online Social Support Scale, the Fear of Missing Out Scale, and Passive Use of Mobile Social Networks Scale. The results showed that neuroticism positively predicted passive use of mobile social networks through the indirect paths of FOMO and online social support and the chain mediating path of "online social support-FOMO".

Associations between adolescent sleep difficulties and active versus passive screen time across 38 countries

BACKGROUND

High screen use has been adversely linked with mental wellbeing; however, little is known about how active versus passive screen time are associated with sleep-onset difficulties among adolescents.

METHODS

We analysed data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey. Difficulties in falling sleep were assessed using a self-reported item with a 5-point Likert scale, and then dichotomised. Participants reported h/day of discretional time spent watching television, electronic gaming, and computer use.

RESULTS

Of the 195,668 participants (M_age 13.59 [1.62] years; 51 % girls), about 25 % of girls reported sleep-onset difficulties, while the rate was 18 % in boys. Adolescents who played electronic games >4 h/day (≤1 h/day as reference) had 30 % higher odds in boys (OR 1.30; 95 % CI: 1.23-1.38) and 38 % higher odds in girls (OR 1.38; 95 % CI: 1.31-1.45) of reporting sleep difficulties. High computer use (>4 h/day) increased the odds of sleep difficulties by 41 % in boys (OR 1.41, 95 % CI: 1.33-1.49) and 61 % in girls (OR 1.61, 95 % CI: 1.53-1.69). Similarly, high television time (>4 h/day) had increased the odds of sleep difficulties by 15 % in boys (OR 1.15, 95 % CI: 1.08-1.22) and 19 % in girls (OR 1.19, 95 % CI: 1.12-1.25).

LIMITATIONS

Cross-sectional analyses cannot establish causality of the associations.

CONCLUSIONS

Higher levels of recreational screen use of any type were associated with sleep-onset difficulties among adolescents with adverse effects being more prevalent in active than passive screen time. Prospective research with objective measures is warranted to understand causality of these relationships.

The Relationship between Binge Drinking and Binge Eating in Adolescence and Youth: A Systematic Review and Meta-Analysis

Adolescence and youth are critical periods in which alcohol consumption is usually initiated, especially in the form of binge drinking. In recent years, it is increasingly common to find adolescents and young people who also present binge behaviors towards unhealthy food with the aim of alleviating their anxiety (emotional eating) and/or because of impulsive personality. Despite the social and health relevance of this issue, it remains scarcely studied and more preventive research needs to be developed. Our meta-analysis study aimed to evaluate the relationship and co-occurrence of both binge behaviors during adolescence and young adulthood to clarify the link between binge drinking and eating. Selective literature search on different online databases was performed. We identified discrete but significant results regarding the direct association between binge drinking and binge eating in correlation coefficients and odds ratio. Future research should focus on the common psychological background and motives behind these problematic behaviors owing to their clinical implications for effective prevention and treatment.

Emerging adults’ digital technology engagement and mental health during the COVID-19 pandemic

Within the past decade, parents, scientists, and policy makers have sought to understand how digital technology engagement may exacerbate or ameliorate young people’s mental health symptoms, a concern that has intensified amidst the COVID-19 pandemic. Previous research has been far from conclusive, and a lack of research consensus may stem in part from widely varying measurement strategies (including subjective and objective measurement) around digital technology engagement. In a cross-sectional study of 323 university students, the present study seeks to understand the ways in which youth engagement with digital technology – across subjective and objective measurements, weekday and weekend distinctions, and social and non-social uses – is associated with mental health (as measured by depression, loneliness, and multidimensional mood and anxiety). The present study also tested a differential susceptibility hypothesis to examine whether COVID-19 related social isolation might exacerbate the potential harms or helps of digital technology engagement. Results yielded few observed associations between digital technology engagement and mental health, with little evidence of detrimental effects of observed or perceived time spent on digital technology. Rather, those significant findings which did emerge underscore potential protections conferred by social connections with friends (both online and offline), and that the loneliest students may be the most likely to be reaching out for these types of connections. It is important that the field move beyond crude (largely self-reported) measures of screen time to instead understand how and to what effect youth are using digital technologies, especially during the social corridor of emerging adulthood.

The convergent effects of primary school physical activity, sleep, and recreational screen time on cognition and academic performance in grade 9

Lab-based experiments and randomized controlled trials consistently demonstrate improvements in youth cognition following physical activity (PA), while cross-sectional studies suggest that sedentary behavior (especially recreational screen time [RST]) and poor sleep are inversely related to cognition. However, little is known about how these 24-h movement behaviors—sleep, PA, and sedentary behavior—converge to affect youth cognition. Therefore, the purpose of this study is to test the associations between childhood 24-h movement behaviors and adolescent cognition using a longitudinal design and examine moderating effects of each behavior. This study utilized structural equation modeling with data from the NICHD Study of Early Child Care and Youth Development (N = 1,364, 52% female, 80% White). Independent variables—sleep, RST, and PA—were collected in grade 5. Dependent variables of cognitive and academic performance were collected at grade 9, including the Stroop task, Woodcock-Johnson, and Tower of London. Grade 5 PA was inversely associated with grade 9 cognition, but this relationship was no longer significant once grade 5 cognition was controlled for in analyses. Grade 5 sleep was positively related to grade 9 cognition, whether baseline cognition was controlled for or not. Finally, grade 5 RST was inversely related to cognition and academic performance, regardless of whether baseline values were controlled. Moderation analyses showed the relationship between grade 5 RST and grade 9 cognition was moderated by grade 5 PA, while the relationship between grade 5 PA and grade 9 cognition was moderated by grade 5 sleep. In each case, more PA and sleep blunted the negative relationships. These findings extend evidence that greater sleep promotes cognition and greater RST impairs cognition, by affirming these relationships over a longer period. They extend the evidence by demonstrating that the longitudinal relationship between individual 24-h movement behavior and cognition is moderated by other behaviors.

Screen-based sedentary behaviors but not total sedentary time are associated with anxiety among college students

Objective

The purpose of the study was to investigate the associations of device-measured total sedentary time and screen-based sedentary time with anxiety in college students.

Methods

Three hundred and twenty-one college students (mean age = 19.72 ± 1.18, 55.8% females) were recruited from Shanghai, China. Total sedentary time was objectively measured using accelerometry, while screen-based sedentary time was self-reported. Anxiety symptom was evaluated using the Self-Rating Anxiety Scale. Linear regression modeling was used to assess the associations of total sedentary time and screen-based sedentary time with anxiety symptom.

Results

Accelerometer-assessed total sedentary time was not associated with anxiety symptom. Prolonged sedentary time on TV and movie viewing (>2 h on weekdays) and social media using (>2 h on weekdays and weekend) were associated with a higher level of anxiety. However, time on video gaming and recreational reading was not associated with anxiety symptom.

Conclusion

The findings indicated that screen-based sedentary behaviors but not total sedentary time were associated with anxiety symptom among college students. The associations of screen-based sedentary behaviors with anxiety symptom varied by the types of screen time.

Relationship between physical activity, screen-related sedentary behaviors and anxiety among adolescents in less developed areas of China

This study aimed to explore the association between physical activity, screen-related sedentary behaviors, and anxiety. The current study used latent profile analysis (LPA) to identify homogenous subtypes of anxiety among adolescents in less-developed areas of China. Data were aggregated from 6 schools in the less-developed areas of China in September 2018. In total, 900 students were evaluated using the 100-item Mental Health Test (MHT) and Youth Risk Behavior Surveillance System (YRBSS) questionnaire. The LPA was conducted to explore the potential classification of anxiety, which makes full use of all the sample data and explore heterogeneous classifications within groups. Logistic regression was used for the multifactor analysis. A P value <.05 was considered statistically significant. The entropy value suggested that the model with 3 latent profile was the best choice. There were 223 adolescents in the severe anxiety group, accounting for 24.78%. Logistics regression analysis of anxiety revealed that the risk of severe anxiety in boys was lower (odds ratio [OR] = 0.317, P < .001) than in girls. Students had a significantly lower probability of suffering from severe anxiety in using cellphones or computers ≤ 2 hours/day than those used cellphones or computers＞2 hours/day (OR = 0.391, P = .004). Decreasing screen-related sedentary behaviors should be a target of community and school-based interventions, because high screen-related sedentary behaviors were associated with higher odds of anxiety among adolescents in less developed area of China.

Different types of screen-based sedentary time and anxiety in adolescents: Video games may be more important

Aim

Evidence demonstrates the negative impact of excessive screen-based sedentary time (screen-based sedentary behavior; SSB) on mental health in adolescents. However, little is known regarding the associations between different types of SSBs and anxiety symptoms in adolescents. Thus, this study sought to explore the associations between different types of SSBs and anxiety symptoms in a sample of Chinese adolescents.

Methods

A web-based questionnaire survey was used to collect data. In total, 1,998 study participants conveniently recruited in Guangdong Province completed the questionnaire. Of them, 1,331 study participants provided valid data for variables of interest. SSB was categorized into television/movie time, video game time, and internet-surfing time. Anxiety symptoms were assessed using Zung Self-Rating Anxiety Scale, a validated assessment in Chinese youth populations. Generalized linear models were used to explore the associations between different types of SSBs and anxiety symptoms.

Results

In adolescents, video game time of 6 or more h was positively and significantly associated with anxiety symptoms (odds ratio = 5.25, 95% CI: 1.86-14.84, p < 0.01). This association was also observed specifically in boys (odds ratio = 5.12, 95% CI: 1.56-17.44, p < 0.05); however, in girls, there were no associations between different types of SSBs and anxiety symptoms.

Conclusion

Interventions aiming at reducing video games in adolescents, especially in boys, should be designed to prevent anxiety symptoms. This kind of intervention should also take sex differences into consideration. Future studies are encouraged to confirm the veracity of the findings in this study.

Linear correlation is insufficient as the sole measure of associations: The case of technology use and mental health

It is common for psychology studies to rely solely on linear correlation (r) or similar statistics and not include other measures of association (such as relative risk, which examines differences in the number of people affected). For example, the association between smoking and lung cancer (r = 0.06) could be dismissed as "small" if only linear r is examined, even though 30 times more smokers than non-smokers get lung cancer. Many studies concluding that associations between technology use and well-being as too small to be of practical importance relied solely on linear r. We show that, across five datasets, "small" correlations between technology use and mental health exist alongside practically important risk associations. As there are several valid types of association, and characterizing an association based on a single type of a measure - such as linear r or r² - can be misleading.

Associations of Passive and Mentally Active Screen Time With Perceived School Performance of 197,439 Adolescents Across 38 Countries

OBJECTIVE

To examine the associations of passive (ie, television) and active (ie, electronic games, computer use) screen time (ST) with perceived school performance of adolescents across gender.

METHODS

Data were from the 2014 Health Behaviour in School-aged Children survey conducted across 38 European countries and Canada. Perceived school performance was assessed using an item and dichotomized as high (good/very good) versus the remainder (average/below-average as reference). Participants reported hours per day of time spent watching television, playing electronic games, and using a computer in their free time. Multilevel logistic regression was used to estimate the associations.

RESULTS

A total of 197,439 adolescents (average age 13.6 [standard deviation 1.63] years; 51% girls) were analyzed. Multivariable modeling showed that engaging in >2 h/d of ST was progressively and adversely associated with high performance in both boys and girls. Adolescents reporting >4 h/d of television time (≤1 h/d as reference) had 32% lower odds in boys (odds ratio [OR] 0.68; 95% confidence interval [CI]: 0.65-0.71) and 39% lower odds in girls (OR 0.61; 95% CI, 0.58-0.65) of reporting high performance. Playing electronic games for >4 h/d was associated with high performance with odds being 38% lower in boys (OR 0.62; 95% CI, 0.59-0.66) and 45% lower in girls (OR 0.55; 95% CI, 0.52-0.57). Sex differences in the estimates were mixed.

CONCLUSIONS

High screen use, whether active or passive, was adversely associated with perceived high school performance, with association estimates being slightly stronger in girls than boys, and for mentally active than passive screen use. Discouraging high levels of screen use of any type could be beneficial to school performance.

Association between Recreational Screen Time and Sleep Quality among Adolescents during the Third Wave of the COVID-19 Pandemic in Canada

The study objective was to verify whether recreational screen time was associated with sleep quality among adolescents during the third wave of the COVID-19 pandemic in Canada. Data collection took place in four high schools in the region of Chaudière-Appalaches (Quebec, Canada) from the end of April to mid-May 2021. Recreational screen time and sleep quality were measured using the French versions of validated questionnaires specifically designed for adolescents. A total of 258 adolescents (14−18 years; 66.3% girls) answered the online survey. Adolescent boys had a higher total mean recreational screen time (454.3 ± 197.5 vs. 300.5 ± 129.3 min/day, p < 0.0001) and a higher total mean sleep quality score (4.2 ± 0.9 vs. 3.9 ± 0.8, p = 0.0364) compared to girls. Recreational screen time (β = −0.0012, p = 0.0005) and frequency of concurrent screen use (sometimes: β = −0.3141, p = 0.0269; often: β = −0.4147, p = 0.0048; almost always or always: β = −0.6155, p = 0.0002) were negatively associated with sleep quality while being a boy (β = 0.4276, p = 0.0004) was positively associated with sleep quality and age (p = 0.6321) was not. This model explained 16% of the variance in adolescents’ sleep quality. Public health interventions during and after the COVID-19 pandemic should target recreational screen time, concurrent screen use and especially girls to possibly improve sleep quality and promote adolescents’ physical and mental health.

Associations of Passive and Active Screen Time With Psychosomatic Complaints of Adolescents

INTRODUCTION

Increased screen time is a ubiquitous part of adolescent life and is adversely associated with their well-being. However, it remains unclear whether different types of screen time have equivalent associations, or if relationships are dose-dependent.

METHODS

The data were from 2 nationally representative Health Behaviour in School-aged Children (2010, 2014) surveys across 44 European and North American countries. Psychosomatic health was assessed using 8 complaints and dichotomized as high or low. Discretionary time spent on passive (e.g., TV) and mentally active (e.g., electronic games, computer use) screen-based activities was categorized into 3 groups. Data were analyzed in 2021.

RESULTS

The study included 414,489 adolescents (average age, 13.6 [SD=1.63] years; 51.1% girls). Multilevel modeling showed that psychosomatic complaints increased monotonically once all forms of screen time exceeded 2 hours/day. Adolescents reporting high (>4 hours/day) TV time, compared with those reporting low (≤2 hours/day), had higher odds of reporting psychosomatic complaints with 67% higher odds (OR=1.67, 95% CI=1.62, 1.72) in boys and 71% (OR=1.71, 95% CI=1.66, 1.75) in girls. High electronic game use was associated with psychosomatic complaints, with odds being 78% higher in boys (OR=1.78, 95% CI=1.73, 1.84) and 88% higher in girls (OR=1.88, 95% CI=1.82, 1.94). Similar associations were found between computer use and psychosomatic complaints.

CONCLUSIONS

Passive and mentally active screen time are adversely associated with psychosomatic complaints in a dose-dependent manner, with associations slightly stronger for active than passive screen time. This study supports limiting any type of screen time, either passive or active, to 2 hours/day to foster well-being.

The relationship between screen time exposure and the presence of anxiety-related disorders among adolescents during the COVID-19 pandemic: A cross-sectional study

Background

The Coronavirus Disease 2019 (COVID-19) pandemic prompted rules and laws such as lockdown, which contributed to staying at home and participating in sedentary activities such as using smartphones, tablets, televisions, gaming devices, and computers. As a result of the increased use of digital screen time, a worldwide issue has arisen among various age groups, especially adolescents, which may have affected their psychological well-being, increasing their susceptibility to anxiety-related disorders.

Objective

This study aimed to assess the relationship between screen time exposure and the presence of anxiety-related disorders among adolescents during the COVID-19 pandemic.

Methods

A quantitative descriptive cross-sectional design using convenience sampling was used in this study. The online self-administered questionnaire, including the Arabic-translated version of the Screen for Child Anxiety-related Disorders (SCARED-C), was distributed through social media using Google forms between February and April 2021. The Chi-Squared test was used for data analysis.

Results

Of 625 participants, majority were females (n = 527, 84.3%) than males (n = 98, 15.7%). A significant difference between screen time and the presence of an anxiety-related disorder among adolescents during the COVID-19 pandemic (p = .021) was noted. More than half of the participants (n = 410, 65.6%) scored above 25 in the SCARED-C test, indicating the presence of an anxiety-related disorder regardless of the type. Of those, more than a quarter (n = 176, 28.2%) used screens for more than 8 hours a day.

Conclusion

The results indicated a relationship between screen time exposure and the presence of anxiety-related disorders among adolescents during the pandemic. In particular, adolescents are more susceptible to the adverse effects of increased exposure to screen time, which is constantly on the rise. Therefore, nurses and other healthcare professionals can play a significant role in providing guidance and advice to parents, caregivers, and adolescents themselves on how to limit screen time exposure. The findings can also be useful for future studies to build on and develop screen time management interventions and guidelines.

Lifestyle Prescription for Depression with a Focus on Nature Exposure and Screen Time: A Narrative Review

Recent lifestyles changes have favored increased time in contact with screens and a parallel reduction in contact with natural environments. There is growing awareness that nature exposure and screen time are related to depression. So far, the roles of how these environmental lifestyles affect depressive symptoms and disorders have not been reviewed simultaneously. The aim of this review was to gather the literature regarding the role of nature exposure and screen time in depression. An emphasis was made on clinical samples of patients with well-defined depression and the different methodological approaches used in the field. A second goal was to suggest an agenda for clinical practice and research. Studies were included if they assessed depressive symptoms in patients with a clinical diagnosis of depression. An overview of the published literature was conducted using three scientific databases up to December 2021. Several interventions involving nature exposure have shown positive effects on depressive symptoms and mood-related measures. The most consistent finding suggests that walks in natural environments may decrease depressive symptoms in patients with clinical depression. Less researched interventions, such as psychotherapy delivered in a forest or access to natural environments via virtual reality, may also be effective. In contrast, fewer observational studies and no experimental research on screen time have been conducted in patients with clinical depression. Thus, recommendations for practice and research are also discussed. Scarce research, diverse interventions, and several methodological shortcomings prevent us from drawing conclusions in this area. More high-quality experimental research is needed to establish interventions with proven efficacy in clinical depression. At this stage, it is too early to formulate practice guidelines and advise the prescription of these lifestyles to individuals with depression. The present findings may serve as a basis to develop strategies based on nature exposure and screen time targeting clinical depression.

Physical activity and sedentary behaviour of female adolescents in Indonesia: A multi-method study on duration, pattern and context

Background/Objective

Exploring comprehensive information on the duration, pattern and context of physical activity and sedentary behaviour is important to develop effective policies and interventions. Especially in lower- and middle-income countries, our understanding of these health-behaviours is limited. Our study aimed to investigate physical activity and sedentary behaviour of female Indonesian adolescents by using a multi-method approach.

Methods

Female adolescents (n = 5; 13–15 years old) from Yogyakarta, Indonesia wore accelerometers and automated wearable cameras for four days, and completed diaries, and interviews between February and March 2020.

Results

Participants’ activity, especially on non-school days, was dominated by light-intensity physical activity. Four of the 5 participants did not meet the physical activity guidelines. Participants spent a great proportion of time on screen-based sedentary behaviour (school days: 83.2% of wear time; non-school days: 75.7% of wear time). During school days, most physical activity and sedentary behaviour was done at school. Screen time was mainly done on the school day evenings and weekend mornings. Participants mostly used smartphones in the bedroom and living room in a solitary environment. Interviews suggest that the high amount of screen time seemed to be influenced by a lack of awareness of current guidelines, the feeling of urgency to check information, and the lack of parental supervision. Non-screen-based sedentary behaviour comprised just over 10% of total camera images.

Conclusion

The use of a multi-method approach facilitated a rich understanding of the duration, patterns, and contexts of physical activity and sedentary behaviour in participants. Future studies might consider using similar methods in a larger sample.

Parental psychological problems were associated with higher screen time and the use of mature-rated media in children

Aim

Parents’ psychological problems may affect children's screen time, but research has been scarce. We examined the association between parental psychological problems and children's screen media behaviours in a nationally representative sample.

Methods

The participants were from the Adolescent Brain Cognitive Development study, recruited by probability sampling from the USA population. Children reported their use of TV, videos, video games, social media and mature‐rated media. The parents (85% mothers) reported psychological problems using the Adult Self‐Report questionnaire.

Results

In 10,650 children (5112 girls, 5538 boys) aged 9.9 ± 0.6 years, the presence of parental psychological problems was associated with children spending more daily time on screen media and with meeting the recommendation of ≤2 daily hours less often than children whose parents did not have psychological problems. Parental psychological problems were associated with children's TV watching, video watching and gaming but not with using social media. Parental internalising problems were associated with children watching mature‐rated movies (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.00, 1.30) and playing mature‐rated games (OR = 1.27, 95% CI = 1.11, 1.45).

Conclusion

Presence of parental psychological problems is associated with higher screen time and use of mature‐rated media in children. This cross‐sectional study was not able to examine causal associations.

Screen-based behaviour in children is more than meets the eye

Increased screen time (ST) in children is quickly becoming a public health concern as children are now reliant on technology for social interaction and educational development. The eye-health community has paid considerable attention to this in the recent literature, documenting it as digital eye strain. Continual close eye work and a lack of outdoor play contribute to digital eye strain and today’s myopia epidemic. This is a cause for concern for public health stakeholders insofar as it leads to sedentary, screen-based behaviour (SSB) in children. This results in a lack of physical activity and impacts both their bodies and their mental health. The potentially harmful effects of prolonged screen exposure on developing brains and bodies are likely to be unique and significant as physiological growth changes intersect with exponentially expanding e-platforms. While embracing the benefits of a highly digitalised world, we need to simultaneously mitigate the potential risks they pose to the health of growing children.

Media use and Coping in Tweens during the COVID-19 Pandemic

Public and scholarly debate about the effects of media on youth has been a topic of concern since the twentieth century. These concerns were further amplified and accelerated with heavy use of and reliance on media for everyday living and learning with the homebound conditions brought on by the COVID-19 pandemic. With the public discourse about children's media use and school safety concerns, we conducted online interviews of 36 young people ages 9-14 years to learn about (1) their life situations, including school experience, (2) their overall media use, (3) their overall worries and difficulty with their situations, and (4) their stress management and coping strategies during the fall semester of 2020. While tweens reported using media more during the pandemic than before, media did not seem to completely displace other activities. Tweens engaged in media, non-media, and hybrid coping strategies to relieve stress, enhance their mood, and stay connected to others outside their home. This qualitative study was a first step in understanding the effect of COVID-19 on tweens within the context of their coping and resiliency building, and how media factor into these processes.

#KidsAnxiety and the Digital World

This article discusses child onset anxiety disorders in conjunction with the risks and benefits of the rapidly changing digital world including screen time, social media, and potential treatment platforms. A section includes the impact of pandemic stressors including social distancing, quarantining, the association of the pandemic and youth mental health, and prolonged screen time.

Screen Use and Mental Health Symptoms in Canadian Children and Youth During the COVID-19 Pandemic

IMPORTANCE

Longitudinal research on specific forms of electronic screen use and mental health symptoms in children and youth during COVID-19 is minimal. Understanding the association may help develop policies and interventions targeting specific screen activities to promote healthful screen use and mental health in children and youth.

OBJECTIVE

To determine whether specific forms of screen use (television [TV] or digital media, video games, electronic learning, and video-chatting time) were associated with symptoms of depression, anxiety, conduct problems, irritability, hyperactivity, and inattention in children and youth during COVID-19.

DESIGN, SETTING, AND PARTICIPANTS

A longitudinal cohort study with repeated measures of exposures and outcomes was conducted in children and youth aged 2 to 18 years in Ontario, Canada, between May 2020 and April 2021 across 4 cohorts of children or youth: 2 community cohorts and 2 clinically referred cohorts. Parents were asked to complete repeated questionnaires about their children's health behaviors and mental health symptoms during COVID-19.

MAIN OUTCOMES AND MEASURES

The exposure variables were children's daily TV or digital media time, video game time, electronic-learning time, and video-chatting time. The mental health outcomes were parent-reported symptoms of child depression, anxiety, conduct problems and irritability, and hyperactivity/inattention using validated standardized tools.

RESULTS

This study included 2026 children with 6648 observations. In younger children (mean [SD] age, 5.9 [2.5] years; 275 male participants [51.7%]), higher TV or digital media time was associated with higher levels of conduct problems (age 2-4 years: β, 0.22 [95% CI, 0.10-0.35]; P < .001; age ≥4 years: β, 0.07 [95% CI, 0.02-0.11]; P = .007) and hyperactivity/inattention (β, 0.07 [95% CI, 0.006-0.14]; P = .04). In older children and youth (mean [SD] age, 11.3 [3.3] years; 844 male participants [56.5%]), higher levels of TV or digital media time were associated with higher levels of depression, anxiety, and inattention; higher levels of video game time were associated with higher levels of depression, irritability, inattention, and hyperactivity. Higher levels of electronic learning time were associated with higher levels of depression and anxiety.

CONCLUSIONS AND RELEVANCE

In this cohort study, higher levels of screen use were associated poor mental health of children and youth during the COVID-19 pandemic. These findings suggest that policy intervention as well as evidence-informed social supports are needed to promote healthful screen use and mental health in children and youth during the pandemic and beyond.

The longitudinal association between objectively measured physical activity and mental health among Norwegian adolescents

Background

Mental health among young people in many countries, including Norway, seems to be deteriorating. Physical activity (PA) has been positively associated with mental health. However, methodological issues related to study design and measurement of PA and mental health outcomes currently limits our understanding of the relationship. The purpose of the present study is to explore the prospective relationship between objectively measured PA and mental health outcomes. More specifically, volume (total PA), intensity (moderate-to-vigorous PA [MVPA]) and sedentary behaviour (SED) were explored in relation to mental health problems (MHP) and mental wellbeing (MWB).

Methods

Data from 599 adolescents (54.4% female, mean age at baseline ±SD 13.3 ± 0.3 years) were collected annually during their 3 years (T1, T2 and T3) at lower secondary school. PA was measured using accelerometry. MWB was measured using the ‘Warwick-Edinburgh Mental Wellbeing Scale’ and MHP by the ‘Strengths and Difficulties Questionnaire’. Multiple linear regression was performed to explore relationships between changes in PA/SED (between T1-T3) and MWB/MHP (at T3). The term ‘movement categories’ was used to refer to components on the movement continuum and includes volume (total PA), intensity (MVPA) and SED.

Results

Among boys, any increase in SED was positively associated with MWB (β = 0.05, 95% CI: 0.01 to 0.10), whereas a small positive association between an increase in total PA (volume) and MWB was found among girls (β = 1.13, 95% CI: 0.05 to 2.21). There were no associations between changes in any movement categories [total PA (volume), MVPA, SED] and score on MHP at T3, neither for girls nor boys.

Conclusion

This study provided no clear evidence of any association between change in volume or intensity of PA and MHP among an overall healthy adolescent study sample. There was, however, evidence of a relationship between increased SED and MWB among boys and increased volume of PA and MWB among girls. The relationship between movement categories and mental health may depend on the measurement used to assess both PA/SED and variables of mental health. Future research would be strengthened by researchers clarifying what construct of mental health is being used and measured.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01211-x.

Digital Overuse and Addictive Traits and Their Relationship With Mental Well-Being and Socio-Demographic Factors: A National Population Survey for Wales

Introduction: Population health concerns have been raised about negative impacts from overuse of digital technologies. We examine patterns of online activity predictive of Digital Overuse and Addictive Traits (DOAT). We explore associations between DOAT and mental well-being and analyse how both relate to self-reported changes in self-esteem, perceived isolation, and anxiety about health when individuals use the internet for health purposes.

Methods: A cross-sectional nationally representative household survey of adults using stratified random sampling (compliance 75.4%, n = 1,252). DOAT was measured using self-reported questions adapted from a social media addiction scale (failure to cut down use, restlessness when not using, and impact on job/studies and home/social life in the last year), combined into a single DOAT score. Higher DOAT score was defined as >1 standard deviation above population mean. The Short Warwick-Edinburgh Mental Well-being Scale was used to measure mental well-being. Analyses were limited to those with internet access (n = 1,003).

Results: Negative impacts of digital technology use on work and home/social lives were reported by 7.4% of respondents. 21.2% had tried but failed to cut down use in the past year. Higher DOAT was associated with higher social media and internet use but also independently associated with greater risks of low mental well-being. Higher DOAT was associated with both improvement and worsening of self-esteem, perceived isolation and anxiety about health when using the internet for health reasons, with no change in these outcomes most likely in those with lower DOAT. Lower mental well-being was associated with a similar bi-directional impact on perceived isolation and was also associated with worsening self-esteem.

Conclusions: Substantial proportions of individuals report negative impacts on home, social and working lives from digital technology use, with many trying but failing to cut down use. Individuals with higher DOAT may experience improvements or worsening in self-esteem and other measures of mental well-being when using the internet for health purposes. From a public health perspective, a greater understanding of risk factors for digital overuse, its impacts on well-being and how to reasonably limit use of technology are critical for a successful digital revolution.

Physical Activity as a Treatment for Social Anxiety in Clinical and Non-clinical Populations: A Systematic Review and Three Meta-Analyses for Different Study Designs

The fear of being in the focus of attention in social situations can develop into a social anxiety disorder (SAD). The classical treatment for SAD is cognitive behavioral therapy, which is in many cases accompanied by drug treatments. A promising alternative treatment is physical activity (PA) interventions, because regular PA has been shown to be suitable for reducing anxiety in general. We conducted a pre-registered systematic review and meta-analysis (PROSPERO registration no. CRD42020191181) as well as two additional searches. Our aim was to investigate whether PA interventions are a suitable treatment for SAD and whether PA is suitable for reducing social anxiety (SA) in general. For studies with randomized controlled trial designs, a not statistically significant effect of medium size toward lower general SA symptomatology was found in the PA group in comparison with the control group (d = -0.24, p = 0.377). For studies with longitudinal designs, significantly lower SA symptoms were found after PA treatments (d = -0.22, p = 0.001). The effect of PA on SA was stronger for adults than for children and adolescents (p = 0.003). For cross-sectional studies, a small negative association between SA symptoms and the amount of PA was found, i.e., lower SA was found for people who were more physically active (r = -0.12, p = 0.003). We conclude that PA is a promising means for the (additional) treatment of SAD or to reduce SA in general in non-clinical samples, but more research in which high-quality studies with randomized controlled trial designs are used is needed. Furthermore, open questions with respect to moderating variables (e.g., age, sex, BMI, type of intervention, stress, amount of regular PA before the intervention, and comorbidities) remain still open.

Contemporary screen time modalities among children 9-10 years old and binge-eating disorder at one-year follow-up: A prospective cohort study

OBJECTIVE

To determine the prospective associations between contemporary screen time modalities in a nationally representative cohort of 9-10-year-old children and binge-eating disorder at one-year follow-up.

METHOD

We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,025). Logistic regression analyses were conducted to estimate associations between baseline child-reported screen time (exposure) and parent-reported binge-eating disorder based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5, outcome) at one-year follow-up, adjusting for race/ethnicity, sex, household income, parent education, BMI percentile, site, and baseline binge-eating disorder.

RESULTS

Each additional hour of total screen time per day was prospectively associated with 1.11 higher odds of binge-eating disorder at 1-year follow-up (95% CI 1.05-1.18) after adjusting for covariates. In particular, each additional hour of social networking (aOR 1.62, 95% CI 1.18-2.22), texting (aOR 1.40, 95% CI 1.08-1.82), and watching/streaming television shows/movies (aOR 1.39, 95% CI 1.14-1.69) was significantly associated with binge-eating disorder.

DISCUSSION

Clinicians should assess screen time usage and binge eating in children and adolescents and advise parents about the potential risks associated with excessive screen time.

Recreational Screen Time Behaviors during the COVID-19 Pandemic in the U.S.: A Mixed-Methods Study among a Diverse Population-Based Sample of Emerging Adults

Understanding how screen time behaviors changed during the COVID-19 pandemic is important to inform the design of health promotion interventions. The purpose of this study was to quantify and describe changes in recreational screen time from 2018 to 2020 among a diverse sample of emerging adults. Participants (n = 716) reported their average weekly recreational screen time in 2018 and again during the pandemic in 2020. Additionally, participants qualitatively reported how events related to COVID-19 had influenced their screen time. Weekly recreational screen time increased from 25.9 ± 11.9 h in 2018 to 28.5 ± 11.6 h during COVID-19 (p < 0.001). The form of screen time most commonly reported to increase was TV shows and streaming services (n = 233). Commonly reported reasons for changes in screen time were boredom (n = 112) and a desire to connect with others (n = 52). Some participants reported trying to reduce screen time because of its negative impact on their mental health (n = 32). Findings suggest that screen time and mental health may be intertwined during the pandemic as it may lead to poorer mental health for some, while promoting connectedness for others. Health professionals and public health messaging could promote specific forms for screen time to encourage social connection during the COVID-19 pandemic and beyond.

Consuming Information Related to COVID-19 on Social Media Among Older Adults and Its Association With Anxiety, Social Trust in Information, and COVID-Safe Behaviors: Cross-sectional Telephone Survey

Background

COVID-19-related information on social media is overabundant and sometimes questionable, resulting in an “infodemic” during the pandemic. While previous studies suggest social media usage increases the risk of developing anxiety symptoms, how induced anxiety affects attitudes and behaviors is less discussed, let alone during a global pandemic. Little is known about the relationship between older adults using social media during a pandemic and their anxiety, their attitudes toward social trust in information, and behaviors to avoid contracting COVID-19.

Objective

The goal of this study was to investigate the associations between using social media for COVID-19-related information and anxiety symptoms as well as the mediation effect of anxiety symptoms on social trust in information and COVID-safe behaviors among older adults.

Methods

A cross-sectional telephone survey was conducted in Hong Kong between May and August 2020. A rapid warm-call protocol was developed to train social workers and volunteers from participant nongovernmental organizations to conduct the telephone surveys. Questions related to COVID-safe behaviors, social trust in information, social media use, anxiety and depressive symptoms, and sociodemographic information were asked. The number of confirmed COVID-19 cases at the community level was used to account for the risk of contracting COVID-19. Ordinary least squares regressions examined the associations between social media use and anxiety symptoms, and how they were associated with social trust in information and COVID-safe behaviors. Structural equation modeling further mapped out these relationships to identify the mediation effects of anxiety symptoms.

Results

This study collected information regarding 3421 adults aged 60 years and older. Use of social media for COVID-19-related information was associated with more anxiety symptoms and lower social trust in information but had no significant relationship with COVID-safe behaviors. Anxiety symptoms predicted lower social trust in information and higher COVID-safe behaviors. Lower social trust in information was predicted by using social media for COVID-19 information, mediated by anxiety symptoms, while no mediation effect was found for COVID-safe behaviors.

Conclusions

Older adults who rely on social media for COVID-19-related information exhibited more anxiety symptoms, while showing mixed effects on attitudes and behaviors. Social trust in information may be challenged by unverified and contradictory information online. The negligible impact on COVID-safe behaviors suggested that social media may have caused more confusion than consolidating a consistent effort against the pandemic. Media literacy education is recommended to promote critical evaluation of COVID-19-related information and responsible sharing among older adults.

Movement Behaviors and Perceived Loneliness and Sadness within Alaskan Adolescents

Physical activity, screen use, and sleep are behaviors that integrate across the whole day. However, the accumulative influence of meeting recommendations for these 24-h movement behaviors on the mental health of Alaskan adolescents has not been examined. The purpose of this study was to examine the associations between movement behaviors, loneliness, and sadness within Alaskan adolescents. Data were obtained from the 2019 Alaska Youth Risk Behavior Survey (YRBS). The number of adolescents participating in the 2019 Alaska YRBS was 1897. Associations between meeting recommendations for movement behaviors with loneliness and sadness were examined using weighted logistic regression models, adjusted for age, sex, race/ethnicity, and body mass index (BMI). Approximately 5.0% of the sample met recommendations for all three movement behaviors. Meeting 2 or 3 movement behavior recommendations was associated with lower odds of loneliness (odds ratio (OR) range = 0.23 to 0.44, p < 0.01). Additionally, meeting 1 to 3 movement behavior recommendations was associated with lower odds of sadness (OR range = 0.29 to 0.52, p < 0.05). Joint association analyses determined that these relationships were primarily driven by meeting the sleep recommendation for loneliness and meeting the screen use recommendation for sadness. The results support use of multiple movement-based behavior programming to attenuate feelings of loneliness and sadness within Alaskan adolescents.