Adolescents with a smartphone sleep less than their peers

Problematic smartphone use and mental health outcomes among Singapore residents: The health and lifestyle survey

BACKGROUND

The excessive use of smartphones and its association with adverse outcomes has been widely reported, with several studies showing an association between smartphone overuse, depression, anxiety, and sleep-related problems.

METHODS

The study used data from the Health and Lifestyle Survey, a nationwide population survey. It examined the prevalence of Problematic Smartphone Use (PSU) and its association with mental health outcomes among Singapore residents aged 15-65 years.

PARTICIPANTS

Participants were assessed for PSU using the Smartphone Addiction Scale-Short Version, psychological distress with the Patient Health Questionnaire-9, and Generalised Anxiety Disorder -7 questionnaire, sleep problems using the Insomnia Severity Index, and positive mental health with Rapid Positive Mental Health Instrument.

RESULTS

In all, 6509 participants completed the survey, giving a survey response rate of 73.2 %. The prevalence of PSU was 30.2 % in the population. Individuals with PSU were more likely to have symptoms of moderate or severe depression (OR: 3.2, 95 % CI: 2.4-4.4), anxiety (OR: 3.4, 95 % CI: 2.4-4.8), insomnia (OR: 3.4, 95 % CI: 2.8-4.2), and poorer positive mental health (β: -0.3, 95 % CI: -0.4 to -0.2).

CONCLUSIONS

The study is the first to examine PSU in a national sample of Singaporeans across a wide age range. It provides valuable insights into mental health comorbidities among those with PSU, which is useful for practitioners.

Associations between media use at bedtime and sleep: a cross-sectional analysis on differences between girls and boys

Objectives

This study investigated associations between the use of electronic media and sleep in children and young adolescents, with a specific focus on the moderation of associations by sex and age.

Methods

Between 2021 and 2022, 453 10- to 14-year-old children participating in the LIFE Child cohort study (Germany) reported on their use of electronic media (daily screen time, use at bedtime, device ownership) and on their sleep difficulties (Sleep Self Report). Associations between media use and sleep as well as interactions with age and sex were assessed using linear regression analyses.

Results

The analyses revealed significant associations between the use of media at bedtime and bedtime problems (in girls only), sleep behavior problems (in girls only), and daytime sleepiness (in girls and boys). Daily screen time, in contrast, was associated with none of the sleep difficulties. The number of media devices owned by the child was only associated with bedtime problems in girls, and this association lost statistical significance once media use at bedtime was included as further predictor.

Conclusion

The findings underline the potentially sleep-disturbing role of electronic media at bedtime. Furthermore, they suggest that this effect is more pronounced in girls than in boys.

Association between smartphone usage and health outcomes of adolescents: A propensity analysis using the Korea youth risk behavior survey

OBJECTIVES

We aimed to investigate the association between smartphone use and adverse behavioral health outcomes using nationwide Korea Youth Risk Behavior Web-based Survey data for 2017 and 2020.

METHODS

The 2020 data (N = 54,809) were used to analyze the relationships between daily smartphone usage time (non-user, 0-2 h [hour], 2-4 h, 4-6 h, 6-8 h, and > 8 h), and adverse health outcomes (stress, sleep, depression, suicide, substance use, and smartphone overdependence). A 1:1 propensity score matching (PSM) was used to control for confounding variables.

RESULTS

A total of 40,998 adolescents with < 4 h/day and > 4 h/day of usage were included. Adolescents' mean smartphone usage time in 2020 increased compared to that in 2017 (weighted % of > 2 h/day; 64.3% vs. 85.7%). The curvilinear relationships between smartphone usage time and adverse health outcomes were prominent after > 4 h/day. Adolescents using smartphones 2-4 h/day showed no increased adverse health outcomes compared to non-users, except for smartphone overdependence. Using a smartphone > 4 h/day was significantly associated with stress perception (1.16; 1.11-1.22), suicidal ideation (1.22; 1.13-1.31), and substance use (alcohol, 1.66; 1.57-1.75) after PSM.

CONCLUSIONS

Our study demonstrated the curvilinear relationship between smartphone usage time and adverse health outcomes in adolescents. Our findings can help establish smartphone usage guidelines for adolescents.

Longitudinal association between problematic smartphone use and sleep disorder among Chinese college students during the COVID-19 pandemic

BACKGROUND

Problematic smartphone use (PSU) and sleep disorders (SD) are common public health problems among college students. While previous cross-sectional studies have found a relationship between PSU and SD, the causal direction of this relationship remains unclear. This study aims to examine the longitudinal changes of PSU and SD during the COVID-19 pandemic, determine the causal relationship between them, and identify confounding factors that affect this association.

METHODS

The study sample consisted of 1186 Chinese college students (47.7% male) with a mean age of 18.08 years. Participants completed the Smartphone Addiction Scale - Short Version (SAS-SV) and the Pittsburgh Sleep Quality Index (PSQI) at both baseline and follow-up surveys, conducted one year apart. The cross-lagged panel model (CLPM) was used to examine the causal relationship between PSU and SD, stratified by gender and duration of daily physical activity. The fixed effect panel regression was used to confirm the findings of CLPM.

RESULTS

The results of the CLPM analysis showed a significant bidirectional relationship between PSU and SD for the overall sample, which was consistent with the fixed effects model findings. However, subgroup analyses revealed that the bidirectional association disappeared among males or those who engaged in daily physical activity for more than 1 h.

CONCLUSIONS

Our study shows a significant bidirectional association between PSU and SD, with variations across gender and daily physical activity levels. Encouraging physical activity may serve as a potential intervention to disrupt the bidirectional association between PSU and SD, which has important implications for public health strategies aimed at reducing the negative consequences of PSU and SD.

The Influence of Smartphones on Adolescent Sleep: A Systematic Literature Review

(1) Background: Sleep is considered to be a complex condition for human beings, with the aim of ensuring physical and psychological recovery. Technology, including the cell phone, is a tool for teenagers that ensures they are always available to interact, even at night. This study aims to understand the influence of the use of smartphones on adolescent sleep quality. (2) Methods: The guidelines proposed by the Joanna Briggs Institute were followed. The search was conducted in October 2022 through the EBSCOhost platform, with access to the CINAHL Complete and Medline databases and through the b-On database. (3) Results: The use of electronic equipment plays an important role in adolescents' lives. There is a negative relationship between the use of electronic equipment, such as smartphones, and sleep, for reducing both the quality and quantity of sleep. There is also a relationship between nighttime smartphone use, insufficient sleep, and mental health problems. (4) Conclusions: The use of new technologies at night causes a change in the behavior of adolescents with repercussions in terms of the quality of sleep and sleep duration and consequent well-being and performance during the day.

Media regulation strategies in parents of 4- to 16-year-old children and adolescents: a cross-sectional study

BACKGROUND

Since children can only control and limit their own media use to a limited extent, it is often the parents who regulate their children's media use. However, there is insufficient research on which strategies they use and on how these strategies are related to socio-demographic and behavioral parameters.

METHODS

The parental media regulation strategies co-use, active mediation, restrictive mediation, monitoring, and technical mediation were assessed in a sample of 563 four- to 16-year-old children and adolescents from middle to high social strata participating in the German cohort study LIFE Child. We investigated cross-sectional associations with socio-demographic characteristics (age and sex of child, age of parent, and socio-economic status (SES)) and other behavioral parameters of children (media use, ownership of media devices, engagement in extracurricular activities) and their parents (media use).

RESULTS

All media regulation strategies were applied frequently, with restrictive mediation occurring most frequently. Overall, parents of younger children and of boys mediated media use more frequently, while we observed no differences depending on SES. Regarding child behavior, the ownership of a smartphone and a tablet/personal computer/laptop was associated with more frequent technical restriction, while screen time and engagement in extracurricular activities was not associated with parental media regulation. In contrast, parental screen time was related to more frequent co-use and less frequent use of restrictive and technical mediation.

CONCLUSION

Parental regulation of child media use is influenced by parental attitudes and a perceived need for mediation (e.g., in younger children or children owning internet-enabled devices) rather than child behavior.

Associations of smartphone addiction, chronotype, sleep quality, and risk of eating disorders among university students: A cross-sectional study from Sharjah/United Arab Emirates

Objectives

As smartphone addiction (SA) becomes more prevalent among young adults, there is growing concern over its impact on dietary and lifestyle habits, such as disturbed sleep and eating patterns. However, limited literature exists particularly on the association between SA and eating disorders (ED). Thus, this study aims to study the prevalence of SA risk, poor sleeping quality, evening chronotype, and ED risk among university students in the UAE. It also aims to assess the associations between them, emphasizing the one between ED and SA risks.

Methods

In this cross-sectional study, a self-administered online questionnaire was disseminated via convenience sampling. Pittsburgh Sleep Quality Index, Morningness-Eveningness Questionnaire, Eating Attitude Test-26 items, and Smartphone Addiction Scale-Short Version were used to measure sleep quality, chronotype, ED risk, and SA risk, respectively. Descriptive and analytical statistics were applied, and P < 0.05 was considered for statistical significance.

Results

Out of 552 students (mean age: 21.2 ± 5.1 years), 71% had poor sleep quality, 33.9% reported evening chronotype, 37.9% had ED risk, and 56.2% had SA risk. SA risk was significantly associated with both poor sleep quality (OR = 2.93; 95% CI: 2.01-4.29; p < 0.001) and evening chronotype (p = 0.005). ED risk was significantly associated with poor sleep quality (p < 0.001). Poor sleep quality predicted ED risk best.

Conclusion

High prevalence of SA, ED risk, and poor sleep quality was reported among university students in the UAE. Associations between poor sleep quality, evening chronotype, SA risk, and ED risk were further confirmed, with sleep quality predicting ED risk.

Addictive smartphone use in the elderly: relationship with depression, anxiety and sleep quality

BACKGROUND

The aim of the present study was to explore the relationship between addictive smartphone use (ASU) and depressive symptoms, anxiety and sleep quality in elderly adults.

METHODS

The study sample included smartphone users over the age of 65 years. The research data were obtained from social networking sites via a Google survey link. In addition to filling out a sociodemographic data form, the participants were also assessed with Smartphone Addiction Scale (SAS), Geriatric Depression Scale, Beck Anxiety Inventory and Pittsburgh Sleep Quality Index tools.

RESULTS

The correlation analysis revealed the SAS score to be positively correlated with depression and anxiety, and negatively correlated with sleep quality. In the regression analysis, depressive symptoms, anxiety level and sleep quality were all found to have an effect on the SAS total score. Furthermore, the SAS score was found to have an effect on depressive symptoms, anxiety and sleep quality.

CONCLUSIONS

Our findings reveal a bidirectional relationship between ASU and depressive, anxiety symptoms and impaired sleep quality in elderly adults. It is important to question smartphone use patterns in people with sleep problems, symptoms of depression or anxiety.

Smartphones as an Ecological Niche of Microorganisms: Microbial Activities, Assembly, and Opportunistic Pathogens

Smartphone usage and contact frequency are unprecedentedly high in this era, and they affect humans mentally and physically. However, the characteristics of the microorganisms associated with smartphones and smartphone hygiene habits remain unclear. In this study, using various culture-independent techniques, including high-throughput sequencing, real-time quantitative PCR (RT-qPCR), the ATP bioluminescence system, and electron microscopy, we investigated the structure, assembly, quantity, and dynamic metabolic activity of the bacterial community on smartphone surfaces and the user's dominant and nondominant hands. We found that smartphone microbiotas are more similar to the nondominant hand microbiotas than the dominant hand microbiotas and show significantly decreased phylogenetic diversity and stronger deterministic processes than the hand microbiota. Significant interindividual microbiota differences were observed, contributing to an average owner identification accuracy of 70.6% using smartphone microbiota. Furthermore, it is estimated that approximately 1.75 × 106 bacteria (2.24 × 104/cm2) exist on the touchscreen of a single smartphone, and microbial activities remain stable for at least 48 h. Scanning electron microscopy detected large fragments harboring microorganisms, suggesting that smartphone microbiotas live on the secreta or other substances, e.g., human cell debris and food debris. Fortunately, simple smartphone cleaning/hygiene could significantly reduce the bacterial load. Taken together, our results demonstrate that smartphone surfaces not only are a reservoir of microbes but also provide an ecological niche in which microbiotas, particularly opportunistic pathogens, can survive, be active, and even grow. IMPORTANCE Currently, people spend an average of 4.2 h per day on their smartphones. Due to the COVID-19 pandemic, this figure may still be increasing. The high frequency of smartphone usage may allow microbes, particularly pathogens, to attach to-and even survive on-phone surfaces, potentially causing adverse effects on humans. We employed various culture-independent techniques in this study to evaluate the microbiological features and hygiene of smartphones, including community assembly, bacterial load, and activity. Our data showed that deterministic processes drive smartphone microbiota assembly and that approximately 1.75 × 106 bacteria exist on a single smartphone touchscreen, with activities being stable for at least 48 h. Fortunately, simple smartphone cleaning/hygiene could significantly reduce the bacterial load. This work expands our understanding of the microbial ecology of smartphone surfaces and might facilitate the development of electronic device cleaning/hygiene guidelines to support public health.

Sleep Habits in Pairs of Japanese High School Students and Their Mothers in Summer and Autumn

This study aimed to examine the sleep habits in pairs of Japanese high school students and their mothers in the summer and autumn. Nineteen pairs of high school students and their mothers participated in this study. Wrist actigraphy, subjective sleep evaluations, and bedroom environmental measurements (temperature, humidity, and light) were performed for a duration of one week. The results of a split-plot analysis of variance revealed no significant difference in the actigraphically evaluated time spent in bed (TIB) between the seasons and between the mothers and students. The TIB was approximately 6 h on weekdays, and significantly lengthened to approximately 7 h on weekends (p < 0.05). The average sleep efficiency values recorded were higher than 90%. The mothers showed significantly advanced sleep phases compared to those of the students (p < 0.05). In addition, the waking time on Monday morning was significantly correlated between the mothers and students in the summer and autumn (p < 0.05). A perceived sleep loss “almost every day” or “several times per week” was reported by approximately half of the mothers and students in each season. The students occasionally fell into nocturnal sleep with the room light turned on. These results suggest that sleep hygiene education considering life habit characteristics is required to ensure sufficient sleep time.

Effects of Frequent Smartphone Use on Sleep Problems in Children under 7 Years of Age in Korea: A 4-Year Longitudinal Study

The use of electronic screen devices has a negative effect on sleep. The purpose of this study is to longitudinally examine the effects of various screen use on sleep problems in children under 7 years of age. A total of 314 caregivers of children aged 4−7 years from three cities in Korea were recruited and responded to a self-administered questionnaire from 2017 to 2020. As a result of the analysis of the mixed model designed as a two-leveled structure, the use frequency of smartphones significantly predicted children’s sleep problems (β = 0.328, p < 0.001) compared to that of TV, PC, and tablet PC. In addition, the frequency of smartphone screen use showed a weak but significant correlation with bedtime resistance (r = 0.067, p = 0.009), sleep duration (r = 0.089, p <0.001), nighttime awakening (r = 0.066, p = 0.010), and daytime sleepiness (r = 0.102, p < 0.001). The results of this study suggest that screen time education in Korea should focus on smartphones above all else.

The Associations between Daytime Physical Activity, While-in-Bed Smartphone Use, Sleep Delay, and Sleep Quality: A 24-h Investigation among Chinese College Students

Bedtime smartphone use is an emerging issue that threatens the sleep health of children and young adults. Physical activity can have numerous health benefits, including reducing problematic or addictive behavior. However, the role of daily physical activity in reducing bedtime smartphone use is understudied. Hence, we conducted a one-day cross-sectional on the weekend (21-22 May 2021) to investigate the associations between daytime physical activity, bedtime smartphone use, and sleep quality. A total of 828 college students were recruited in two colleges. Their daytime physical activity indices were captured, including self-reported physical activity duration, intensity, volume, and smartphone-monitored walking steps. The participants reported whether they used smartphone while lying in bed (before sleep) and whether they delayed sleep due to smartphone use. Their while-in-bed screen time (duration) and subsequent sleep quality were also measured with self-report and a numeric rating scale, respectively. The results suggested that daytime physical activity duration was associated with lower chances of while-in-bed smartphone use (OR = 0.907, p = 0.019) and smartphone-related sleep delay (OR = 0.932, p = 0.014). However, no significant association was found between physical activity indices and while-in-bed screen time or sleep quality. These findings may contribute to understanding the reciprocal relationship between physical activity and smartphone use and highlighting the potential of controlling problematic bedtime smartphone use through daily physical activity. Future research is warranted to examine the associations with extra objective measures.

The Effects of Anthropomorphism, Message Framing, and Voice Type on Unhealthy Sleep Behavior in Young Users: The Mediating Role of Risk Perception

Insufficient sleep is a severe social public health problem that can adversely affect the physical and mental health of young people. This study examined risk perceptions for unhealthy sleep behaviors and intentions for healthy sleep behaviors under different combinations of anthropomorphism, message framing, and voice type in cartoons. We used a three-factor between-subject experiment of two (anthropomorphism: anthropomorphic vs. non-anthropomorphic) × two (message framing: positive frame vs. negative frame) × two (voice type: cartoon child voice vs. adult female voice) design. We examined the effects of different audiovisual combinations of cartoon attitude, risk perception, and behavioral intention and the mediating role of risk perception. The research results show that (1) the integration of anthropomorphic design elements can positively impact users’ attitudes toward cartoons; (2) when the interface information is presented in a negative frame, anthropomorphism can more positively influence users’ attitudes toward cartoons than non-anthropomorphism; and (3) anthropomorphism, message framing, and voice type in cartoons significantly interact with risk perception. In addition, risk perception mediates the influence of anthropomorphism, message framing, and voice type on behavioral intention.

Association between smartphone addiction risk, sleep quality, and sleep duration among Korean school-age children: a population-based panel study

Smartphone addiction is regarded as a public health threat to the lives of children and adolescents. However, its association with sleep quality and quantity is poorly understood in the Korean context. This study investigated the association between smartphone addiction, sleep quality, and sleep duration among Korean school-age children. Our study employed data from the Korean Children and Youth Panel Survey of 2018-2019, which included 4287 participants. Smartphone addiction was assessed using the Smartphone Addiction Proneness Scale. A generalized estimating equation model was used to analyze the data. Children in the high-risk group showed an increased likelihood of poor sleep quality compared to those in the low-risk group (odds ratio (OR) = 1.59, confidence interval (CI) [1.06-2.38]). Children in the potential-risk and high-risk groups showed an increased likelihood of short sleep duration compared to those in the low-risk group (potential-risk: OR = 1.44, CI [1.09-1.90]; high-risk: OR = 2.25, CI [1.66-3.05]) Children who are at high risk for smartphone addiction are likely to have poor sleep quality and short sleep duration. Therefore, appropriate interventions and continuous monitoring are required to protect children from smartphone addiction and improve their sleep quality and duration.

Gender differences in the relationships between parental phubbing and adolescents' depressive symptoms: The mediating role of parent-adolescent communication

Phubbing, as a common phenomenon in modern society's communication, describes the act of using one's phone in face-to-face interactions. In recent years, parental phubbing has attracted the attention of researchers, and it is imperative to explore the relationship between father phubbing (Fphubbing), mother phubbing (Mphubbing) and adolescent development. Therefore, this study investigated 4213 adolescents (mean age = 16.41, SD = 0.77, 52.5% were boys) and explored the relationship between Fphubbing and Mphubbing and adolescents' depressive symptoms. Our single-group path analysis showed that both Fphubbing and Mphubbing were positively associated with adolescents' depressive symptoms. These positive associations were mediated by father-adolescent communication and mother-adolescent communication. Furthermore, multiple-group path analysis revealed that, compared to male adolescents, the relationship between Fphubbing and father-adolescent communication, and the relationship between Mphubbing and mother-adolescent communication were stronger in female adolescents. These findings offer a more ecological and comprehensive understanding of how parental phubbing associates with parent-adolescent communication and adolescents' depressive symptoms.

Internet Use and Quality of Life: The Multiple Mediating Effects of Risk Perception and Internet Addiction

The impact of internet use on quality of life (QoL) has become an increasing focus of academic research. This paper aims to explore the internal influencing mechanisms of internet use (i.e., leisure-oriented internet use (LIU); work-oriented internet use (WIU)) on QoL, with a focus on the multiple mediating effects of risk perception and internet addiction. We constructed a theoretical framework from a psychological perspective and tested the hypotheses using hierarchical regression analysis with a sample of 1535 participants. The results showed that: (1) LIU had a positive effect on QoL, while WIU did not have a significant impact on QoL; (2) both risk perception and internet addiction had a negative influence on QoL; (3) risk perception positively impacted internet addiction; (4) risk perception and internet addiction had multiple mediating effects on the relationship between internet use and QoL.

[Measuring adolescents' use of social media: A systematic review]

OBJECTIVE

The purpose of this review was to provide an overview of the methods used to measure social network site use among adolescents. Such a review is important given the number and diversity of sites and the prevalence of their use among adolescents.

METHODS

A systematic review of the literature was conducted in line with PRISMA guidelines to arrive at an analysis of 58 peer-reviewed studies indexed in PubMed, PsychInfo, or Scopus. To be included in the review, articles had to be peer-reviewed, available in full text, and published in French or English. For inclusion, studies were required to pertain to adolescents aged between 11 and 18 years; to focus on social network site use and indicate how their use was estimated. Studies that simultaneously examined social network sites and general internet use or video games and only provided a combined analysis were excluded. The keywords for the search were: social media use, social media usage, social media misuse, measure, teen, and adolescents.

RESULTS

In the literature, different methods were used to operationalize the use of social network sites: quantitative methods with the measurement of frequency and duration of use of social network sites, and qualitative methods to measure the different activities adolescents engage in on such sites. In this review, 28 articles investigated the use of social media through a measurement of frequency and 22 articles through a measurement of the duration of use. Most of the studies focused on social network sites in general, without specifying which sites in particular were considered by the respondents when answering the question. However, some articles provided cross measures of quantitative and qualitative measurements resulting in the examination of both the frequency of use and the time spent on specific activities on social network sites.

CONCLUSIONS

The present review highlights the great diversity in the methods used to measure the use of social network sites among adolescents. The reliance on frequency-based measurements without taking into account the specificities of the activities or sites involved limits the investigation of their impact on adolescent functioning and behaviors. Given the observed discrepancies in the literature concerning the measurement of social network site use among adolescents and their associated biases, the development of specific instruments is needed to advance in this important field of research.

Link between Excessive Smartphone Use and Sleeping Disorders and Depression among South Korean University Students

The purpose of this study was to explore the link between smartphone use and sleeping disorders and depression among university students in South Korea. South Korea has the highest mobile phone penetration rate as well as the highest rate of suicide of any of the Organization for Economic Cooperation and Development (OECD) nations, thus making this study of great importance. The core aim was to see whether the excessive use of smartphones has an association with sleeping disorders and depression. A cross-sectional analysis was performed to establish if there was any link between smartphone use and sleeping disorders and depression. Samples from 188 participants were used for this study. Data were collected using two well-established questionnaires, the Center for Epidemiologic Studies-Depression (CES-D) and the Athene Insomnia Scale (AIS), as well as a few questions on smartphone use. A few demographic questions were added to the questionnaire. The results of this study concluded that a significant relationship exists between smartphone use and depression. However, the finding of this research could not uncover a significant relationship between smartphone use and sleeping disorders among university students in South Korea. The excessive use of smartphones shows a relationship to an unhealthy lifestyle. There is a clear indication that the overuse of smartphones could be linked to depression. Furthermore, the study found that students with depression also tend to have sleeping disorders.

Factors related to smartphone addiction in adolescents from a region in Northeastern Brazil

Adverse effects on the physical and mental health of adolescents associated with excessive smartphone use have been reported. This paper aims to assess adolescent smartphone addiction and related factors in a region in Northeastern Brazil. This cross-sectional study was carried out in six State-run Professional Education Schools in Fortaleza, Ceará, Brazil, from September to October 2019 with 286 adolescents aged 15-19 years who completed five data collection instruments. Bivariate and multivariate analyses were performed to assess factors related to the outcome using SPSS version 23.0. Smartphone addiction prevalence rate was 70,3% and was associated with being underage (OR=0,583; p=0,001), fewer sleep hours (OR=0,715; p=0,020), longer use on weekends (OR=1,115; p=0,015), cervical pain (OR=2,206; p=0,020), and suspected common mental disorder (OR=1,272; p=0,000). A high smartphone addiction level was observed among adolescents in the sample and was related to multiple factors. Attention should be drawn to the importance of educational campaigns to guide adolescents, parents, educators, and health professionals about the risks of excessive smartphone use to the health of adolescents.

Awaking insomnia: sleeplessness in the 19th century through medical literature

Sleep disorders have received growing public and scientific attention in the last decades. Scientific research and publications on sleeplessness are ongoing and considerable progress has been made on the medical understanding of sleep. And yet, insomnia affects an ever-growing number of people around the globe and remains both a difficult and common complaint general practitioners have to deal with on a daily basis. Sleeplessness is not new, although its transformation from a state of accepted wake to that of exasperating insomnia is a relatively recent transition in which, this article argues, Western medicine took an active part. In the 19th century, the theorisation of different nervous disorders and later of neurasthenia shaped the transformation of insomnia from a constituent of everyday life into a pathology. Based on research in French medical journals published in the second half of the 19th century, this article retraces a succession of medical paradigms for sleeplessness, including 'symptomatic insomnia', 'nervous insomnia' and interestingly, 'insomnia' as a key element in neurasthenia theories. The analysis of medical discourse in all successive theories reveals the decisive influence of physicians in the medicalisation of insomnia, their sociocultural representations echoing patient's complaints as well as professional imperatives.

The Matthew Effect in Recovery from Smartphone Addiction in a 6-Month Longitudinal Study of Children and Adolescents

The clinical course of problematic smartphone use (PSU) remains largely unknown due to a lack of longitudinal studies. We recruited 193 subjects with smartphone addiction problems for the present study. After providing informed consent, the subjects completed surveys and underwent comprehensive interviews regarding smartphone usage. A total of 56 subjects among the 193 initially recruited subjects were followed up for six months. We compared baseline characteristics between persistent addicted users and recovered users at the end of the 6-month follow-up. Persistent problematic smartphone users displayed higher baseline smartphone addiction severity and were more prone to develop mental health problems at the follow-up. However, baseline depressive or anxiety status did not significantly influence the course of PSU. PSU behaved more like an addictive disorder rather than a secondary psychiatric disorder. Harm avoidance, impulsivity, higher Internet use, and less conversation time with mothers were identified as poor prognostic factors in PSU. Lower quality of life, low perceived happiness, and goal instability also contributed to persistent PSU, while recovery increased these scores as well as measures of self-esteem. These findings suggest that the Matthew effect is found in the recovery of PSU with better premorbid psychosocial adjustment leading to a more successful recovery. Greater clinical resources are required for interventions in vulnerable populations to modify the course of this increasingly prevalent problematic behavior worldwide.

Reciprocal Longitudinal Associations Between Adolescents' Media Consumption and Sleep

Background/Objective: Associations between adolescents' sleep and their media consumption have been shown in several cross-sectional studies. However, longitudinal investigations are still sparse and have mainly investigated associations between sleep duration and the usage of TV or computer games. The present study explored reciprocal longitudinal relationships between the consumption of different screen-based media and sleep-related problems in German adolescents. Participants: Four hundred sixty-seven 10- to 17-year-old adolescents participated in the LIFE Child Study in Leipzig, Germany. Methods: The consumption of screen-based media (TV or video, computer and Internet, mobile phones) as well as sleep-related problems (problems at bedtime, sleep behavior problems, daytime sleepiness) were assessed at two time points, 12 months apart. Reciprocal longitudinal relations were assessed by multiple regression analyses. All associations were controlled for age, gender, socioeconomic status, and dependent variables at baseline. Results: The consumption times of the different screen-based media were significantly related. Similarly, the different sleep-related problems showed significant interrelations. Most importantly, the analyses revealed significant associations between a high baseline consumption of computer and Internet with more problems at bedtime, as well as more daytime sleepiness at follow-up. Furthermore, baseline daytime sleepiness was associated with a higher consumption of TV or video at follow-up. Conclusions: These results indicate a mutual dependency of media consumption and sleep over time.

Smartphone Nonusers: Associated Sociodemographic and Health Variables

Smartphone abuse and the associated consequences have been intensely studied. However, little attention has been given to the group of people who have a smartphone and yet barely use it. One might think that they are at the opposite end of abuse, both behaviorally and in relation to the consequences. This study aims to establish sociodemographic variables and health indicators for smartphone nonusers. A population survey through random stratified sampling in a large city (Madrid, Spain) obtained 6,820 people between 15 and 65 years who own a smartphone. About 7.5 percent (n = 511) stated they do not use their smartphone regularly. This group comprised more of men than of women with a higher mean age, underprivileged social class, residence in less-developed districts, and a lower education level. They showed worse mental health indicators, lower perceived quality of life relating to their health, more sedentarism, and greater tendency toward being overweight/obese and a higher feeling of loneliness. When looking at all these variables together, the regression model showed that in addition to sex, age, social class, and education level, the only significantly associated health indicator was a feeling of loneliness. Mobile phone abuse is associated with health problems, but nonregular use does not reflect the opposite. It is important to study the group of nonusers and explore the reasons and related consequences, particularly the role of perceived loneliness, which is paradoxical as a smartphone is a tool that can foster interpersonal contact.

Effects of light on human circadian rhythms, sleep and mood

Humans live in a 24-hour environment, in which light and darkness follow a diurnal pattern. Our circadian pacemaker, the suprachiasmatic nuclei (SCN) in the hypothalamus, is entrained to the 24-hour solar day via a pathway from the retina and synchronises our internal biological rhythms. Rhythmic variations in ambient illumination impact behaviours such as rest during sleep and activity during wakefulness as well as their underlying biological processes. Rather recently, the availability of artificial light has substantially changed the light environment, especially during evening and night hours. This may increase the risk of developing circadian rhythm sleep-wake disorders (CRSWD), which are often caused by a misalignment of endogenous circadian rhythms and external light-dark cycles. While the exact relationship between the availability of artificial light and CRSWD remains to be established, nocturnal light has been shown to alter circadian rhythms and sleep in humans. On the other hand, light can also be used as an effective and noninvasive therapeutic option with little to no side effects, to improve sleep,mood and general well-being. This article reviews our current state of knowledge regarding the effects of light on circadian rhythms, sleep, and mood.

Sleep and new media usage in toddlers

Several studies over the years have demonstrated the association between lack of sleep in children and certain physical, psychological, and behavioral disorders. The aim of this study was to disentangle the association between new screen-based electronic devices and sleep problems in toddlers, adjusting for other covariates already known to be associated with sleep quality. We conducted a cross-sectional study with the aid of a national sample of 1117 toddlers. Parents reported children's sleeping habits such as total sleep time and sleep onset latency, recreational activities, bedtime routines, and temperament. An ordered logistic regression was run to assess the associations between new media exposure and two sleep outcomes (total sleep time and sleep onset latency). Everyday use of a tablet or smartphone raised the odds of a shorter total sleep time (OR 1.95 [1.00-3.79], p < 0.05) and a longer sleep onset latency (OR 2.44 [1.26-4.73] p < 0.05) irrespective of other factors, such as temperament (restlessness, sociability), or traditional screen exposure (watching TV or playing videogames).Conclusion: New media usage is a factor associated in toddlers with sleeping fewer hours and taking longer to fall asleep, irrespective of other confounding factors. What is known • Studies have found an association between sleep behavior and the use of computers and video games in early childhood. • The blue light emitted from TV screens suppresses endogenous melatonin. What is new • The study found an association between daily new media (tablet and smartphone) usage and sleep quality in toddlers • New media usage exposes toddlers to the risk of fewer hours of sleep and taking longer to fall asleep, irrespective of other factors.

Night-time screen-based media device use and adolescents' sleep and health-related quality of life

OBJECTIVE

The present study investigates the relationship between night-time screen-based media devices (SBMD) use, which refers to use within 1 h before sleep, in both lit and dark rooms, and sleep outcomes and health-related quality of life (HRQoL) among 11 to 12-year-olds.

METHODS

We analysed baseline data from a large cohort of 6616 adolescents from 39 schools in and around London, United Kingdom, participating in the Study of Cognition Adolescents and Mobile Phone (SCAMP). Adolescents self-reported their use of any SBMD (mobile phone, tablet, laptop, television etc.). Sleep variables were derived from self-reported weekday and/or weekend bedtime, sleep onset latency (SOL) and wake time. Sleep quality was assessed using four standardised dimensions from the Swiss Health Survey. HRQoL was estimated using the KIDSCREEN-10 questionnaire.

RESULTS

Over two-thirds (71.5%) of adolescents reported using at least one SBMD at night-time, and about a third (32.2%) reported using mobile phones at night-time in darkness. Night-time mobile phone and television use was associated with higher odds of insufficient sleep duration on weekdays (Odds Ratio, OR = 1.82, 95% Confidence Interval, CI [1.59, 2.07] and OR = 1.40, 95% CI [1.23, 1.60], respectively). Adolescents who used mobile phones in a room with light were more likely to have insufficient sleep (OR = 1.32, 95% CI [1.10, 1.60]) and later sleep midpoint (OR = 1.64, 95% CI [1.37, 1.95]) on weekends compared to non-users. The magnitude of these associations was even stronger for those who used mobile phones in darkness for insufficient sleep duration on weekdays (OR = 2.13, 95% CI [1.79, 2.54]) and for later sleep midpoint on weekdays (OR = 3.88, 95% CI [3.25, 4.62]) compared to non-users. Night-time use of mobile phones was associated with lower HRQoL and use in a dark room was associated with even lower KIDSCREEN-10 score (β = -1.18, 95% CI [-1.85, -0.52]) compared to no use.

CONCLUSIONS

We found consistent associations between night-time SBMD use and poor sleep outcomes and worse HRQoL in adolescents. The magnitude of these associations was stronger when SBMD use occurred in a dark room versus a lit room.

"Let's talk about sleep": a qualitative examination of levers for promoting healthy sleep among sleep-deprived vulnerable adolescents

OBJECTIVE

Deficient sleep is highly prevalent in disadvantaged adolescents and contributes to a range of adverse health and behavioral outcomes. We examined mediating mechanisms and strategies that adolescents adopt to improve sleep, and possible levers for promoting sleep in this population.

METHODS

We conducted three focus groups (N = 27 total, age 14-18 years) in adolescents living in low- and middle-income racially/ethnically diverse neighborhoods of Boston, Massachusetts. Participants completed a survey on their sleep and health habits prior to the moderator-led discussions. Discussions were audio-recorded, transcribed, and thematically analyzed.

RESULTS

The study population did not meet the minimum sleep recommendations, and we found a high prevalence of "social jet-lag." We also identified a disconnect between the acknowledgment of the importance of sleep and actual behavior, especially for electronic use. Phone use and screen time were the most commonly cited barriers to a good night's sleep, along with caffeine consumption, which was also high in this sample. There was also a general lack of awareness of sleep hygiene practices and recommendations. Participants reported regulating food intake and physical activity, using allopathic sleep aids, creating a comfortable sleeping environment, and a routine as some strategies to improve sleep.

CONCLUSION

Results from this study suggest facilitating the linkage between participant-generated mediating factors and strategies for better-designed interventions. These include making the negative impact of sleep on health more explicit, improving youth awareness about sleep hygiene, targeting caffeine consumption and electronic use, and introducing sleep recommendations through appropriate and effective channels.

The relationship between problematic smartphone use and psychiatric symptoms among adolescents who applied to psychiatry clinics

Problematic mobile phone use is an important problem which has increasing prevalence among adolescents. We should address risk factors to create intervention frameworks related to this problem. In this study, we aimed to determine the prevalence of problematic smartphone use among adolescents who were referred to clinics, its relationship to sociodemographic characteristics, psychiatric symptoms and emotion regulation problems. We included 150 adolescents aged 12-18 years who own smartphones. All participants filled out the Sociodemographic Information Form, Brief Symptom Inventory (BSI), Difficulties in Emotion Regulation Scale (DERS) and Problematic Mobile Phone Use Scale (PMPUS). Problematic smart phone use was detected in 50.6% of the sample. Adolescents with problematic use were found to be older than the others, with lower levels of maternal education and self-achievement. Regression analysis revealed that the factors predicting the risk of problematic smartphone use are somatization, interpersonal sensitivity and hostility symptoms. According to our results, we suggest psychiatrists consider the high prevalence of problematic smartphone use, address the relationship between hostility, somatic symptoms and interpersonal sensitivity (susceptibility) and the effects of this current problem on social-academic functioning while evaluating and treating adolescents.

What Drives Young Vietnamese to Use Mobile Health Innovations? Implications for Health Communication and Behavioral Interventions

BACKGROUND

Mobile phone use in Vietnam has become increasingly popular in recent years, with youth (people aged 15-24 years) being one of the groups with the heaviest use. Health-related apps on mobile phones (mobile health [mHealth] apps) appear to be a feasible approach for disease and health management, especially for self-management. However, there has been a scarcity of research on mobile phone usage for health care among youth and adolescents.

OBJECTIVE

This study aims to identify the patterns of usage of mobile phone apps and the preferences for functionalities of mobile phone-based health-related apps among Vietnamese youth.

METHODS

An online cross-sectional study was conducted in Vietnam in August to October 2015. Web-based respondent-driven sampling technique was adopted to recruit participants. The online questionnaire was developed and distributed using Google Forms. Chi square and Mann-Whitney tests were used to investigate the difference in attitude and preference for mobile phone apps between the two genders.

RESULTS

Among 356 youths (age from 15 to 25 years) sampled, low prevalence was found of using mHealth apps such as beauty counseling (6.5%, 23/356), nutrition counseling (7.9%, 28/356), disease prevention (9.8%, 35/356), and disease treatment (7.6%, 27/356). The majority of users found the app(s) they used to be useful (72.7%, 48/356) and reported satisfaction with these apps (61.9%, 39/356). No significant differences were found between the genders in their perception of the usefulness of apps and their satisfaction with mobile health apps. Most of the participants (68.2%, 238/356) preferred apps which are conceptualized and designed to run on a mobile phone compared to Web-based apps, and 50% (176/356) preferred visual materials. Approximately 53.9% (188/356) reported that it was integral for the mobile phone apps to have a sharing/social network functionality. Participants with a higher perceived stress score and EuroQol-5 Dimensions (EQ-5D) index were significantly less likely to use mHealth apps.

CONCLUSIONS

This study found a low proportion using mHealth-related mobile phone apps, but a high level of receptiveness and satisfaction among Vietnamese youth. Acceptance level and preferences toward mHealth apps as well as specifically preferred functionalities discovered in this study are essential not only in conceptualizing and developing appropriate mobile phone interventions targeting youth and adolescents, but also in the application of technically advanced solutions in disease prevention and health management.

Mobile Phone Use and Mental Health. A Review of the Research That Takes a Psychological Perspective on Exposure

The purpose of this study was to carry out a review of observational studies that consider links between mobile phone use and mental health from a psychological or behavioral perspective. Systematic literature searches in PubMed and PsycINFO for articles published until 2017 were done. Exclusion criteria included: papers that considered radiofrequency fields, attention, safety, relational consequences, sexual behavior, cyberbullying, and reviews, qualitative, and case or experimental studies. A total of 4738 papers were screened by title and abstract, 404 were retrieved in full text, and 290 were included. Only 5% had any longitudinal design. Self-reporting was the dominating method of measurement. One third of the studies included children or youth. A majority of adult populations consisted of university students and/or self-selected participants. The main research results included associations between frequent mobile phone use and mental health outcomes, such as depressive symptoms and sleep problems. Mobile phone use at bedtime was associated with, e.g., shorter sleep duration and lower sleep quality. "Problematic use" (dependency) was associated with several negative outcomes. In conclusion, associations between mobile phone use and adverse mental health outcomes are found in studies that take a psychological or behavioral perspective on the exposure. However, more studies of high quality are needed in order to draw valid conclusions about the mechanisms and causal directions of associations.

Adolescents' smartphone use at night, sleep disturbance and depressive symptoms

Nowadays smartphones are used anywhere and at any time, day or night, by adolescents. Smartphone use, especially at night, is a risk factor for sleep disturbance and depression in adolescents. The purpose of this study was to analyse the correlation between smartphone use at night, sleep disturbance and depression symptoms in adolescents. This cross-sectional study analysed the data from 714 students in Surabaya, who were selected by using a simple random sampling technique. The independent variable was smartphone usage at night while the dependent variable was sleep disturbance and depressive symptoms. The data was collected using three questionnaires: the smartphone usage at night questionnaire, the Insomnia Severity Index questionnaire and the Kutcher Adolescent Depression Scale questionnaire. The data was then analysed using Spearman's rho analysis (α < 0.05). The results indicated that there was a relationship between the use of smartphones at night and sleep disturbance in adolescents with a positive correlation (r = 0.374), and that there was a relationship between the use of smartphones at night and depression symptoms in adolescents with a positive correlation (r = 0.360). This study highlights that the excessive use of smartphones during the night may play a significant role in sleep problems and depressive symptoms among teenagers. Adolescents with sleep disturbance and depressive symptoms should be carefully monitored for signs of smartphone addiction. Nurses should improve health education for adolescents to inform them about the positive use of smartphones to prevent sleep disturbance and to minimise depressive symptoms.

Evaluation of Internet addiction and the quality of life of Brazilian adolescents from public and private schools

Abstract This study evaluated the profile of public and private high school students (N = 254, Mage = 15.1, SD = 1.3) in the city of São Paulo in relation to their Internet use patterns and quality of life. We used the Internet Addiction Test and the Pediatric Quality of Life Inventory. About 70% of the students had moderate Internet addiction. Those students from public school showed higher scores of Internet addiction (p < 0.001) than students from private schools. Regarding the quality of life, those from private school showed better scores regarding academic performance (p < 0.01) and worse scores in social aspect (p < 0.05). The data showed a strong association between Internet addiction and poor levels of quality of life, as observed in studies from other countries.