Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study

Intense and problematic social media use and sleep difficulties of adolescents in 40 countries

INTRODUCTION

Social media has become a ubiquitous part of everyday life; however, evidence suggests patterns of social media use can affect sleep health in children and adolescents. This study aimed to examine the associations of intense and problematic social media use (SMU) with sleep-onset difficulties in adolescence.

METHODS

We analysed data from 212,613 adolescents aged 11-15 years (51.1% girls) from 40 European and North American countries that participated in the 2017/2018 Health Behaviour in School-aged Children survey. Intense SMU assessed how often respondents had online contact through social media, and problematic SMU was assessed by symptoms of addiction to social media. Sleep-onset difficulties were assessed using a self-reported item. Multilevel mixed-effects logistic regression was used to obtain the estimates.

RESULTS

Sleep-onset difficulties were more common among girls than boys (27.1% vs 20.8%). Intense SMU was significantly associated with sleep-onset difficulties in boys in 17 countries and in girls in 25 countries, while problematic SMU was significantly associated in most of the participating countries. Overall, exposure to problematic SMU alone was highly associated with sleep-onset difficulties both in girls (OR 2.20, 2.04-2.38) and boys (OR 1.88, 1.73-2.04), while the association estimates for intense SMU were smaller and comparable across gender (Girls: OR 1.27, 1.23-1.31; Boys: OR 1.22, 1.18-1.27). Sensitivity analyses supported the above findings.

CONCLUSIONS

Intense and/or problematic SMU were associated with sleep-onset difficulties across gender with associations being higher for problematic compared to intense SMU. Prospective research with objective measures is needed to understand the causal mechanisms underlying these relationships.

Prevalence and co-occurrence of cognitive impairment in children and young people up to 12-months post infection with SARS-CoV-2 (Omicron variant)

BACKGROUND

Cognitive impairment is often reported after SARS-CoV-2 infection, yet evidence gaps remain. We aimed to (i) report the prevalence and characteristics of children and young people (CYP) reporting "brain fog" (i.e., cognitive impairment) 12-months post PCR-proven SARS-CoV-2 infection and determine whether differences by infection status exist and (ii) explore the prevalence of CYP experiencing cognitive impairment over a 12-month period post-infection and investigate the relationship between cognitive impairment and poor mental health and well-being, mental fatigue and sleep problems.

METHODS

The Omicron CLoCk sub-study, set up in January 2022, collected data on first-time PCR-test-positive and PCR-proven reinfected CYP at time of testing and at 3-, 6- and 12-months post-testing. We describe the prevalence of cognitive impairment at 12-months, indicating when it was first reported. We characterise CYP experiencing cognitive impairment and use chi-squared tests to determine whether cognitive impairment prevalence varied by infection status. We explore the relationship between cognitive impairment and poor mental health and well-being, mental fatigue and trouble sleeping using validated scales. We examine associations at 3-, 6- and 12-months post-testing by infection status using Mann-Whitney U and chi-square tests.

RESULTS

At 12-months post-testing, 7.0 % (24/345) of first-positives and 7.5 % (27/360) of reinfected CYP experienced cognitive impairment with no difference between infection-status groups (p = 0.78). The majority of these CYP experienced cognitive impairment for the first time at either time of testing or 3-months post-test (no difference between the infection-status groups; p = 0.60). 70.8 % of first-positives experiencing cognitive impairment at 12-months, were 15-to-17-years-old as were 33.3 % of reinfected CYP experiencing cognitive impairment (p < 0.01). Consistently at all time points post-testing, CYP experiencing cognitive impairment were more likely to score higher on all Strengths and Difficulties Questionnaire subscales, higher on the Chalder Fatigue sub-scale for mental fatigue, lower on the Short Warwick-Edinburgh Mental Wellbeing Scale and report more trouble sleeping.

CONCLUSIONS

CYP have a fluctuating experience of cognitive impairment by 12-months post SARS-CoV-2-infection. Cognitive impairment is consistently correlated with poorer sleep, behavioural and emotional functioning over a 12-month period. Clinicians should be aware of cognitive impairment post-infection and its co-occurring nature with poorer sleep, behavioural and mental health symptoms.

Differentiating the relationships between traditional and new media use and sleep quality during the COVID-19 pandemic: roles of psychological distress and age

Background

Numerous studies have consistently demonstrated a decline in sleep quality during the COVID-19 pandemic. The primary objective of this study is to explore the impact of engaging with pertinent epidemic information through the media amid the COVID-19 crisis on individuals' sleep quality and the underlying mechanisms through which this influence operates.

Methods

An online cross-sectional study design was employed. A total of 1,063 British adults (36.2% males; M age = 38.85, SD age = 13.36, ranging from 18 to 77 years old) participated in the study and completed our questionnaires, which included media usage frequency during the pandemic, the 10-item Kessler Psychological Distress Scale (K10), the Insomnia Severity Index (ISI), and the Ten-item Personality Inventory (TIPI).

Results

Pearson's correlation analyses indicated that there was no significant correlation between COVID-19-related traditional media use (television, radio, newspaper) and psychological distress or sleep quality. However, exposure to information related to COVID-19 through new media use (Facebook, Tik Tok, Twitter) was correlated with greater psychological distress and poorer sleep quality. A moderated mediation analysis showed that psychological distress fully mediated the relationship between new media use and poor sleep, which was moderated by age, with the association between psychological distress and poor sleep quality being stronger among older adults.

Conclusion

Exposure to information of COVID-19 via new (but not traditional) media use deteriorated sleep quality through greater psychological distress, and this relationship was stronger among older adults.

The Relationship Between Fast Food Consumption and Daily Lifestyle Changes During School Closures Following the COVID-19 Pandemic: A Cross-Sectional Study Among Adolescents in Korea

OBJECTIVE

Increased fast food consumption can have adverse effects on health and well-being among adolescents, posing a significant public health concern. The school closures due to the coronavirus disease-2019 (COVID-19) pandemic have led to changes in eating patterns and disrupted a balance diet among adolescents. This study explored the factors associated with fast food consumption among adolescents during school closures due to the COVID-19 pandemic.

METHODS

A total of 1,710 middle and high school students in Gwangju, South Korea participated in a cross-sectional survey. The self-administered questionnaire included items assessing dietary intake, physical activity, sleep, media use, and sociodemographic information. The Patient Health Questonnaire-9, Generalized Anxiety Disorder-7, and three item version of the UCLA Loneliness Scale were also administered. Multivariable logistic regression was used to examine the factors associated with increased fast food consumption.

RESULTS

Approximately 34.6% of the surveyed adolescents reported increased fast food consumption during school closures, as well as increased sleep duration, increased sedentary behaviors including watching TV and using the internet, and reduced physical activity. Multivariable logistic regression analysis revealed that fast food consumption during school closures was associated with irregular patterns of main meals and sleep, decreased physical activity, increased internet use, and a lack of daytime adult supervision.

CONCLUSION

Our results highlight the need for dietary and lifestyle monitoring and guidelines to promote health among adolescents, especially during school closures. In conclusion, nutrition intervention programs aiming to limit fast food consumption and enhance healthy dietary habits among adolescents during long-term school closures are warranted.

Cohort profile: The Social media, smartphone use and Self-harm in Young People (3S-YP) study-A prospective, observational cohort study of young people in contact with mental health services

OBJECTIVES

The Social media, Smartphone use and Self-Harm (3S-YP) study is a prospective observational cohort study to investigate the mechanisms underpinning associations between social media and smartphone use and self-harm in a clinical youth sample. We present here a comprehensive description of the cohort from baseline data and an overview of data available from baseline and follow-up assessments.

METHODS

Young people aged 13-25 years were recruited from a mental health trust in England and followed up for 6 months. Self-report data was collected at baseline and monthly during follow-up and linked with electronic health records (EHR) and user-generated data.

FINDINGS

A total of 362 young people enrolled and provided baseline questionnaire data. Most participants had a history of self-harm according to clinical (n = 295, 81.5%) and broader definitions (n = 296, 81.8%). At baseline, there were high levels of current moderate/severe anxiety (n = 244; 67.4%), depression (n = 255; 70.4%) and sleep disturbance (n = 171; 47.2%). Over half used social media and smartphones after midnight on weekdays (n = 197, 54.4%; n = 215, 59.4%) and weekends (n = 241, 66.6%; n = 263, 72.7%), and half met the cut-off for problematic smartphone use (n = 177; 48.9%). Of the cohort, we have questionnaire data at month 6 from 230 (63.5%), EHR data from 345 (95.3%), social media data from 110 (30.4%) and smartphone data from 48 (13.3%).

CONCLUSION

The 3S-YP study is the first prospective study with a clinical youth sample, for whom to investigate the impact of digital technology on youth mental health using novel data linkages. Baseline findings indicate self-harm, anxiety, depression, sleep disturbance and digital technology overuse are prevalent among clinical youth. Future analyses will explore associations between outcomes and exposures over time and compare self-report with user-generated data in this cohort.

Social media & subjectivity: Adolescent lived experiences with social media in a Southern California middle school

The widespread use of social media (SM) platforms among adolescents has raised concerns over its role in increased adverse physical and mental health conditions. However, current research linking SM use with adolescent health relies on tenuous correlational associations, disproportionately focuses on harmful effects of its use, and seldom examines the perspectives of youth themselves (Odgers and Jensen, 2020; Schønning et al., 2020). This article examines adolescent lived experience in relation to SM platform engagement. Drawing from ethnographic fieldwork conducted in 2018-2019 and 2021-2022 among 75 middle-school adolescents living in an ethnically diverse and low-income Southern California community, we examine adolescent subjective experiences with SM platforms that illuminate adolescent concerns during this developmental stage. By attending to adolescent subjectivity, this article reveals the ways in which engagement with SM platforms is inextricable from cultural, social, political, and socio-emotional milieu.

SESSAMO, follow-up of secondary students to assess mental health and obesity: a cohort study

During last decades, a departure from health-related lifestyles has been observed among adolescents. Evidence reports that healthy lifestyles could be predictors of better mental health status. The aims of the SESSAMO Project are: 1) to assess the association between lifestyles and physical and mental health; 2) to assess how self-concept and stressful life events can modulate these associations; and 3) to establish the role of social determinants in the lifestyle and in adolescents' health. The SESSAMO Project is a prospective cohort carried out in Spain. Students aged 14-16 years (2nd-4th ESO) and their parents are invited to participate. Baseline data are collected through on-line, validated, self-administered questionnaires through a digital platform. Information on lifestyles, stressful life events and self-concept are collected. Screening of depression, anxiety, eating disorders, suicide risk, psychotic experiences and COVID impact is assessed. Every three years, up to age of 25, participants will be contacted again to update relevant information.

Sleep and circadian rhythms in adolescents with attempted suicide

Sleep and circadian rhythm disorders are very common in adolescents and have been linked to suicidal ideation. However, little is known about adolescent sleep before a suicide attempt (SA). The objectives of this study were to compare the sleep of adolescents aged 13 to 18 over a period of 4 weeks before a SA compared to a non-SA group, then to analyze the association between sleep, support social and well-being based on information from validated questionnaires. In 2015, 250 adolescents were included, 55 were recruited the day after a SA in French hospitals (before SA evaluations were retrospective). Logistic regression analyzes showed that during school days, bedtime was equivalent in both groups, but sleep onset latency was significantly longer in SA (86 min vs. 52 min, p = 0.016), and wake-up time was earlier (6 h 22 vs. 6 h 47, p = 0.002), resulting in a shorter total sleep time of 44 min (OR = 0.76, CI 95% [0.61-0.93]) the month preceding SA. Adolescents with longer sleep time performed better on perceived psychological well-being (p = 0.005), relationship with parents (p = 0.011) and school environment (p < 0.001). Results indicate a significant change in the quantity and quality of adolescents' subjective sleep in the 4 weeks preceding SA requiring objective measures to study the predictive properties of sleep in SA.

Text Analysis of Suicide Risk in Adolescents and Young Adults

OBJECTIVE

Suicide is of primary public concern for adolescents and young adults (AYAs) who commonly use social media platforms to express their suicidal thoughts and behaviors. Understanding how AYAs communicate their suicide-related thoughts and behaviors in texts can support early detection of suicide risk from their social media posts. Therefore, this study sought to identify themes relevant to suicide risk in AYAs and explore words or terms used by AYAs when they described suicidal thoughts and behaviors.

METHOD

This secondary data analysis utilized an existing data set collected from 255 AYAs between 12 and 25 years of age, who provided brief descriptions of how they and their peers expressed their experiences of self-harm, suicidal thinking, and attempts. Text analysis was conducted using KH Coder software. Three-step theory of suicide was used to guide a content analysis to explore the key themes from the narratives.

RESULTS

A word co-occurrence network with 24 clusters of words was generated from the text analysis. These word clusters were further grouped into pain or hopelessness, connectedness, and capacity to attempt suicide in the content analysis. Six subthemes corresponding to these three themes were identified to provide detailed information: psychological or physical pain, hopelessness, relationship, help seeking, methods, and outcomes. Moreover, several slang terms and acronyms (e.g., Kermit Sewage Slide, KMS) were also identified.

CONCLUSIONS

The findings of this study, including themes and slang terms and acronyms, are valuable to facilitate the use of terms or phrases within social media texts to identify suicide risk in AYAs.

Smartphones, social Media and Adolescent mental well-being: the impact of school policies Restricting dayTime use-protocol for a natural experimental observational study using mixed methods at secondary schools in England (SMART Schools Study)

INTRODUCTION

Smartphone and social media use is prevalent during adolescence, with high levels of use associated with lower levels of mental well-being. Secondary schools in the UK have introduced policies that restrict daytime use of smartphones and social media, but there is no evaluation on the impact of these policies on adolescent mental well-being. The SMART Schools Study aims to determine the impact of daytime restrictions of smartphone and social media use on indicators of adolescent mental well-being, anxiety, depression, physical activity, sleep, classroom behaviour, attainment and addictive social media use.

METHODS AND ANALYSIS

This is a natural experimental observational study using mixed methods. Secondary schools within a 100 mile radius of the recruiting centre in the West Midlands (UK) have been categorised into two groups: Schools that restrict (intervention) and permit (comparator) daytime use of smartphones. We aim to recruit 30 schools (20 restrictive, 10 permissive) and 1170 pupils aged 12-13 and 14-15 years. We will collect data on mental well-being, anxiety and depressive symptoms, phone and social media use, sleep and physical activity from pupil surveys, and accelerometers. Policy implementation measures and data on individual pupil factors will be collected through school staff surveys, and website/policy analysis. Six case study schools will explore individual, school and family/home factors that influence relationships between school smartphone policies, smartphone/social media use, and mental well-being. Economic evaluation will be completed through a cost-consequence analysis from an education sector perspective.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Birmingham's Research Ethics Committee (ERN_22-0723). Parents/carers of pupil participants can complete a form to opt their child out of the study. Pupil, school staff and parent/carer participants are asked to complete online/written consent (or assent). Findings will be disseminated through policy briefings, resources for schools, social media, reports, and open access publications.

TRIAL REGISTRATION NUMBER

ISRCTN77948572.

Sedentary behavior is associated with poor sleep quality during the COVID-19 pandemic, and physical activity mitigates its adverse effects

BACKGROUND

We aimed to evaluate the association of sedentary behavior (SB) and moderate to vigorous leisure-time physical activity (MVPA) with sleep quality during the COVID-19 pandemic.

METHODS

Cross-sectional, population-based study in adults, conducted from October to December 2020 in the Iron Quadrangle region, Brazil. The outcome was sleep quality, evaluated with the Pittsburgh Sleep Quality Index. SB was assessed by self-report of total sitting time, before and during the pandemic. Individuals with ≥ 9 h of total sitting time were classified as SB. In addition, the ratio of time spent in MVPA to time in SB was analyzed. A contrasted directed acyclic graph (DAG) model was constructed to adjust logistic regression models.

RESULTS

A total of 1629 individuals were evaluated, the prevalence of SB before the pandemic was 11.3% (95%CI: 8.6-14.8), and during the pandemic 15.2% (95%CI: 12.1-18.9). In multivariate analysis, the chance of poor sleep quality was 77% higher in subjects with SB ≥ 9 h per day (OR: 1.77; 95% CI: 1.02-2.97). Furthermore, a one-hour increase in SB during the pandemic, increased the chance of poor sleep quality by 8% (OR: 1.08; 95%CI 1.01-1.15). In the analysis of the ratio of MVPA per SB in individuals with SB ≥ 9 h, practicing 1 min of MVPA per hour of SB reduces the chance of poor sleep quality by 19% (OR: 0.84; 95%CI: 0.73-0.98).

CONCLUSION

SB during the pandemic was a factor associated with poor sleep quality, and the practice of MVPA can reduce the effects of SB.

Adolescent use of social media and associations with sleep patterns across 18 European and North American countries

OBJECTIVE

Over the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use).

DESIGN, SETTING, AND PARTICIPANTS

Data were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study.

MEASUREMENTS

Mixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data.

RESULTS

For all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results.

CONCLUSIONS

These findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep.

"Instead of Being on a Screen You Can Be More Out There and Enjoy Your Life": Young People's Understandings of Physical Activity for Health

BACKGROUND

Despite documented evidence of the benefits of leading a physically active life, it is reported that less than half of young people in Europe meet the physical activity recommendations. Schools, and in particular physical education (PE), are viewed to be at the forefront of addressing inactive lifestyles and educating young people about physical activity. Nonetheless, given advancements in technology, young people are increasingly exposed to physical activity information "beyond the school gates". Consequently, if PE teachers are to support young people to understand the information they receive surrounding physical activity online, then they need to be able to address any misconceptions about health they may have.

METHODS

In this study, fourteen young people (7 boys and 7 girls) in year 9 (13-14 years old) from two secondary schools in England participated in a digitally-based activity and semi-structured interviews which aimed to explore their conceptions of physical activity for health.

RESULTS

It was found that the young people had limited and narrow conceptions of what it means to be physically active.

CONCLUSIONS

It was suggested the findings could be partly attributed to limitations in students' learning and experiences with respect to physical activity and health in the PE curriculum.

TikTok use and psychosocial factors among adolescents: Comparisons of non-users, moderate users, and addictive users

Short-video applications like TikTok are increasingly popular. This study examines the association between short-video application use (SVU) and psychosocial factors in 1,346 adolescents (M_age = 14.97, 51.8% female). 199 non-users and 1147 users (686 moderate users, 461 addictive users) were identified. Results revealed a high prevalence of addictive SVU in the sample. Addictive users exhibited worse mental health conditions than non-users and moderate users, including higher levels of depression, anxiety, stress, loneliness, social anxiety, attention problems, and lower life satisfaction and sleep quality. Addictive users also faced higher academic stress, poorer academic performance, more bullying victimization, worse parental relationships, more negative parenting styles, and lower parental education levels. Moderate users had different family environments than non-users, but no differences in mental health or school performance. Together, these findings suggest that addictive users experience a more disadvantageous situation across mental health, family, and school conditions, while non-users have advantageous family environments. Moderate SVU may not be associated with negative mental health condition or poor school performance. Moderate and addictive SVU should be considered distinct phenomena. Given the psychiatric symptoms present in addictive users of TikTok and similar apps, targeted interventions and treatments are urgently needed.

Time spent on social media use and BMI z-score: A cross-sectional explanatory pathway analysis of 10798 14-year-old boys and girls

BACKGROUND

The association between adolescent time spent on social media use and body mass index z-score (BMI z-score) is unclear. Pathways of association and sex differences are also unclear. This study examined the association between time spent on social media use and BMI z-score (primary objective) and potential explanatory pathways (secondary objective) for boys and girls.

METHODS

Data are from 5332 girls and 5466 boys aged 14 years in the UK Millennium Cohort Study. BMI z-score was regressed on self-reported time spent on social media use (h/day). Potential explanatory pathways explored included dietary intake, sleep duration, depressive symptoms, cyberbullying, body-weight satisfaction, self-esteem, and well-being. Sex-stratified multivariable linear regression and structural equation modelling were used to examine potential associations and explanatory pathways.

RESULTS

Using social media for ≥5 h/day (vs. <1 h/day) was positively associated with BMI z-score for girls (β [95% CI]) (0.15 [0.06, 0.25]) (primary objective, multivariable linear regression). For girls, the direct association was attenuated when sleep duration (0.12 [0.02, 0.22]), depressive symptoms (0.12 [0.02, 0.22]), body-weight satisfaction (0.07 [-0.02, 0.16]), and well-being (0.11 [0.01, 0.20]) were included (secondary objective, structural equation modelling). No associations were observed for boys and potential explanatory pathway variables were not examined.

CONCLUSIONS

In girls, high time spent on social media use (≥5 h/day) was positively associated with BMI z-score, and this association was partially explained by sleep duration, depressive symptoms, body-weight satisfaction, and well-being. Associations and attenuations between a self-reported summary variable of time spent on social media use and BMI z-score were small. Further research should examine whether time spent on social media use is related to other adolescent health metrics.

A preliminary study on the association between social media at night and sleep quality: The relevance of FOMO, cognitive pre-sleep arousal, and maladaptive cognitive emotion regulation

Research shows that nighttime social media is negatively associated with sleep quality and that it might be utilized to cope with aversive psychological states related to cognitive pre-sleep arousal (i.e., transdiagnostic psychopathology variables, referring to maladaptive repetitive thought), namely Fear of Missing Out (FoMO). The use of nighttime social media to cope with other aversive cognitive states (i.e., worry/rumination), their relationship with FoMO, and these variables' association with sleep are not fully understood. This study explored the relationships between nighttime social media, sleep quality, FoMO, cognitive pre-sleep arousal, and maladaptive cognitive emotion regulation (i.e., worry/rumination). The present correlational study followed a cross-sectional design. Participants were 525 university students, ranging in age from 18 to 64 (M = 22.39, SD = 5.62). Measures of sleep quality, morningness/eveningness, cognitive pre-sleep arousal, worry, rumination, FoMO, nighttime screen, and social media use were collected online or in pencil-paper format. Multiple linear regression analyses were performed. Nighttime social media and FoMO were associated with rumination, worry (H1) and cognitive pre-sleep arousal. Both FoMO and worry predicted higher levels of cognitive pre-sleep arousal (H2) and nighttime social media use (H3). Nighttime social media use independently predicted poor sleep quality (H4). These results suggest that worry and FoMO may potentially affect sleep quality by increasing cognitive pre-sleep arousal and nighttime social media. A possible explanation for these findings is that nighttime social media might be used as a strategy to cope with aversive cognitive states. These conclusions may contribute to improving sleep intervention in this population.

Parental Perception of Children's Online Behaviour: A Study on Ethnic Communities in Australia

The overwhelming growth of the Internet in all spheres of life poses new challenges for young children growing up in the digital age, with potential short- and long-term ramifications. Parents have an essential role in the development of the attitudes and behaviour of their children. However, studies indicate that adults are not adequately mitigating the range of cyber risks that children face and that parent-oriented solutions are simply inadequate. This study attempts to fill research gaps in the status and nature of parents' perceptions of the online use of their children in Australia based on their ethnic background. This study adopted a mixed-method approach, surveying 204 parents from different ethnic communities in Australia followed by 16 in-depth interviews and three focus-group discussions. The results indicate that parents' perceptions of online risk for children differ based on their ethnicity, cultural adaptation, gender, and age. Parents from multicultural societies are less equipped to deal with cyber threats that their children face and are ill-equipped to monitor and mitigate the risks posed. The results of this study have important policy implications, from deepening our understanding of the nature of the problems to facilitating the development of short- and long-term strategies, appropriate information systems, policy guidelines, and interventions.

Insufficient sleep during adolescence and risk of multiple sclerosis: results from a Swedish case-control study

BACKGROUND

Shift work, which often results in sleep deprivation and circadian desynchrony, has been associated with increased risk of multiple sclerosis (MS). We aimed at studying the impact of sleep duration, circadian disruption and sleep quality on MS risk.

METHODS

We used a Swedish population-based case-control study (2075 cases, 3164 controls). Aspects of sleep were associated with MS risk by calculating OR with 95% CIs using logistic regression models.

RESULTS

Compared with sleeping 7-9 hours/night during adolescence, short sleep (<7 hours/night) was associated with increased risk of developing MS (OR 1.4, 95% OR 1.1-1.7). Similarly, subjective low sleep quality during adolescence increased the risk of subsequently developing MS (OR 1.5, 95% CI 1.3 to 1.9), whereas phase shift did not significantly influence the risk. Our findings remained similar when those who worked shifts were excluded.

CONCLUSIONS

Insufficient sleep and low sleep quality during adolescence seem to increase the risk of subsequently developing MS. Sufficient restorative sleep at young age, needed for adequate immune functioning, may be a preventive factor against MS.

Estimation of Bedtimes of Reddit Users: Integrated Analysis of Time Stamps and Surveys

BACKGROUND

Individuals with later bedtimes have an increased risk of difficulties with mood and substances. To investigate the causes and consequences of late bedtimes and other sleep patterns, researchers are exploring social media as a data source. Pioneering studies inferred sleep patterns directly from social media data. While innovative, these efforts are variously unscalable, context dependent, confined to specific sleep parameters, or rest on untested assumptions, and none of the reviewed studies apply to the popular Reddit platform or release software to the research community.

OBJECTIVE

This study builds on this prior work. We estimate the bedtimes of Reddit users from the times tamps of their posts, test inference validity against survey data, and release our model as an R package (The R Foundation).

METHODS

We included 159 sufficiently active Reddit users with known time zones and known, nonanomalous bedtimes, together with the time stamps of their 2.1 million posts. The model's form was chosen by visualizing the aggregate distribution of the timing of users' posts relative to their reported bedtimes. The chosen model represents a user's frequency of Reddit posting by time of day, with a flat portion before bedtime and a quadratic depletion that begins near the user's bedtime, with parameters fitted to the data. This model estimates the bedtimes of individual Reddit users from the time stamps of their posts. Model performance is assessed through k-fold cross-validation. We then apply the model to estimate the bedtimes of 51,372 sufficiently active, nonbot Reddit users with known time zones from the time stamps of their 140 million posts.

RESULTS

The Pearson correlation between expected and observed Reddit posting frequencies in our model was 0.997 on aggregate data. On average, posting starts declining 45 minutes before bedtime, reaches a nadir 4.75 hours after bedtime that is 87% lower than the daytime rate, and returns to baseline 10.25 hours after bedtime. The Pearson correlation between inferred and reported bedtimes for individual users was 0.61 (P<.001). In 90 of 159 cases (56.6%), our estimate was within 1 hour of the reported bedtime; 128 cases (80.5%) were within 2 hours. There was equivalent accuracy in hold-out sets versus training sets of k-fold cross-validation, arguing against overfitting. The model was more accurate than a random forest approach.

CONCLUSIONS

We uncovered a simple, reproducible relationship between Reddit users' reported bedtimes and the time of day when high daytime posting rates transition to low nighttime posting rates. We captured this relationship in a model that estimates users' bedtimes from the time stamps of their posts. Limitations include applicability only to users who post frequently, the requirement for time zone data, and limits on generalizability. Nonetheless, it is a step forward for inferring the sleep parameters of social media users passively at scale. Our model and precomputed estimated bedtimes of 50,000 Reddit users are freely available.

The Association of Contemporary Screen Behaviours with Physical Activity, Sedentary Behaviour and Sleep in Adolescents: a Cross-sectional Analysis of the Millennium Cohort Study

BACKGROUND

Screen behaviours are highly prevalent in adolescents and may be adversely associated with physical and mental health. Understanding how screen behaviours inter-relate with physical activity and sleep may help to clarify pathways through which they impact health and potential routes to behaviour change. This cross-sectional study examines the association of contemporary screen behaviours with physical activity, sedentary behaviour and sleep in adolescents.

METHOD

Data are from sweep 6 (2015/2016) of the Millennium Cohort Study, conducted when participants were aged 14 years. Outcome variables were accelerometer-assessed overall physical activity and moderate-to-vigorous physical activity (MVPA), self-reported sedentary behaviour and sleep duration. Screen behaviours were assessed using a 24-h time-use diary. Multivariable regression was used to examine the association between screen behaviours and each outcome variable separately for weekdays and weekend days.

RESULTS

The use of social network sites was associated with (beta coefficient, 95% confidence interval (CI); minutes/day) less time in MVPA (weekdays: - 5.2 (- 10.3, - 0.04); weekend: - 10.0 (- 15.5, - 4.5)), and sedentary behaviours (weekdays: - 19.8 (- 31.0, - 8.6); weekend: - 17.5 (- 30.9, - 4.1)). All screen behaviours were associated with shorter sleep duration on weekdays, whereas only the use of email/texts and social network sites was associated with shorter sleep duration on weekend days. The association of using social network sites with overall physical activity was stronger in girls than in boys; the association of internet browsing with sedentary behaviour was stronger in boys than in girls.

CONCLUSION

Intervention strategies to enhance MVPA and sleep duration by limiting screen-based activities may be warranted.

Contemporary screen time modalities and disruptive behavior disorders in children: a prospective cohort study

BACKGROUND

Cross-sectional studies have demonstrated associations between screen time and disruptive behavior disorders (conduct disorder and oppositional defiant disorder); however, prospective associations remain unknown. This study's objective was to determine the prospective associations of contemporary screen time modalities with conduct and oppositional defiant disorder in a national cohort of 9-11-year-old children.

METHODS

We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,875). Modified Poisson regression analyses were conducted to estimate the associations between baseline child-reported screen time (total and by modality) and parent-reported conduct or oppositional defiant disorder based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) at 1-year follow-up, adjusting for potential confounders.

RESULTS

Participants reported an average of 4 hr of total screen time per day at baseline. Each hour of total screen time per day was prospectively associated with a 7% higher prevalence of conduct disorder (95% CI 1.03-1.11) and a 5% higher prevalence of oppositional defiant disorder (95% CI 1.03-1.08) at 1-year follow-up. Each hour of social media per day was associated with a 62% higher prevalence of conduct disorder (95% CI 1.39-1.87). Each hour of video chat (prevalence ratio [PR] 1.21, 95% CI 1.06-1.37), texting (PR 1.19, 95% CI 1.07-1.33), television/movies (PR 1.17, 95% CI 1.10-1.25), and video games (PR 1.14, 95% CI 1.07-1.21) per day was associated with a higher prevalence of the oppositional defiant disorder. When examining thresholds, exposure to >4 hr of total screen time per day was associated with a higher prevalence of conduct disorder (69%) and oppositional defiant disorder (46%).

CONCLUSIONS

Higher screen time was prospectively associated with a higher prevalence of new-onset disruptive behavior disorders. The strongest association was between social media and conduct disorder, indicating that future research and interventions may focus on social media platforms to prevent conduct disorder.

What's "app"-ning to adolescent sleep? Links between device, app use, and sleep outcomes

This study investigated the associations between adolescent evening use of technology devices and apps, night time sleep, and daytime sleepiness. Participants were 711 adolescents aged 12-18 years old (46% Female, M_age = 15.1, SD = 1.2). Time spent using technology devices and apps in the hour before bed, and in bed before sleep onset, was self-reported. Participants additionally completed a questionnaire about their sleep on school nights and next day sleepiness. In the hour before bed, 30 min of phone use was associated with a 9-min delay in bedtimes. Thirty minutes spent using laptops, gaming consoles, and watching YouTube was associated with later lights out times of 9 min, ∼16 min and ∼11 min respectively, while watching TV was associated with a 9 min earlier lights out times. Using gaming consoles and watching YouTube were associated with greater odds of receiving insufficient sleep (≤7 h TST). In bed before sleep onset, 30 min spent using laptops, phones, iPad/tablets, and watching YouTube were linked with later lights out times of ∼7 min for phones and laptops, 9 min for iPad/tablets, and ∼13 min for YouTube. Watching Netflix was associated with greater daytime sleepiness. YouTube at this time point was associated with increased odds of sleeping ≤7 h on school nights. Adolescents are engaging with a wide range of technology devices and apps in the evenings. However, certain devices and apps (e.g., phones, laptops, gaming and YouTube) might lead to more negative sleep outcomes for adolescents on school nights compared to others.

Self-reported changes in sleep patterns and behavior in children and adolescents during COVID-19

The COVID-19 pandemic and lockdowns worldwide forced children and adolescents to change and adapt their lives to an unprecedented situation. Using an online survey, we investigated whether they showed changes in sleep quality and other related factors due to this event. Between February 21st, 2021 and April 19th, 2021, a total of 2,290 Austrian children and adolescents (6-18 years) reported their sleep habits and quality of sleep as well as physical activity, daylight exposure and usage of media devices during and, retrospectively, before the pandemic. Results showed an overall delay of sleep and wake times. Almost twice as many respondents reported having sleeping problems during the pandemic as compared to before, with insomnia, nightmares and daytime sleepiness being the most prevalent problems. Furthermore, sleeping problems and poor quality of sleep correlated positively with COVID-19 related anxiety. Lastly, results showed a change from regular to irregular bedtimes during COVID-19, higher napping rates, a strong to very strong decrease in physical activity and daylight exposure, as well as a high to very high increase in media consumption. We conclude that the increase in sleeping problems in children and adolescent during COVID-19 is concerning. Thus, health promoting measures and programs should be implemented and enforced.

Mental health professionals as influencers on TikTok and Instagram: What role do they play in mental health literacy and help-seeking?

BACKGROUND

Mental disorders are recognised as the leading causes of disability worldwide. Despite high rates of incidence, few young people pursue formal help-seeking. Low levels of mental health literacy have been identified as a contributing factor to the notable lack of formal help-seeking by young people. Social media offers a potential means through which to engage and improve young people's mental health literacy. Mental health influencers could be a means through which to do this.

OBJECTIVE

The objectives of this study were two-fold: (1) to systematically identify the most popular mental health professionals who could be classified as 'influencers'; and (2) to determine whether their content contributed to mental health literacy.

METHODS

The search function of Instagram and TikTok was used to generate a list of accounts owned by mental health professionals with over 100,000 followers. Accounts not in English, in private, with no posts in the last year or with content unrelated to the search terms were excluded. Accounts were assessed for number of followers, country of origin, verified status and whether a disclaimer was included. Using content analysis, the five most recent posts dating back from 15 November 2021 were analysed for purpose and dimensions of mental health literacy as outlined by Jorm (2000) by three separate reviewers.

RESULTS

A total of 28 influencer accounts were identified on TikTok and 22 on Instagram. Majority of the accounts on both TikTok and Instagram originated from the United States (n = 35). A greater number of accounts included disclaimer and crisis support information on Instagram (12/22, 54.55 %) than on TikTok (8/22, 36.36 %). A total of 140 posts were analysed on TikTok and 110 posts on Instagram. When addressing elements of mental health literacy from this sample, 23.57 % (33/140) TikTok posts and 7.27 %. (8/110) posts on Instagram enhanced the ability to recognise specific difficulties.

CONCLUSIONS

These platforms and accounts provide a potential means through which to make mental health information more accessible, however, these accounts are not subjected to any credibility checks. Careful consideration should be given to the impact of content created by mental health professionals and its role in supporting help-seeking.

"Leave your smartphone out of bed": quantitative analysis of smartphone use effect on sleep quality

Smartphones have become an integral part of people's everyday lives. Smartphones are used across all household locations, including in the bed at night. Smartphone screens and other displays emit blue light, and exposure to blue light can affect one's sleep quality. Thus, smartphone use prior to bedtime could disrupt the quality of one's sleep, but research lacks quantitative studies on how smartphone use can influence sleep. This study combines smartphone application use data from 75 participants with sleep data collected by a wearable ring. On average, the participants used their smartphones in bed for 322.8 s (5 min and 22.8 s), with an IQR of 43.7-456. Participants spent an average of 42% of their time in bed using their smartphones (IQR of 5.87-55.5%). Our findings indicate that smartphone use in bed has significant adverse effects on sleep latency, awake time, average heart rate, and HR variability. We also find that smartphone use does not decrease sleep quality when used outside of bed. Our results indicate that intense smartphone use alone does not negatively affect well-being. Since all smartphone users do not use their phones in the same way, extending the investigation to different smartphone use types might yield more information than general smartphone use. In conclusion, this paper presents the first investigation of the association between smartphone application use logs and detailed sleep metrics. Our work also validates previous research results and highlights emerging future work.

Association of outdoor activity time and screen time with sleep for 36 to 54 months children in Kaifu District, Changsha: A birth cohort study

OBJECTIVES

The prevalence rate of sleep problems in children in China is increasing in recent years. There are inconsistencies in the relationship between physical activity and sleep, and the impact of screen time on young children seems more obvious.This study aims to understand the current situation of outdoor activity time, screen time and sleep (total sleep duration, bedtime, and wake-up time) and the associations between outdoor activity time and screen time with sleep for children aged 36-54 months in Kaifu District of Changsha.

METHODS

Using the cluster sampling method, 1 286 newborns delivered in 3 community health service centers in Kaifu District, Changsha from January to December 2015 were selected as the research subjects to establish a prospective birth cohort. According self-designed questionnaire and household follow-up to select 36, 42, 48, 54 months Children's data. The mixed linear model was used to explore the associations of outdoor activity time and screen time with sleep.

RESULTS

The 36-54 months children's total sleep duration was decreased from 11.60 h/d to 10.92 h/d (P<0.001); bedtime time delayed from 21:58 to 22:00 (P=0.124); wake-up time advanced from 7:52 to 7:37 (P<0.001); outdoor activity time was decreased from 2.58 h/d to 1.94 h/d (P<0.001), and screen time was decreased from 1.28 h/d to 1.09 h/d (P<0.001). With aging, the prevalence of sleep <10 h/d and outdoor activity time <2 h/d was increased significantly, and the prevalence of screen time ≥1 h/d was decreased (P<0.05). Mixed linear models showed that longer outdoor activity time was related to increased total sleep duration (β=0.22, 95% CI 0.00 to 0.44) and delayed wake-up time (β=0.16, 95% CI 0.00 to 0.32), and longer screen time was related to delayed bedtime (β=0.22, 95% CI 0.05 to 0.39) and wake-up time (β=0.24, 95% CI 0.08 to 0.41). These associations were different in gender. Longer outdoor activity time was related to delayed wake-up time (β=0.37, 95% CI 0.14 to 0.59) in boys, but not in girls (β=-0.16, 95% CI -0.33 to 0.01). Longer screen time was associated with delayed bedtime (β=0.40, 95% CI 0.09 to 0.63) and wake-up time (β=0.33, 95% CI 0.15 to 0.51) in girls, but only related to delayed wake-up time (β=0.29, 95% CI 0.06 to 0.52) in boys, and the degree of association was lower than that of girls.

CONCLUSIONS

Among children aged 36-54 months in Kaifu District, Changsha, there are problems including going to bed late and getting up late, insufficient physical activity, and long screen time. Outdoor activity time and screen time are related to sleep. Increasing outdoor activity time and reducing screen time can help to improve children's sleep.

How university students changed their habits and developed mental disorders in the context of the coronavirus disease 2019 (COVID-19) pandemic in Japan: Three case reports

Background

Since the COVID-19 pandemic reached Japan in 2020, the country has faced an unprecedented increase in suicide rate and school refusal among adolescents, as well as increased rates of depression and anxiety among young people. However, the effects of the COVID-19 pandemic on adolescents in terms of changes in habits, the development of mental disorders, social isolation, and suicidal ideation remain largely unclear.

Case Presentation

We examined three cases of university students who changed their habits during the COVID-19 pandemic and developed mental disorders. All three cases had similar habitual changes, experienced loneliness, and developed depression and circadian rhythm sleep-wake disorder. Their habitual changes were delayed sleep and wake times, delayed first mealtime, a tendency to eat before sleeping, decreased social contact, increased digital media usage, and a tendency to use digital media before going to bed. We established a model of increasing mental health difficulties, school refusal, and suicidal ideation during the COVID-19 pandemic.

Conclusion

This report suggests possible approaches for preventing a decline in mental health during the COVID-19 pandemic among university students.

Association of Social Media Use on Sleep Quality and Performance Among Collegiate Athletes

OBJECTIVE

(1) To examine the effect of social media (SM) use on sleep quality and (2) to determine the effect of SM on competition performance among college athletes.

DESIGN

Cross-sectional study.

SETTING

Two local Division III colleges, MA, USA.

PARTICIPANTS

National Collegiate Athletic Association Division III swim and track and field athletes.

INTERVENTION

Data were collected onsite through an SM use form, the lifestyle survey, and the Patient-Reported Outcomes Measurement Information System Sleep Disturbance Questionnaire. Participants were divided into 3 groups based on their SM volume: (1) less active SM users (≤2 h/d), (2) moderately active SM users (>2-≤5 h/d), and (3) active SM users (>5 h/d) for analysis.

MAIN OUTCOME MEASURES

Sleep quality and sport performance data collected through publicly available competition results. The independent variable, SM volume (hours of SM use per day over 7 days), was collected using the iPhone screen time function.

RESULTS

The cohort consisted of 40 male track and field athletes and 47 female track and field (37, 79%) and swimming (10, 21%) athletes. Mean SM use was 4.6 ± 3.4 h/d. The sleep quality of active SM users was worse than less active SM users ( P = 0.033). There was an independent association between increased Facebook time and poor performance after adjusting confounders (adjusted odds ratio: 0.990, 95% confidence interval: 0.981-0.999, P = 0.049).

CONCLUSIONS

High SM use has a negative impact on sleep quality and may hinder competition performance among college athletes. These findings may have implications for developing SM use guidelines for college athletes to improve their sleep quality and performance.

Sleep health and its related influencing factors in primary and middle school students in Fuzhou: A large multi-center cross-sectional study

Background

This current study set out to investigate the status of sleep health in 7–20-year-old students in Fuzhou and explore the related influencing factors of sleep health.

Methods

A total of 38,467 children and adolescents in Fuzhou were included in the study through a random stratified cluster sampling. Data were collected from May to June 2019, in 18 primary schools and 18 middle schools from nine districts, Fuzhou. Children's parents and adolescents of sampled classes were invited to fill out a series of questionnaires about the performance of the last 6 months (sociodemographic characteristics, sleep-related lifestyle behaviors, and electronic-products usage). Multiple linear regression was carried out to analyze data.

Results

Of the total 40,888 questionnaires we released, 38,467 were valid and effective with the response rate was 94.08%. The age of the surveyed participants was 11.85 ± 3.1, including 20,013 boys and 18,454 girls. The multiple linear regression analysis identified factors associated with sleep health (p < 0.05): Boy (coef = 0.073, 95% CI: 0.030–0.115), age (coef = 1.797, 95% CI: 0.224–0.243), key school (coef = 2.069, 95% CI: 0.105–0.193), urban (coef = 0.096, 95% CI: 0.054–0.139), excessive daytime sleepiness (coef = 0.535, 95% CI: 0.432–0.639), unhealthy sleep habits (coef = 0.363, 95% CI: 0.307–0.419), eating before sleep (coef = 0.578, 95% CI: 0.527–0.630), using electronic products in bedroom (coef = 0.074, 95% CI: 0.028–0.121), screen time per day during school (coef = 0.260, 95% CI: 0.235–0.284), frequency of using electronics 30 min before bedtime (coef = 0.150, 95% CI: 0.134–0.166), strained relationship with parents (coef = 0.361, 95% CI: 0.270–0.452), strained relationship with peers (coef = 0.267, 95% CI: 0.171–0.363), excessive homework or learning (coef = 0.189, 95% CI: 0.141–0.237), time for doing homework (coef = 0.266, 95% CI: 0.245–0.287), and mood swings frequently (coef = 1.174, 95% CI: 1.127–1.221) negatively impact sleep health. Sleep alone (coef = −0.204, 95% CI: −0.262–0.147) were the risk factors for sleep health. Furthermore, frequent mood swings was considered the most influential factor on overall variables.

Conclusions

Sleep health is associated with factors covered sociodemographic characteristics, family sleep habits, and routine activities before bedtime. Multiple measures should be taken to improve sleep quality in a targeted manner.

Association between Recreational Screen Time and Sleep Quality among Adolescents during the Third Wave of the COVID-19 Pandemic in Canada

The study objective was to verify whether recreational screen time was associated with sleep quality among adolescents during the third wave of the COVID-19 pandemic in Canada. Data collection took place in four high schools in the region of Chaudière-Appalaches (Quebec, Canada) from the end of April to mid-May 2021. Recreational screen time and sleep quality were measured using the French versions of validated questionnaires specifically designed for adolescents. A total of 258 adolescents (14−18 years; 66.3% girls) answered the online survey. Adolescent boys had a higher total mean recreational screen time (454.3 ± 197.5 vs. 300.5 ± 129.3 min/day, p < 0.0001) and a higher total mean sleep quality score (4.2 ± 0.9 vs. 3.9 ± 0.8, p = 0.0364) compared to girls. Recreational screen time (β = −0.0012, p = 0.0005) and frequency of concurrent screen use (sometimes: β = −0.3141, p = 0.0269; often: β = −0.4147, p = 0.0048; almost always or always: β = −0.6155, p = 0.0002) were negatively associated with sleep quality while being a boy (β = 0.4276, p = 0.0004) was positively associated with sleep quality and age (p = 0.6321) was not. This model explained 16% of the variance in adolescents’ sleep quality. Public health interventions during and after the COVID-19 pandemic should target recreational screen time, concurrent screen use and especially girls to possibly improve sleep quality and promote adolescents’ physical and mental health.

Characteristics of Sleep Patterns in Adolescents: Comparisons between Saudi Arabia and the UK

There are concerns regarding sleep deprivation among adolescents, especially with mounting evidence for the importance of sleep during puberty, and its effects on health and families. The present study aimed to characterise sleep in typical development (TD) adolescents in Saudi Arabia, and compare their sleep profiles to TD adolescents in the UK, to evaluate sleep patterns in adolescents in Saudi Arabia, and to examine the relationship between sleep patterns and the use of social media in both groups. Findings from the current study reported a shorter sleep duration for the Saudi Arabia group than in previous studies and the UK group, which may be attributed to the lack of sleep hygiene practised in Saudi Arabia. Multiple analysis of variance results found significant differences in daytime sleepiness (p < 0.001) and a preference for morningness/eveningness (p < 0.001) between Saudia Arabia and UK adolescents. Statistically significant negative correlations (p > 0.05) between the duration of social media usage and sleep duration were found in both the Saudi Arabia and UK adolescents, where a lower number of sleep hours was observed with a higher duration of social media use. This study fills a gap in the research of sleep in Saudi Arabia in adolescents, and offers important insights on the comparison in sleep habits between Saudi Arabia and UK adolescents.

Usability of Smart Home Thermostat to Evaluate the Impact of Weekdays and Seasons on Sleep Patterns and Indoor Stay: Observational Study

Background

Sleep behavior and time spent at home are important determinants of human health. Research on sleep patterns has traditionally relied on self-reported data. Not only does this methodology suffer from bias but the population-level data collection is also time-consuming. Advances in smart home technology and the Internet of Things have the potential to overcome these challenges in behavioral monitoring.

Objective

The objective of this study is to demonstrate the use of smart home thermostat data to evaluate household sleep patterns and the time spent at home and how these behaviors are influenced by different weekdays and seasonal variations.

Methods

From the 2018 ecobee Donate your Data data set, 481 North American households were selected based on having at least 300 days of data available, equipped with ≥6 sensors, and having a maximum of 4 occupants. Daily sleep cycles were identified based on sensor activation and used to quantify sleep time, wake-up time, sleep duration, and time spent at home. Each household’s record was divided into different subsets based on seasonal, weekday, and seasonal weekday scales.

Results

Our results demonstrate that sleep parameters (sleep time, wake-up time, and sleep duration) were significantly influenced by the weekdays. The sleep time on Fridays and Saturdays is greater than that on Mondays, Wednesdays, and Thursdays (n=450; P<.001; odds ratio [OR] 1.8, 95% CI 1.5-3). There is significant sleep duration difference between Fridays and Saturdays and the rest of the week (n=450; P<.001; OR 1.8, 95% CI 1.4-2). Consequently, the wake-up time is significantly changing between weekends and weekdays (n=450; P<.001; OR 5.6, 95% CI 4.3-6.3). The results also indicate that households spent more time at home on Sundays than on the other weekdays (n=445; P<.001; OR 2.06, 95% CI 1.64-2.5). Although no significant association is found between sleep parameters and seasonal variation, the time spent at home in the winter is significantly greater than that in summer (n=455; P<.001; OR 1.6, 95% CI 1.3-2.3). These results are in accordance with existing literature.

Conclusions

This is the first study to use smart home thermostat data to monitor sleep parameters and time spent at home and their dependence on weekday, seasonal, and seasonal weekday variations at the population level. These results provide evidence of the potential of using Internet of Things data to help public health officials understand variations in sleep indicators caused by global events (eg, pandemics and climate change).

Circadian misalignment is associated with Covid-19 infection

Background

Circadian system contributes to the regulation of inflammatory processes, but the role of circadian misalignment as a risk factor for contracting Covid-19 has up to now been poorly studied. The aim of this study was to explore the relationship between circadian misalignment (chronic disturbance of the circadian system) and the risk of Covid-19 infection in a population of subjects suspected of contact or infection with SARS-CoV-2.

Methods

Cross-sectional single-center study conducted during a period without lockdown in winter 2021. Recruitment took place in a Covid-19 outpatient testing center. Subjects between 18 and 45 years old were included whether they were symptomatic or not, healthcare workers or not, in contact with a Covid-19 case or not. To determine social jetlag, a proxy of circadian misalignment, they were asked about their usual sleep-wake behaviors. Usual sleep duration and sleep-wake timing were explored on workdays and free days. Social jetlag was defined as at least 2 h shift of circadian alignment (defined as the difference between mid-sleep on workdays and mid-sleep on free days, mid-sleep as the median between bedtime and rise time).

Results

One thousand fourteen subjects were included (sampling rate: 10.8%, 39% men, mean age 28 ± 8) with 56 subjects positive for Covid-19 (positivity rate: 5.5%). Usual mean sleep duration was equivalent in both groups (7h47 versus 7h49, p = 0.733). Social jetlag greater than 2 h comprised 33.3% of subjects in the Covid-19 group versus 20.6% in the control group (p = 0.026). After adjustment on age, gender, BMI and work schedules, subjects presenting with social jetlag greater than 2 h had a 2.07-fold higher likelihood to test positive than subjects who had identical sleep-wake timing on workdays and free days (OR = 2.07, 95%CI = [1.12–3.80], p = 0.024).

Conclusion

Circadian misalignment not only is present in subjects infected by Covid-19 but could also be responsible for a higher likelihood of being infected. The chronobiological impact on the immune system or a higher likelihood of being exposed to social contacts during nocturnal activities could explain our findings, which need to be confirmed in a future large cohort study. Regular sleep-wake timing could ultimately become a target for preventing Covid-19 infection.

Lockdown impact on lifestyle and its association with oral parafunctional habits and bruxism in a Spanish adolescent population

AIM

To analyse the possible association between decreased physical and social activity and an increase in the use of mobile devices, internet, and social networks with increased anxiety and the appearance of oral parafunctions and bruxism for adolescents before and during COVID-19.

DESIGN

A total of 213 adolescents attended private clinics at two different times: before lockdown (T0) and after completion of total lockdown (T1). In T0 and T1, a clinical examination was carried out to assess dental wear (IA) and only in T1 were they given the self-report questionnaire which focuses on the periods before and during lockdown (self-reported bruxism, state anxiety, mobile phone and internet, social network use, physical and social activity, and questions on parafunctions).

RESULTS

There were a decrease in physical activity at T0-T1 and an increase in social media use, internet, state anxiety, and clinical and self-reported bruxism at T0-T1. There was a positive correlation between increased self-reported bruxism, increased social media use, mobile device use, and state anxiety.

CONCLUSIONS

There has been a change in adolescent lifestyle during lockdown with an increase in the prevalence of oral parafunctions and bruxism. In particular, the increase in the use of social networks at night and also in anxiety levels during lockdown were associated with of the increase in self-reported bruxism.

Associations between Sleep and Mental Health in Adolescents: Results from the UK Millennium Cohort Study

(1) Background: There is a growing interest in investigating the relationship between sleep and mental health development in adolescents. This study aims to further investigate this relationship by identifying the specific associations between several sleep problems in adolescents and several mental health areas, and the role of gender in these associations. (2) Methods: Data from the Millennium cohort survey containing 11,553 individuals at 13–14 years old was included. Nighttime sleep duration and bedtime during weekdays and weekends, night awakening frequency, and sleep onset latency were assessed using self-reported questionnaires. Affective symptom and emotional and behavioural problems were examined with self-reported questionnaires. (3) Results: Regression analyses and path analysis models suggested that frequent night awakening was associated with all the outcomes, and hyperactivity/inattention was the outcome that presented a higher number of significant associations with sleep patterns. Long sleep onset latency and late bedtime at school days were associated with higher risk of emotional and behavioural difficulties. Further, poor sleep seems to manifest more externally in males, while more internally in females. (4) Conclusions: Specific sleep problems should be considered when assessing mental health in adolescence, which would allow more targeted prevention and intervention strategies. Further, special attention should be given to gender differences when addressing sleep and mental health.

A trans-diagnostic cognitive behavioural conceptualisation of the positive and negative roles of social media use in adolescents’ mental health and wellbeing

Whilst research into the association between social media and mental health is growing, clinical interest in the field has been dominated by a lack of theoretical integration and a focus on pathological patterns of use. Here we present a trans-diagnostic cognitive behavioural conceptualisation of the positive and negative roles of social media use in adolescence, with a focus on how it interacts with common mental health difficulties. Drawing on clinical experience and an integration of relevant theory/literature, the model proposes that particular patterns of social media use be judged as helpful/unhelpful to the extent that they help/hinder the adolescent from satisfying core needs, particularly those relating to acceptance and belonging. Furthermore, it introduces several key interacting processes, including purposeful/habitual modes of engagement, approach/avoidance behaviours, as well as the potential for social media to exacerbate/ameliorate cognitive biases. The purpose of the model is to act as an aide for therapists to collaboratively formulate the role of social media in young people’s lives, with a view to informing treatment, and ultimately, supporting the development of interventions to help young people use social media in the service of their needs and values.

Key learning aims

(1)

Cyberbullying involvement and short sleep duration among adolescents

BACKGROUND

Research has shown that cyberbullying victimization is associated with short sleep duration among adolescents; however, the association between cyberbullying perpetration and sleep duration is unclear. Furthermore, little is known about the factors that could moderate these associations. Thus, the objectives of this study were to investigate the associations of cyberbullying victimization, perpetration, or both with short sleep duration among adolescents, and to test whether age, sex, and adherence to the screen time recommendations (≤2 hours/day) moderate these associations.

METHODS

Data on 6834 adolescents aged 11-20 years were derived from a representative cross-sectional study of middle and high school students across Ontario, Canada. Short sleep duration was self-reported and defined as sleeping less than the age-appropriate sleep duration recommendations. Multivariable logistic regression models were adjusted for important covariates. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) are reported.

RESULTS

Cyberbullying victimization (AOR = 1.60, 95% CI = 1.37-1.86), perpetration (AOR = 1.44, 95% CI = 1.16-1.79), or both perpetration and victimization (AOR = 1.71, 95% CI = 1.27-2.30) was associated with greater odds of short sleep duration. Results further indicated that younger students who were not cyberbullied had a lower probability of short sleep duration, but there was no difference in the probability of short sleep duration between being cyberbullied or not among older adolescents. Sex and screen time did not moderate any of the associations between cyberbullying involvement and short sleep duration.

CONCLUSION

Involvement in cyberbullying as either a victim, a perpetrator, or both is associated with short sleep duration among adolescents. Strategies that can help to eliminate cyberbullying are needed in public health.

Sleep in the time of COVID-19: findings from 17000 school-aged children and adolescents in the UK during the first national lockdown

STUDY OBJECTIVES

Sleep is essential to young people's wellbeing, yet may be constricted by the adolescent delayed sleep phase coupled with school start times. COVID-19 restrictions caused major disruptions to everyday routines, including partial school closures. We set out to understand changes in students' self-reported sleep quality, and associations with mental wellbeing and interpersonal functioning, during these restrictions.

METHODS

The OxWell school survey-a cross-sectional online survey-collected data from 18 642 children and adolescents (aged 8-19 years, 60% female, school year 4-13) from 230 schools in southern England, in June-July 2020. Participants completed self-report measures of the impact of COVID-19 restrictions on sleep quality, happiness, and social relationships. Sleep timing was compared with data collected from 4222 young people in 2019.

RESULTS

Females and older adolescents were more likely to report deteriorations in sleep during the national lockdown. Regression analysis revealed that changes in happiness (β = .34) and how well students were getting on with others in their household (β = .07) predicted change in sleep quality. Students' bedtimes and wake times were later, and sleep duration was longer in 2020 compared to the 2019 survey. Secondary school students reported the greatest differences, especially later wake times.

CONCLUSIONS

During COVID-19 restrictions, sleep patterns consistent with adolescent delayed sleep phase were observed, with longer sleep times for secondary school students in particular. Perceived deteriorations in sleep quality were associated with reductions in happiness and interpersonal functioning, highlighting the importance of including sleep measures in adolescent wellbeing research.

Increased digital media use is associated with sleep problems among university students: A study during the COVID-19 pandemic in Japan

This retrospective cohort study investigates the association between the incidence of sleep problems and changes in digital media use among university students during the COVID-19 pandemic. It used data from annual health check-ups performed at a Japanese university in 2019 and 2020. Students undergoing these check-ups were identified to respond to questions about sleep problems, digital media use, breakfast and exercise habits, and stress. In total, 3,869 students were included in the analysis. The association between the incidence of sleep problems in 2020 and the changes in digital media use between 2019 and 2020 was assessed using logistic regression models. The rate of long digital media use (≥ 2 hours) in 2019 was 42.6%, while in 2020 it was 53.6%. Incidence of sleep problems was observed in 244 students (6.3%) in 2020. There were 786 students (20.3%) who used digital media for ≤ 2 h in 2019 and ≥ 2 h in 2020. From the sample, 66 students (8.4%) reported incidence of sleep problems in 2020. Additionally, those respondents who specifically reported increased digital media use between 2019 and 2020 (increased use) where at greater risk (OR: 1.76; 95% CI: 1.21, 2.55) of reporting sleep problems in 2020, even after controlling for other study variables. Thus, this study provides evidence that the incidence of sleep problems has had a significant association with an increase in digital media use among university students throughout the COVID-19 pandemic. These findings highlight the importance of ensuring appropriate digital media use among students for improved quality of sleep.

Use of digital screens by adolescents and association on sleep quality: a systematic review

This study aimed to analyze the influence of digital screen use on adolescents’ quality of sleep. This systematic review was recorded on PROSPERO (CRD42020203403) and conducted according to PRISMA guidelines. Studies covering adolescents from 10 to 19 years were included without language or publication restrictions which answered the following guiding question: “Does the use of digital screen influence adolescents’ quality sleep?”. Article search included the following databases: (MEDLINE/PubMed), LILACS, SciELO, Scopus, EMBASE, Web of Science, IBECS, Cochrane Library, ClinicalTrials.gov, and Open Gray. The following descriptors were used: “Sleep Quality”, “Screen Time”, and “Adolescent”. The Newcastle-Ottawa Scale (NOS) assessed the methodological quality of the cohort studies, and a modified NOS was used to assess the cross-sectional ones. In total, 2,268 articles were retrieved, of which 2,059 were selected for title and abstract reading, after duplicates were deleted. After this stage, 47 articles were selected for full reading, resulting in the 23 articles which compose this review. Excessive use of digital screens was associated with worse and shorter sleep, showing, as its main consequences, night awakenings, long sleep latency, and daytime sleepiness. The use of mobile phones before bedtime was associated with poor quality of sleep among adolescents. Our evaluation of the methodological quality of the chosen studies found seven to be poor and 16, moderate.

#Skinny girls: young girls' learning processes and health-related social media

This paper provides in-depth knowledge into young girls' learning processes in relation to physical activity, diet/nutrition and body image. Data were generated from interviews with 49 girls (age 13-15) in England. The practical epistemological analysis technique was used to explore young people as both producers and consumers, or prosumers, of content and knowledge. The data illustrate that adolescent girls navigate two interrelated health-related paradoxes within publicly private spaces: (i) skinny fat and (ii) naturally fake. Skinny fat refers to how participation in social media represents a continuous struggle of becoming skinny, but at the same time not trying too hard to become too skinny. Naturally fake refers to how having a 'natural' look is highly valued, but equally, it is acceptable to be 'fake'. Overall, adolescent girls are competent users of social media, who are able to navigate the complexity of the medium and its contents. At the same time, the adolescent girls sometimes found themselves, unintentionally, exposed to risks (e.g. bullying or body dysmorphia), particularly when social media was experienced publicly in a temporal order, connected to the past or present, and without control of potential future effects and impacts. Relevant adults should acknowledge young people's vast competence of life on social media and further empower young people to self-regulate their learning through social media, and in ways that help them to learn from experiences about their health and bodies to shape future actions.

Exploring the “Social” in Social Media: Adolescent Relatedness—Thwarted and Supported

The pervasiveness of social media in adolescents’ lives has important implications for their relationships. Considering today’s adolescents have grown up with social media, research capturing their unique perspectives of how social media impacts their relationships is needed to increase understanding and help guide behaviors that nurture social-connectedness. Utilizing multiple qualitative methods, this study explores adolescents’ perspectives of how their social media use impacts their relationships. The sample comprised 36, Year 9 students aged 15 years from four metropolitan schools in Melbourne, Australia. All participants completed a rich picture mapping activity and focus group discussions. To gain deeper understandings, a sub-sample of 11 adolescents participated in subsequent one-on-one interviews. Reflexive thematic analysis generated two overarching themes (1) developing and strengthening relationships and (2) diminishing relationships. Sub-themes included; making new friends, maintaining relationships, deepening connections, enhancing belonging, rifts and strains, and anti-social behavior. Findings revealed nuanced insights into “how” and “why” adolescents believe social media impacts relationships. Adolescents explained that social media transforms interactions through amplifying and intensifying relational experiences resulting in both beneficial and detrimental outcomes for their relationships. Cultivating the positive aspects of adolescents’ social media use whilst mitigating the negative is important toward supporting relatedness and fostering wellbeing.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Electronic media use and sleep in children and adolescents in western countries: a systematic review

Background

Sleep is essential for child and adolescent health and well-being. There is an increasing interest in whether electronic media use affects children and young adolescents’ sleep. Prior reviews have focused on a school-aged population. Moreover, it is crucial that research continuously addresses the processes of technology and media use and the implication on sleep. This systematic review examines the evidence of electronic media use related to sleep among 0–15-year-olds.

Methods

Searches were carried out in four databases (CINAHL, Web of Science, EMBASE, and Medline). Inclusion criteria included age ≤ 15 years, and intervention, cohort, or cross-sectional studies from western countries. Methodological quality was rated using the Quality Assessment Tool for Quantitative Studies by two independent reviewers. Data was extracted using a standardized data extraction form. Synthesis was done by summarizing results across studies by age groups of 0–5, 6–12, and 13–15 years within four sleep domains: Bedtime and sleep onset; Sleep quality; Sleep duration; Daytime tiredness.

Results

The search identified 10,719 unique studies, of which 109 fulfilled inclusion and exclusion criteria and were assessed for methodological quality. In total, 49 studies were included in the review. The study designs were randomized controlled trials (n = 3), quasi-experimental studies (n = 2), prospective cohort studies (n = 15), and cross-sectional studies (n = 29). Evidence for an association between electronic media use and sleep duration was identified, with stronger evidence for 6–15-years-olds than 0–5-year-olds. The evidence for a relationship between electronic media use and other sleep outcomes was more inconclusive. However, for 6–12-year-old children, there was evidence for associations of electronic media use with delayed bedtime and poor sleep quality. For 13–15-year-olds, there was evidence for associations between screen time and problems falling asleep, and between social media use and poor sleep quality.

Conclusions

Overall, electronic media use was generally associated with shorter sleep duration in children and adolescents. Studies with stronger research design and of higher quality are needed to draw solid conclusions about electronic media’s impact on other sleep outcomes. Public awareness and interventions could be promoted about the potential negative impact on children’s sleep of electronic media devices that are used excessively and close to bedtime.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11640-9.

Contemporary Variables that Impact Sleep and Development in Female Adolescent Swimmers and Gymnasts

The effects of sleep on elite athletes in late adolescence and early adulthood have been well documented in a myriad of sports. However, there is underrepresentation of pre-pubertal and young female adolescent athlete research between the ages of 11-17, and specifically female gymnast and swimmers. Neglecting to understand how high energy demand at a young age relates to sleep and restoration may lead to developmental ramifications for this group, as they display physiological dysfunctions like delayed puberty, amenorrhea and are at risk for the female athlete triad or components of the triad. This review aims to summarize the contemporary variables of blue light emitting screens, social media, and caffeine on quality and quantity of sleep in young athletes while identifying gaps in the literature on how these factors impact the target group of young female swimmers and gymnasts.  The implications of this work include sleep hygiene recommendations for increasing duration and quality of sleep, as well as future research with respect to electronic device usage, social media participation, caffeine consumption, and sport engagement in female early adolescent athletes.

Social Media Addiction in High School Students: A Cross-Sectional Study Examining Its Relationship with Sleep Quality and Psychological Problems

The aim of this study was to examine the relationship of social media addiction with sleep quality and psychological problems in high school students. The study is a cross-sectional, correlational type. The study was conducted with 1,274 students receiving education in a district located in the western region of Turkey. For the collection of the data, a Descriptive Information Form, the Social Media Addiction Scale for Adolescents (SMASA), the Strengths and Difficulties Questionnaire (SDQ), the Sleep Quality Scale (SQS) and the Sleep Variables Questionnaire (SVQ) were used. Among the high school students who participated in the research, 49.3% stated that they had been using social media for 1-3 years, 53.9% reported that they spent 1-3 h per day on social media, and 42.8% stated that they placed their telephone under their pillow or beside their bed while sleeping. Students' mean scores were 16.59 ± 6.79 (range: 9-45) for the SMASA, 16.54 ± 4.27 (range: 0-40) for total difficulties, and 14.18 ± 1.56 (range: 7-21) for the SQS, while their sleep efficiency value was 97.9%. According to the research model, difficulties experienced by high school students increase their social media addiction, while they decrease prosocial behaviours. Social media addiction in high school students decreases students' sleep efficiency (p < 0.05). It is considered important to conduct further public health studies for children and adolescents related to the risks caused by the excessive use of technology, the consequences of social media addiction, measures to protect psychological health, sleep programmes and the importance of sleep quality.

Digital dermatoses: skin disorders engendered by social media in tweens and teens

PURPOSE OF REVIEW

Photograph-based social media use among children and adolescents has skyrocketed over the past decade, raising concerns about the implications for self-confidence and behavior in this population. Social media 'challenges' encourage participants to complete potentially dangerous tasks while sharing their completion of the tasks on social media. Many of these challenges affect the skin and lead to recognizable findings on physical examination. This review discusses the history of prominent social media challenges and their effects on the skin. Attention is also given to the effects of social media trends on self-confidence and body image in children and adolescents.

RECENT FINDINGS

Over the past several years, there have been several notable social media trends that can harm the skin. These include the Kylie Jenner lip challenge, salt and ice challenge, deodorant challenge, eraser challenge, fire challenge, and hot water challenge. Participation in these challenges can cause morbidity in children and adolescent that should be recognized by clinicians.

SUMMARY

Social media has become an important platform for communication and self-expression among children and adolescents. Pediatricians should remain aware of social trends in this age group and look out for cutaneous findings that may signal dangerous behavior on social media.

Quantity, Content, and Context Matter: Associations Among Social Technology Use and Sleep Habits in Early Adolescents

PURPOSE

This study aimed to investigate the associations of social technology access and content, bedtime behaviors, parental phone restrictions, and timing and duration of sleep on school nights in early adolescents.

METHODS

Adolescents (aged 11-15 years, n = 772) in the Northeast U.S. completed an online survey during or after school in spring 2019.

RESULTS

Quantity of social technology use (e.g., checking social media, problematic internet behaviors, mobile use), content viewed (e.g., emotional or violent videos, risky behaviors), and social context (e.g., bedtime behaviors, starting social media at an early age) were significantly related to later bedtimes and fewer hours of sleep on school nights. Parental rules restricting mobile phone and online use before bed and obtaining a smartphone at a later age were associated with increased sleep time and earlier bedtime.

CONCLUSIONS

Quantity, content, and context of social technology use may affect sleep timing and duration in early adolescents.

Young People's health-related learning through social media: What do teachers need to know?

International regulatory bodies have argued that young people should be better supported to engage safely, responsibly and effectively with social media. This paper considers ways in which the introduction of structured social media engagement in schools could bring educational benefits for young people, particularly in supporting them to deal with challenges relating to health and wellbeing. New evidence is provided on: (i) the value of social media as a health-related learning tool to bridge informal and formal learning contexts; (ii) how teachers should be supported to better understand and respond to young people's learning needs; and (iii) the school-based policies, expectations and resources that will help teachers to offer relevant support.