Intrinsic and extrinsic predictors of video-gaming behaviour and adolescent bedtimes: the relationship between flow states, self-perceived risk-taking, device accessibility, parental regulation of media and bedtime

Electronic Media Use and Sleep Quality: Updated Systematic Review and Meta-Analysis

BACKGROUND

This paper explores the widely discussed relationship between electronic media use and sleep quality, indicating negative effects due to various factors. However, existing meta-analyses on the topic have some limitations.

OBJECTIVE

The study aims to analyze and compare the impacts of different digital media types, such as smartphones, online games, and social media, on sleep quality.

METHODS

Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the study performed a systematic meta-analysis of literature across multiple databases, including Web of Science, MEDLINE, PsycINFO, PubMed, Science Direct, Scopus, and Google Scholar, from January 2018 to October 2023. Two trained coders coded the study characteristics independently. The effect sizes were calculated using the correlation coefficient as a standardized measure of the relationship between electronic media use and sleep quality across studies. The Comprehensive Meta-Analysis software (version 3.0) was used to perform the meta-analysis. Statistical methods such as funnel plots were used to assess the presence of asymmetry and a p-curve test to test the p-hacking problem, which can indicate publication bias.

RESULTS

Following a thorough screening process, the study involved 55 papers (56 items) with 41,716 participants from over 20 countries, classifying electronic media use into "general use" and "problematic use." The meta-analysis revealed that electronic media use was significantly linked with decreased sleep quality and increased sleep problems with varying effect sizes across subgroups. A significant cultural difference was also observed in these effects. General use was associated with a significant decrease in sleep quality (P<.001). The pooled effect size was 0.28 (95% CI 0.21-0.35; k=20). Problematic use was associated with a significant increase in sleep problems (P≤.001). The pooled effect size was 0.33 (95% CI 0.28-0.38; k=36). The subgroup analysis indicated that the effect of general smartphone use and sleep problems was r=0.33 (95% CI 0.27-0.40), which was the highest among the general group. The effect of problematic internet use and sleep problems was r=0.51 (95% CI 0.43-0.59), which was the highest among the problematic groups. There were significant differences among these subgroups (general: Qbetween=14.46, P=.001; problematic: Qbetween=27.37, P<.001). The results of the meta-regression analysis using age, gender, and culture as moderators indicated that only cultural difference in the relationship between Eastern and Western culture was significant (Qbetween=6.69; P=.01). All funnel plots and p-curve analyses showed no evidence of publication and selection bias.

CONCLUSIONS

Despite some variability, the study overall confirms the correlation between increased electronic media use and poorer sleep outcomes, which is notably more significant in Eastern cultures.

Digital media use and sleep in late adolescence and young adulthood: A systematic review

Despite much attention on digital media use and young peoples' sleep, the literature on digital media and its impact on sleep in older adolescents and young adults remains to be synthesized. We conducted a systematic review of studies including young people aged 16-25 years. We searched Medline, Web of Science, and CINAHL for observational studies, identifying 60 studies. These studies were assessed for methodological quality. Only studies rated as moderate or high-quality studies were included (n = 42). A narrative synthesis summarized the impact of digital media use on eight sleep outcomes: Bedtime; Sleep onset latency or problems falling asleep; Sleep duration; Early awakening; Sleep disturbance; Daytime tiredness and function; Sleep deficits; Sleep quality. In summary, digital media use was associated to shorter sleep duration and poorer sleep quality. These associations were found for general screen use and use of mobile phone, computer, internet, and social media, but not for television, game console, and tablet use. Most studies investigating bedtime or nighttime use found associations to poor sleep outcomes. Later bedtime and daytime tiredness were associated with mobile phone use at night. Additional research is warranted to draw solid conclusions about the causal direction and to understand the underlying mechanisms.

Regretful pleasure: Toward an understanding of flow cost in media use

Flow (state of intense focus) during media use has been largely considered a desirable experience, with technologies developed to maximize the chance of encountering flow in computer-mediated environments. However, the total absorption of attention due to flow could be problematic in contexts where the user has multiple predetermined goals, and engaging with the flow-inducing media could cost them resources that may be otherwise devoted to other goals. When flow imposes a cost on the user’s goal performance, it may also reduce their post-experience gratification with the flow-inducing media. The present study proposes a novel theoretical framework to begin understanding the potential cost of flow in media use with supporting evidence from two survey and vignette studies (N = 235 and N = 245). Its findings will extend human-computer interaction research by highlighting the double-edged impact that flow might have on media users’ larger goal performance and downstream well-being.

Gaming Behaviors and the Association with Sleep Duration, Social Jetlag, and Difficulties Falling Asleep among Norwegian Adolescents

The relationship between gaming and sleep is mostly informed by studies of addictive gaming behavior, thus limiting our understanding of sleep in the context of nonproblematic engaged gaming. The present study investigated whether addicted, problem, and engaged gaming behavior was associated with sleep duration, social jetlag, and difficulties falling asleep. The sample consisted of 13- and 16-year-old Norwegian adolescents (n = 3228) participating in the Health Behavior in School-Aged Children (HBSC) survey in 2018. Participants were categorized into addicted, problem, engaged, and normal/non-gaming behavior groups according to which GAS-7 criteria they fulfilled. Robust generalized linear mixed models with a random intercept for class ID were used to examine the association between the sleep variables and gaming behavior. Addicted gaming behavior was unfavorably associated with all sleep parameters. The findings for engaged gaming and problem gaming behavior were somewhat mixed. Engaged gamers slept less on weekends, less on weekdays for those aged 16, and experienced greater social jetlag compared to the normal/non-gaming group. Problem gamers experienced greater social jetlag and had higher odds of experiencing difficulties falling asleep. Overall, the results suggest that all types of gaming behaviors might harm sleep health, but to a greater extent for the addicted gamers.

Effects and mechanisms of action of light-emitting diodes on the human retina and internal clock

White light-emitting diodes (LEDs) will likely become the most used lighting devices worldwide in the future because of their very low prices over the course of their long lifespans which can be up to several tens of thousands of hours. The expansion of LED use in both urban and domestic lighting has prompted questions regarding their possible health effects, because the light that they provide is potentially high in the harmful blue band (400-500 nm) of the visible light spectrum. Research on the potential effects of LEDs and their blue band on human health has followed three main directions: 1) examining their retinal phototoxicity; 2) examining disruption of the internal clock, i.e., an out-of-sync clock, in shift workers and night workers, including the accompanying health issues, most concerningly an increased relative risk of cancer; and 3) examining risky, inappropriate late-night use of smartphones and consoles among children and adolescents. Here, we document the recognized or potential health issues associated with LED lighting together with their underlying mechanisms of action. There is so far no evidence that LED lighting is deleterious to human retina under normal use. However, exposure to artificial light at night is a new source of pollution because it affects the circadian clock. Blue-rich light, including cold white LEDs, should be considered a new endocrine disruptor, because it affects estrogen secretion and has unhealthful consequences in women, as demonstrated to occur via a complex mechanism.

Effortful Control Moderates the Relation Between Electronic-Media Use and Objective Sleep Indicators in Childhood

Electronic-media use is associated with sleep disruptions in childhood and adolescence, although research relies primarily on subjective sleep. Effortful control, a dimension of self-regulation, may mitigate this association by helping children disengage from and regulate responses to media. We examined associations between media use and multiple actigraph-measured sleep parameters at mean and day levels and tested children's effortful control as a moderator of mean-level relations. We collected actigraph data and parents' diary reports of children's prebedtime television, video-game, laptop, desktop, cell-phone, and tablet use in 547 twin children (7-9 years old; 51.74% female). Mean-level media use was associated with bedtime and sleep duration. For the proportion of nights on which twins used media, but not the average number of media types, effortful control attenuated associations between media use and reduced sleep duration and efficiency. Day-level media use was related only to bedtime. Findings replicate and extend existing research and highlight self-regulation as a potential protective factor.

Investigating the "Flow" Experience: Key Conceptual and Operational Issues

The “flow” experience (Csikszentmihalyi, 1975) has been the focus of a large body of empirical work spanning more than four decades. Nevertheless, advancement in understanding – beyond what Csikszentmihalyi uncovered during his initial breakthrough in 1975 – has been modest. In this conceptual analysis, it is argued that progress within the field has been impeded by a lack of consistency in how flow is operationalized, and that this inconsistency in part reflects an underlying confusion regarding what flow is. Flow operationalizations from papers published within the past 5 years are reviewed. Across the 42 reviewed studies, flow was operationalized in 24 distinct ways. Three specific points of inconsistency are then highlighted: (1) inconsistences in operationalizing flow as a continuous versus discrete construct, (2) inconsistencies in operationalizing flow as inherently enjoyable (i.e., “autotelic”) or not, and (3) inconsistencies in operationalizing flow as dependent on versus distinct from the task characteristics proposed to elicit it (i.e., the conditions/antecedents). After tracing the origins of these discrepancies, the author argues that, in the interest of conceptual intelligibility, flow should be conceptualized and operationalized exclusively as a discrete, highly enjoyable, “optimal” state of consciousness, and that this state should be clearly distinguished from the conditions proposed to elicit it. He suggests that more mundane instances of goal-directed engagement are better conceived and operationalized as variations in task involvement rather than variations in flow. Additional ways to achieve greater conceptual and operational consistency within the field are suggested.

Sleep Research: A Primer for Media Scholars

The average amount of sleep people of all ages get has declined sharply in the past 50 years. The detrimental health effects of sleep deprivation are well documented and substantial. Even though electronic media use often takes place in the hours before sleep, the extent to which media use may interact with sleep is understudied and not well understood. Communication scholars are well positioned to contribute to this area, as a systematic, theoretical understanding of the relationship between media and sleep is still lacking. This primer charts the state of knowledge on electronic media and sleep and explores possible next steps. First, we introduce the problem of sleep deprivation and describe the basic science of sleep with relevant terminology. Then, we review the research on electronic media and sleep and offer an agenda for research.

Sleep quality and video game playing: Effect of intensity of video game playing and mental health

The aim of this study was to explore sleep quality in a video game population and to prospect the role of different factors such as sociodemographic data, video game duration, intensity of video game playing, and mental and physical health. Two hundred and seventeen participants (24.40 ± 6.98 years old) completed an online questionnaire composed of sociodemographic informations, the Pittsburg Sleep Quality Index (PSQI), the Medical Outcomes Study (MOS SF-36), video game play time per week, and intensity of video game playing as defined by Décamps (AIE-Q). We carried out hierarchical cluster analysis on the 7 dimensions of PSQI to determine sleep quality profiles. Two profiles were found: (1) « High sleep quality profile » for 132 (60.83%) participants, and (2) « Low sleep quality profile » for 85 (39.17%) participants. These two profiles were differently associated with video game duration per week, intensity of video game playing, and mental health. Sleep quality was positively related to mental health and negatively with intensity of video game playing. Intensity of video game playing was a more salient factor to predict poor sleep quality than video game duration.

Bidirectional effects of Internet-specific parenting practices and compulsive social media and Internet game use

INTRODUCTION

This two-wave prospective study investigated the bidirectional relation between Internet-specific parenting (reactive restrictions, Internet-specific rules, and frequency and quality of communication about Internet) and adolescents' symptoms of social media disorder (SMD) and Internet gaming disorder (IGD). In addition, we investigated whether this relation was different for boys and girls.

METHODS

A sample of 352 adolescents (48.9% boys, M_age = 13.9, SD_age = 0.74, range: 11-15) completed questionnaires at two waves. Zero-inflated cross-lagged analyses in Mplus were performed to predict the level of IGD and SMD symptoms by Internet-specific parenting practices and vice versa, while controlling for age, level of education, and outcome at T₁.

RESULTS

More frequent parent-adolescent communication about Internet predicted more IGD (β = 0.26, p = .03) and SMD symptoms among boys, and more restrictive rules predicted fewer SMD symptoms among girls (β = -0.23, p = .08). More IGD symptoms predicted more reactive rules (β = 0.20, p = .08) among boys and girls and a higher frequency (β = 0.16, p = .02) and lower quality of communication (β = -0.24, p < .001) among boys and girls, respectively.

CONCLUSIONS

This study demonstrates bidirectional relations between Internet-specific parenting and IGD symptoms, but not SMD symptoms. Displaying IGD symptoms seems to elicit ineffective parental responses, which may further exacerbate problematic involvement in gaming. With respect to problematic social use media among girls, this study suggests that parents should set strict rules regarding Internet use, prior to problematic use of social media. Longitudinal studies on the role of parenting in development of Internet-related disorders would be promising in enhancing our understanding of how parents can effectively prevent problematic involvement in online behaviors among their children.

Cross sectional associations of screen time and outdoor play with social skills in preschool children

Screen time and physical activity behaviours develop during the crucial early childhood period (0–5 years) and impact multiple health and developmental outcomes, including psychosocial wellbeing. Social skills, one component of psychosocial wellbeing, are vital for children’s school readiness and future mental health. This study investigates potential associations of screen time and outdoor play (as a proxy for physical activity) with social skills. Cross sectional data were available for 575 mothers with a child (54% boys) aged 2–5 years. Mothers reported their child’s screen time, outdoor play time and social skills (Adaptive Social Behavior Inventory; ASBI). Multiple linear regression analyses assessed associations of screen and outdoor play time (Model 1) and compliance with screen time and physical activity recommendations (Model 2) with three ASBI subscales. Boys and girls spent a mean of 2.0 and 2.2 hours per day in screen time, and 3.3 and 2.9 hours per day in outdoor play, respectively. Girls scores for express and comply skills were significantly higher than boys (p<0.005). After applying the Benjamini-Hochberg Procedure to adjust for multiple associations, children’s television/DVD/video viewing was inversely associated with their compliant scores (B = -0.35 95% CI -0.26, -0.14; p = 0.001) and outdoor play time was positively associated with both expressive (B = 0.20 95% CI 0.07, 0.34; p = 0.004) and compliant (B = 0.22 95% CI 0.08, 0.36; p = 0.002) scores. Findings indicate that television/DVD/video viewing may be adversely, and outdoor play favourably, associated with preschool children’s social skills. Future research is required to identify the direction of causation and explore potential mechanisms of association.

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

With the widespread use of portable electronic devices and the normalization of screen media devices in the bedroom, insufficient sleep has become commonplace. In a recent literature review, 90% of included studies found an association between screen media use and delayed bedtime and/or decreased total sleep time. This pervasive phenomenon of pediatric sleep loss has widespread implications. There is a need for basic, translational, and clinical research examining the effects of screen media on sleep loss and health consequences in children and adolescents to educate and motivate clinicians, teachers, parents and youth themselves to foster healthy sleep habits.

Modifiable predictors of insufficient sleep durations: A longitudinal analysis of youth in the COMPASS study

The purpose of the current study was to simultaneously examine commonly proposed risk and protective factors for sleep deprivation over time among a large cohort of Ontario and Alberta secondary school students. Using 4-year linked longitudinal data from youth in years 1 through 4 (Y₁[2012/2013], Y₂[2013/2014], Y₃[2014/2015], Y₄[2015/2016]) of the COMPASS study (n=26,205), the likelihood of students meeting contemporary sleep recommendations was tested based on their self-reported substance use, bullying victimization, physical activity, and homework and screen time. Models controlled for the effect of student-reported gender, race/ethnicity, grade, school clustering, and all other predictor variables. Relative to baseline, students became less likely to meet the sleep recommendations if at follow-up they had initiated binge drinking, experienced cyber bullying victimization, or were spending more time doing homework, with other factors held constant. The likelihood of reporting sufficient sleep increased if students had begun engaging in resistance training at least three times a week. No longitudinal effect was observed when students increased their caffeine consumption (energy drinks, coffee/tea), initiated cannabis or tobacco use, experienced other forms of bullying victimization (physical, verbal, or belongings), engaged in more moderate-vigorous physical activity, or increased their screen use of any type. Few of the commonly purported modifiable risk and protective factors for youth sleep deprivation held in multinomial longitudinal analyses. Causal conclusions appear premature, with further research required to confirm the targets likely to be most effective in assisting more youth in meeting the sleep recommendations.