Children, adolescents, and the media

Pathways from adolescent screen time to eating related symptoms: a multilevel longitudinal mediation analysis through self-esteem

OBJECTIVE

Screen time and self-esteem have been shown to be important correlates of eating disorders in adolescence. However, there is an absence of longitudinal studies that distinguish between time-varying factors, accounting for parallel developmental changes and common underlying vulnerability.

DESIGN

A total of 3,801 adolescents were administered self-report measures, annually, over the course of 5 years. The association of screen time (social media use, television watching, video gaming) on eating related symptoms was analyzed using a longitudinal Bayesian multilevel path analysis framework. Self-esteem was examined as a mediating factor in this model. This study investigated direct and indirect associations at between-person, concurrent within-person, and lagged-within-person levels, while controlling for gender.

RESULTS

The findings revealed that all types of screen time exposure were significantly associated with eating related symptoms at between and within-person levels. A significant association at the lagged-within person level was only revealed for social media use. Self-esteem was found to be a significant mediating factor between screen time and eating related symptoms.

CONCLUSION

An increase in social media use one year was associated with increased of eating related symptoms two years later through lower self-esteem. Implications for prevention are discussed.

Association of Smartphone Use With Body Image Distortion and Weight Loss Behaviors in Korean Adolescents

IMPORTANCE

Despite high use of smartphones among adolescents, little is known about the association of smartphone use with body image and related behaviors.

OBJECTIVE

To examine the associations of duration of smartphone use and types of content most frequently accessed via smartphone with body image distortion and weight loss behaviors in adolescents.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used data from the population-based Korea Youth Risk Behavior Web-Based Survey 2017. Participants comprised a nationally representative sample of 53 133 Korean adolescents aged 12 to 18 years. Data were collected from June 1 to July 18, 2017. The analysis was performed from February 7, 2020, to March 30, 2022.

EXPOSURES

Self-reported duration of smartphone use (min/d) and types of content (educational or informational searches; chatting, messaging, or email; social networking services or forums; games; videos, movies, or music; webtoons or web novels; and shopping or other activities) most frequently accessed during smartphone use.

MAIN OUTCOMES AND MEASURES

Body image distortion (overperception of body weight), weight loss attempt, use of inappropriate weight loss strategies (skipping meals, eating only 1 food at a time, vomiting, or using laxatives), and healthy weight loss behaviors (muscle-strengthening and aerobic physical activity). Multivariable logistic regression analysis was performed to estimate odds ratios (ORs) and 95% CIs, accounting for survey sampling and adjusting for potential confounders.

RESULTS

Among 53 133 participants, the mean (SD) age was 15.0 (1.8) years; 50.7% of participants were female, and 49.3% were male. After adjusting for types of content accessed, prolonged smartphone use (≥301 min/d) was positively associated with body image distortion (boys: OR, 1.17; 95% CI, 1.07-1.28; girls: OR, 1.20; 95% CI, 1.10-1.30) and inappropriate weight loss strategies (boys: OR, 1.54; 95% CI, 1.25-1.90; girls: OR, 2.45; 95% CI, 2.14-2.79) in both sexes compared with minimal smartphone use (1-120 min/d). After adjusting for duration of smartphone use, the use of smartphones mainly for videos, movies, or music (OR, 1.15; 95% CI, 1.02-1.29), webtoons or web novels (OR, 1.28; 95% CI, 1.10-1.48), and games (OR, 1.17; 95% CI, 1.03-1.32) was positively associated with body image distortion in boys compared with the use of smartphones mainly for educational or informational content. Among boys, the use of smartphones mainly for chatting, messaging, or email was positively associated with muscle-strengthening activity (OR, 1.31; 95% CI, 1.18-1.44) and aerobic physical activity (OR, 1.41; 95% CI, 1.29-1.55), as was the use of smartphones mainly for social networking services or forums (muscle-strengthening activity: OR, 1.27; 95% CI, 1.13-1.42; aerobic physical activity: OR, 1.28; 95% CI, 1.15-1.43). Among girls, the use of smartphones mainly for chatting, messaging, or email was positively associated with weight loss attempts (OR, 1.34; 95% CI, 1.19-1.51) and the use of inappropriate weight loss strategies (OR, 1.57; 95% CI, 1.25-1.99), as was the use of smartphones mainly for social networking services or forums (weight loss attempts: OR, 1.20; 95% CI, 1.07-1.36; use of inappropriate weight loss strategies: OR, 1.37; 95% CI, 1.08-1.73).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, both the duration of smartphone use and the types of content most frequently accessed via smartphone were associated with body image distortion and weight loss behaviors in adolescents. These findings suggest a need for the identification of strategies to help adolescents develop healthy smartphone use behaviors.

Effect of video game playing and a glucose preload on subjective appetite, subjective emotions, and food intake in overweight and obese boys

Video game playing (VGP) is associated with overweight/obesity (OW/OB). VGP and caloric preloads in the pre-meal environment influence short-term food intake (FI) in healthy-weight children. Therefore, the purpose of the present study was to examine the effect of pre-meal VGP and a glucose preload on subjective emotions, subjective appetite, and FI in boys with OW/OB. On 4 separate mornings, boys with OW/OB (n = 22; mean ± SD: age = 11.9 ± 1.6 years; body mass index percentile = 94.3 ± 3.9) participated in 4 test conditions. Two hours after a standardized breakfast, boys consumed equally sweetened preloads (250 mL) of sucralose (0 kcal) or glucose (200 kcal), with or without 30 min of subsequent VGP. Immediately after each test condition, FI was evaluated during an ad libitum pizza meal. Subjective appetite was measured at 0 (baseline), 15, and 30 min. Subjective emotions (aggression, anger, excitement, disappointment, happiness, upset, and frustration) were measured at 0 and 30 min. VGP did not affect FI, but the glucose preload decreased FI compared with the sucralose control (Δ = -103 ± 48 kcal, p < 0.01). However, cumulative FI (preload kcal + meal kcal) was 9% higher after the glucose preload (p < 0.01). Subjective appetite increased with time (p < 0.05) but was not influenced by preload or VGP. Frustration was the only subjective emotion that increased following VGP (p < 0.01). A glucose preload, but not VGP, suppressed FI in boys with OW/OB, suggesting a primary role of physiological factors in short-term FI regulation.

Perceptions of Peer Sexual Behavior: Do Adolescents Believe in a Sexual Double Standard?

BACKGROUND

The purpose of the study was to (1) examine attitudes of adolescents toward peer models having sex or choosing abstinence, and (2) determine whether a "double standard" in perception existed concerning adolescent abstinence and sexual behavior.

METHODS

Adolescents (N = 173) completed questionnaires that included 1 of 6 randomly assigned vignettes that described male and female peer models 3 ways: (1) no information about model's sexual behavior, (2) model in love but choosing abstinence, and (3) model in love and having sex. Participants read the vignette to which they had been assigned and responded to statements about the peer model. Data were analyzed using multivariate analysis of variance.

RESULTS

Results did not show evidence of a sexual double standard among male participants, but did show some evidence of a sexual double standard among female participants. Additionally, both male and female participants evaluated more harshly peer models that were having sex than peer models that chose abstinence.

CONCLUSIONS

Findings provide insight concerning the lack of a sexual double standard among male participants, the existence, to some degree, of a sexual double standard among female participants, and demonstrate the existence of a social cost to both young men and young women for choosing to have sex.

The relationship between physical activity, sedentary behaviour and mental health in Ghanaian adolescents

BACKGROUND

Research development is needed in physical activity and sedentary behaviour and their associations with mental health in young people. In Western countries the weather is a key contributing factor of sedentary behaviour in youth. The likely contributing factor of sedentary behaviour among African youth has not been explored. This study examined the association between sedentary behaviour and mental health in African young people.

METHODS

Participants were 296 adolescents (150 males, 146 females) aged 13 to 18 years (mean = 14.85 years) living in Ghana. Participants' physical activity levels were assessed using the Physical Activity Questionnaire for Older Adolescents (PAQ-A) and sedentary behaviour, using the Adolescents Sedentary Activity Questionnaire. Depression was assessed using the Children Depression Inventory and aspects of self-esteem were measured with the Physical Self-worth test and Body Image Silhouette test.

RESULTS

There was a significant negative correlation between physical activity and mental health independent of sedentary behaviour [depression (r =-0.78, p < 0.001); physical self-worth (r = 0.71, p < 0.001); body dissatisfaction (r =-0.76, p < 0.001)]. Moreover, sedentary behaviour was significantly associated with higher depression (r = 0.68, p < 0.001). Affluence was a significant contributing factor of sedentary behaviour in African young people [t (294) =-7.30, p < 0.001].

CONCLUSION

The present study has found that sedentary behaviour is highly prevalent among African adolescents especially among adolescents from affluent homes. Low levels of physical activity as well as sedentary behaviour is significantly associated with mental health problems among African youth, which is consistent with reports from studies among Western young people. The present research, therefore, contributes new information to the existing literature. Increased physical activities can improve the mental health of adolescents.

The politics and strategy of industry self-regulation: the pharmaceutical industry's principles for ethical direct-to-consumer advertising as a deceptive blocking strategy

As the pharmaceutical industry lobbies European regulators to permit direct-to-consumer advertising (DTCA) of prescription drugs in the European Union, we found that five leading companies violated industry-developed and -promulgated standards for ethical advertising in the United States. Utilizing multiple data sources and methods, we demonstrate a consistent failure by companies that market erectile dysfunction drugs to comply with the industry's guiding principles for ethical DTCA over a four-year period despite pledges of compliance by company leaders. Noncompliance resulted in children being exposed to sexually themed promotional messages more than 100 billion times. We argue that the guidelines are a coordinated effort by the industry to prevent unwanted federal regulation, and we introduce the concept of a blocking strategy to explain company behavior and to advance theoretical understanding of firms' public affairs strategies. We recommend policy responses to prevent deceptive practices, protect children from adult content, and promote genuine health care education.

Asthma episodes: stigma, children, and Hollywood films

Asthma has been systematically stigmatized in Hollywood feature films, including films seen by children. Through content analysis of 66 movies containing one or more scenes showing asthma, and through informant interviews with a dozen U.S. children about representative scenes, the study explores how stigmatizing portrayals are interpreted, accepted, or resisted. Children suffering from asthma actively counterargued with incriminating excerpts, but in some respects their healthy friends were less critical. Overall, children viewed stigmatizing scenes in terms of the social interaction and the social ethics entailed. They did not scrutinize the characters for damaged selfhood, per se, but dwelled on the social processes out of which stigma is erected.

Modernization and cardiometabolic risk in Samoan adolescents

OBJECTIVE

To describe the prevalence of cardiometabolic risk factor clustering in Samoan adolescents and to relate risk factor clustering to weight status and general modernization.

METHODS

Anthropometric and biochemical data collected from adolescents aged 12-17.9 years who participated in the Samoan Family Study of Overweight and Diabetes were used to describe the prevalence of cardiometabolic risk factors (high waist circumference, high blood pressure, high triglyceride level, low-high-density lipoprotein cholesterol, and high fasting serum glucose). A total of 436 adolescents were included in this analysis; 237 (54.4%) from American Samoa (n = 123 males) and 199 (45.6%) from Samoa (n = 90 males). Risk factor clustering was indicated by the presence of ≥ 3 risk factors.

RESULTS

Cardiometabolic risk factor clustering was greater in American Samoan adolescents (17.9% males, 21.9% females) than Samoan adolescents (1.1% males, 2.8% females). The frequency of risk factor clustering varied according to body mass index status. In males, risk factor clustering was entirely confined to obese adolescents, whereas female adolescents who were overweight or obese were at risk.

CONCLUSIONS

Cardiometabolic risk factor clustering is prevalent in the young American Samoan population and is likely to become more prevalent with increasing modernization in Samoan youth. Screening and intervention should be targeted at this age group to reduce the non-communicable disease burden faced by these populations.

Outcomes of nutrition knowledge and healthy food choices in 5- to 6-year-old children who received a nutrition intervention based on Piaget's theory

PURPOSE

To develop nutrition education for preschool children based on Piaget's theory and to examine the effects of this education on children's nutritional knowledge, nutritional behaviors, and anthropometric measurements.

DESIGN AND METHODS

Pre- and postexperimental design. In experimental schools nutrition education was given. Children's nutritional knowledge, food consumption frequencies, and anthropometric measurements were evaluated.

RESULTS

The experimental group's nutritional knowledge scores increased and the group's food preferences positively changed. No significant difference was observed between the experimental and control groups' anthropometric measurements.

PRACTICE IMPLICATIONS

The nutrition education program used in this study may guide nurses in preparing education for preschoolers. The participation of families is recommended in their children's nutrition program.

Television Use, Sexual Behavior, and Relationship Status at Last Oral Sex and Vaginal Intercourse

The current longitudinal study explores the relationship between adolescent television use at time 1 and sexual experience and relationship status (i.e., committed/romantic versus casual) 1 year later. The sample (N = 824) comprised youth aged 14-18. Multinomial logistic regressions predicting group membership from television exposure variables were conducted controlling for socio-demographic characteristics and prior sexual behavior. Results indicate that sexually inexperienced youth watched more television overall than sexually experienced youth, but less adult, premium and music television on cable networks. Premium cable exposure predicted group membership among sexually active youth. Youth who watched more premium cable at time 1 were more likely to be in casual relationship at last intercourse than a committed one. A more complete understanding of media effects on adolescent sexual relationships can help guide policy development, media education/literacy efforts, and contribute to the design of interventions to reduce the negative consequences associated with adolescent sexual behavior.

Televised sexual content and parental mediation: Influences on adolescent sexuality

Little research has been conducted to examine the influence of exposure to televised sexual content on adolescent sexuality or how parental intervention may reduce negative effects of viewing such content. This study uses self-report data from 1,012 adolescents to investigate the relations among exposure to sexually suggestive programming, parental mediation strategies, and three types of adolescent sexuality outcomes: participation in oral sex and sexual intercourse, future intentions to engage in these behaviors, and sex expectancies. As predicted, exposure to sexual content was associated with an increased likelihood of engaging in sexual behaviors, increased intentions to do so in the future, and more positive sex expectancies. Often, parental mediation strategies were a significant factor in moderating these potential media influences.

Information and Communication Technology: A Descriptive Study of Children's Communication Patterns

The emergence of information and communication technologies as primary agents of socialisation has raised concerns for child practitioners and researchers alike. Recent findings which indicate that children and adolescents are using these technologies in relative isolation from adult influence are of particular concern. We investigated children's communication patterns with various people including parents, teachers, siblings, and peers. More specifically, we explicated children's predilection for communicating with the various people, as well as the frequency of these communications. The sample was selected from nine schools in the Western Cape and consisted of 1002 learners, between the ages of 13 and 16 years, equally differentiated by gender. The sample also included the parents of these learners. A structured instrument was administered to the children in a controlled classroom environment. Parents completed the instrument as a self-administered questionnaire. The findings conform to international trends with children generally reporting low levels of communication with adults, but higher levels with peers and siblings. Of particular concern was the low level of communication between children and teachers. The findings further suggest conspicuous discrepancies between parents' and children's perceptions of these communication patterns. Finally, the results elucidate significant gender disparities in the communication patterns of the respondents.

Television use and food choices of children: Qualitative approach

This study reports the results of 12 focus group interviews with primary school students (7-10 years old, n=57) in Florianópolis, Brazil, regarding their food choices, television (TV) viewing, and physical activity habits. In 2005, an average Brazilian child aged 4-11 years watched TV almost 5 h per day. Intensive TV use in childhood and adolescence may contribute to sedentarism and unhealthy eating habits, and excessive viewing might have long-lasting adverse effects on health. Results indicated that frequent ingestion of snack foods was not a habit for most students, possibly because of an acknowledged parental interference, but these were the food items they bought with their own money. Daily TV viewing was reported by almost all students, especially during meals and before bedtime, but students still found the time to be physically active. Most of them mentioned going to sports classes and engaging in active play regularly. No attempts by the parents to regulate TV viewing in the household were mentioned. The habit of eating while watching TV, together with the students' behavior as primary consumers of food products, pointed to the need for strategies that will reduce TV viewing and educate the children as consumers.

The impact of electronic media on mental and somatic children's health

A concise review of the literature on the influence of electronic media on children's health is given. The exposure to different media is estimated with special reference to the situation in Germany. The impact on violence and aggressive behavior, on sexuality, on physical activity, obesity and nutrition, on substance use and abuse and addiction, on anxiety, depression, irregular sleep, and attention deficits, on cognition, language and reading, creativity is discussed. Although some of the results reported are still in question, there is no doubt that television and other electronic media negatively influence children's mental and somatic well-being. They have fundamentally changed the life of children and expose them to a powerful experiment with unpredictable and possibly irreversible outcome.

Media Content and Externalizing Behaviors in Latino Toddlers

OBJECTIVE

There has been limited study of the association between media exposure and behavior in children younger than age 3 years. We sought to study this association in toddlers and determine whether the association varied depending on media content.

METHODS

We carried out a secondary analysis of a cohort of Latino mother-infant dyads followed from birth to 33 months. We assessed media exposure at 21 and 33 months with a 24-hour recall diary that included information about the duration and content of each program watched. Behavior was assessed at 33 months by the Child Behavior Checklist.

RESULTS

This analysis included 99 dyads. Results from multiple logistic regression analyses indicated associations of child behavior outcomes with 21-month total media exposure and both 21-month and 33-month exposure to noneducational young child media such as cartoons, after adjusting for maternal education, country of origin, and depressive symptoms, participation in a parenting program, and difficult child temperament. Media exposure has most consistent associations with aggressive behavior and externalizing problems.

CONCLUSIONS

Media exposure was associated with externalizing behavior in Latino toddlers, with the strongest association for media oriented toward young children but without educational content. This finding has importance for both parents of young children and pediatricians as they provide anticipatory guidance.

Children, adolescents, and advertising

Advertising is a pervasive influence on children and adolescents. Young people view more than 40,000 ads per year on television alone and increasingly are being exposed to advertising on the Internet, in magazines, and in schools. This exposure may contribute significantly to childhood and adolescent obesity, poor nutrition, and cigarette and alcohol use. Media education has been shown to be effective in mitigating some of the negative effects of advertising on children and adolescents.

Family and home correlates of television viewing in 12-13 year old adolescents: the Nepean Study

BACKGROUND

Few young people meet television viewing guidelines.

PURPOSE

To determine the association between factors in the family and home environment and watching television, including videos and DVDs, in early adolescence.

METHODS

Cross-sectional, self-report survey of 343 adolescents aged 12-13 years (173 girls), and their parents (338 mothers, 293 fathers). Main measures were factors in the family and home environment potentially associated with adolescents spending >or= 2 hours per day in front of the television. Factors examined included family structure, opportunities to watch television/video/DVDs, perceptions of rules and regulations on television viewing, and television viewing practices.

RESULTS

Two-thirds of adolescents watched >or= 2 hours television per day. Factors in the family and home environment associated with adolescents watching television >or= 2 hours per day include adolescents who have siblings (Adjusted Odds Ratio [95%CI] AOR = 3.0 [1.2, 7.8]); access to pay television (AOR = 2.0 [1.1, 3.7]); ate snacks while watching television (AOR = 3.1 [1.8, 5.4]); co-viewed television with parents (AOR = 2.3 [1.3, 4.2]); and had mothers who watched >or= 2 hours television per day (AOR = 2.4 [1.3, 4.6]).

CONCLUSION

There are factors in the family and home environment that influence the volume of television viewed by 12-13 year olds. Television plays a central role in the family environment, potentially providing a means of recreation among families of young adolescents for little cost. Interventions which target family television viewing practices and those of parents, in particular, are more likely to be effective than interventions which directly target adolescent viewing times.

Predictors of inconsistent contraceptive use among adolescent girls: findings from a prospective study

PURPOSE

To assess the independent effects of various behavioral and psychosocial antecedents on contraceptive use among a sample of low-income African-American adolescent females.

METHODS

Stepwise logistic regression was used to calculate odds ratios for baseline predictors of inconsistent contraceptive use six months later. Study participants include 375 nonpregnant African-American girls aged 14-18 years who reported sexual activity in the previous six months. Data were collected using a self-administered survey, individual interview and urine pregnancy test.

RESULTS

Adolescents who were inconsistent contraceptive users at follow-up were more likely to have reported a desire for pregnancy, previous inconsistent contraceptive use, less frequent communication with their partners about prevention issues, and an increased number of lifetime sexual partners at the baseline assessment. Of equal importance was the finding that a previous pregnancy or sexually transmitted infection did not influence future contraceptive behaviors.

CONCLUSIONS

Clinicians can play an important role in counseling adolescents about sexual health and dispelling misperceptions that hinder consistent contraceptive use. Findings from this research could have significant implications for the development of effective sexually transmitted infection (STI) and pregnancy prevention programs for adolescents and can help in guiding clinicians toward relevant treatment practices.

Risky Business: What Primary Care Practitioners Need to Know About the Influence of the Media on Adolescents

Media can be powerfully prosocial, educational, and entertaining. Negative effects do exist, however, and they have been well documented. Despite the power of the new multinational media conglomerates and the intransigence of the entertainment industry,practitioners can make a difference in the future.

Sexy media matter: exposure to sexual content in music, movies, television, and magazines predicts black and white adolescents' sexual behavior

OBJECTIVE

To assess over time whether exposure to sexual content in 4 mass media (television, movies, music, and magazines) used by early adolescents predicts sexual behavior in middle adolescence.

METHODS

An in-home longitudinal survey of 1017 black and white adolescents from 14 middle schools in central North Carolina was conducted. Each teen was interviewed at baseline when he or she was 12 to 14 years old and again 2 years later using a computer-assisted self interview (audio computer-assisted self-interview) to ensure confidentiality. A new measure of each teen's sexual media diet (SMD) was constructed by weighting the frequency of use of 4 media by the frequency of sexual content in each television show, movie, music album, and magazine the teen used regularly.

RESULTS

White adolescents in the top quintile of sexual media diet when 12 to 14 years old were 2.2 times more likely to have had sexual intercourse when 14 to 16 years old than those who were in the lowest SMD quintile, even after a number of other relevant factors, including baseline sexual behavior, were introduced. The relationship was not statistically significant for black adolescents after controlling for other factors that were more predictive, including parental disapproval of teen sex and perceived permissive peer sexual norms.

CONCLUSIONS

Exposure to sexual content in music, movies, television, and magazines accelerates white adolescents' sexual activity and increases their risk of engaging in early sexual intercourse. Black teens appear more influenced by perceptions of their parents' expectations and their friends' sexual behavior than by what they see and hear in the media.