Virtually impossible: limiting Australian children and adolescents daily screen based media use

The impact of parental migration on screen exposure among children aged 1-66 months in rural China

BACKGROUND

Screen exposure, particularly recreational screen exposure, is an integral part of children's lives. However, little is known about how family factors influence children's excessive screen exposure, especially in the context of 69 million left-behind children experiencing parent-child separation in China. This study mainly concentrates on the correlation between parental migration, type of caregiver, depression and disciplinary practices of the caregiver and children's screen exposure, including average daily screen time (on weekdays or weekends) and screen content (recreational activities or learning activities).

METHODS

For a cross-sectional study, we collected data of family basic features, parental migration status and children's screen use in the past week from caregivers of 1,592 children aged 1-66 months in Anhui province. Children were classified into left-behind children (LBC), previously left-behind children (PLBC) and never left-behind children (NLBC) based on their parental migration. Multiple linear regression and binary logistic regression were used to identified the association between family factors and children's screen exposure.

RESULTS

Overall, PLBC had higher rates of screen exposure, as well as higher average daily exposure times, than NLBC and LBC. The results of logistic regression showed that PLBC had a higher likelihood of excessive screen use compared to NLBC (60 min/day, OR = 1.40, p < 0.05; 120 min/day, OR = 1.76, p < 0.05). The higher the score of disciplinary practices, the less time children spent on screens for entertainment (B = -3.37, p < 0.01).

CONCLUSIONS

Our findings provide insights into the risks of children's screen exposure in different contexts of parental migration. The study emphasizes the urgent need to pay attention to PLBC's screen use and to strengthen caregivers' discipline and supervision over children's screen exposure.

The impact of social media screen-exposure time on suicidal ideation among Pakistani adolescents

BACKGROUND

Adolescence is a crucial life stage for the individual identity formation. The growing employment of social media and screen-exposure among teenagers and the concerning rise in suicide ideation rates in this susceptible group both suggested this study. Thus, we explored the association between adolescents' suicidal ideation and their daily social media screen-exposure.

METHODS

We surveyed 502 students, aged 13 to 19 years old, recruited in colleges and universities of Punjab, Pakistan. The survey was based on a 28-item self-reported questionnaire and demographic data collection.

RESULTS

Approximately 40% of adolescents reporting suicidal ideation showed an extended social media screen-exposure, as well as significant depressive feelings and problematic personality traits. In particular, suicidal ideation increased by 0.39 for each one-unit increase in screen-exposure time and levels of depression increased by 0.21 times by unit of screen-exposure. The correlation coefficients further indicated a moderate positive association between depression and suicidal thoughts as well as personality traits played as mediators between social media screen-exposure time and suicidal ideation among adolescents.

CONCLUSION

Our study found a positive association, even if modest, between the use of social media screens and suicidal ideation among adolescents. This evidence may suggest to adopt specific strategies to address the use of media among youths and prevent mental disorders related to the prolonged and inappropriate use of digital technologies in those users with a vulnerable personality.

Screen time and mental health: a prospective analysis of the Adolescent Brain Cognitive Development (ABCD) Study

BACKGROUND

Despite the ubiquity of adolescent screen use, there are limited longitudinal studies that examine the prospective relationships between screen time and child behavioral problems in a large, diverse nationwide sample of adolescents in the United States, which was the objective of the current study.

METHODS

We analyzed cohort data of 9,538 adolescents (9-10 years at baseline in 2016-2018) with two years of follow-up from the Adolescent Brain Cognitive Development (ABCD) Study. We used mixed-effects models to analyze associations between baseline self-reported screen time and parent-reported mental health symptoms using the Child Behavior Checklist, with random effects adjusted for age, sex, race/ethnicity, household income, parent education, and study site. We tested for effect modification by sex and race/ethnicity.

RESULTS

The sample was 48.8% female and racially/ethnically diverse (47.6% racial/ethnic minority). Higher total screen time was associated with all mental health symptoms in adjusted models, and the association was strongest for depressive (B = 0.10, 95% CI 0.06, 0.13, p < 0.001), conduct (B = 0.07, 95% CI 0.03, 0.10, p < 0.001), somatic (B = 0.06, 95% CI 0.01, 0.11, p = 0.026), and attention-deficit/hyperactivity symptoms (B = 0.06, 95% CI 0.01, 0.10, p = 0.013). The specific screen types with the greatest associations with depressive symptoms included video chat, texting, videos, and video games. The association between screen time and depressive, attention-deficit/hyperactivity, and oppositional defiant symptoms was stronger among White compared to Black adolescents. The association between screen time and depressive symptoms was stronger among White compared to Asian adolescents.

CONCLUSIONS

Screen time is prospectively associated with a range of mental health symptoms, especially depressive symptoms, though effect sizes are small. Video chat, texting, videos, and video games were the screen types with the greatest associations with depressive symptoms. Future research should examine potential mechanisms linking screen use with child behavior problems.

Trajectories of Loneliness During Adolescence Predict Subsequent Symptoms of Depression and Positive Wellbeing

There is a need to identify the outcomes of changes in loneliness during adolescence, and to consider this within a multidimensional framework of loneliness. This study considered the effects of different trajectories of change in Isolation Loneliness and in Friendship Loneliness upon both positive wellbeing and symptoms of depression. To achieve this, 1782 (43% female; 12.92 years old at the start of the study, SD = 1.60) young people took part in a longitudinal study with four data points across 2 years. Four Isolation Loneliness trajectories and five Friendship Loneliness trajectories were identified. Youth who experienced low levels of Isolation Loneliness that subsequently increased appear to be at particular risk for poor outcomes. Similarly, initially high levels of Friendship Loneliness that decreased rapidly, or which began at a low level and only increased marginally, seem to also be a risk. Loneliness is a multi-dimensional construct and its development during adolescence impacts upon young people's depressive symptomatology and positive mental wellbeing.

Replacing screen time, with physical activity and sleep time: influence on cardiovascular indicators and inflammatory markers in Brazilian children

OBJECTIVE

To examine if the substitution of different screen time intervals with light physical activity (LPA), moderate to vigorous physical activity (MVPA) and sleep is associated with cardiovascular indicators and inflammatory markers in children.

METHODS

This is a cross-sectional study developed with 186 children aged between six and 11 years old from public schools in southern Brazil. CRF was measured with the 6-minute running and walking test, following the Brazil Sports Project procedures. The percentage of fat was evaluated through DXA. LPA and MVPA were measured using accelerometers. Sleep and screen time were assessed by questionnaires answered by parents. Leptin and C-reactive protein were measured by fasting blood collection. Systolic and diastolic blood pressure were determined through a digital sphygmomanometer. Isotemporal substitution models were used for statistical analysis.

RESULTS

Replacing 1 h of screen time with MVPA was associated with lower BMI, systolic and diastolic blood pressure, fat percentage, leptin, and C-reactive protein. When screen time was substituted for sleep time, lower waist circumference was observed. Regarding the substitution of 1 h of screen time with LPA, significant values were found only for leptin.

CONCLUSION

The replacement of screen time with physical activities of different intensities and sleep time was associated with benefits in cardiovascular indicators and inflammatory markers in childhood.

Impact of digital screen media activity on functional brain organization in late childhood: Evidence from the ABCD study

The idea that the increased ubiquity of digital devices negatively impacts neurodevelopment is as compelling as it is disturbing. This study investigated this concern by systematically evaluating how different profiles of screen-based engagement related to functional brain organization in late childhood. We studied participants from a large and representative sample of young people participating in the first two years of the ABCD study (ages 9-12 years) to investigate the relations between self-reported use of various digital screen media activity (SMA) and functional brain organization. A series of generalized additive mixed models evaluated how these relationships related to functional outcomes associated with health and cognition. Of principal interest were two hypotheses: First, that functional brain organization (assessed through resting state functional connectivity MRI; rs-fcMRI) is related to digital screen engagement; and second, that children with higher rates of engagement will have functional brain organization profiles related to maladaptive functioning. Results did not support either of these predictions for SMA. Further, exploratory analyses predicting how screen media activity impacted neural trajectories showed no significant impact of SMA on neural maturation over a two-year period.

Severity of slouched posture during smartphone use is associated with the musculoskeletal discomfort, daily usage, and school year among adolescents

Real-time measurement of the craniovertebral, thoracic kyphosis, and lumbar lordosis angles during natural and smartphone usage postures in sitting were analysed in a cohort of 560 adolescents using independent t-tests and Spearman's correlations between their reported musculoskeletal symptoms, daily device use and school year. Students with musculoskeletal symptoms (mean difference: 4.1-9.4°, p < .001) and in secondary schools (mean difference: 13.6-29.4°, p < .001) had a greater forward-head posture quantified by craniovertebral angle in both postures. Loss of lumbar lordosis was found in students spending ≥2 h/day on electronic devices (mean difference: 3.2°, p = .029) and those with musculoskeletal symptoms (mean difference: 5.4°, p = .001). Secondary school students exhibited a greater thoracic kyphosis when using smartphones (mean difference: 3.3°, p = .003). Findings suggest the urgent need for early and proactive intervention targeted to minimise the risk of developing musculoskeletal disorders related to intense device use for young adolescents.Practitioner Summary: Adolescents: (1) in higher school year had increased forward-head posture (FHP) and thoracic kyphosis; (2) with musculoskeletal symptoms had increased FHP and loss of lumbar lordosis, and; (3) with extended device use had a loss of lumbar lordosis. Early intervention targeting young adolescents promoting optimal posture and habit of device use is warranted.

Excessive use of electronic devices among children and adolescents is associated with musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life: a cross-sectional study

Objective

Electronic devices have become an indispensable part of our daily lives. The frequency and duration of device use in children and adolescents have increased drastically over the years and the study of its negative musculoskeletal, visual and psychosocial health impacts is necessary.

Materials and methods

This cross-sectional study aimed to evaluate the associations between electronic device use and the prevalence and severity of musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life in children and adolescents studying at primary and secondary schools. Data were collected through confidential online and paper-and-pencil questionnaires. Primary 4-5 and Secondary 1-4 students were recruited from 3 schools in Hong Kong. Demographics, frequency and duration of electronic device use, frequencies of musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life outcomes were measured.

Results

1,058 children and adolescents aged 9-17  years participated. Sixty-one percent and 78% of all students spent more than 2  h per day using electronic devices during school days and weekend/holidays, respectively. Extended electronic device use was associated with increased prevalence and severity of musculoskeletal symptoms (ρ's = 0.28-0.33, P's < 0.001), visual symptoms (ρ's = 0.33-0.35, P's < 0.001), and poorer device use-related psychosocial health (ρ's = 0.38-0.47, P's < 0.001). Secondary school students reported greater device use and severity of symptoms than primary school students.

Conclusion

Excessive electronic device use was associated with increased prevalence and severity of physical and psychosocial symptoms, and such use is more prevalent in adolescents when compared to the children. The findings have important health implications for children and adolescents, suggesting that early intervention is needed to reduce the risk of developing device use-related disorders.

The role of life satisfaction in the association between problematic technology use and anxiety in children and adolescents during the COVID-19 pandemic

The main aim of this study is to explore problematic technology use among adolescents (Internet, video games, mobiles, and television) and its association with anxiety symptoms. Furthermore, we also analysed the possible moderating role of life satisfaction in this relationship during the COVID-19 pandemic in Spain. A cross-sectional survey of 4025 children and adolescents (52% females and 48% males) between 12 and 18 years old was carried out to explore problematic technology use and its correlation with anxiety and life satisfaction after pandemic lockdown. Four multivariate regressions containing the independent variable (problematic technology use), the moderator (life satisfaction), and their interaction were entered to predict the outcome (anxiety). The moderated models were examined using SPSS PROCESS macro software (Model 1). Analyses showed significant positive correlations with anxiety and negative correlations with life satisfaction regarding problematic technology use (mobile phone, television, and internet). Both gender and age had a significant direct effect on anxiety (showing that women and older participants had the greatest anxiety). In the moderation analysis, when life satisfaction was higher, the presence of anxiety symptoms depended to a greater extent on the problematic use of technology. Our results confirm that problematic technology use is related to higher levels of anxiety in adolescents, with differences by age and gender. The results also showed that life satisfaction mediated the relationship between technology abuse and anxiety, such that when life satisfaction was higher, the presence of anxiety symptoms was more dependent on problematic technology use. These findings have implications for health and education professionals.

Youth screen use in the ABCD® study

Adolescent screen usage is ubiquitous and influences development and behavior. Longitudinal screen usage data coupled with psychometrically valid constructs of problematic behaviors can provide insights into these relationships. We describe methods by which the screen usage questionnaire was developed in the Adolescent Brain Cognitive Development (ABCD) Study, demonstrate longitudinal changes in screen usage via child report and describe data harmonization baseline-year 2. We further include psychometric analyses of adapted social media and video game addiction scales completed by youth. Nearly 12,000 children ages 9-10 years at baseline and their parents were included in the analyses. The social media addiction questionnaire (SMAQ) showed similar factor structure and item loadings across sex and race/ethnicities, but that item intercepts varied across both sex and race/ethnicity. The videogame addiction questionnaire (VGAQ) demonstrated the same configural, metric and scalar invariance across racial and ethnic groups, however differed across sex. Video gaming and online social activity increased over ages 9/10-11/12 (p's < 0.001). Compared with boys, girls engaged in greater social media use (p < .001) and demonstrated higher ratings on the SMAQ (p < .001). Compared with girls, boys played more video games (p < .001) and demonstrated higher ratings on the VGAQ (p < .001). Time spent playing video games increased more steeply for boys than girls from age 9/10-11/12 years (p < .001). Black youth demonstrated significantly higher SMAQ and VGAQ scores compared to all other racial/ethnic groups. These data show the importance of considering different screen modalities beyond total screen use and point towards clear demographic differences in use patterns. With these comprehensive data, ABCD is poised to address critical questions about screen usage changes across adolescence.

Unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents

BACKGROUND

It is well known that some lifestyle-related behaviors are related to depressive symptoms, but the unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents are still controversial.

AIMS

The aims of this study were to examine the unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents, and explored the potential influences of gender difference on these associations.

METHODS

We conducted a cross-sectional study among 3967 Chinese adolescents aged 11 to 19 from Jilin, China during September and October of 2018. Students reported their lifestyle factors including sleep duration, time spent on computer, time spent on television, time spent on homework, eating breakfast, smoking, drinking, physical activity, and outdoor activity. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

The prevalence of depressive symptoms was 28.2% among Chinese adolescents. Multivariate logistic regression analysis revealed that sleep duration <8 hour/day, time spent on homework ⩾3 hour/day, skipping breakfast, alcohol use, physical activity <3 days/week, and outdoor activity <2 hour/day were positively associated with depressive symptoms in both girls and boys. Time spent on computer ⩾2 hour/day was an independent risk predictor for depressive symptoms in males, while smoking only showed higher risk of depressive symptoms in females. There was an additive relationship between the lifestyle risk index scores and the risk of depressive symptoms for both genders, the relationship being strongest among females.

CONCLUSION

The important role of lifestyle factors should be taking into consideration when create intervention programs to prevent and reduce depressive symptoms among adolescents. In addition, preventive interventions may need to focus on gender-informed approaches when targeting multiple lifestyle factors.

Association of Night-Time Screen-Viewing with Adolescents' Diet, Sleep, Weight Status, and Adiposity

Night-time screen-viewing (SV) contributes to inadequate sleep and poor diet, and subsequently excess weight. Adolescents may use many devices at night, which can provide additional night-time SV. Purpose: To identify night-time SV patterns, and describe differences in diet, sleep, weight status, and adiposity between patterns in a cross-sectional and longitudinal manner. Methods: Adolescents (10–16 y) reported devices they viewed at night and completed food recalls. Accelerometry, anthropometrics, and imaging were conducted to measure sleep, weight status, and adiposity, respectively. Latent class analysis was performed to identify night-time SV clusters. Linear regression analysis was used to examine associations between clusters with diet, sleep, weight status, and adiposity. Results: Amongst 273 adolescents (12.5 ± 1.9 y, 54% female, 59% White), four clusters were identified: no SV (36%), primarily cellphone (32%), TV and portable devices (TV+PDs, 17%), and multiple PDs (17%). Most differences in sleep and adiposity were attenuated after adjustment for covariates. The TV+PDs cluster had a higher waist circumference than the no SV cluster in cross-sectional analysis. In longitudinal analysis, the primarily cellphone cluster had less change in waist circumference compared to the no SV cluster. Conclusions: Directing efforts towards reducing night-time SV, especially TV and PDs, may promote healthy development.

Young People’s Coping Strategies When Dealing With Their Own and a Friend’s Symptoms of Poor Mental Health: A Qualitative Study

Young people struggle to seek help for their mental health, despite having different resources available. As the coping process is very complex, and elements such as trust and availability of resources have been said to influence it, this study aimed to understand how young people cope with their own or a friend’s symptoms of poor mental health. Eleven young people (13–15 years old) were interviewed. Thematic Analysis of the interviews showed that participants reported different coping strategies for dealing with their own hypothetical symptoms and those of a friend. Participants identified the social impact of experiencing symptoms of poor mental health and choice of resources as the main factors influencing their coping strategies. For their own symptoms, young people expressed concern about being judged and that they would only disclose to someone they trust. Participants would not disclose a friend’s symptoms because they did not want to break their trust. Finally, choice of resources was mainly influenced by the severity of symptoms being experienced, especially when it comes to asking for professional help. This study contributes to a better understanding of the different ways in which young people cope with their own symptoms and symptoms experienced by a friend.

The association of mobile touch screen device use with parent-child attachment: a systematic review

Mobile touch screen devices (smartphones and tablet computers) have become an integral part of many parents' and children's lives, with this interaction linked to physical, mental and social outcomes. Despite the known importance of parent-child attachment, evidence on the association between device use and attachment was yet to be reviewed. Following protocol pre-registration, databases were searched, papers screened, and methodological quality assessed. Three papers met the inclusion criteria, and reported some negative associations between duration of parent/child smartphone use and attachment outcomes. A narrative synthesis on two groups of related papers found child time using any screen technology (including television viewing), and child 'problematic' internet, mobile phone, gaming and social media use, was negatively associated with attachment outcomes. Currently there is limited direct evidence on any association between time parents or children spend using these devices and parent-child attachment to support time guidelines for families and professionals working with families. Practitioner summary: Many parents and children regularly spend time using smartphones and tablet computers. This systematic review found limited evidence evaluating associations between child/adolescent or parent time using devices and parent-child attachment. Until quality evidence exists, practitioners should be alert to potential impacts of device use on family relationships and child outcomes.

Assessment of life factors affecting the experience of depressive symptoms in adolescents: a secondary analysis using the Korea Youth Risk Behavior Survey

BACKGROUND

Adolescents may experience several changes in their lifestyle, such as social activity and school life, which makes them vulnerable to developing a depressive disorder. Therefore, the present study aimed to identify the factors affecting the experience of depressive symptoms during adolescence.

METHODS

We conducted a secondary analysis using the 2019 Korean Youth Risk Behavior Web-based survey data, including a total of 57,303 middle and high school students selected from among 400 schools. Factors such as dietary habits, physical activity levels, time spent studying, duration of internet use, and other health risk behaviors were included in the analysis. Logistic regression analysis was performed to identify factors that predict the risk of experiencing depressive symptoms.

RESULTS

The perceived stress of Korean adolescents showed a tendency to increase with age, and high school seniors and girls were more likely to report depressive symptoms. Perceived health status, academic performance, time spent studying, physical activity, duration of internet use, and effort to control weight were associated with individual experiences of depressive symptoms.

CONCLUSION

We identified factors that influence the experience of depressive symptoms in adolescents. Our results suggest the possibility that the purpose of students' physical activities and their leisure activity preferences may be related to their emotional status. We suggest that activities that are appropriate to the culture and lifestyle of adolescents should be recommended to reduce the occurrence of depressive symptoms.

Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis

BACKGROUND

Excessive screen time ([Formula: see text] 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children's (0-18 years) screen time.

METHODS

A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children's (0-18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics.

RESULTS

The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased.

CONCLUSIONS

Both intervention content and context are important to consider when designing interventions to reduce children's screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children's screen time.

Concurrent screen use and cross-sectional association with lifestyle behaviours and psychosocial health in adolescent females

Aim:

To describe concurrent screen use and any relationships with lifestyle behaviours and psychosocial health.

Methods:

Participants wore an accelerometer for seven days to calculate physical activity sleep and sedentary time. Screen ownership and use and psychosocial variables were self-reported. Body mass index (BMI) was measured. Relationships were explored using mixed models accounting for school clustering and confounders.

Results:

In 816 adolescent females (age: 12.8 SD 0.8 years; 20.4% non-white European) use of ≥2 screens concurrently was: 59% after school, 65% in evenings, 36% in bed and 68% at weekends. Compared to no screens those using: ≥1 screens at weekends had lower physical activity; ≥2 screens at the weekend or one/two screen at bed had lower weekend moderate-to-vigorous physical activity; one screen in the evening had lower moderate-to-vigorous physical activity in the after-school and evening period; ≥1 screens after school had higher BMI; and ≥3 screens at the weekend had higher weekend sedentary time. Compared to no screens those using: 1–3 after-school screens had shorter weekday sleep; ≥1 screens after-school had lower time in bed.

Conclusion:

Screen use is linked to lower physical activity, higher BMI and less sleep. These results can inform screen use guidelines.

Does physical activity moderate the association between screen time and psychosocial development in early childhood? Analysis of a longitudinal infant cohort study in Ireland

The objective of this study was to explore the extent to which the association between screen time and psychosocial development in preschool children differed between the sexes and according to their frequency of engagement in physical activity. Data are based on a prospective cohort of Irish children, collected between 2010 and 2013 when children were ages 3 (n=9786) and 5 years (n=9001). Children's screen time (h/day), psychosocial development (Strengths and Difficulties Questionnaire), and physical activity (bouts/week) were assessed via caregiver report. The magnitude of the association between screen time and changes in behavioural difficulties differed significantly between the sexes. For boys, the association between increased screen time and the onset of behavioural problems coincided directly with a reduction in their frequency of engagement in physical activity. The association between screen time and changes in behavioural difficulties was not moderated by girls' engagement in physical activity, however; and there was no difference in the association between screen time and prosocial behaviours at different frequencies of engagement in physical activity for either boys or girls.Conclusions: Results support recommendations to establish greater balance between physical activity and sedentary behaviours in token economy systems to minimise the negative effects of excessive screen time. What is Known: • Provision of screen time has become normalised as a behavioural reinforcer for use with young children. • Screen viewing above recommended guidelines is associated with behavioural problems that reflect poor self-regulation. What is New: • Boys' levels of engagement in physical activity moderated the relationship between screen time and changes in behavioural difficulties between the ages of 3 and 5 years. • Neither screen time nor physical activity was significantly associated with changes in prosocial behaviours between the ages of 3 and 5 years for either boys or girls.

From screen time to the digital level of analysis: a scoping review of measures for digital media use in children and adolescents

OBJECTIVES

This scoping review aims to facilitate psychometric developments in the field of digital media usage and well-being in young people by (1) identifying core concepts in the area of "screen time" and digital media use in children, adolescents, and young adults, (2) synthesising existing research paradigms and measurement tools that quantify these dimensions, and (3) highlighting important areas of need to guide future measure development.

DESIGN

A scoping review of 140 sources (126 database, 14 grey literature) published between 2014 and 2019 yielded 162 measurement tools across a range of domains, users, and cultures. Database sources from Ovid MEDLINE, PsycINFO and Scopus were extracted, in addition to grey literature obtained from knowledge experts and organisations relevant to digital media use in children. To be included, the source had to: (1) be an empirical investigation or present original research, (2) investigate a sample/target population that included children or young persons between the ages of 0 and 25 years of age, and (3) include at least one assessment method for measuring digital media use. Reviews, editorials, letters, comments and animal model studies were all excluded.

MEASURES

Basic information, level of risk of bias, study setting, paradigm, data type, digital media type, device, usage characteristics, applications or websites, sample characteristics, recruitment methods, measurement tool information, reliability and validity.

RESULTS

Significant variability in nomenclature surrounding problematic use and criteria for identifying clinical impairment was discovered. Moreover, there was a paucity of measures in key domains, including tools for young children, whole families, disadvantaged groups, and for certain patterns and types of usage.

CONCLUSION

This knowledge synthesis exercise highlights the need for the widespread development and implementation of comprehensive, multi-method, multilevel, and multi-informant measurement suites.

Parental perception on screen time and psychological distress among young children

OBJECTIVE

We aimed to assess the parent-reported screen time of children, identify the perceived risk factors for increased screen time and its relationship to psychological distress in children.

MATERIALS AND METHOD

A cross sectional study was conducted at a teaching hospital in Karachi, Pakistan. A total of 230 employees from medical and non-medical departments were included. Participants were employees with child/children ages 4-12 year who consented to participate in the study, we included 135 fathers and 91 mothers. The questionnaire included (i) demographic data (ii) Media history exam form and (iii) parent reported strength and difficult questionnaire (SDQ).

RESULT

The average daily screen time reported was 2.5 (1.5-5) hour for boys and 2 (1-4) hour for girls. Preschoolers had greater screen time as compared to school-aged children (Median (IQR): 3 (1.5-5.6) vs 2 (1-4), P = 0.46). The children owned devices with approximately equal distribution of preschoolers and school-aged children (19 (27.1%) and 48 (30%), P = 0.661 respectively). Emotional score was found higher in school-aged group in comparison to preschoolers (p = 0.036). Moreover, mother screen time and number of devices owned by a child were found to be positively associated with child's screen time.

CONCLUSION

We conclude that as we are embracing the digital age providing a tech free zone to children is virtually impossible. Children screen time related activities in our part of the world exceeds the limitation. Parental awareness and co-viewing screen with their children are essential to avoid media related behavior problems.

16Up: Outline of a Study Investigating Wellbeing and Information and Communication Technology Use in Adolescent Twins

The '16Up' study conducted at the QIMR Berghofer Medical Research Institute from January 2014 to December 2018 aimed to examine the physical and mental health of young Australian twins aged 16-18 years (N = 876; 371 twin pairs and 18 triplet sets). Measurements included online questionnaires covering physical and mental health as well as information and communication technology (ICT) use, actigraphy, sleep diaries and hair samples to determine cortisol concentrations. Study participants generally rated themselves as being in good physical (79%) and mental (73%) health and reported lower rates of psychological distress and exposure to alcohol, tobacco products or other substances than previously reported for this age group in the Australian population. Daily or near-daily online activity was almost universal among study participants, with no differences noted between males and females in terms of frequency or duration of internet access. Patterns of ICT use in this sample indicated that the respondents were more likely to use online information sources for researching physical health issues than for mental health or substance use issues, and that they generally reported partial levels of satisfaction with the mental health information they found online. This suggests that internet-based mental health resources can be readily accessed by adolescent Australians, and their computer literacy augurs well for future access to online health resources. In combination with other data collected as part of the ongoing Brisbane Longitudinal Twin Study, the 16Up project provides a valuable resource for the longitudinal investigation of genetic and environmental contributions to phenotypic variation in a variety of human traits.

Physical Activity, Sedentary Time, and Diet as Mediators of the Association Between TV Time and BMI in Youth

PURPOSE

This study examined dietary indicators, sedentary time, and physical activity as potential mediators of the association between TV time and BMIz in youth.

DESIGN

Cross-sectional study in 2 independent samples of youth.

SETTING

Data collection occurred by mail and telephone for adolescents and either at home or in medical settings for children.

SAMPLE

928 youth ages 12-16 and 756 youth ages 6-12 and a parent.

MEASURES

TV time, snacking/eating while watching TV, and a 3-day dietary recall were assessed via child/parent report. Physical activity and sedentary time were assessed by accelerometer wear.

ANALYSIS

Direct and indirect associations (through 8 diet and activity variables) of TV time with BMIz were tested in boys and girls in each sample.

RESULTS

TV time had a positive association with BMIz in 6-12 year old boys and girls. Direct associations emerged between TV time and the diet/activity variables, and between diet/activity variables and BMIz. Snacking/eating while watching TV had a significant positive association with BMIz in younger boys and mediated the association between TV time and BMIz (β = .06, p = .019; 25% attenuation).

CONCLUSIONS

Snacking/eating while watching TV may be a possible reason TV time is consistently associated with obesity in youth. Targeting reductions in TV time and associated snacking could improve health impacts.

Gambling Marketing Strategies and the Internet: What Do We Know? A Systematic Review

Background: The gambling industry has developed many types of gambling on Internet in recent years. Gambling is a social activity for a majority of the world population, but problem gambling (PG) can emerge. The trajectories of gamblers from initiation to PG development are influenced by many variables, including individual and environmental variables and also variables linked to the gambling characteristics. Marketing has been reported to influence gamblers' perceptions and behaviors, but this is not as clear for digital marketing. Digital gambling marketing is broad, ranging from the marketing of gambling websites to communication and advertising on the social media and networks. The objective of this article was to fill this gap by conducting a systematic literature review in order to answer the following questions: (1) What are the strategies of digital gambling marketing? (2) What is the effect of this exposure on gambling representations, intentions and practices? Method: A systematic review was conducted following the PRISMA guidelines on Pubmed database (Medline) from February 2020 to March 2020 and Scopus. Existing papers published between January 2000 and February 2020 were identified by searching with this algorithm: ((("internet"[MeSH Major Topic] OR (communications[All Fields] AND media[All Fields])) OR ("social media"[MeSH Terms] OR ("social"[All Fields] AND "media"[All Fields]) OR "social media"[All Fields])) AND "gambling"[MeSH Major Topic]) AND ("marketing"[MeSH Terms] OR "marketing"[All Fields]), in title, keywords or abstract. Results: Ninety-one candidate studies were selected, 21 studies were selected for the systematic review. Sport appeared as a specific target of online gambling marketing. A growing range of platforms for online sport betting and the development of strategies on the social media were identified. Regarding content, a systematic association between sport and gambling was highlighted. Vulnerable populations, such as young people, appeared to be at high risk of exposure to gambling marketing. Conclusion: Little data is available on the strategies of digital gambling marketing or on exposure to it. Sport could be the first target for future research to understand how the industry is targeting specific populations, and what influence these strategies could have on PG development.

Effect of internet use and electronic game-play on academic performance of Australian children

This study examined the association of internet use, and electronic game-play with academic performance respectively on weekdays and weekends in Australian children. It also assessed whether addiction tendency to internet and game-play is associated with academic performance. Overall, 1704 children of 11–17-year-olds from young minds matter (YMM), a cross-sectional nationwide survey, were analysed. The generalized linear regression models adjusted for survey weights were applied to investigate the association between internet use, and electronic-gaming with academic performance (measured by NAPLAN–National standard score). About 70% of the sample spent > 2 h/day using the internet and nearly 30% played electronic-games for > 2 h/day. Internet users during weekdays (> 4 h/day) were less likely to get higher scores in reading and numeracy, and internet use on weekends (> 2–4 h/day) was positively associated with academic performance. In contrast, 16% of electronic gamers were more likely to get better reading scores on weekdays compared to those who did not. Addiction tendency to internet and electronic-gaming is found to be adversely associated with academic achievement. Further, results indicated the need for parental monitoring and/or self-regulation to limit the timing and duration of internet use/electronic-gaming to overcome the detrimental effects of internet use and electronic game-play on academic achievement.

Electronic based reported anthropometry-A useful tool for interim monitoring of obesity prevalence in developing states

BACKGROUND

Wide participation in electronic surveys and reliable reporting of anthropometry can serve to reduce costs associated with monitoring of obesity among adolescents where resources are limited. We conducted a single school pilot study among Caribbean adolescents to assess use of electronic surveys and whether face to face encouragement could promote enrollment. In addition, we assessed students' ability to reliably report simple anthropometry.

METHODS

Students were provided with access to an electronic survey on anthropometry and food preferences regarding school-based food offerings. Responses to survey questions were presented as percentages. A sample of students also had their heights and weights measured after reporting these measures from memory. Intra-class correlation coefficients were used to assess reliability among measurers and Bland-Altman plots, consistency between student reported and recorded anthropometric measures and Support Vector Machine to assess robustness of anthropometry prediction models.

RESULTS

Response rate to the electronic survey was low (9%). Students were able to interpret questions; open-ended options were inappropriately used 13% of the time. Post survey qualitative responses indicated displeasure with use of school-associated e-mail addresses. Concerns with confidentiality were expressed as well as preference for completion of surveys during school time. Students reliably reported anthropometry most measures fell within the 95% CI of Bland-Altman plots. SVM classified with a prediction accuracy of 95%. Estimates of overweight from recorded and reported measures were similar.

CONCLUSIONS

Adolescents are able to report simple anthropometry, and this can be used to help with monitoring of growth and overweight. Although they are capable of competently completing electronic surveys, school-based email is an ineffective contact tool. In-person school-based contact and administration of surveys are preferred. Adolescents can reliably report simple anthropometry that can be utilized for estimation of overweight/obesity prevalence. This method can be widely applied.

Screen-based behaviors in Australian adolescents: Longitudinal trends from a 4-year follow-up study

The longitudinal trends of screen time, a highly prevalent behavior in adolescents, are relatively unknown. This study examined longitudinal trends in screen time among a large sample of Australian primary school-aged children transitioning into secondary school-aged adolescence. Data were derived from the Longitudinal Study of Australian Children (LSAC). In 2010, 2179 children (49.7% boys; 10.3 ± 1.1 years) completed a time-use diary, recording their main activities during waking hours. This was repeated with the same sample in 2012 (12.4 ± 0.5 years) and 2014 (14.4 ± 0.5 years). Data were analyzed for time spent in TV viewing, computer use, electronic gaming, and social networking and online communication. Repeated-measures MANCOVA tests were performed to analyze trends in screen time. Trends were also analyzed by sex. Total screen time significantly increased (+85.9 min/day) over four years (η_p² = 0.010, P < .001), but differed by sex, with a larger increase in boys (boys: +41.6, girls: +22.7 min/day). Electronic gaming increased in boys (+43.2 min/day) and decreased in girls (-16.8 min/day). In contrast, girls reported larger increases in TV viewing (boys: +0.4, girls: +29.1 min/day), computer use (boys: +24.8, girls: +34.3 min/day) and time communicating online and social networking (boys: +4.3, girls: +15.2 min/day). To conclude, screen time among adolescents increases between the ages of 10 and 14 years, but differs by sex and screen time domain. Future screen time reduction interventions may choose to focus on recreational computer use and electronic gaming in boys and TV viewing and time spent communicating online and social networking for girls.

Healthy Lifestyle Behaviours Are Associated with Children's Psychological Health: A Cross-Sectional Study

Protecting children’s mental health is important and studies have shown that diet and exercise can have a positive impact. There are limited data available, however, from representative populations of children on the relationship between regular healthy lifestyle behaviours and psychological health. Data were obtained from the New South Wales Child Population Health Survey, 2013–2014. Parents were asked about diet, physical activity and screen time behaviours and completed the Strengths and Difficulties Questionnaire (SDQ) for one child aged 5–15. Higher SDQ scores indicate poorer psychological health and risk for mental health problems. Multivariable linear and logistic regression examined the relationships among dietary consumption, physical activity, screen time and SDQ scores, adjusting for potential confounding. Meeting screen time recommendations was most strongly associated with a lower SDQ total difficulties score (5–10 years: −1.56 (−2.68, −0.44); 11–15 years: −2.12 (−3.11, −1.12)). Children and adolescents who met screen time recommendations were also significantly less likely to have any score in the at-risk range. Children and adolescents meeting vegetable intake guidelines had significantly lower total difficulties scores (5–10 years: −1.54 (−3.03, −0.05); 11–15 years: −1.19 (−3.60, −0.39)), as did adolescents meeting discretionary food guidelines (−1.16 (−2.14, −0.18)) and children consuming the recommended fruit intake (−1.26 (−2.42, −0.10)). Our findings indicate that more effective interventions to increase the proportion of young Australians who meet the guidelines for diet and screen time would contribute to protecting their mental health.

How Much Is Too Much? Examining the Relationship Between Digital Screen Engagement and Psychosocial Functioning in a Confirmatory Cohort Study

OBJECTIVE

Previous studies have offered mixed results regarding the link between digital screen engagement and the psychosocial functioning of young people. In this study, we aimed to determine the magnitude of this relation, to inform the discussion regarding whether amount of digital screen time has a subjectively significant impact on the psychosocial functioning of children and adolescents.

METHOD

We analyzed data from primary caregivers participating in the National Survey of Children's Health (NSCH), an annual nationally representative survey fielded by the US Census Bureau between June 2016 and February 2017. NSCH uses an address-based sampling frame and both Web- and paper-based data collection instruments to measure psychosocial functioning and digital engagement, including a modified version of the Strengths and Difficulties questionnaire and caregiver estimates of daily television- and device-based engagement, respectively.

RESULTS

The expected parabolic inverted-U-shaped relationship linking digital screen engagement to psychosocial functioning was found. These results replicated past findings suggesting that moderate levels of screen time (1-2 hours a day) were associated with slightly higher levels of psychosocial functioning compared to lower or higher levels of engagement. Furthermore, it indicated that children and adolescents would require 4 hours 40 minutes of television-based engagement and 5 hours 8 minutes of daily device-based engagement before caregivers would be able to notice subjectively significant variations in psychosocial functioning.

CONCLUSION

The possible influence of digital screen engagement is likely smaller and more nuanced than we might expect. These findings do not rule out the possibility that parents might only notice very high levels of screen time when their child manifests pronounced psychosocial difficulties. Future work should be guided by transparent and confirmatory programs of research.

The indirect influence of child play on the association between parent perceptions of the neighborhood environment and sense of community

The neighborhood is a critical setting that broadly affects health, although specific mechanisms that link relationships between the neighborhood environment and indicators of health are still emerging. Children playing is a simple, but underexplored marker that may explain how the neighborhood built environment is related to a psychological sense of community. A telephone survey was conducted among parents with children in the Greater Phoenix Metropolitan area (n = 251) to gather information on perceptions of the built environment, parent attitudes and physical activity behaviors, children's play, and sense of community in the neighborhood. Results of a structural equation modeling analysis (SEM) indicated that children playing in the neighborhood partially explained the relationship between perceptions of the built environment and sense of community (β = 0.031, CI = 0.007-0.067). Parent perceptions of the built environment were positively associated with both children playing (β = 0.229, CI = 0.120-0.341) and sense of community (β = 0.360, CI = 0.220-0.505), and children playing (β = 0.135, CI = 0.027-0.243) and parent attitudes (β = 0.440, CI = 0.319-0.546) were positively related to sense of community. As planners and community advocates consider strategies to build a sense of community within neighborhoods, the importance of favorable environmental conditions that facilitate children's play should be considered.

Exploring the Reliability and Validity of the TechU-Q to Evaluate Device and Purpose Specific Screen Use in Preschool Children and Parents

Young children are increasingly using mobile technology, with potential for positive and negative developmental consequences. Parents are responsible to guide children in their use of technology based on recommendations and guidelines. Guidelines for screen use in young children have been based on little empirical information on contemporary screen use. This study surveyed parents of young children (n = 96, mean child age 3.0, SD 1.0 years) from three settings (Australia, United States) to test the reliability and validity of a new tool to capture richer data on technology use within a techno-microsystem. The TechU-Q demonstrated reasonable test-retest reliability and face and construct validity. Young children averaged more than 60 min per day of total technology use, mostly using TV, tablet computers, and mobile phones. The primary purposes for child use were educational and watching videos. Parental attitudes towards technology and parent use were associated with their child's use. Future guidelines should utilize detailed descriptions of technology use by device and purpose to provide more relevant advice on technology use for young children.

Associations between Childhood and Adolescent Emotional and Behavioral Characteristics and Screen Time of Adolescents

The correlations between emotional and behavioral problems and increased screen time among young people has been highlighted in the literature. This study examined both longitudinal and cross-directional associations between the degree of childhood and adolescent emotional and behavioral problem characteristics and a higher level of daily screen time in adolescence using an extensive population study. Questionnaires providing data on a representative cohort sample (the Northern Finland Birth Cohort 1986 Study, NFBC 1986; n = 6479; 3101 males) were completed at birth, in childhood, and in adolescence. Male gender, and self-reported behavioral issues (such as a higher degree of hyperactivity/distractibility problems at the beginning of formal schooling and adolescent rule-breaking problems), predicted higher daily screen time in adolescence, after controlling for confounding factors. Higher levels of anxious-depression symptoms among adolescents were inversely related to them having elevated daily digital screen time. Individual behavioral tendencies at the start of formal schooling and later in adolescence may predict higher screen time among young people.

Social inequalities in traditional and emerging screen devices among Portuguese children: a cross-sectional study

BACKGROUND

Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in pre-school and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP).

METHODS

A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children's screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children's age, gender and family SEP (classified using father's educational degree).

RESULTS

Daily screen time was high both in children aged 3 to 5 and 6 to 10 years - 154 min/day (95% CI: 149.51-158.91) and 200.79 min/day (95% CI: 197.08-204.50), respectively - and the majority of children, independently of their gender, exceed the recommended 2 h/day of screen viewing. Children are still primarily engaging in screen time through television but the use of mobile devices, particularly tablets, were already high among 3 year-old children and increased with age. SEP was a negative predictor of screen time in the linear regression analysis, including after adjustment.

CONCLUSIONS

Considering the negative health impacts of excessive screen time, recognizing subgroups at risk of excessive screen time and identifying how each device is used according to age is fundamental to enable appropriate future interventions. The screen time in children aged 3-10 years is longer than the recommended, particularly among boys and in those children from lower SEP. Parents and policymakers should have in mind that children spend most of their screen time watching television but mobile devices are becoming extremely popular starting at a young age.

Ellis D, C. Hunter S, Houghton S. The Conceptual and Methodological Mayhem of "Screen Time"

Debates concerning the impacts of screen time are widespread. Existing research presents mixed findings, and lacks longitudinal evidence for any causal or long-term effects. We present a critical account of the current shortcomings of the screen time literature. These include poor conceptualisation, the use of non-standardised measures that are predominantly self-report, and issues with measuring screen time over time and context. Based on these issues, we make a series of recommendations as a basis for furthering academic and public debate. These include drawing on a user-focused approach in order to seek the various affordances gained from “screen use”. Within this, we can better understand the way in which these vary across time and context, and make distinction between objective measures of “screen time” compared to those more subjective experiences of uses or affordances, and the differential impacts these may bring.

Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents

OBJECTIVES

Emerging evidence suggests that inconsistent sleep may affect physical and psychological health. Thus, it is important to identify modifiable determinants of sleep variability. Screen time and physical activity are both thought to affect sleep, but studies of their relationship to sleep variability using objective measures are lacking. We examined cross-sectional associations between these variables in mid-teen adolescents using objectively measured sleep and activity.

METHODS

Wrist-worn accelerometers were used to measure one week of sleep and activity in 315 tenth grade students (mean age 15.8y) from six Reykjavík compulsory schools. Participants reported their daily hours of screen time. Regression analysis was used to explore associations of screen time and physical activity with variability in duration, quality, and timing of sleep, adjusting for DXA-measured body fat percentage, parental education, and physical activity or screen time.

RESULTS

Screen time, especially game playing, was associated with variability in duration, timing, and quality of sleep, most strongly with variation in bedtime. Physical activity was inversely associated with variability in duration, timing, and quality of sleep, most strongly with variation in the number of awakenings. Boys had less stable sleep patterns and higher screen time than girls, and sex-specific associations of screen time with sleep variability parameters were significant for boys only.

CONCLUSIONS

Less screen time and more physical activity were independently associated with less sleep variability among mid-teen adolescents. Our results indicate that encouraging youngsters toward an active lifestyle with limited screen use may be important to achieve more consistent sleep.

Associations between meeting sleep, physical activity or screen time behaviour guidelines and academic performance in Australian school children

BACKGROUND

Current guidelines suggest too little sleep, too little physical activity, and too much sedentary time are associated with poor health outcomes. These behaviours may also influence academic performance in school children. The primary purpose of this study was to examine the relationships between sleep, physical activity, or sedentary behaviours and academic performance in a school with a well-developed and integrated technology use and well-being program.

METHODS

This was a cross-sectional survey of students (n = 934, Grades 5-12) in an Australian school with a bring-your-own device (tablet or laptop computer) policy. Students reported sleep, physical activity, and sedentary (screen and non-screen) behaviours. Academic performance was obtained from school records. Linear regressions were used to test the association between behaviours and academic performance outcomes.

RESULTS

Seventy-four percent of students met sleep guidelines (9 to 11 h for children 5-13 years and 8 to 10 h for 14-17 year olds), 21% met physical activity guidelines (60 min of moderate-to-vigorous physical activity every day), and 15% met screen time guidelines (no more than 2 h recreational screen time per day); only 2% met all three. There were no associations between meeting sleep guidelines and academic performance; however later weekend bedtimes were associated with poorer academic performance (- 3.4 points on the Average Academic Index, 95%CI: - 5.0, - 1.7, p < .001). There were no associations between meeting physical activity guidelines and academic performance. Meeting screen guidelines was associated with higher Average Academic Index (5.8, 95%CI: 3.6, 8.0, p < .001), Maths 7.9, 95%CI: 4.1, 11.6, p < .001) and English scores (3.8, 95%CI: 1.8, 5.8, p < .001) and higher time in sedentary behaviours was associated with poorer academic performance, including total sedentary behaviours in hrs/day (5.8 points on Average Academic Index, 95%CI: 3.6, 8.0, p < .001. Meeting at least two of the three behaviour guidelines was associated with better academic performance.

CONCLUSIONS

Sleep and sedentary behaviours were linked to academic performance. School communities should emphasize comprehensive wellness strategies to address multiple behaviours to maximize student health and academic success.

The relationship between screen-based sedentary behaviors and symptoms of depression and anxiety in youth: a systematic review of moderating variables

Background

To elucidate the populations and conditions where screen-based sedentary behaviors (SB) and internalizing symptoms are coupled, this review synthesized the evidence for factors that may moderate the associations between screen-based SB, depressive symptoms, and anxiety symptoms among youth.

Methods

Two independent researchers conducted a systematic literature search of the Medline, psycINFO, and Scopus electronic databases in late 2018 for observational studies assessing moderators of the association between screen-based SB and depressive and anxiety symptoms. Studies among children and adolescents were eligible if moderation was assessed by statistical test (interaction) or stratification; and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines.

Results

Seventy empirical studies (46 cross-sectional, 19 longitudinal, and 5 both) of 13 different moderating variables of screen-based SB-internalizing symptom associations met the eligibility criteria. Of these, 40 studies were of depressive symptoms, 2 were of anxiety symptoms, and 28 studies assessed symptoms of both. The most consistent evidence of moderation was for screen-type, such that TV viewing was not as strongly associated with internalizing symptoms compared to other forms of screen-based SB. There was also inconsistent evidence for physical activity buffering screen-based SB-internalizing symptom associations and for female sex amplifying screen-based SB-internalizing symptom associations. In general, the body of evidence for anxiety symptoms was more limited than that for depressive symptoms, and were therefore more inconsistent.

Conclusions

Screen-type, physical activity, and sex may influence the magnitude of screen-based SB-internalizing symptom coupling; highlighting potential sources of heterogeneity of screen-based SB-internalizing symptom associations. Additional studies aimed at understanding potential mechanistic explanations for the above moderators are needed prior to the development of tailored intervention strategies designed to decouple screen-based SB and internalizing symptoms among youth.

Reciprocal associations between depression and screen-based sedentary behaviors in adolescents differ by depressive symptom dimension and screen-type

BACKGROUND

The heterogeneity of depression and sedentary behavior complicates understanding of mechanisms underlying and interventions addressing comorbid depression and sedentary behavior in adolescents. This study investigated reciprocal associations between four depressive symptom dimensions and two types of screen-based sedentary behaviors in adolescents, and tested whether these associations differed by sex.

METHODS

A school-based longitudinal cohort (N = =2,717, baseline Mage=14.57 years) completed questionnaires during two assessments one year apart. Participants reported on levels of four depressive symptom dimensions (continuous) and television viewing and computer/videogame use (≥2 h/day; yes vs. no).

RESULTS

Reciprocal associations between computer/videogame use and higher negative affect symptoms were observed (computer/video games predicting negative affect, β=0.06, 95%CI 0.01-0.11, p = =0.01; negative affect predicting computer/video games, OR 1.29, 95%CI 1.06-1.58, p = =0.01). The relationship between baseline computer/videogame use and subsequent negative affect differed by sex (p = =0.02), and was significant in girls (β=0.11, 95%CI 0.04-0.18, p = =0.002), but not boys (β=0.004, 95%CI -0.06-0.07, p = =0.90). Baseline computer/videogame use predicted somatic symptoms at follow-up (β=0.06, 95%CI 0.01-0.10, p = =0.02), but the reverse association was non-significant. Higher baseline positive affect predicted computer/videogame use at follow-up (OR 1.16, 95%CI 1.02-1.31, p = =0.02), but the reverse association was non-significant. Television viewing was unrelated to each depressive symptom dimension in either direction.

LIMITATIONS

Self-reports may be subject to recall errors and biases, and do not provide clinical diagnoses.

CONCLUSIONS

Associations are not uniform across screen-based sedentary behavior type, depressive symptom dimension, and sex. The association between computer/videogame use and negative affect symptoms may be reciprocal across time and particularly robust among girls.

Relationship between screen-time and hand function, play and sensory processing in children without disabilities aged 4-7 years: A exploratory study

INTRODUCTION

Screen-time has become a regular occupation for young children at home and school, with little evidence of its impact on children's developmental skills. This study explored the association between children's screen-time, fine motor, in-hand manipulation (IHM), visual-motor integration (VMI), sensory processing (SP) and parent-reported play skills.

METHOD

The fine motor, IHM, VMI, SP and play skills of a sample of 25 Australian children without disabilities (M age = 6.2 years, SD = 1.03; 64% girls) were assessed using the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, Test of In-Hand Manipulation-Revised, Berry Buktenica Developmental Test of Visual-Motor Integration Sixth Edition, Sensory Processing Measure-Home Form and Pretend Play Enjoyment Developmental Checklist (PPEDC). Parents completed a week-long log of their child's screen-time. Spearman's rho correlations and linear regressions with bootstrapping were used for data analysis.

RESULTS

Statistically significant moderate level negative correlations were found between Total Screen-Time (TST) and VMI skills (r = -.67, p < .01); Interactive Screen-Time and IHM abilities (r = -.46, p < .05) and TST and bilateral coordination skills (r = -.42, p < .05). There were significant negative correlations between SP ability and both TST (r = -.53, p < .01) and Watching Screen-Time (r = -.66, p < .01). When the PPEDC Object Substitution variable was entered into a regression model as a co-variate of hand function, it appeared to lessen the impact of TST as an independent predictor variable of children's VMI and bilateral coordination skills (p < .23 and p < .61).

CONCLUSION

Playing with toys and using object substitution in play (e.g. a child uses an object for something else other than its intended use when playing with it) potentially appear to be a moderating factor of the impact of children's screen-time on their bilateral coordination and VMI skills. Clinicians can encourage children's active and dynamic involvement in games and play pursuits to counteract the potential impact of increased use of devices that involve screen-time.

Longitudinal relationships between sexting and involvement in both bullying and cyberbullying

INTRODUCTION

Sexting is a new way to explore sexuality among adolescents that can be associated with bullying behaviors. Previous studies have focused on peer-victimization but relationships between bullying and different forms of sexting have not been explored. This study evaluates the reciprocal relationships between the perpetration of traditional bullying, cyberbullying, and four forms of sexting (sending, receiving, third-party forwarding, and receiving sexts via an intermediary).

METHODS

The sample consisted of 1736 Spanish High School students (46.3% female; M_age = 13.60, SD = 1.25). Four direct questions were used to assess sexting, the EBIPQ to measure traditional bullying and the ECIPQ to evaluate cyberbullying. These measures were completed twice, four months apart. A cross-lagged panel analysis evaluated the reciprocal associations of all study measures.

RESULTS

Traditional bullying and cyberbullying were positively, reciprocally associated with each other. Generally, those young people who engaged in sexting at T1 were more likely to report engaging in sexting at T2. Third-party forwarding of sexts (forwarding on sexts which have been sent to a young person by others) displays clear relationships with bullying. Young people who reported using traditional bullying behaviours at T1 were more likely to report third-party forwarding of sexual content at T2. Bullies are more likely to later report third-party forwarding of sexts.

CONCLUSIONS

A focus on bullying behavior may be important for intervention efforts targeting to prevent possible negative outcomes of engaging in sexting. Recommendations are provided for educational and prevention efforts.

Mobile touch screen device use and associations with musculoskeletal symptoms and visual health in a nationally representative sample of Singaporean adolescents

This study aimed to describe contemporary technology use, especially smartphones and tablets (mobile touch screen devices), and examine associations with musculoskeletal symptoms and visual health among adolescents in Singapore. A representative sample of 1884 adolescents (50.4% girls) from grades primary 5 to post-secondary (10-18 years old), recruited from 13 schools, completed an online questionnaire in class. Total technology use was high, with smartphone duration being highest (mean = 264 [SD = 243] min/day). Patterns of use, including multitasking and bout length, were influenced by gender, school level, type of device and activities. Musculoskeletal discomfort and visual symptoms were commonly reported. After adjusting for potential confounders, more hours/day of smartphone use was associated with increased risk of neck/shoulders, upper back, arms and wrist/hand discomfort (OR = 1.04[95%CI = 1.01-1.07] to 1.07[1.03-1.10]) and visual symptoms (OR = 1.05[1.02-1.08]), but was associated with decreased odds of myopia (OR = 0.97[0.94-0.99]). No significant associations were found for tablet use. Practitioner Summary: 1884 adolescents in Singapore completed an in-depth questionnaire regarding their use of technology. The smartphone was the device with the highest usage, and greater smartphone use was associated with increased odds of musculoskeletal and visual symptoms. High use of smartphones has physical health implications for adolescents.

Digital Screen Time and Pediatric Sleep: Evidence from a Preregistered Cohort Study

OBJECTIVES

To determine the extent to which time spent with digital devices predicts meaningful variability in pediatric sleep.

STUDY DESIGN

Following a preregistered analysis plan, data from a sample of American children (n = 50 212) derived from the 2016 National Survey of Children's Health were analyzed. Models adjusted for child-, caregiver-, household-, and community-level covariates to estimate the potential effects of digital screen use.

RESULTS

Each hour devoted to digital screens was associated with 3-8 fewer minutes of nightly sleep and significantly lower levels of sleep consistency. Furthermore, those children who complied with 2010 and 2016 American Academy of Pediatrics guidance on screen time limits reported between 20 and 26 more minutes, respectively, of nightly sleep. However, links between digital screen time and pediatric sleep outcomes were modest, accounting for less than 1.9% of observed variability in sleep outcomes.

CONCLUSIONS

Digital screen time, on its own, has little practical effect on pediatric sleep. Contextual factors surrounding screen time exert a more pronounced influence on pediatric sleep compared to screen time itself. These findings provide an empirically robust template for those investigating the digital displacement hypothesis as well as informing policy-making.

Young people's awareness of the timing and placement of gambling advertising on traditional and social media platforms: a study of 11-16-year-olds in Australia

BACKGROUND

Research has demonstrated that the promotion of gambling, particularly within sport, may have a significant impact on positively shaping young people's attitudes towards gambling. While some governments have implemented restrictions to limit young people's exposure to gambling advertising, few studies have investigated where young people recall seeing gambling advertising, and whether they perceive that advertising restrictions have gone far enough in reducing exposure to these promotions.

METHOD

Mixed methods, interviewer-assisted surveys were conducted with n = 111 young people aged 11-16 years, who were self-reported fans of basketball in Victoria, Australia. Interviews were conducted at basketball stadiums between May and July 2018. The study assessed media viewing patterns; recall and awareness of the timing, placement, and content of gambling advertising; the impact of gambling advertising restrictions; and attitudes towards sporting organisations' roles in the promotion of gambling.

RESULTS

The majority of young people recalled seeing gambling advertising on television (n = 101, 91.0%), with most recalling advertising within sporting matches or games (n = 79, 71.2%). Most young people recalled seeing gambling advertising in the early evening before 8:30 pm (n = 75, 67.6%). Just over half of young people described seeing gambling advertisements on social media (n = 61, 55.0%), and over a third (n = 40, 36.0%) recalled gambling advertising on YouTube, predominantly before watching sporting or gaming videos. The majority stated that they continued to watch sport after 8:30 pm (n = 93, 83.7%), which is when restrictions on advertising in live sport in Australia end. The majority (n = 88, 79.3%) stated that there were too many gambling advertisements in sport. Three quarters believed that sporting codes should do more to prevent young people from being exposed to advertising for gambling in sport (n = 84, 75.7%).

CONCLUSIONS

There is now a clear body evidence that current regulatory systems for gambling advertising are ineffective, with further restrictions urgently needed across a range of media channels to prevent exposure to promotions that may encourage young people's interest and involvement in gambling.

Screen time exposure and sleep among children with developmental disabilities

AIM

Children with developmental disabilities are at risk of excessive screen time and are more vulnerable to sleep problems. The aim of this study was to determine the extent of screen time use in children with developmental disabilities and its relationship with sleep duration.

METHODS

Consecutive children aged 6-15 years diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth or Fifth Edition (DSM-IV or DSM-5) developmental disabilities were recruited for this study from December 2014 to April 2015. Of those recruited, 87.0% of families gave consent and provided questionnaire information on demographics and child's screen time use and completed the Children's Sleep Habits Questionnaire.

RESULTS

Parents of 102 children in a tertiary-care developmental clinic completed the study. The mean age of children was 10 years, 1 month (standard deviation (SD), 22.7 months). The mean daily total screen time exposure was 2 h, 52.7 min (172.7 min, SD 120.8 min), with a median of 150.0 min. The mean amount of sleep per weekday was 8 h, 23.3 min (SD 64.6 min). Linear regression showed that, for every additional 9.17 min of screen time per day, sleep was reduced by 1 min (β = -0.11, P = 0.04). Older age (β = -0.64, P = 0.02) and living with a single parent (β = -69.29, P = 0.003) were also associated with less sleep.

CONCLUSIONS

Among children with developmental disabilities, greater daily screen time is associated with lower sleep duration. Older children and those from single-parent families are at risk of lower sleep duration. Clinicians should routinely ask about screen time exposure and sleep habits in order to provide appropriate anticipatory guidance.