Digital media: Promoting healthy screen use in school-aged children and adolescents

The Design and Acceptability of a Hip Hop Themed Integrated Nutrition Math Curriculum for Minoritized 5th Grade Students Using the Multisensory Multilevel Health Education Model

Digital technology creates new opportunities to design multisensory learning experiences. Evidence suggests that digital innovation can greatly benefit health education, including nutrition programs. The COVID-19 pandemic disrupted the education sector, forcing schools to modify standard practices from exclusively in-person delivery to online or blended learning. Digitalized curriculums became particularly useful as an Emergency Remote Teaching tool. This article focuses on developing and implementing a multimedia, multisensory, and scalable Hip-Hop Healthy Eating and Living in Schools (H.E.A.L.S.) Nutrition-Math Curriculum (NMC). NMC comprises 20 lessons-music-based multimedia resources used in the classroom or at home. Fourteen lessons represent self-directed online modules (asynchronous learning) hosted on a Learning Management System (LMS) called "Gooru." The remaining six lessons are teacher-facilitated (in person or using Zoom) review sessions (synchronous learning). The article discusses (1) the development of NMC through the lens of the Multisensory Multilevel Health Education Model (MMHEM), (2) the high acceptability of NMC evaluated using a mixed-methods design among minoritized fifth-grade students attending an after-school program, and (3) the students' completion and mastery rates of the NMC modules based on LMS data. Multimedia nutrition education programs integrated with common core curriculum content, such as NMC, may be a promising avenue for disseminating health education to minoritized children living in New York City and similar high fast-food density cities.

Prevalence and factors associated with cyberbullying among adolescents (15-19 years) in Gurugram District - A community based cross-sectional study

Background

Digitalization in the form of increased Internet use through screen media has also shown its ramification like cyberbullying. They are aggressive acts with the intention or motivation to harm another person through technology. The aim is to study the prevalence of cyberbullying and its association with mental illness in the adolescent age group (15-19 years).

Methods

This community-based cross-sectional study was rolled out among adolescents aged 15-19 years. A total of 387 were given a semistructured interviewer-administered questionnaire consisting of general details, cyberbullying victimization, and offending questions, PHQ-9 and GAD-7.

Results

The mean (SD) age was 16.8 (1.3) years. More than half (53.2%) were males, and nearly three-fourths (74.4%) were school-going. Around 28.2% reported being cyberbullied at least once in their lifetime. About 7.0% of adolescents were cyberbullied more than once, and 0.8% more than five times in the past 30 days. The most common ways were posting a mean or hurtful picture (31.9%) and the concerned person's comments (24.2%) online. Multivariable logistic regression analysis found that adolescents attending colleges (AOR 1.9, 95% CI 1.1 to 3.4), using tobacco (AOR 2.5, 95% CI 1.4 to 4.5), and depressed (of any severity, AOR 2.0, 95% CI 1.1 to 4.3) were at significantly increased risk of being cyberbullied (P < 0.05).

Conclusion

The prevalence of cyberbullying among adolescents aged 15-19 is notable, with significant associations found between cyberbullying and attending college, tobacco use, and depression. Understanding the correlates of cyberbullying can inform targeted interventions to support mental health and well-being among adolescents.

Digital citizenship of children and youth with autism: Developing guidelines and strategies for caregivers and clinicians to support healthy use of screens

LAY ABSTRACT

Children and youth with autism use screens in their daily lives and in their rehabilitation programs. Although parents and clinicians experience specific challenges when supporting positive screen time use of children and youth with autism, no detailed information for this group exists. Therefore, this study aimed to develop clear guidelines that are agreed by expert clinicians and parents of children and youth with autism. Using a method called Delphi, 30 experts-20 clinicians and 10 caregivers, who have experience working with or caring for children and youth with autism were invited to complete a series of three surveys. In each round, the experts had to rate their agreement with statements regarding screen time management. The agreement level was set to 75%. The final themes to be included in the guidelines were accepted by more than 75% of the panel. The final guidelines included six main sections: (1) general principles, (2) considerations for timing and content of leisure screen time use, (3) strategies for caregivers and clinicians to monitor and regulate screen time use, (4) behaviors to monitor for screen time overuse, (5) additional guidelines for clinicians, and (6) resources. The new guidelines developed in this study can provide potential guidance on how to further the development of digital citizenship for children and youth with autism and provide strategies to families to help manage screen time use.

Family Meal Environment Differentially Conditions the Prospective Association between Early Childhood Screen Time and Key Social Relationships in Adolescent Girls

Background: Despite screen time recommendations, children are increasingly spending time on electronic devices, rendering it an important risk factor for subsequent social and developmental outcomes. Sharing meals could offer a way to promote psychosocial development. This study examines the interaction between family meal environment and early childhood screen time on key adolescent social relationships. Methods: Participants are 1455 millennial children (49% boys) from the Quebec Longitudinal Study of Child Development birth cohort. Parents reported on child screen use at ages 2 and 6 years and family meal environment quality at age 6 years. Parents and children reported on parent-child relationships and peer victimization experiences, respectively, at age 13 years. Sex-stratified multiple regression estimated the direct association between screen time trends, family meal environment quality, and their interaction on later social relationship outcomes. Results: For girls, when preschool screen time increased, sharing family meals in high-quality environments was associated with more positive and less conflictual relationships with their mothers, whereas meals shared in low- and moderate-quality environments were associated with fewer instances of victimization by their peers. Non-linear associations were not significant for boys. Conclusion: Capitalizing on family meal environment represents a simple/cost-efficient activity that can compensate for some long-term risks associated with increased screen use, above and beyond pre-existing and concurrent individual and family characteristics. Public health initiatives may benefit from considering family meals as a complementary intervention strategy to screen use guidelines.

Promoting optimal mental health outcomes for children and youth

While paediatric care providers are often the first point of contact for children or youth experiencing mental health challenges, they may lack the resources (e.g., access to a multidisciplinary team) or training to adequately identify or manage such problems. This joint statement describes the key roles and competencies required to assess and address child and youth mental health problems, and the factors that optimize outcomes in this age group. Evidence-informed guidance on screening for and discussing mental health concerns with young people and families is provided. Preventive and therapeutic interventions with demonstrated efficacy in community care settings are discussed. This foundational statement also focuses on the changes to medical education, health systems, and health policy that are needed to improve clinical practice and advocacy efforts in Canada, including appropriate remuneration models, stepped-care approaches, targeted government funding, and professional training and education.

Paediatricians' awareness of Canadian screen time guidelines, perception of screen time use, and counselling during the COVID-19 pandemic

Objectives

Paediatricians are essential in guiding families on screen time use as digital media becomes increasingly prevalent. While this has been highlighted through the COVID-19 pandemic there is no literature on paediatricians' awareness of Canadian screen time guidelines, or perception of these guidelines during this time. The aim of this study was to assess pediatricians' knowledge, attitudes, and comfort with the Canadian Paediatric Society's (CPS) screen time guidelines, specifically during the COVID-19 pandemic.

Methods

Our survey was developed by a paediatric resident and paediatric endocrinologist, reviewed by local experts, and sent electronically to members of the CPS Community and Developmental Paediatrics sections.

Results

All 53 respondents were aware of current CPS screen time guidelines, and the majority self-reported fair to excellent knowledge of guidelines for both age groups (<5 years and school-aged children/adolescents). Over 80% noticed increased screen use during the pandemic, and 98% were somewhat or very concerned about screen use and their patients' health and well-being. Pediatricians reported concerns about associations between increased screen time with worsening behaviour, mental health concerns, obesity, and sedentary lifestyle. The greatest barrier to reducing screen time was perceived insufficient motivation or support from caregivers/families.

Conclusions

Responding Canadian paediatricians are knowledgeable and comfortable with current screen time guidelines in Canada. Despite this, there is increasing concern with health outcomes associated with screen use. These results highlight paediatricians' important role in counselling patients and may encourage further local advocacy and public education around screen use and associated health risks in children.

Digital applications as a means for promotion of healthy behaviours among Albanian children

Digital applications can be effective tools for strengthening school-based health education programs as they can provide valuable health information to children through interactive videos, quizzes and games. We aimed at assessing the change in the prevalence of healthy behaviours among children exposed to digital applications (intervention) employed for promoting healthy behaviours. We conducted a cross-sectional study before the intervention in March 2022 including a representative sample of 1500 Albanian schoolchildren (≈54% girls) aged 12-15 years. In June 2022, after 4-month exposure to digital applications aimed at promoting healthy behaviours (intervention), we carried out a second cross-sectional study in the same sample of schoolchildren. In both survey rounds, an anonymous and structured self-administered questionnaire inquired children about a range of behavioural practices including nutrition, oral health, physical activity and hygiene practices. After the intervention, overall, there was evidence of a significant increase in the prevalence of all healthy behavioural practices measured: ~9% for breakfast consumption and/or environmental protection, 12% for toothbrushing, 14% for handwashing, 15% for leisure time physical exercise and 24% for adequate fruit and vegetable intake (all p < 0.001). Engagement in healthy behaviours only after the intervention was higher among rural children (from 18% for breakfast consumption to 37% for handwashing and/or adequate fruit and vegetable intake) and especially those pertinent to Roma/Egyptian communities (from 18% for breakfast consumption to 46% for adequate fruit and vegetable intake), except for engagement in safe environmental protection which was more prevalent among urban residents (28% vs. 15% among rural children) and ethnic Albanian children (24% vs. 13% among Roma/Egyptian children). Our findings from Albania indicate that digital applications can be useful for strengthening school-based health promotion programs.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Screen time and preschool children: Promoting health and development in a digital world

COVID-19 transformed the family media environment and spurred research on the effects of screen media exposure and use on young children. This update of a 2017 CPS statement re-examines the potential benefits and risks of screen media in children younger than 5 years, with focus on developmental, psychosocial, and physical health. Four evidence-based principles-minimizing, mitigating, mindfully using, and modelling healthy use of screens-continue to guide children's early experience with a rapidly changing media landscape. Knowing how young children learn and develop informs best practice for health care providers and early years professionals (e.g., early childhood educators, child care providers). Anticipatory guidance should now include child and family screen use in (and beyond) pandemic conditions.

Psychosocial Correlates of Recreational Screen Time among Adolescents

The study objective was to identify the psychosocial correlates of recreational screen time among adolescents. Data collection took place in four high schools from the Chaudière-Appalaches region (Quebec, Canada) from late April to mid-May 2021. A total of 258 French-speaking adolescents (69.8% between 15 and 16 years and 66.3% girls) answered an online questionnaire based on the Reasoned Action Approach. Recreational screen time was measured using the French version of a validated questionnaire. Adolescents reported a mean of 5 h and 52 min/day of recreational screen time. Recreational screen time was associated with being a boy (β = 0.33; p < 0.0001) and intention to limit recreational screen time to a maximum of 2 h/day (β = -0.15; p = 0.0001); this model explained 30% of the variance in behavior. Intention to limit recreational screen time to a maximum of 2 h/day in the next month was associated with attitude (β = 0.49; p < 0.0001), self-identity (β = 0.33; p < 0.0001), being a boy (β = -0.21; p = 0.0109), perceived behavioral control (β = 0.18; p = 0.0016), and injunctive norm (β = 0.17; p < 0.0001); this model explained 70% of the variance in intention. This study identified avenues to design public health interventions aimed at lowering recreational screen time among this population.

Digital Interventions for Universal Health Promotion in Children and Adolescents: A Systematic Review

BACKGROUND AND OBJECTIVES

Digital media has been used mostly to deliver clinical treatments and therapies; however limited evidence evaluates digital interventions for health promotion. The objective of this review is to identify digital interventions for universal health promotion in school-aged children and adolescents globally.

METHODS

Eligible articles were searched in PubMed, Embase, Medline, Ovid SP, The Cochrane Library, Cochrane Central Register of Controlled Trials, WHO regional databases, Google Scholar, and reference lists from 2000 to March 2021. Randomized controlled trials and quasi-experimental studies evaluating interventions that promote health in school-aged children and adolescents (5-19.9 years) were included. Methods were conducted in duplicate. Where possible, data were pooled with a random-effects model.

RESULTS

Seventy-four studies were included (46 998 participants), of which 37 were meta-analyzed (19 312 participants). Interventions increased fruit and vegetable consumption (servings per day) (mean difference [MD] 0.63, 95% confidence interval [CI] 0.21 to 1.04; studies = 6; P = .003; high quality of evidence), and probably reduced sedentary behavior (MD -19.62, 95% CI -36.60 to -2.65; studies = 6; P = .02; moderate quality of evidence), and body fat percentage (MD -0.35%, 95% CI -0.63 to -0.06; studies = 5; P = .02; low quality of evidence). The majority of studies were conducted in high-income countries and significant heterogeneity in design and methodology limit generalizability of results.

CONCLUSIONS

There is great potential in digital platforms for universal health promotion; however, more robust methods and study designs are necessitated. Continued research should assess factors that limit research and program implementation in low- to middle-income countries.

International school-related sedentary behaviour recommendations for children and youth

BACKGROUND

Existing sedentary behaviour guidelines for children and youth target overall sedentary behaviour and recreational screen time, without any specific recommendations regarding school-related sedentary behaviours (i.e., sedentary behaviours performed during the school day, or within the influence of school). The purpose of this paper is to describe the development of international evidence-based recommendations for school-related sedentary behaviours for children and youth, led by the Sedentary Behaviour Research Network (SBRN).

METHODS

A panel of international experts was convened by SBRN in November 2020 to guide the development of these recommendations for children and youth aged ~ 5-18 years. The recommendations were informed by 1) age-relevant existing sedentary behaviour guidelines, 2) published research on the relationship between overall sedentary behaviour and health, 3) a de novo systematic review on the relationship between school-related sedentary behaviours and health and/or academic outcomes, and 4) a de novo environmental scan of the grey literature to identify existing recommendations for school-related sedentary behaviours. Draft recommendations were presented to the Expert Panel in June 2021. Following thorough discussion and modifications, updated recommendations were distributed for stakeholder feedback from July 9-26. Feedback was received from 148 stakeholders across 23 countries, leading to additional updates to the recommendations. Following further rounds of discussion and updates with the Expert Panel in August and September 2021, consensus was achieved on the final recommendations.

RESULTS

A healthy day includes breaking up extended periods of sedentary behaviour and incorporating different types of movement into homework whenever possible, while limiting sedentary homework. School-related screen time should be meaningful, mentally or physically active, and serve a specific pedagogical purpose that enhances learning. Replacing sedentary learning activities with movement-based learning activities, and replacing screen-based learning activities with non-screen-based learning activities, can further support students' health and wellbeing.

DISCUSSION

This paper presents the first evidence-based recommendations for school-related sedentary behaviours for children and youth. These recommendations will support the work of parents, caregivers, educators, school system administrators, policy makers, researchers and healthcare providers interested in promoting student health and academic success.

An Objective System for Quantitative Assessment of Television Viewing Among Children (Family Level Assessment of Screen Use in the Home-Television): System Development Study

BACKGROUND

Television viewing among children is associated with developmental and health outcomes, yet measurement techniques for television viewing are prone to errors, biases, or both.

OBJECTIVE

This study aims to develop a system to objectively and passively measure children's television viewing time.

METHODS

The Family Level Assessment of Screen Use in the Home-Television (FLASH-TV) system includes three sequential algorithms applied to video data collected in front of a television screen: face detection, face verification, and gaze estimation. A total of 21 families of diverse race and ethnicity were enrolled in 1 of 4 design studies to train the algorithms and provide proof of concept testing for the integrated FLASH-TV system. Video data were collected from each family in a laboratory mimicking a living room or in the child's home. Staff coded the video data for the target child as the gold standard. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each algorithm, as compared with the gold standard. Prevalence and biased adjusted κ scores and an intraclass correlation using a generalized linear mixed model compared FLASH-TV's estimation of television viewing duration to the gold standard.

RESULTS

FLASH-TV demonstrated high sensitivity for detecting faces (95.5%-97.9%) and performed well on face verification when the child's gaze was on the television. Each of the metrics for estimating the child's gaze on the screen was moderate to good (range: 55.1% negative predictive value to 91.2% specificity). When combining the 3 sequential steps, FLASH-TV estimation of the child's screen viewing was overall good, with an intraclass correlation for an overall time watching television of 0.725 across conditions.

CONCLUSIONS

FLASH-TV offers a critical step forward in improving the assessment of children's television viewing.

Screen Media Overuse and Associated Physical, Cognitive, and Emotional/Behavioral Outcomes in Children and Adolescents: An Integrative Review

INTRODUCTION

Screen media overuse is seen as a public health concern because of its negative effects on child and adolescent health. This integrative literature review examines recent empirical evidence on the relationship between screen media overuse and physical, cognitive, and emotional/behavioral outcomes in children and adolescents.

METHODS

Empirical research of experimental design, observational studies, and systematic reviews from several data sources was reviewed and synthesized to form the basis of this integrative review.

RESULTS

Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems. Bidirectional associations may exist.

DISCUSSION

Findings support the importance of understanding the impact of screen media use on health and wellbeing. Generating screen time guidelines and developing effective prevention/intervention strategies are critical to mitigating screen media overuse and its adverse outcomes in children and families.

NURSING STUDENTS’ LIFESTYLE AND RELATED FACTORS

ABSTRACT Objective: to determine nursing students’ lifestyle at a university in Mexico, according to personal factors and previous behaviors of Nola J. Pender’s Health Promotion Model. Method: this is a cross-sectional study developed at a public university of Minatitlán, Veracruz, Mexico, in 2019, with nursing students enrolled in the curricular internship course, totaling 130. Data were collected that include sociodemographic, clinical and lifestyle and behavior characteristics through the Health-Promoting Lifestyle Profile I. We used Student’s t-tests, ANOVA and Pearson’s correlation for the analyses. Results: of the 130 participants, 92 (70.8%) were classified as healthy lifestyle and 38 (29.2%) had a moderately healthy lifestyle. Among the scale domains, the physical activity domain was the one with the lowest score. Negative correlations were found between the self-actualization domain and clinical variables, such as blood pressure, Body Mass Index and waist circumference, and also between this domain and the time of cell phone and television use. Conclusion: the lifestyle general classification of most participants was healthy, but the analyzes of the individual domains demonstrate the need for political and clinical interventions that influence nursing students’ health-promoting behaviors.

ESTILO DE VIDA DE ESTUDANTES DE ENFERMAGEM E FATORES RELACIONADOS

RESUMO Objetivo: determinar o estilo de vida de estudantes de enfermagem de uma Universidade no México, segundo fatores pessoais e comportamentos anteriores do Modelo de Promoção da Saúde de Nola J. Pender. Método: estudo transversal desenvolvido em uma Universidade Pública de Minatitlán, Veracruz, México, no ano 2019, com os estudantes de enfermagem matriculados na disciplina de estágio curricular, totalizando 130. Coletaram-se dados que incluem características sociodemográficas, clínicas e de estilo de vida e comportamento por meio da Health-Promoting Lifestyle Profile I. Utilizaram-se os testes T de Student, Anova e correlação de Pearson para as análises. Resultados: dos 130 participantes, 92 (70,8%) foram classificados com estilo de vida saudável e 38 (29,2%) obtiveram estilo de vida moderadamente saudável. Entre os domínios da escala, o de exercício foi o de menor pontuação. Constataram-se correlações negativas entre o domínio autorrealização e variáveis clínicas, tais como pressão arterial, índice de massa corpórea e circunferência abdominal, e também entre esse domínio e o tempo de uso de celular e televisão. Conclusão: a classificação geral do estilo de vida da maioria dos participantes foi saudável, todavia as análises dos domínios individuais demonstram a necessidade de intervenções políticas e clínicas que influenciem os comportamentos promotores de saúde dos estudantes de enfermagem.

Effectiveness of digital primary prevention interventions targeting physical activity, motor skills and nutrition in children aged 3-10 years in the setting of day care and primary school: protocol for a systematic review

INTRODUCTION

Available evidence points to an association of increased screen time and the availability of digital tools during childhood with negative health outcomes in later life. For many years, public discourse focused on restricting access and use of digital technologies below certain ages. However, little is known about the specific benefit of a responsible use of digital primary prevention in the setting of (early) childhood education. The objective of this evidence synthesis is to investigate the effectiveness of digital primary prevention interventions targeting physical activity, motor skills and/or nutrition in children aged 3-10 years in day-care facilities and (pre-) schools.

METHODS AND ANALYSIS

We present the rationale and methodological steps of a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures. Automated searches will be conducted by applying a pretested search strategy to the databases MEDLINE/PubMed, EMBASE and PsycInfo to identify relevant interventional (randomised controlled trials, controlled trials, crossover trials and pilot and feasibility) and observational (case-control, cohort) studies in English or German, with no date restrictions. The overall search will be complemented by backward, forward and additional hand searches. Two researchers will independently screen titles/abstracts and assess full texts by applying predefined eligibility criteria. Data extraction will be conducted by using a pretested data extraction sheet. The assessment of methodological quality will be performed independently by two review authors using the Critical Appraisals Skills Programme relevant to the study design applied in the given study. Additionally, qualitative content analysis will be conducted to analyse priorities for future research extracted from the discussion sections and conclusions of included studies.

PROSPERO REGISTRATION NUMBER

CRD42020207682.

Life in lockdown: impact of COVID-19 lockdown measures on the lives of visually impaired school-age children and their families in India

PURPOSE

The COVID-19 outbreak has adversely impacted all societal domains including education. Home confinement, school closures and distance learning impacted children's, teachers' and parents' lives worldwide. In this study, we aimed to examine the impact of the COVID-19 lockdown on the lives, including education, of school-age children with vision impairment (VI) and their parents in India.

METHODS

Primary and secondary school children with VI were recruited from the Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India. A qualitative research methodology, utilising a self-constructed questionnaire with open and closed questions and stem and leaf design, was employed to explore the experiences of school closure and its impact on education and attending online classes during the COVID-19 lockdown. Textual data from responses to the questions were analysed using content analysis to identify themes pertinent to the cohort studied.

RESULTS

Forty eight child-parent dyads were included. The median age of children was 10 years (range, 7-19 years) and 60% were male. Inherited retinal disorders were the major cause of VI (40%). Best spectacle corrected visual acuity (better eye) ranged from 0.30 to 2.09 logMAR (6/12 to 6/750). Six major themes were identified: (1) accessibility of technology (online learning and technology); (2) parental beliefs/concerns (harmful effects of technology, prioritisation of normally sighted children, online classes considered a distraction); (3) support (peers, parents, teachers, private tuition); (4) socialisation and physical activity; (5) socioeconomic status and (6) near vision.

CONCLUSIONS

This study provides an understanding of the adverse impact of lockdown on the lives of children with VI and their parents, especially related to education in India. The study identified critical factors that affect online learning and the participation of children with VI in these sessions. Policymakers and educators should implement effective measures for supporting online classes.

Towards Consensus on Good Practices for the Use of New Technologies for Intervention and Support in Developmental Dyslexia: A Delphi Study Conducted among Italian Specialized Professionals

The use of new technologies for intervention in developmental dyslexia is steadily growing. In order to better understand the needs, the expectations, and the attitudes of Italian expert health professionals concerning such technologies, a national survey was conducted applying the Delphi methodology. Ad-hoc questionnaires were sent out to a group of eighteen experts over three successive rounds, and anonymously collected responses were aggregated and shared with the group after each round, aiming to reach a consensus on the proposed response. The goal was to define a series of statements that could form the basis for international "good practices" in the use of technologies for intervention to support dyslexia in children and adolescents. In the first round, the experts' general opinions were collected with both multiple choice and open questions, and in the second round consensus was assessed on a series of statements based on the first replies. The cut-off of 75% consensus on each statement was reached after three rounds. Fifteen experts completed all the rounds of the process, and a final version of the statements regarding good practice in the use of technologies for dyslexia could be defined.

Screen Time in the Coronavirus 2019 Era: International Trends of Increasing Use Among 3- to 7-Year-Old Children

OBJECTIVE

To evaluate changes in electronic screen-based media use in 3- to 7-year-old children across 6 countries as a result of the coronavirus disease 2019 (COVID-19) pandemic.

STUDY DESIGN

Between April and July 2020, parents of 2516 children completed online survey measures reporting current ("now") and retrospective ("before the pandemic") screen-based media use for the purposes of entertainment, educational app use, and socializing with family and friends. Parents also reported family socioeconomic characteristics and impacts of the pandemic to their physical wellbeing (eg, whether a family member or friend had been diagnosed with COVID-19) and social disruption (eg, whether family experienced a loss of income or employment due to the pandemic).

RESULTS

On average, children engaged with screens more than 50 minutes more during the pandemic than before. This was largely driven by increases in screen use for entertainment purposes (nearly 40 minutes) and for use of educational apps (over 20 minutes). There was no overall change in screen use for socializing with family and friends. Children from lower socioeconomic status households increased screen use both for entertainment and educational app use more so than did children from higher socioeconomic status households.

CONCLUSIONS

The global pandemic caused by COVID-19 has increased overall electronic screen-based media use. As lives become increasingly digital by necessity, further research is needed to better understand positive and negative consequences of electronic screen-based media use.

The associations between smart device use and psychological distress among secondary and high school students in Kuwait

BACKGROUND

Smart devices (SDs) are widely used among adolescents. Numerous studies have recommended further research on this topic to find out the prevalence of SD overuse among school students and to what extent this is associated with psychological distress. The present study aimed to investigate the pattern of SD use among secondary and high school students in the state of Kuwait, as well as the possible associations with psychological problems, weight, physical activity, and school performance.

MATERIALS AND METHODS

The correlational study design aimed to survey students from public schools by using a questionnaire and valid instruments, which included: Smartphone Addiction Scale-Short Version (SAS-SV) and Stress, Anxiety, and Depression Scale-(DASS-21). Pearson's correlation coefficient, t-tests, one-way ANOVA were applied to find associations or significant differences between the categorical variables, in which p < 0.05 was considered statistically significant.

RESULTS

The study included 1,993 students from secondary schools (48.9%) and high schools (51.1%), of which 47.5% were male and 52.5% were female. There were significant statistical differences in the pattern of use of SDs, addiction to SD use, stress, anxiety, and depression according to gender, school type, school performance, and sport engagement. In addition, there were positive correlations between students' addiction to SD use and stress, anxiety, and depression.

CONCLUSIONS

The findings suggest that excessive SD use is associated with addiction among secondary and high school students. In addition, levels of stress, anxiety, and depression differ according to the number of hours of SD use. Strategies should be developed at the community and school levels to avoid the overuse of SDs among school-aged students.

Parents' Attitudes Toward School Students' Overuse of Smartphones and Its Detrimental Health Impacts: Qualitative Study

BACKGROUND

Parents' awareness of the risks of the overuse of smartphones (SPs) among their children and parents' attitudes toward this societal phenomenon are crucial factors to consider when investigating the causes and effects of, as well as interventions to control, this public health issue.

OBJECTIVE

This study aimed to explore the awareness and attitudes of parents regarding SP overuse among their children and the detrimental impacts associated with it.

METHODS

The qualitative method of semistructured face-to-face interviews was used to collect data from fathers and mothers of children aged 6-18 years from all 6 educational/governorate regions in the governmental sector in Kuwait.

RESULTS

A total of 120 parents agreed to participate in the study; there were more female (75/120, 62.5%) than male (45/120, 37.5%) respondents. Almost all of the participants (118/120, 98.3%) were aware that the overuse of SPs could lead to their children becoming addicted to the devices; they were also aware that there could be side effects on their children's health (117/120, 97.5%). Although the participants, mostly the mothers, supervised their children's use of SPs closely (106/120, 88.3%), the majority could not control their children's length of time using SPs, as the children considered this a deprivation of their rights. Eye-related problems, headaches, and anger were the most common side effects experienced by the children.

CONCLUSIONS

Although the parents were aware of the detrimental impacts of SP overuse, the majority could not control the length of time their children spent using the devices. It was found that strong social bonds among family members play a large role in controlling the use of SPs. A number of solutions for families and the government to combat the overuse of SPs are suggested.

Screens across the pond: Findings from longitudinal screen time research in the US and UK

Digital media are increasingly pervasive in the lives of young children. This increase in the availability of digital media might have long-run implications for child development; however, it is too soon to definitively conclude the direction of effects. In part due to this lack of certainty, leading health organizations have chosen to make different recommendations to parents of young children: Many international health organizations (e.g., the American Academy of Pediatrics, World Health Organization) recommend very young children be limited to under one hour of screen time daily, whereas others (e.g., Royal College of Paediatrics and Child Health) have intentionally opted not to make recommendations about specific limits. These guidelines might contribute to parents in different countries making meaningfully different choices about children's use of digital media. Using a sample of N = 303 families recruited in Cambridgeshire, England and New York City prior to the birth of couples' first child, we explore predictors of digital media use across the first two years of life. Data were collected when children were 4, 14, and 24 months of age. Results of latent growth curve analyses show that generally, children spend more time engaging with digital media as they grow older; however, growth mixture models reveal most children fit into one of two classes: One group of children (High Media Users; 52.2 %) engages with a substantial amount of digital media, whereas the other (Low Media Users; 48.8 %) engages with relatively little. Children in the US were approximately 30 % more likely to be in the Low Media Users group and there were no differences in group membership on the basis of parents' psychosocial wellbeing. While these differences could be due to a number of factors, these findings may reflect the power of pediatric recommendations.

Policy Recommendations for Preventing Problematic Internet Use in Schools: A Qualitative Study of Parental Perspectives

Parenting in the digital age has been characterized as one of the most challenging tasks of the modern era. Parents are ambivalent about their mediating role. However, problematic aspects of adolescent online use have not been adequately addressed in education. The present study investigated parental perceptions of intervention needs within schools to prevent excessive/problematic use, enhance parent-child communication, and reduce family conflicts. Nine interviews with parents of adolescents residing in the UK were carried out and analyzed utilizing thematic analysis. Three main themes emerged as parental proposals: (i) schools as digital education providers and prevention hubs, (ii) provision of mental health literacy to raise awareness, resolve ambiguity regarding impacts and mitigate excessive use and impacts, and (iii) psychoeducation and upskilling. The third theme related to impacts from time spent on screens (time displacement), content-related impacts, and context-related impacts. The present study offers recommendations for media literacy during adolescence beyond e-safety (i.e., addressing interpersonal communication problems, privacy vs. disclosure issues), based on parents' views, and provides new insights for media and emotional health literacy collaboration efforts. Future work should investigate the feasibility and effectiveness of such interventions to support the emotional health of young people and prevent problematic internet use escalation.

Exploring the extent of digital food and beverage related content associated with a family-friendly event: a case study

Background

Exposure to unhealthy food and beverage content is a contributing factor to the obesity epidemic. Youth are susceptible to unhealthy digital food marketing including content shared by their peers, which can be as influential as commercial marketing. Current Canadian regulations do not consider the threat digital food marketing poses to health. No research to date has examined the prevalence of food related posts on social media surrounding family-friendly events. The aim of this study was to explore the frequency of food related content (including food marketing) and the marketing techniques employed in social media posts related to a family-friendly event in Canada.

Methods

In this case study, a content analysis of social media posts related to a family-friendly event on Facebook, Twitter, and Instagram was conducted between January to February 2019. Each post containing food related content was identified and categorized by source and food category using a coding manual. Marketing techniques found in each food related post were also assessed.

Results

A total of 732 food and beverage related posts were assessed. These posts were most commonly promoted through Instagram (n = 561, 76.6%) with significantly more individual users (61.5%; p < 0.05) generating food and beverage related content (n = 198, 27%) than other post sources. The top most featured food category was fast food (n = 328, 44.8%) followed by dine-in restaurants (n = 126, 17.2%). The most frequently observed marketing techniques included predominantly featuring a child in the post (n = 124, 16.9%; p < 0.0001), followed by products intended for children (n = 118, 16.1%; p < 0.05), and the presence of family (n = 57, 7.8%; p < 0.0001).

Conclusions

The present study highlights the proliferation of unhealthy food and beverage content by individuals at a family-friendly event as well as the presence of food marketing. Due to the unfettered advertising found in digital spaces, and that they are largely unregulated, it is important for future policies looking to combat childhood obesity to consider incorporating social media into their regulations to safeguard family-friendly events. General awareness on the implications of peer to peer sharing of unhealthy food and beverage posts should also be considered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10716-w.

Digital Screen Time During the COVID-19 Pandemic: Risk for a Further Myopia Boom?

PURPOSE

To review the impact of increased digital device usage arising from lockdown measures instituted during the COVID-19 pandemic on myopia and to make recommendations for mitigating potential detrimental effects on myopia control.

DESIGN

Perspective.

METHODS

We reviewed studies focused on digital device usage, near work, and outdoor time in relation to myopia onset and progression. Public health policies on myopia control, recommendations on screen time, and information pertaining to the impact of COVID-19 on increased digital device use were presented. Recommendations to minimize the impact of the pandemic on myopia onset and progression in children were made.

RESULTS

Increased digital screen time, near work, and limited outdoor activities were found to be associated with the onset and progression of myopia, and could potentially be aggravated during and beyond the COVID-19 pandemic outbreak period. While school closures may be short-lived, increased access to, adoption of, and dependence on digital devices could have a long-term negative impact on childhood development. Raising awareness among parents, children, and government agencies is key to mitigating myopigenic behaviors that may become entrenched during this period.

CONCLUSION

While it is important to adopt critical measures to slow or halt the spread of COVID-19, close collaboration between parents, schools, and ministries is necessary to assess and mitigate the long-term collateral impact of COVID-19 on myopia control policies.

Association of screen time and cardiometabolic risk in school-aged children

Screen use has become a pervasive behaviour among children and has been linked to adverse health outcomes. The objective of this study was to examine the association between screen time and a comprehensive total cardiometabolic risk (CMR) score in school-aged children (7-12-years), as well as individual CMR factors. In this longitudinal study, screen time was measured over time (average duration of follow-up was 17.4 months) via parent-report. Anthropometric measurements, blood pressure, and biospecimens were collected over time and used to calculate CMR score [sum of age and sex standardized z-scores of systolic blood pressure (SBP), glucose, log-triglycerides, waist circumference (WC), and negative high-density lipoprotein cholesterol (HDL-c)/square-root of 5]. Generalized estimating equations (GEE) were used to examine the association between screen time and total CMR score as well as individual CMR factors. A total of 567 children with repeated measures were included. There was no evidence of an association between parent-reported child screen time and total CMR score (adjusted β = -0.01, 95% CI [-0.03, 0.005], 0.16). Screen time was inversely associated HDL-c (adjusted β = -0.008, 95% CI [-0.011, -0.005], p = 0.016), but there was no evidence that the other CMR components were associated with screen time. Among children 7-12 years, there was no evidence of an association between parent-reported child screen time and total CMR, but increased screen time was associated with slightly lower HDL-c. Research is needed to understand screen-related contextual factors which may be related to CMR factors.

The detrimental impacts of smart technology device overuse among school students in Kuwait: a cross-sectional survey

BACKGROUND

Children and adolescents are becoming the most prolific users of smart technology (ST) devices due to the numerous advantages presented by these devices. However, the overuse of ST devices can have detrimental impacts on health. Therefore, the aim of this study was to investigate the pattern of ST device use among school students in Kuwait and the possible associated health problems.

METHODS

This cross-sectional survey used a pretested questionnaire to collect data from students of different educational levels within the governmental sector: primary, secondary and high school. Chi-square tests were applied to find associations or significant differences between the categorical variables, in which p < 0.05 was considered statistically significant.

RESULTS

This study included 3015 students, of whom 53.6% were female. The sample had an equal distribution of primary (33.8%), secondary (32.4%) and high school students (33.8%). Almost all of the participants (99.7%) owned a ST device, chiefly smartphones (87.7%). Most of the students used ST devices for > 4 total hours per day on average, which is categorised as "overuse". Among those overusing ST devices, the symptoms most commonly experienced included headaches (35.0%), sleep disturbances (36.6%) and neck/shoulder pain (37.7%). Students who used ST devices for < 1 h per session experienced eye-related problems. Moreover, students who played sports on a regular basis were more likely to spend less time per session on ST devices. The prolonged use of ST devices was associated with higher reporting of seizures, eye squints and transient vision loss.

CONCLUSION

The overuse of ST devices per day and per session by school-aged children has the potential to have a detrimental impact on their health, as has been noticed among students in Kuwait. Healthcare professionals, school authorities and parents could use these results to plan strategies to change ST device use behaviours among schoolchildren.

Psychological impacts of "screen time" and "green time" for children and adolescents: A systematic scoping review

Technological developments in recent decades have increased young people's engagement with screen-based technologies (screen time), and a reduction in young people's contact with nature (green time) has been observed concurrently. This combination of high screen time and low green time may affect mental health and well-being. The aim of this systematic scoping review was to collate evidence assessing associations between screen time, green time, and psychological outcomes (including mental health, cognitive functioning, and academic achievement) for young children (<5 years), schoolchildren (5-11 years), early adolescents (12-14 years), and older adolescents (15-18 years). Original quantitative studies were identified in four databases (PubMed, PsycInfo, Scopus, Embase), resulting in 186 eligible studies. A third of included studies were undertaken in Europe and almost as many in the United States. The majority of studies were cross-sectional (62%). In general, high levels of screen time appeared to be associated with unfavourable psychological outcomes while green time appeared to be associated with favourable psychological outcomes. The ways screen time and green time were conceptualised and measured were highly heterogeneous, limiting the ability to synthesise the literature. The preponderance of cross-sectional studies with broadly similar findings, despite heterogeneous exposure measures, suggested results were not artefacts. However, additional high-quality longitudinal studies and randomised controlled trials are needed to make a compelling case for causal relationships. Different developmental stages appeared to shape which exposures and outcomes were salient. Young people from low socioeconomic backgrounds may be disproportionately affected by high screen time and low green time. Future research should distinguish between passive and interactive screen activities, and incidental versus purposive exposure to nature. Few studies considered screen time and green time together, and possible reciprocal psychological effects. However, there is preliminary evidence that green time could buffer consequences of high screen time, therefore nature may be an under-utilised public health resource for youth psychological well-being in a high-tech era.

Testing a school-based program to promote digital health literacy and healthy lifestyle behaviours in intermediate elementary students: The Learning for Life program

Promoting digital health literacy and healthy lifestyle behaviours in children can lead to positive long-term health outcomes and prevent chronic diseases. However, there are few school-based interventions promoting this education to intermediate elementary students. The objective of this study was to test the effectiveness of a novel intervention to increase students' digital health literacy and health knowledge. Learning for Life is a classroom-based education program, developed for grade 4-7 students and delivered by teachers over six weeks. Three Canadian schools were recruited to deliver the intervention in 2018. This study had a pre-post design and no control group. Students' self-reported digital health literacy and healthy lifestyle behaviours were measured at pre-intervention (n = 126), post-intervention (n = 119), and two-month follow-up (n = 104). Students at pre-intervention had a mean (SD) age of 10.98 (0.56) years (57.1% females). Almost all (97%) students had unsupervised access to the Internet through a computer or smartphone. From pre- to post-intervention, students' digital health literacy increased (p = 0.009), but decreased from post-intervention to follow-up (p < 0.001). Post-intervention, the majority of students could identify at least one healthy behaviour (e.g., exercising one hour/day) and reported making at least one healthy change in their lives (e.g., eating more fruits/vegetables). This study demonstrated that the Learning for Life intervention can improve intermediate elementary students' digital health literacy over the short-term and help them learn and retain healthy lifestyle knowledge and behaviours. These findings affirm the need for interventions promoting digital healthy literacy and healthy lifestyle behaviours for this age group.

The Digital Media Environment and Cardiovascular Risk in Children

Children today are exposed to multiple forms of digital media including traditional (eg, televisions, computers) and newer mobile devices (eg, smartphones, tablets, etc). As the digital media environment evolves, it is important that health care providers and policymakers adapt to develop, implement, and evaluate strategies to ameliorate its effects on health. In this article we provide an overview of the literature on the relationship between the digital media environment and cardiovascular risk factors in childhood. Existing evidence on the relationship between digital media environment and cardiovascular risk in infants, children, and youth are reported. Potential mechanisms underpinning the relationship between the digital media environment and cardiovascular disease risk in children such as the displacement of movement behaviours, food and beverage marketing to children, and eating while viewing were explored. National and international guidelines aimed at addressing the digital media environment are highlighted, and suggestions for future research and guideline development are provided. Action-oriented professional recommendations for health care providers, families, and children are urgently needed. As the prevalence of screen use in childhood continues to exceed those of past generations, concern about the effects and strategies to reduce harm including cardiovascular outcomes must remain a top public health priority.