Youth Screen Media Habits and Sleep: Sleep-Friendly Screen Behavior Recommendations for Clinicians, Educators, and Parents

Association of digital media use with sleep habits in school children: A cross-sectional study

Background

The use of digital media (DM) is increasing among school-children, which can affect their sleep habits. The primary objective of this study was to evaluate the association of DM use with sleep habits in school-children.

Methods

It was a cross-sectional study of healthy school children. Sleep habits and DM use were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and SCREENS-Q, respectively. The Pearson correlation coefficient was used to establish the correlation between the two variables. Logistic regression analysis was performed to quantify the extent of association between variables. A p-value <0.05 was considered statistically significant.

Results

A total of 205 children were enrolled with a mean (SD) age of 7.1 (2.1) years. The mean (SD) sleep duration was 7.58 (0.80) hours. The mean (SD) CSHQ score was 50.6 (5.1). Use of DM was observed in 204 (99.5 %) children. On multivariate logistic regression analysis, DM use ≥2 h/day was significantly associated with higher CSHQ score (OR 1.28, 95%CI 1.18-1.40; p = 0.001). Sleep domains significantly affected by DM use ≥2 h/day were bedtime resistance (OR 1.55, 95 % CI 1.24-1.94; p < 0.001), sleep duration (OR 0.40, 95 % CI 0.28-0.58:p < 0.001), sleep anxiety (OR 1.69, 95%CI 1.40-2.04:p < 0.001), night awakening (OR 4.81 95 % CI 2.98-7.78:p < 0.001), parasomnias (OR 1.86, 95 % CI 1.45-2.38:p < 0.001), and daytime sleepiness (OR1.89,95 % CI 1.52-2.36: p < 0.001). DM use 30 min before bedtime was significantly associated with a higher CSHQ score (OR 1.32, 95 % CI 1.20-1.45; p < 0.001). In bivariate regression analysis, DM use ≥2 h/day was associated with poor academic performance (OR 2.36 95 % CI 1.28-4.35; p 0.006).

Conclusion

This study has shown that the average sleep duration in children was shorter than the recommended duration. DM use was common in school children and it has a significant association with sleep habits especially with use of ≥2 h/day and 30 mints before bedtime. It was also associated with poor academic performance. Public awareness on effect of DM use in school children is the need of the hour.

The enigma of sleep: Implications of sleep neuroscience for the dental clinician and patient

BACKGROUND

Sleep disturbances have been shown to result in considerable morbidity and mortality. It is important for dental clinicians to understand the neuroscience behind sleep disorders.

TYPES OF STUDIES REVIEWED

The authors conducted a search of the literature published from January 1990 through March 2024 of sleep medicine-related articles, with a focus on neuroscience. The authors prioritized articles about the science of sleep as related to dental medicine.

RESULTS

The authors found a proliferation of articles related to sleep neuroscience along with its implications in dental medicine. The authors also found that the intricate neuroscientific principles of sleep medicine are being investigated robustly. The salient features of, and the differences between, central and obstructive sleep apneas have been elucidated. Sleep genes, such as CRY, PER1, PER2, and CLOCK, and their relationship to cancer and neurodegeneration are also additions to this rapidly developing science.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The dental clinician has the potential to be the first to screen patients for possible sleep disorders and make prompt referrals to the appropriate medical professionals. This can be lifesaving as well as minimize potential future morbidity for the patient.

Developmental changes in school burnout: The importance of sleep and problematic Internet use

INTRODUCTION

School burnout remains a prevalent problem among adolescents; it is associated with low academic achievement and school dropout risk, in turn linked to a whole host of deleterious developmental outcomes. The current longitudinal study sought to better understand the developmental course of school burnout by testing whether poor sleep and problematic internet use each uniquely and additively explained the variance in school burnout over time.

METHOD

Data were collected four times over 18 months, 6 months apart from N = 405 adolescents, grades 9 to 11.

RESULTS

Sleep quality, but not quantity, was significantly associated with the school burnout intercept (β = -0.29); no effects were found for the slope. Problematic internet use was also significantly associated with the intercept (β = .44), but not the slope. In a combined model, both sleep quality and problematic internet use significantly predicted the school burnout intercept. The slope was only predicted by age (β = -0.21).

CONCLUSIONS

The study found partial support for the hypotheses that both poor sleep quality and problematic internet use predicted school burnout, intercept only, not the rate of change. The evidence suggests that school burnout increased across high school; however, the rate of increase slowed with age. In contrast to some previous work, study findings highlight the importance of separately considering both poor sleep and problematic internet use in understanding the development of school burnout during adolescence. N = 229.

Screen time, sleep, brain structural neurobiology, and sequential associations with child and adolescent psychopathology: Insights from the ABCD study

Background and Aims

The precise roles of screen media activity (SMA) and sleep problems in relation to child/adolescent psychopathology remain ambiguous. We investigated temporal relationships among sleep problems, SMA, and psychopathology and potential involvement of thalamus-prefrontal-cortex (PFC)-brainstem structural covariation.

Methods

This study utilized data from the Adolescent Brain Cognitive Development study (n = 4,641 ages 9-12) at baseline, Year1, and Year2 follow-up. Cross-Lagged Panel Models (CLPMs) investigated reciprocal predictive relationships between sleep duration/problems, SMA, and psychopathology symptoms. A potential mediating role of baseline Thalamus-PFC-brainstem covariation on SMA-externalizing relationships was examined.

Results

Participants were divided into discovery (n = 2,359, 1,054 girls) and replication (n = 2,282, 997 girls) sets. CLPMs showed 1) bidirectional associations between sleep duration and SMA in late childhood, with higher frequency SMA predicting shorter sleep duration (β = -0.10 [95%CI: -0.16, -0.03], p = 0.004) and vice versa (β = -0.11 [95%CI: -0.18, -0.05], p < 0.001); 2) externalizing symptoms at age 10-11 predicting sleep problems (β = 0.11 [95%CI: 0.04, 0.19], p = 0.002), SMA (β = 0.07 [95%CI: 0.01, 0.13], p = 0.014), and internalizing symptoms (β = 0.09 [95%CI: 0.05, 0.13], p < 0.001) at age 11-12; and 3) externalizing behavior at age 10-11 partially mediating the relationship between baseline thalamus-PFC-brainstem covariation and SMA at age 11-12 (indirect effect = 0.032 [95%CI: 0.003, 0.067], p-value = 0.030). Findings were replicable.

Conclusion

We found bi-directional SMA-sleep-duration associations in late childhood. Externalizing symptoms preceded future SMA and sleep disturbances and partially mediated relationships between structural brain covariation and SMA. The findings emphasize the need for understanding individual differences and developing and implementing integrated strategies addressing both sleep concerns and screen time to mitigate potential impacts on psychopathology.

Effects of COVID-19 lockdown on children´s sleep quality, physical activity, screen time, and diet

BACKGROUND

this study aimed to assess how the COVID-19 lockdown (March to June 2020) affected children's sleep quality, physical activity, screen time, and nutrition.

MATERIAL AND METHODS

the survey consisted of 479 children from the SENDO project, a pediatric cohort in Spain, aged 4-5 years. The BEAR questionnaire was used to evaluate sleep quality. Hierarchical models with two-level clustering were used to account for intra-cluster correlation between siblings, and the difference regression method was used to study the association between changes in screen consumption and physical activity and changes in sleep quality.

RESULTS

the results showed an increase in the consumption of homemade pastries and snacks. Sleep quality worsened significantly during confinement, with a mean score on the BEAR scale of 0.52 before, 1.43 during, and 1.07 after confinement. Although sleep quality improved significantly after the end of confinement, it remained worse than before. The average daily screen time increased from 1.13 hours before confinement to 2.65 hours during confinement. Physical activity decreased during confinement, with the mean number of hours per day decreasing from 1.27 to 0.79. Children who spent more time on screens during confinement had worse sleep quality, as indicated by their higher scores on the BEAR scale. We used the difference regression method to identify a statistically significant association between the increased screen time for leisure hours and the worsening of children's sleep quality during confinement.

CONCLUSION

we observed a significant relationship between confinement and reduced sleep quality. Although the end of the lockdown led to a slight improvement, the average BEAR scale score remained higher post-confinement, suggesting that the consequences of the lockdown may persist over time.

Impact of sleep on educational outcome of Indigenous Australian children: A systematic review

INTRODUCTION

The association between quality sleep and improved cognition is well reported in literature. However, very few studies have been undertaken to evaluate the impact of poor sleep on educational outcomes in Indigenous Australian children.

OBJECTIVES

The objective of this review was to explore the association between sleep and educational outcomes of Indigenous children.

METHODS

For this systematic review, a literature search covering research articles in academic databases and grey literature sources was conducted to retrieve studies published until March 2022. Eight online e-databases (PubMed, Ovid MEDLINE, CINAHL, SCOPUS, HealthinfoNet, PsycINFO, Cochrane and Google Scholar) were searched for data extraction and two appraisal tools (NIH and CREATE) were used for quality assessment. Studies that explored any aspect of sleep health in relation to educational/academic outcomes in school going Indigenous Australian children aged 5-18 were included in this study. All review articles and studies that focused on physical/ mental disabilities or parent perceptions of sleep and educational outcomes were excluded. A convergent integrated approach was used to collate and synthesize information.

RESULTS

Only three studies (two cross-sectional and one longitudinal) met the eligibility criteria out of 574 articles. The sample size ranged from 21-50 of 6 to 13 year old children. A strong relationship was indicated between sleep quantity and educational outcomes, in two of the three studies. One study related the sleep fragmentation/shorter sleep schedules of short sleep class and early risers with poorer reading (B = -30.81 to -37.28, p = 0.006 to 0.023), grammar (B = -39.79 to -47.89, p = 0.012-0.013) and numeracy (B = -37.93 to -50.15, p = 0.003 to 0.022) skills compared with long sleep and normative sleep class whereas another reported no significant relation between sleep and educational outcomes.

CONCLUSION

The review highlights the need for more research to provide evidence of potentially modifiable factors such as sleep and the impact these may have on academic performance.

Exposure to maternal experiences of IPV in early childhood and sleep health in adolescence

BACKGROUND

Half of US women will experience intimate partner violence (IPV), and nearly all children in families experiencing such violence will be exposed. The negative effects of IPV exposure on children's mental and physical health are well-documented; however, less is known about effects on children's sleep health, a key marker of well-being.

OBJECTIVE

This study examines the associations of early childhood exposure to maternal experiences of IPV with sleep health in adolescence, focusing on multiple dimensions of sleep health and differences by child sex.

PARTICIPANTS AND SETTING

We rely on data from the Future of Families and Child Wellbeing Study, a population-based study following 5000 children in large US cities, from birth to age 15. Analyses are based on 2687 adolescents interviewed at the year-15 follow-up.

METHODS

Early childhood exposure to IPV is based on mothers' reports of her experiences of IPV from the child's birth to age 5. Adolescent sleep health is measured using 6 items approximating the BEARS sleep problem scale, at age 15. We estimate multivariate linear regression models to examine associations of early childhood IPV exposure with adolescent sleep health and stratify models by child sex.

RESULTS

Early childhood IPV exposure is associated with worse overall sleep health (β = 0.08; p < 0.001) and multiple dimensions of poor sleep health in adolescence. Associations are notably stronger among girls than boys.

CONCLUSIONS

The strong and lasting associations of early childhood exposure to IPV with adolescents' sleep health, particularly among girls, has important consequences for addressing adolescent health disparities.

Sex Differences in Temporal Sleep Patterns, Social Jetlag, and Attention in High School Adolescents

Insufficient sleep and irregular sleep hours are common in adolescents, who experience a delayed sleep phase due to biopsychosocial changes associated with puberty, resulting in later sleep times. However, early morning class hours shorten sleep duration on weekdays. This condition is harmful to cognitive performance, which may be accentuated in girls due to a greater sleep need and less resistance to sleep deprivation. In this study, we evaluated sex differences concerning temporal sleep patterns, social jetlag, and attention in high school adolescents attending morning classes. Students ( n  = 146 - F: 73-16.1 ± 0.8 years; M: 73-16.2 ± 0.9 years) completed a Health and Sleep questionnaire, kept a sleep diary for 10 days, which incorporated a Maldonado Sleepiness Scale, and performed a Continuous Performance Task. Girls went to bed earlier and woke up on weekends, and spent more time in bed at night and in 24 h on weekdays and weekends, while they also had a greater irregularity in wake-up times ( p  < 0.05). There were no differences between sexes in terms of social jetlag, sleep debt, and sleepiness upon awakening ( p  > 0.05). Regarding attention, the girls had a longer reaction time in phasic alertness ( p  < 0.01) and a tendency to have fewer errors in selective attention ( p  = 0.06). These results persisted when controlled for sleep parameters. Therefore, we suggest that girls have a greater sleep need and less resistance to sleep deprivation, while the differences in attention performance could be due to different strategies, the girls could be making a trade, increasing reaction time in favor of better accuracy, while the boys could be prioritizing a faster response time.

Effects of evening smartphone use on sleep and declarative memory consolidation in male adolescents and young adults

Exposure to short-wavelength light before bedtime is known to disrupt nocturnal melatonin secretion and can impair subsequent sleep. However, while it has been demonstrated that older adults are less affected by short-wavelength light, there is limited research exploring differences between adolescents and young adults. Furthermore, it remains unclear whether the effects of evening short-wavelength light on sleep architecture extend to sleep-related processes, such as declarative memory consolidation. Here, we recorded polysomnography from 33 male adolescents (15.42 ± 0.97 years) and 35 male young adults (21.51 ± 2.06 years) in a within-subject design during three different nights to investigate the impact of reading for 90 min either on a smartphone with or without a blue-light filter or from a printed book. We measured subjective sleepiness, melatonin secretion, sleep physiology and sleep-dependent memory consolidation. While subjective sleepiness remained unaffected, we observed a significant melatonin attenuation effect in both age groups immediately after reading on the smartphone without a blue-light filter. Interestingly, adolescents fully recovered from the melatonin attenuation in the following 50 min before bedtime, whereas adults still, at bedtime, exhibited significantly reduced melatonin levels. Sleep-dependent memory consolidation and the coupling between sleep spindles and slow oscillations were not affected by short-wavelength light in both age groups. Nevertheless, adults showed a reduction in N3 sleep during the first night quarter. In summary, avoiding smartphone use in the last hour before bedtime is advisable for adolescents and young adults to prevent sleep disturbances. Our research empirically supports general sleep hygiene advice and can inform future recommendations regarding the use of smartphones and other screen-based devices before bedtime.

Accelerometer-measured sleep behaviour and parent-child sleep guideline adherence and sleep quality in Czech families with children aged 3-8 years: the FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study

Assessing parent-child relationship in sleep behaviours is important for facilitating changes in the sleep guideline compliance in preschool age children. The aim of this study was to examine accelerometer-measured sleep quantity and quality in families with children aged 3-8 years and investigate the parents' influence on the child's sleep. The data were obtained from the Czech cross-sectional FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study, with a final sample of 374 families. Families were recruited through the enrolment of their children in kindergartens/primary schools between March 2022 and May 2023. The sleep time window and total sleep time were assessed using a wrist-worn ActiGraph accelerometer. Participants wore this device continuously for 24 h/day over a period of 7 consecutive days. Demographic data and potential correlates were obtained via questionnaires completed by parents. Statistical analyses were completed using logistic regression and independent-samples Mann-Whitney U test. In all, 65.5% of children (60% boys, 70.9% girls) and 58.3% of parents (52.4% fathers, 64.3% mothers) achieved the recommended sleep duration. Greater sleep quantity and duration in good-quality sleep were significantly higher in girls/mothers, compared to boys/fathers. Preschoolers were more likely to comply with sleep guidelines if their mother (but not father) met the sleep recommendation and their mothers did not have a higher education level. Adhering to sleep guidelines in children was also associated with children's female gender, absence of screen device in the bedroom, and being more active. Given the high concurrence in mother-child sleep quantity, it is important to promote healthy sleep behaviours in the whole family.

Enhancing sleep health in urban American Indian/Alaska Native adolescents: Implications for culturally tailored interventions

BACKGROUND

Urban American Indian/Alaska Native (AI/AN) adolescents are vulnerable to sleep and other health-related disparities due to numerous social drivers, including historical trauma and relocation to urban areas. This study aims to identify strategies to increase protective factors and culturally tailor sleep health interventions for this population.

METHODS

Using community-based participatory research, the NAYSHAW study conducted in-depth interviews with urban AI/AN adolescents aged 12-19 years to understand critical components needed for developing a culturally sensitive sleep health intervention. Data from two qualitative subsamples (N = 46) and parent surveys (N = 110) were analyzed, focusing on factors that affect sleep health behaviors, including parental involvement, technology, and traditional practices.

RESULTS

Key findings include the detrimental impact of electronics use at night and protective effects of traditional practices on sleep. Parental involvement in sleep routines varied by adolescent's age. Adolescents desired sleep health education in interactive formats, whereas parents preferred workshops and digital applications for sleep health strategies. Findings suggest that interventions need to address electronics use and should also be culturally tailored to address the unique experiences of urban AI/AN adolescents.

CONCLUSIONS

Results underscore the importance of utilizing community-based strategies to develop culturally tailored sleep interventions for underserved populations, specifically urban AI/AN adolescents. Integrating traditional practices with evidence-based sleep health strategies can provide a holistic approach to improving sleep and overall well-being. Parental education and involvement will be critical to the success of such interventions.

Evolution of Sleep Duration and Screen Time Between 2018 and 2022 Among Canadian Adolescents: Evidence of Drifts Accompanying the COVID-19 Pandemic

PURPOSE

We quantified the joint evolution of sleep duration and screen time between 2018 and 2022 in a large sample of adolescents from Quebec, Canada, to ascertain changes that occurred during the COVID-19 pandemic.

METHODS

A natural experiment design was used to compare variations from year to year and in association with the pandemic outbreak. Using structural equation modeling on data collected between 2018 and 2022 among adolescents attending 63 high schools, we analyzed the joint evolution of sleep duration and screen time while adjusting for previous year values, concurrent flourishing score, sex, age, and family level of material deprivation.

RESULTS

A total of 28,307 adolescents, aged on average 14.9 years, were included in the analyses. Between 2019 and 2022, sleep duration increased by 9.6 (5.7, 13.5) minutes and screen time by 129.2 (120.5, 138.0) minutes on average. In 2022, the adolescents spent almost equal amounts of time sleeping and using screens. Lower flourishing scores were associated with shorter sleep duration and lengthier screen time. Girls' screen time became similar to boys' over time.

DISCUSSION

Adolescents now spend almost equal amounts of time sleeping and using screens, a situation that calls for urgent public health actions. These findings highlight the importance of tracking changes in adolescents' behaviours over time, to design and implement interventions adapted to the changing health needs of different groups.

Effect of sleep on oral health: A scoping review

Sleep is a vital biological process that facilitates numerous vital functions integral to mental and physical restoration of the body. Sleep deprivation or poor sleep quality not only affects physical health but may also affect oral health. This scoping review aims to collate existing evidence related to the impact of sleep duration and/or quality on oral health. A systematic search strategy using PubMed, Embase, Scopus and CINAHL databases was performed to identify studies that assessed the association between sleep quality or duration and oral health or hygiene. Two researchers independently screened and extracted the data. Eligible studies were critically appraised using the NIH quality assessment tool for observational cohort and cross-sectional studies checklist. The search identified 18,398 studies, from which 14 fulfilled the inclusion criteria. Of the 14 papers, four papers were associated with effect of sleep on caries, 8 papers described the effect of sleep on gingival and periodontal health, and two papers described the effect of sleep on general oral health and oral disease symptoms. This review found a direct link between sleep and dental decay in children, and short sleep duration was associated with an increased risk of periodontitis adults.

Interactive Screen-Based Activities Predict Worse Actigraphic Sleep Health That Night Among Adolescents

PURPOSE

To determine the micro-longitudinal effects of duration and timing of screen-based activities on sleep within and between adolescents.

METHODS

Daily survey and actigraphy data from the age 15 wave of the Future of Families and Child Wellbeing Study were analyzed using multilevel modeling. Four hundred seventy five adolescents provided three or more days of valid daily survey and nighttime sleep data.

RESULTS

Within-person results showed that on days when adolescents played video games more than their daytime average ± SE (1.3 ± 1.2 hours), sleep onset (6 ± 2 minutes, p < .01) and midpoint (4 ± 2 minutes, p < .02) were delayed for each additional hour of gaming. Between-person results showed that for each hour adolescents used screens to communicate with friends across the day, sleep onset was later (11 ± 3 minutes, p < .01), sleep midpoint was later (8 ± 3 minutes, p < .01), and sleep duration was shorter (-5 ± 2 minutes, p < .03). Adolescents who used screens to communicate with friends or play video games in the hour before bed had later sleep onset (30 ± 14 minutes, p < .03) and midpoint (25 ± 13 minutes, p < .05).

DISCUSSION

Among adolescents, passive screen usage such as browsing the Internet or watching videos may not affect sleep timing or duration, but limiting interactive screen-based activities could protect adolescent sleep health and well-being.

Nocturnal Smartphone Use Affects Sleep Quality and Cognitive and Physical Performance in Tunisian School-Age Children

Nocturnal smartphone use emits blue light, which can adversely affect sleep, leading to a variety of negative effects, particularly in children. Therefore, the present study aimed to determine the effect of acute (AC) (one night) and repeated (RC) (five nights) nocturnal smartphone exposure on sleep, cortisol, and next-day performance in Tunisian children. Thirteen participants (seven girls and six boys, age 9 ± 0.6, height 1.32 ± 0.06, weight 34.47 ± 4.41) attended six experimental nights. The experiment started with a baseline night (BL) with no smartphone exposure, followed by repeated sessions of nocturnal smartphone exposure lasting 90 minutes (08:00 pm-09:30 pm). Actigraphy; salivary cortisol; the Stroop test (selective attention); choice reaction time (CRT); N-back (working memory); counter-movement jump (CMJ), composed of flight time (time spent in the CMJ flight phase) and jump height; and a 30 m sprint were assessed the morning after each condition. Both AC and RC shortened total sleep time (TST) (p < 0.01), with a greater decrease with RC (-46.7 min, ∆% = -9.46) than AC (-28.8 min, ∆% = -5.8) compared to BL. AC and RC significantly increased waking after sleep onset (3.5 min, ∆% = 15.05, to 9.9 min, ∆% = 43.11%) and number of errors made on the Stroop test (1.8 error, ∆% = 74.23, to 3.07 error, ∆% = 97.56%). Children made 0.15 and 0.8 more errors (∆% = 6.2 to 57.61%) and spent 46.9 s and 71.6 s more time on CRT tasks (∆% = 7.22 to 11.11%) with AC and RC, respectively, compared to BL. The high-interference index of the Stroop task, CMJ performance, and 30 m sprint speed were only altered (p < 0.01) following RC (0.36, Δ% = 41.52%; -34 s, Δ% = -9.29%, for flight time and -1.23 m, -8.72%, for jump height; 0.49 s, Δ% = 6.48, respectively) when compared to BL. In conclusion, one- or five-night exposure to smartphones disturbed the children's sleep quality and their performance, with more pronounced effects following RC.

The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions

Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.

Contributions of the light environment and co-sleeping to sleep consolidation into nighttime in early infants: A pilot study

BACKGROUND

Sleep consolidation into nighttime is considered the primary goal of sleep development in early infants. However, factors contributing to sleep consolidation into nighttime remain unclear.

AIM

To clarify the influences of the light environment and nighttime co-sleeping on sleep consolidation into nighttime in early infants.

STUDY DESIGN

Cross-sectional study.

SUBJECTS AND METHODS

Sleep-wake time and light stimulation were measured in infants for 4 consecutive days using actigraphy. The infants' mothers were asked to complete a sleep events diary and a questionnaire about childcare, including "co-sleeping", defined as when the infant and mother slept on the same surface throughout the night.

OUTCOME MEASURES

The data were analyzed with a focus on daytime and nighttime sleep parameters.

RESULTS

Daytime light stimulation reduced daytime "active sleep", tended to reduce daytime sleep, and increased daytime waking. Nighttime light stimulation reduced nighttime "quiet sleep" and nighttime sleep and increased nighttime waking. Co-sleeping reduced nighttime waking, and, as a result, nighttime sleep time and sleep efficiency increased. Co-sleeping reduced daytime sleep and tended to increase daytime waking. Consequently, co-sleeping tended to increase the ratio of nighttime sleep to daytime sleep.

CONCLUSIONS

The present findings suggest that an appropriate light environment promotes daytime waking and nighttime sleep in early infants, but it does not contribute to sleep consolidation into nighttime by itself. On the other hand, co-sleeping may promote sleep consolidation into nighttime. Therefore, further methods for safe co-sleeping need to be established while avoiding risk factors for sudden unexpected death in infancy/sudden infant death syndrome.

Associations of social jetlag with physical activity and sedentary behaviour in children and adolescents: A systematic review and meta-analysis

Sleep and daytime movement behaviours occur co-dependently with each other within a finite 24 h day. Sleep parameters other than sleep duration, such as social jetlag and chronotype, have been linked to health problems and unhealthy behaviours among children and adolescents. Given the increasing number of studies examining sleep timing/chronotype and weight-related behaviours, including physical activity and sedentary behaviour, in the past decade, this systematic review and meta-analysis collated and evaluated the evidence on the relationships of social jetlag and chronotype with physical activity and sedentary behaviour among children and adolescents aged 3-17 years. Seven databases were searched on 16 March 2022, and 52 studies were identified as eligible for inclusion, 47 of which were suitable for the meta-analysis. A positive association was found between social jetlag and screen media use (r = 0.14, 95% CI: 0.04-0.24; I2  = 96%; p = 0.008). The morning chronotype was associated with a higher level of physical activity and a lower level of sedentary behaviour than the evening chronotype. No relationship was found between social jetlag and physical activity. The magnitude of heterogeneity among the included studies was high. Further experimental studies are urgently required to understand how circadian preference or misalignment affects activity behaviours. Interventions to promote an active lifestyle in young populations should consider their circadian preference, especially among individuals with the evening chronotype.

'I tried to take my phone off my daughter, and i got hit in the face': a qualitative study of parents' challenges with adolescents' screen use and a toolbox of their tips

BACKGROUND

Concerns about adolescent screen use are often expressed but poorly understood, particularly in terms of how parents are supposed to respond in ways that balance safety, care and developing independence and autonomy. This qualitative study investigated parental perceptions and concerns about screen use of adolescents aged 13 to 17. Current strategies to manage screen use and barriers to doing so were explored, and parents were asked to outline recommended interventions for better outcomes.

METHODS

Interviews and focus groups were held with 33 adults in Auckland, Aotearoa New Zealand (mean age 48 years) who were parenting adolescents (mean age 14 years). Interviews were transcribed verbatim, then inductive analysis and interpretation by the research team distilled the key ideas and illustrative quotes. A table of recommendations for a practical 'toolbox' was developed from these in-depth conversations.

RESULTS

Parents reported extensive use of screens by their adolescents, constantly throughout the day (and night, instead of sleeping). Four areas of specific concern included: (1) addict-like behavior, (2) exposure to harmful (and inane) content, (3) living in a virtual world, and (4) negative impacts on physical, mental, and cognitive wellbeing. To manage adolescent screen use, family rules and restrictions (on time and place) were common. Some used technical control via software or accessing the adolescent's devices and/or accounts to check for inappropriate content (such as pornography). Communication about device use and self-regulation were important. Barriers to managing screen use included trying to avoid conflict with their child; difficulties with consistency or follow-through on rules; lack of technical knowledge; parental screen use that set a bad example; and device use needed for school or other purposes. Recommendations from parents are presented in a toolbox of tips and techniques they shared, and their 'wish list' for better access to practical, local, scientific information, examples of techniques that have worked for other families, tools for problematic behavior and risk (including how to begin conversations with adolescents about their concerns), and having schools and young people involved in developing interventions to build digital citizenship.

CONCLUSIONS

Rich, nuanced accounts from parents about adolescent screen use in their families and communities underpinned their practical ideas for more skillful responses to young people grappling with an addictive digital existence.

A Study of the Correlation Between Screen Time and Hypertension Among Young Adults in North India: A Cross-Sectional Analysis

BACKGROUND

Hypertension is a major risk factor for coronary artery disease. Due to the increased accessibility of smartphones over the past decade, there has been an increase in the screen time of adolescents and young adults. However, the relationship between screen time and hypertension has not been adequately studied. Our study aims to find a correlation between screen time and blood pressure (BP) among young adults.

METHODS

A cross-sectional analysis was performed on a sample of medical students (n = 210) from New Delhi, India. Participants' screen time was monitored over three weeks and BP was recorded using a standardized sphygmomanometer by auscultatory method. Exclusion criteria included known cases of hypertension (with or without ongoing treatment), smokers > five pack year, heavy alcoholics, and participants having sleep time of less than seven hours or more than nine hours per day. Screen time was correlated with BP readings using standard statistical methods.

RESULTS

 Participants with screen time >390 minutes (six hours and 30 minutes), >420 minutes (seven hours), and >480 minutes (eight hours) had higher odds of elevated BP (OR: 1.86, 95% CI: 1.05-3.30; OR: 1.86, 95% CI: 1.04-3.30; OR: 1.87, 95% CI: 1.02-3.43, respectively) compared to students with screen time <390 minutes. The findings were consistent after excluding participants with high BMI based on the WHO and Asia-Pacific criteria, which also showed higher odds of elevated BP with screen time >390 minutes (OR: 3.21, 95% CI: 1.58-6.49 and OR: 3.92, 95% CI: 1.49-10.31, respectively). Regression analysis showed no significant linear correlation between screen time and BP (p > 0.05). However, a significant association was observed between BMI and elevated BP (p < 0.001).

CONCLUSION

 This study revealed an association exists between screen time and BP.

Recreational screen time behaviour among ambulatory children and adolescents diagnosed with cerebral palsy: A cross-sectional analysis

AIM

To describe the recreational screen time behaviour of 8-16-year-olds diagnosed with cerebral palsy (CP) and explore associations between health-related quality of life, sleep duration and physical activity behaviour versus screen time.

METHODS

This cross-sectional study used proxy-reported questionnaire data of 381 ambulatory (with or without assistance) 8-16-year-olds diagnosed with CP corresponding to Gross Motor Function Classification System (GMFCS) levels I-III. Descriptive statistics were used to report age, sex and the GMFCS level. The potential associations of health-related quality of life, physical activity behaviour and sleep duration (dependent variables) versus screen time (independent variable) were determined using multiple linear regression. Health-related quality of life was evaluated using the Pediatric Quality of Life Inventory, including seven dimensions: Daily Activities; School Activities; Movement and Balance; Pain and Hurt; Fatigue; Eating Activities; and Speech and Communication.

RESULTS

The participants spent a median screen time of 3.9 h daily. The boys spent a longer screen time during weekends than the girls (p = 0.003). Boys spent more time on games (p < 0.001), whereas girls spent more time on social media and video calls (p < 0.001). Increasing age (p < 0.001) was associated with increased screen time but did not differ between the GMFCS levels. Sleep duration, perceived fatigue and perceived movement and balance correlated negatively with screen time.

CONCLUSION

This study sheds light on the recreational screen time habits of ambulatory children and adolescents diagnosed with CP. Further investigation into the observed associations is warranted to investigate potential causation and relationships between sleep behaviour, quality of life and screen time behaviour.

Gamification as a health education strategy of adolescents at school: Protocol for a systematic review and meta-analysis

The objective of the study is to present a systematic review and meta-analysis protocol for evaluating the effects of health education gamification-based interventions, on health parameters (food consumption, sleep quality and physical activity) of adolescent students. This protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022373833). The search will be performed in the following databases: MEDLINE, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, APA, and ADOLEC. Intervention studies (clinical trials - randomized or non-randomized) and quasi-experimental studies will be included. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomized controlled trials, non- randomized controlled trials and quasi-experimental trials. Two independent researchers will conduct all assessments, and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be analyzed using RevMan 5.4.1 software. We will conduct the study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guideline. The review will summarize the current evidence on gamification health education changes in parameters related to the health of adolescents. Gamification has been used to verify the increase in adherence to healthy habits or the development of health-related skills, but there are still few results for the adolescent population. We expect that the systematic review could indicate strategies with gamification interventions and also determine how these strategies can improve health parameters of adolescent students, and they will be available as a reference for these interventions.

Investigation of the correlation between internet addiction, obesity risk and sleep disorder in children

AIM

This study was performed with the aim of investigating the correlation and the effective factors between internet addiction, obesity risk and sleep disorders in children.

MATERIAL AND METHOD

The sample for this descriptive and relational search type study comprised the parents of 458 children aged 7-10 years attending a primary school in Turkey. Data were collected the Parent and Child Descriptive Information Form, Family Child Internet Addiction Scale (FCIAS), Family Nutrition and Physical Activity Tool (FNPAT) and Sleep Disturbance Scale for Children (SDSC).

RESULTS

There was a statistically significant, positive and weak correlation between the Body Mass Index (BMI) and FCIAS scores of children (p < 0.001). There was a statistically significant, negative and very weak correlation between FNPAT total score with FCIAS total score (p = 0.007). There was a statistically significant, positive and moderate correlation between SDSC total score and FCIAS total score (p < 0.001). According to regression analysis, FCIAS was a determinant at significant levels for FNPAT and SDSC (p < 0.05).

CONCLUSION

There was a relationship between internet addiction and obesity and sleep quality. As a result of the study, the increase in internet use was determined to negatively impact physical activity and health nutrition behavior, and to increase sleep disturbance.

IMPLICATIONS FOR PRACTICE

Pediatric nurses are recommended to give counseling to children and families about preventing obesity and the risk of sleep disorders by identifying children at risk in terms of internet addiction in the early period.

Healthy Social Network Use and Well-Being during Adolescence: A Biopsychosocial Approach

Screen time and the use of social networks is the most frequent form of leisure time occupation and socializing for adolescents. The present study is aimed at understanding and characterizing, from an ecological perspective, what distinguishes healthy and less healthy or even dependent use of social media in young people and the influence on adolescents' well-being. This paper is based on the Health Behaviour in School-aged Children (HBSC) from 2022, a survey carried out every 4 years, in collaboration with the World Health Organisation (WHO), following an international protocol. A total of 7643 students from the 6th, 8th, 10th, and 12th school grades responded, of which 53.9% were female, with an average age of 15.05 (SD = 2.36). The sample is representative of the school grades under study. The results allow us to study and identify similarities and differences between three groups related to the level of healthiness in the use of social networks and its relations to well-being from an ecological perspective. What distinguishes adolescents with less healthy use of social networks is that they are more often female, older, have more self-injurious behaviour, higher alcohol consumption, and a worse relationship with teachers. The adolescents with the highest level of dependence on social networks are those who have a higher perception of lack of safety at school and in their area of residence, as well as a higher use of screen time as a leisure activity. The well-being of adolescents using social media in a healthy way is explained by fewer psychological symptoms, better stress management strategies, better body awareness, more physical activity, less time online with friends, and better relationships with family and teachers. Technologies and social networks are important for the well-being of adolescents; it is essential to promote a healthy, critical and balanced use with other "screen-free" activities and to promote socio-emotional skills, a lack of which seems to be one of the biggest risk factors associated with the healthy use of technologies.

Bedtime screen use behaviors and sleep outcomes: Findings from the Adolescent Brain Cognitive Development (ABCD) Study

OBJECTIVES

To determine associations between bedtime screen time behaviors and sleep outcomes in a national study of early adolescents.

METHODS

We analyzed cross-sectional data from 10,280 early adolescents aged 10-14 (48.8% female) in the Adolescent Brain Cognitive Development Study (Year 2, 2018-2020). Regression analyses examined the association between self-reported bedtime screen use and self- and caregiver-reported sleep measures, including sleep disturbance symptoms, controlling for sex, race/ethnicity, household income, parent education, depression, data collection period (pre- vs. during COVID-19 pandemic), and study site.

RESULTS

Overall, 16% of adolescents had at least some trouble falling or staying asleep in the past 2 weeks and 28% had overall sleep disturbance, based on caregiver reports. Adolescents who had a television or an Internet-connected electronic device in the bedroom had a greater risk of having trouble falling or staying asleep (adjusted risk ratio 1.27, 95% CI 1.12-1.44) and overall sleep disturbance (adjusted risk ratio 1.15, 95% CI 1.06-1.25). Adolescents who left their phone ringer activated overnight had more trouble falling/staying asleep and greater overall sleep disturbance compared to those who turned off their cell phones at bedtime. Streaming movies, playing video games, listening to music, talking/texting on the phone, and using social media or chat rooms were all associated with trouble falling/staying asleep and sleep disturbance.

CONCLUSIONS

Several bedtime screen use behaviors are associated with sleep disturbances in early adolescents. The study's findings can inform guidance for specific bedtime screen behaviors among early adolescents.

Sleep Quality of Undergraduate Medical Students during and Post-Lockdown: A Cross-Sectional Research

Background

The COVID-19 and associated lockdowns have significantly impacted the lives of undergraduate medical students, including their sleep quality. This study attempts to investigate how sleep patterns, sleep quality, and associated factors altered during and post-lockdown.

Material and Methods

In this cross-sectional study, 171 medical students from colleges registered under the National Medical Council participated. The study used a validated PSQI questionnaire. The data collected through Google forms were analyzed using SPSS v2021.

Result

Among 171 study participants, 9.4% had bad sleep quality during lockdown which reduced to 4.7% post-lockdown significantly. Sleep latency and sleep duration were also significantly affected by the lockdown. There was a weak correlation between PSQI score during and post-lockdown, suggesting that individuals with poor sleep quality during lockdown also had poor sleep post-lockdown. According to the study, poor sleep quality decreased after lockdown as opposed to lockdown, with improvements in sleep latency and decreased use of sleep duration.

Conclusion

However, there was a weak correlation between PSQI score during and post-lockdown. Increased screen time during lockdown negatively affected sleep quality, emphasizing the importance of practicing sleep hygiene and promoting outdoor activities to reduce stress levels and improve mental health.

Bedtime digital media use, sleep and fatigue among survivors of childhood cancer, their siblings and healthy control sibling pairs

Bedtime digital media use (BDM) is linked to poor sleep and fatigue in many populations. Pediatric cancer patients have been observed to engage in BDM in clinical settings, but it is unknown whether BDM rates are higher in this population or how this impacts their sleep and fatigue during treatment and into survivorship. The goal of this study was to evaluate patterns of BDM and its relationship with sleep and fatigue in a sample of pediatric cancer survivors and to compare these patterns with children from their own family (i.e. siblings) and children from unaffected families (i.e. healthy matched controls and siblings of controls). Ninety-nine children (4 groups: 24 acute lymphoblastic leukemia survivors, 13 survivor siblings, 33 controls, 29 control siblings) ages 8-18 were recruited from a long-term survivor clinic at a large children's hospital and via community advertisements. Survivors were 2-7 years post-treatment (M = 4.80 years). Children's BDM was parent-reported. Children completed 7 consecutive days of sleep actigraphy and the PedsQL Multidimensional Fatigue Scale. Most survivors (66.67%) engaged in BDM; smartphones were the most common medium. BDM patterns were equivalent across survivors, their siblings, controls, and control siblings. Statistical trends suggested that BDM was associated with fewer minutes of sleep and greater fatigue for all children; these relationships were equivalent across groups. BDM was common among survivors, but usage was not different from their own siblings or compared to healthy control children and sibling pairs. This study underscores the importance of assessing bedtime digital media use in childhood cancer survivors, although other factors impacting sleep should be explored. Clinicians should emphasize established recommendations for healthy media use and sleep habits in pediatric oncology settings.

Eating habits matter for sleep difficulties in children and adolescents: A cross-sectional study

Background

Sleep difficulties are a common sleep-related problem among children and adolescents. However, the association between eating habits and sleep difficulties has not been extensively studied. Therefore, this study aimed to investigate the relationship between eating habits and sleep difficulties in children and adolescents.

Methods

This study utilized cross-sectional data from the 2013/2014 Health Behaviour in School-aged Children survey. A total of 213,879 young adolescents provided self-reported information on their weekday and weekend breakfast consumption, fruit and vegetable intake, sweet and soft drink consumption, and sleep difficulties. Covariates such as sex, age, family affluence, physical activity, and body mass index were also assessed. Multilevel generalized linear modelling was used to analyse the association between independent and dependent. Results were reported as odds ratios (OR) with 95% confidence intervals.

Results

Of all study participants, approximately 50% were girls. Regression models indicated that more frequent breakfast consumption was associated with fewer sleep difficulties (e.g., consuming breakfast on weekdays for 5 days: OR = 1.49, 95% CI: 1.45-1.54). Fruit and vegetable consumption once a week or more was also linked to fewer sleep difficulties (all OR > 1.08, ≥ 1.07). In addition, consuming fewer sweets and soft drinks was generally associated with fewer sleep difficulties.

Conclusion

This study provides evidence supporting the association between healthier eating habits and reduced sleep difficulties in children and adolescents. Future research using longitudinal or experimental designs is encouraged to confirm or negate these findings. Additionally, this study offers practical guidance for nutritional counselling professionals and sleep health promotion practitioners.

The Effects of COVID-19 Lockdown on the Sleep Quality of Children

INTRODUCTION

The COVID-19 lockdown has caused important changes in children's routines, especially in terms of nutrition, physical activity, screen time, social activity, and school time. Regarding these changes, recent studies show that the COVID-19 lockdown is associated with higher levels of anxiety and depression in children. The objective of this study was to assess changes in sleep quality in Spanish children during the lockdown decreed by the Spanish government between March and June 2020.

METHODOLOGY

We compared the BEAR (bedtime, excessive daytime sleepiness, awakening during the night, and regularity and duration of sleep) scores of 478 participants (median age = 7.5 years; 48% girls) in the SENDO project during the periods before, during, and after lockdown. The questionnaires were filled out by one of the parents. We used hierarchical models with two levels of clustering to account for the intra-cluster correlation between siblings. The interaction of time with a set of a priori selected variables was assessed by introducing the interaction term into the model and calculating the likelihood ratio test.

RESULTS

The mean scores in the BEAR questionnaire referred to the periods before, during, and after lockdown were 0.52 (sd 1.25), 1.43 (sd 1.99), and 1.07 (sd 1.55), respectively. These findings indicate a deterioration in sleep quality during the period of confinement. Parental level of education was found to be an effect modifier (p for interaction = 0.004). Children whose parents had higher education (university graduates or higher) showed a smaller worsening than those without.

CONCLUSION

Our study shows that the COVID-19 lockdown was associated with a significant worsening of sleep quality. Moreover, although the end of the lockdown brought about a slight improvement, mean scores on the BEAR scale remained significantly higher than before the lockdown, suggesting that the consequences for sleep quality could persist over time. This worsening was higher in children whose parents had lower educational degrees. Helping children maintain healthy sleeping habits despite the circumstances and providing early psychological support when needed is important to prevent negative psycho-physical symptoms due to lockdown that could persist over the years.

The Relationship between Nomophobia, Insomnia, Chronotype, Phone in Proximity, Screen Time, and Sleep Duration in Adults: A Mobile Phone App-Assisted Cross-Sectional Study

Earlier studies that have investigated the association between nomophobia and insomnia revealed that a strong relationship exists between both variables. This study aimed to explore possible associations between these variables and their impact on physical and mental health outcomes using a cross-sectional study design and mobile phone apps to collect data. Using a survey approach, data were collected from 444 participants (52% female, mean age 34 ± 12) using the Nomophobia Questionnaire (NMP-Q), the Insomnia Severity Index (ISI), the Morningness-Eveningness Questionnaire (MEQ) and three Android mobile phone apps. The Plees Tracker, screen time, and pedometer apps aided in collecting data on sleep duration, time spent on screen per day, and how close the phone was to the person. A statistically significant association was noted between nomophobia and insomnia, nomophobia and the eveningness chronotype, and nomophobia and screen time. The eveningness chronotype was also associated with an increased screen time use. The results show that NMP-Q, ISI, and screen time increase according to the chronotype. No statistically significant differences were noted in daily steps or sleep duration according to chronotype. The findings suggest that interventions targeting nomophobia may be beneficial in addressing insomnia among adults, particularly those with an evening chronotype. Future studies should consider exploring the causal relationship between them.

Development and validation of a prediction nomogram for academic burnout among Chinese adolescents: a cross-sectional study

OBJECTIVES

This study aimed to screen the potential risk factors for academic burnout among adolescents during the COVID-19 pandemic, develop and validate a predictive tool based on the risk factors for predicting academic burnout.

DESIGN

This article presents a cross-sectional study.

SETTING

This study surveyed two high schools in Anhui Province, China.

PARTICIPANTS

A total of 1472 adolescents were enrolled in this study.

OUTCOME MEASURES

The questionnaires included demographic characteristic variables, living and learning states and adolescents' academic burnout scale. Least absolute shrinkage and selection operator and multivariate logistic regression analyses were employed to screen the risk factors for academic burnout and develop a predictive model. The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to assess the accuracy and discrimination of the nomogram.

RESULTS

In this study, 21.70% of adolescents reported academic burnout. Multivariable logistic regression analysis showed that single-child family (OR=1.742, 95% CI: 1.243 to 2.441, p=0.001), domestic violence (OR=1.694, 95% CI: 1.159 to 2.476, p=0.007), online entertainment (>8 hours/day, OR=3.058, 95% CI: 1.634 to 5.720, p<0.001), physical activity (<3 hours/week, OR=1.686, 95% CI: 1.032 to 2.754, p=0.037), sleep duration (<6 hours/night, OR=2.342, 95% CI: 1.315 to 4.170, p=0.004) and academic performance (<400 score, OR=2.180, 95% CI: 1.201 to 3.958, p=0.010) were independent significant risk factors associated with academic burnout. The area under the curve of ROC with the nomogram was 0.686 in the training set and 0.706 in the validation set. Furthermore, DCA demonstrated that the nomogram had good clinical utility for both sets.

CONCLUSIONS

The developed nomogram was a useful predictive model for academic burnout among adolescents during the COVID-19 pandemic. It is essential to emphasise the importance of mental health and promote a healthy lifestyle among adolescents during the future pandemic.

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.

Adherence to 24-Hour Movement Recommendations and Health Indicators in Early Adolescence: Cross-Sectional and Longitudinal Associations in the Adolescent Brain Cognitive Development Study

PURPOSE

Adherence to 24-hour movement guidelines of ≥60 minutes of physical activity, ≤2 hours of screen time, and 9-11 hours of sleep has been shown to benefit cognitive, physical, and psychosocial health in children and young adolescents aged 5-13 years. However, these findings have mostly been based on cross-sectional studies or relatively small samples and the associations between adherence to guidelines and brain structure remain to be evaluated.

METHODS

Data from the Adolescent Brain Cognitive Development℠ (ABCD) study of 10,574 early adolescents aged 9-14 years from September 2016 to January 2021 were used to examine whether adherence to 24-hour movement guidelines benefits cognition (general cognitive ability, executive function, and learning/memory assessed by the National Institutes of Health Toolbox neurocognitive battery), body mass index, psychosocial health (internalizing, externalizing, and total problems from the parent-reported Child Behavior Checklist), and magnetic resonance imaging-derived brain morphometric measures at baseline (T1), ∼2 years later (T2), and longitudinally from T1 to T2 (T2-T1). Multivariable linear mixed models were used, with adjustments for sociodemographic confounders. Time elapsed and T1 outcome measures were also controlled for in longitudinal models.

RESULTS

Better cognitive scores, fewer behavioral problems, lower adiposity levels, and greater gray matter volumes were observed in those who met both sleep and screen time recommendations compared to those who met none. Longitudinal follow-up further supports these findings; participants who met both recommendations at T1 and T2 evidenced better outcome measures than those who met none.

DISCUSSION

These findings support consideration of integrated rather than isolated movement recommendations across the day in early adolescence for better cognitive, physical and psychosocial health. Although the associations between physical activity and health indicators were less consistent in this study, the significant findings from sleep and screen time demonstrate the importance of considering movement recommendations in an integrated rather than isolated manner for adolescent health. It is recommended that movement behaviors be simultaneously targeted for better developmental outcomes.

Questionnaire survey on sleep habits of 3-year-old children in Asahikawa City: Comparison between 2005 and 2020

BACKGROUND

Good sleep is essential for children's healthy growth. In 2005, we conducted a questionnaire survey on children's sleep habits and their background, targeting parents who attended health checkups for their 3-year-old children in Asahikawa City, Hokkaido. In 2020, we performed a secondary survey, including additional questions regarding media usage. We analyzed changes in children's sleep environment by comparing the results of both surveys.

METHODS

Children from 500 families (n = 420; 219 males, 201 females; mean age, 3.6 years) who underwent 3.5-year-old health checkups (per the changed schedule in 2015) in Asahikawa City from July 2020 to November 2020 and their parents who had completely answered the questionnaire were included.

RESULTS

The proportion of children who used childcare support system such as nursery schools or kindergarten increased from 30% in the previous survey to 95% in the present survey. The mean nocturnal sleep duration of children was 9.33 h in the present survey, 0.77 h shorter than that in the previous survey; similar to the previous survey results, it was significantly short (8.71 h) in children who went to bed after 10 PM. Moreover, it was significantly short in children who watched television for more than two hours or used media within two hours before going to bed or if parents used smartphones or watched motion pictures for >30 min/day. The rate of consulting pediatricians regarding sleep problems decreased from 3% to 2.4%.

CONCLUSION

Parents' lifestyles greatly influenced children's sleep habits in 2020. Pediatricians should actively participate in managing children's sleep problems.

Prevalence of mental health symptoms in children and adolescents during the COVID-19 pandemic: A meta-analysis

The COVID-19 pandemic and its accompanying infection control measures introduced sudden and significant disruptions to the lives of children and adolescents around the world. Given the potential for negative impacts on the mental health of youths as a result of these changes, we conducted a systematic review and meta-analysis to examine the prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances in children and adolescents during the pandemic. We searched major literature databases for relevant cross-sectional or longitudinal studies that included primary and secondary school students or children and adolescents ≤18 years of age. Prevalence values were extracted, logit-transformed, and pooled. Based on 191 included studies with 1,389,447 children and adolescents, we found the pooled prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances to be 31%, 31%, and 42%, respectively. Age, grade levels, education levels, gender, geographical regions, and electronics use were correlated with the prevalence of mental health symptoms. The prevalence of mental health symptoms also increased with time, although signs of recovery and stabilization were also observed. Overall, the results from this review demonstrate the need for increased mental health research, monitoring, and intervention for children and adolescents during the current and future pandemics.

Wireless technologies, non-ionizing electromagnetic fields and children: Identifying and reducing health risks

Children today are conceived and live in a sea of wireless radiation that did not exist when their parents were born. The launch of the digital age continues to transform the capacity to respond to emergencies and extend global communications. At the same time that this increasingly ubiquitous technology continues to alter the nature of commerce, medicine, transport and modern life overall, its varied and changing forms have not been evaluated for their biological or environmental impacts. Standards for evaluating radiation from numerous wireless devices were first set in 1996 to avoid heating tissue and remain unchanged since then in the U.S. and many other nations. A wide range of evidence indicates that there are numerous non-thermal effects from wireless radiation on reproduction, development, and chronic illness. Many widely used devices such as phones and tablets function as two-way microwave radios, sending and receiving various frequencies of information-carrying microwave radiation on multiple simultaneously operating antennas. Expert groups advising governments on this matter do not agree on the best approaches to be taken. The American Academy of Pediatrics recommends limited screen time for children under the age of two, but more than half of all toddlers regularly have contact with screens, often without parental engagement. Young children of parents who frequently use devices as a form of childcare can experience delays in speech acquisition and bonding, while older children report feelings of disappointment due to 'technoference'-parental distraction due to technology. Children who begin using devices early in life can become socially, psychologically and physically addicted to the technology and experience withdrawal upon cessation. We review relevant experimental, epidemiological and clinical evidence on biological and other impacts of currently used wireless technology, including advice to include key questions at pediatric wellness checkups from infancy to young adulthood. We conclude that consistent with advice in pediatric radiology, an approach that recommends that microwave radiation exposures be As Low As Reasonably Achievable (ALARA) seems sensible and prudent, and that an independently-funded training, research and monitoring program should be carried out on the long term physical and psychological impacts of rapidly changing technological milieu, including ways to mitigate impacts through modifications in hardware and software. Current knowledge of electrohypersensitivity indicates the importance of reducing wireless exposures especially in schools and health care settings.

Extending weeknight sleep of delayed adolescents using weekend morning bright light and evening time management

STUDY OBJECTIVES

Shift sleep onset earlier and extend school-night sleep duration of adolescents.

METHODS

Forty-six adolescents (14.5-17.9 years; 24 females) with habitual short sleep (≤7 h) and late bedtimes (≥23:00) on school nights slept as usual for 2 weeks (baseline). Then, there were three weekends and two sets of five weekdays in between. Circadian phase (Dim Light Melatonin Onset, DLMO) was measured in the laboratory on the first and third weekend. On weekdays, the "Intervention" group gradually advanced school-night bedtime (1 h earlier than baseline during week 1; 2 h earlier than baseline during week 2). Individualized evening time management plans ("Sleep RouTeen") were developed to facilitate earlier bedtimes. On the second weekend, Intervention participants received bright light (~6000 lux; 2.5 h) on both mornings. A control group completed the first and third weekend but not the second. They slept as usual and had no evening time management plan. Weekday sleep onset time and duration were derived from actigraphy.

RESULTS

Dim light melatonin onset (DLMO) advanced more in the Intervention (0.6 ± 0.8 h) compared to the Control (-0.1 ± 0.8 h) group. By week 2, the Intervention group fell asleep 1.5 ± 0.7 h earlier and sleep duration increased by 1.2 ± 0.7 h; sleep did not systematically change in the Control group.

CONCLUSIONS

This multi-pronged circadian-based intervention effectively increased school-night sleep duration for adolescents reporting chronic sleep restriction. Adolescents with early circadian phases may only need a time management plan, whereas those with later phases probably need both time management and morning bright light.

CLINICAL TRIALS

Teen School-Night Sleep Extension: An Intervention Targeting the Circadian System (#NCT04087603): https://clinicaltrials.gov/ct2/show/NCT04087603.

Correlation of Screen Time With Eating Behavior Among School-Going Children Aged 8 to 10 Years in East Delhi, India

Background and aim:

Excessive screen time (ST) negatively impacts physical activity and eating behavior among children <5 years. There is a dearth of data on older Indian children; hence, the present study aimed to assess the effect of ST on eating behavior among older children.

Methods:

The present cross-sectional study purposively recruited 100 school-going children. E-questionnaire was prepared to gather information regarding the demographic profile and self-reported weight and height. For the assessment of ST, the SCREENS questionnaire was used. Eating behavior was assessed using the Children Eating Behavior Questionnaire, and for physical activity, the PAQ-C was used. The nutrition status of children was assessed using body mass index (BMI) for age cut-offs.

Results:

The results revealed that 52% of the children were using screens for > 4 hours per day excluding school-related activities and online classes. ST of children was directly proportional to the parent’s ST ( P < .05). There was a negative correlation between ST and the physical activity of children ( P < .01). A positive correlation was observed between ST and emotional overeating, desire to drink, slow eating, satiety responsiveness, food fussiness, and emotional undereating ( P < .01). BMI was positively associated with ST and negatively associated with physical activity, though the results were not significant. Satiety responsiveness (a food-avoiding subscale) was negatively associated with BMI ( P < .05).

Conclusion:

The present study concludes that excessive ST among 8 to 10 years old school-going children has been associated with physical inactivity and poor eating behavior which could lead to an increased risk of being overweight and obese.

Internet addiction and suicidal behavior among vocational high school students in Hunan Province, China: A moderated mediation model

Background

Vocational education is an important part of high school education in China. However, there is little research on high school students' mental health. This study aimed to investigate the prevalence of suicidal behavior (SB) among this population and the mediating role of insomnia, depression, anxiety, and stress in the relationship between Internet addiction (IA) and SB using a structural equation model.

Methods

A cross-sectional questionnaire survey was conducted among several vocational high school students in Hunan Province, and 7,968 valid questionnaires were obtained. General demographic data and data from the Dual-Mode Self-Control Scale, Athens Insomnia Scale, Depression Anxiety Stress scale-21, and Revised Chen Internet Addiction Scale were collected. A structural equation model was used to explore the different pathways from IA to SB.

Results

Among the participants, 37.7, 15.7, and 21.8% reported suicidal ideation, plans, and attempts, respectively. The structural equation model confirmed that IA was indirectly related to SB and was mediated by insomnia and/or depression, anxiety, and stress.

Limitations

First, we only recruited students from vocational schools in Hunan Province, therefore, the sample may not represent the entire population of vocational students in China. Second, self-report scales were used in this study, and clinical diagnosis required professional interviews. Third, since this study had a cross-sectional design, the causal relationship between the variables could not be determined.

Conclusions

The prevalence of SB among vocational high school students in China was significantly high. The prevention of SB related to IA can be attributed to the improvement of insomnia and emotional problems.

Association between trajectories of problematic mobile phone use and chronotype among Chinese college students

AIMS

This study aimed to describe the prevalence of problematic mobile phone use (PMPU) and chronotype among Chinese college students, estimate PMPU development trajectories, and further examine the effect of PMPU trajectories on chronotype.

DESIGN

In a stratified cluster sampling design, PMPU and chronotype were evaluated in 999 college students from two universities in a 2-year prospective investigation from April 2019 to April 2021, and an investigation was conducted every six months (time 1 ∼ time 5, T1 ∼ T5).

PARTICIPANTS

N = 999 college students (mean age at T1: 18.8 years (SD = 1.2), 37.7% male) took part in the study.

MEASUREMENTS

The Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU) and the Pittsburgh Sleep Quality Index (PSQI) were used to assess the PMPU and sleep quality of college students at each time point. The Morning and Evening Questionnaire (MEQ) was adopted to investigate the chronotype of college students at T5.

FINDINGS

The prevalence of PMPU at T1 ∼ T5 was 24.3%, 27.3%, 35.1%, 31.2% and 31.9%, respectively. The prevalence rates of morning types (M-types), neutral types (N-types), and evening types (E-types) were 19.1%, 70.8%, and 10.1%, respectively. Using latent growth mixture modelling, we identified three trajectories of PMPU: low-level (49.5%), moderate-level (38.6%), and high-level score trajectories (11.9%). Multivariate logistic regression analysis results showed that a trajectory with a high score was positively associated with E-types (P < 0.05). After stratification by gender, a high-level score trajectory was positively associated with E-types only among female college students (P < 0.05). There were sex differences in the association between trajectories of PMPU and chronotype.

CONCLUSION

Long-term symptoms of PMPU may be a potential risk factor for circadian rhythm disturbance among college students, and this effect was significantly different between genders.

Factors Associated with Poor Sleep among Young People in Mauritius: A Survey-Based Study

Background: Poor sleep quality in young people is a global concern. This study was conducted to explore sleep quality and its contributory factors in young people of Mauritius. Methods: This cross-sectional study comprised 202 participants aged between 14 to 29 years. The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Adolescent Sleep Hygiene Scale (ASHS) were used to measure sleep quality, daytime sleepiness, and sleep hygiene respectively. Chi-squared tests were conducted to evaluate relationships between the collected variables. Multivariate logistic regression was used to identify associated factors with poor sleep quality. Results: The mean global PSQI was 4.81 (95%CI: 4.4, 5.22). Prevalence of poor sleep quality (global PSQI score > 5) was 30.7%. The male gender reported better sleep (p=0.008). Sleep quality was significantly associated with longer sleep duration (p<0.0001), pre-bedtime relaxing activities (p=0.01), and daytime physical exercise (p=0.001). In contrast, alcohol consumption after 18:00 (p<0.0001), tobacco smoking after 18:00 (p<0.0001), pre-bedtime awakening activities (p=0.001), and poor sleep environment (p<0.0001) negatively influenced sleep quality. Multivariate logistic regression confirmed that female gender and sleep environment factors were associated with higher likelihood of poor sleep quality, while participants with longer duration of sleep (>7 hours), cognitive/emotional and sleep stability factors were found to be less likely to have poor sleep quality. Conclusion: This study showed that the prevalence of poor sleep in young people in Mauritius was 30.7%. Female gender and sleep environment factors were main contributory factors. These initial results can guide further research on sleep quality

A Social Media Outage Was Associated with a Surge in Nomophobia, and the Magnitude of Change in Nomophobia during the Outage Was Associated with Baseline Insomnia

We examined the immediate impact of a social media outage on nomophobia and associated symptoms using a longitudinal cohort design. Data were collected at two timepoints, baseline (T1) and during the social media outage of 4 October 2021 (T2). T1 was collected in August–September 2021 as part of the baseline of an ongoing study. The nomophobia questionnaire (NMP-Q), Generalized Anxiety Disorder-7 scale (GAD-7), and Athens insomnia scale (AIS) were administered to 2706 healthy participants from the general Bahraini population (56% females, mean age 33.57 ± 11.65 years). Approximately one month later, during the social media outage, 306 of the study participants were opportunistically assessed using the NMP-Q. At baseline, we found that nomophobia levels strongly correlated positively with both insomnia (p = 0.001) and anxiety symptoms (p = 0.001). This is the first report to examine the impact of a social media outage on nomophobia. Our findings indicate that symptoms of nomophobia increased significantly during a social media outage. Baseline insomnia scores predicted a surge in the global scores of nomophobia symptoms during a social media outage.

Cognitive Behavioral Therapy for Insomnia in School-Aged Children and Adolescents

One of the most prevalent sleep disorders in children and adolescents is "insomnia," which can be briefly described as problems with initiating and/or maintaining sleep with associated daytime consequences. These are typical insomnia symptoms, and when experienced for long enough and when they interfere with an important area of the young person's life (eg, schooling), then a diagnosis of an insomnia disorder may be warranted. The authors strongly urge the scientific community to conduct further controlled trials, including dismantling trials that evaluate the relative effectiveness of individual cognitive behavioral therapy for insomnia components.

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.

Relationship between time spent playing internet gaming apps and behavioral problems, sleep problems, alexithymia, and emotion dysregulations in children: a multicentre study

BACKGROUND

Internet gaming addiction (IGA) is a serious condition that can significantly impact personal and social functioning. Many studies of IGA have been conducted in adolescents and young adults, but there are limited data available in children. We investigated the time spent using internet gaming apps in children and its association with behavioral problems, sleep problems, alexithymia, and emotional regulation.

METHODS

The research populations (N = 564) were categorized based on the number of hours spent using online gaming applications. The Strengths and Difficulties Questionnaire, the Children's Sleep Habits Questionnaire Abbreviated, the Children's Alexithymia Measure (CAM), and the Clinical Evaluation of Emotional Regulation-9 were used to assess all participants.

RESULTS

Compared to other groups, children who used internet gaming applications for more than 6 h had a higher proportion of abnormal responses on the emotional symptoms and hyperactivity scales. Children who used internet gaming applications for more than 6 h had the poorest sleep quality (75%), while children who used internet gaming applications for 1-2 h had the best (36.7%). Participants who used internet gaming apps for 1-2 h had significantly lower mean total scores on the emotional regulation scale and total CAM, whereas those using internet gaming apps for more than 6 h had the highest mean scores in the CAM.

CONCLUSIONS

Excessive use of internet gaming apps during childhood may be associated with hyperactivity, peer problems, high socioeconomic level, alexithymia concerns, shorter daytime sleep duration, and a delayed morning wake-up.

The Association between Diet and Sleep Quality among Spanish University Students

While it has long been recognized that diet is a leading behavioral risk factor for human health, recent scientific findings have also suggested that diet and sleep quality may be connected. The purpose of the present study is to evaluate the association between diet and sleep quality among a group of Spanish university students. To do so, a cross-sectional study of 868 students was carried out. Sleep quality was assessed using the Spanish version of the Pittsburgh Sleep Quality Index (PSQI), while diet was assessed using the Spanish Healthy Eating Index (SHEI). The study revealed a noteworthy rate of bad sleepers (51.6%) and students whose diet needed modifications (82.2%). Unhealthy eaters were more likely to have poor sleep quality (aOR = 4.20; CI 95%: 2.07-8.52). The unbalanced intake of vegetables (aOR = 1.63; CI 95%: 1.14-2.34), fruits (aOR = 4.08; CI 95%: 2.90-5.74), dairy products (aOR = 1.96; CI 95%: 1.41-2.72), lean meats (aOR = 1.82; CI 95%: 1.19-2.78), legumes (aOR = 1.43; CI 95%: 1.00-2.02), sweets (aOR = 1.60; CI 95%: 1.13-2.25) and sugary soft drinks (aOR = 1.46; CI 95%: 1.07-1.99) was associated with lower sleep quality.

Sleep Duration and Kindergarten Adjustment

OBJECTIVES

The current study examined longitudinal linkages between child sleep duration and children's socioemotional, learning engagement, executive functioning, and academic outcomes across the full kindergarten (K) year.

METHODS

A measurement-burst design was employed to examine 3 different measures of child sleep duration in 7-day bursts at pre-K (July-August), early K (late September), mid-K (late November), and late K (mid-to-late April), using wrist actigraphy. These measures included mean amounts of child sleep per 24-hour period across the full week, proportion of 24-hour periods per week that children slept 10 or more hours, and proportion of nighttime sleep periods per week that children slept 10 or more hours. Children's outcomes at early, mid-, and late K were provided by their K teachers blind to children's sleep histories, and by assessments administered by project staff.

RESULTS

Among the 3 sleep measures examined, regularity of nighttime sleep in which children slept 10 or more hours per night, especially at pre-K, consistently predicted more favorable K outcomes in both socioemotional, learning engagement, and academic domains. Results suggested that establishing healthy nighttime sleep habits before K start was especially promotive of better K adjustment across the full K year. These findings were controlled for income-to-poverty threshold ratios, child health status, and number of missed school days.

CONCLUSIONS

Efforts to promote a favorable transition to first-time schooling should pay particular attention to sleep hygiene and regularity of 10-plus hours of nightly child sleep established before the start of K.

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.