Development and evaluation of the digital-screen exposure questionnaire (DSEQ) for young children

Association of digital media use with sleep habits in school children: A cross-sectional study

Background

The use of digital media (DM) is increasing among school-children, which can affect their sleep habits. The primary objective of this study was to evaluate the association of DM use with sleep habits in school-children.

Methods

It was a cross-sectional study of healthy school children. Sleep habits and DM use were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and SCREENS-Q, respectively. The Pearson correlation coefficient was used to establish the correlation between the two variables. Logistic regression analysis was performed to quantify the extent of association between variables. A p-value <0.05 was considered statistically significant.

Results

A total of 205 children were enrolled with a mean (SD) age of 7.1 (2.1) years. The mean (SD) sleep duration was 7.58 (0.80) hours. The mean (SD) CSHQ score was 50.6 (5.1). Use of DM was observed in 204 (99.5 %) children. On multivariate logistic regression analysis, DM use ≥2 h/day was significantly associated with higher CSHQ score (OR 1.28, 95%CI 1.18-1.40; p = 0.001). Sleep domains significantly affected by DM use ≥2 h/day were bedtime resistance (OR 1.55, 95 % CI 1.24-1.94; p < 0.001), sleep duration (OR 0.40, 95 % CI 0.28-0.58:p < 0.001), sleep anxiety (OR 1.69, 95%CI 1.40-2.04:p < 0.001), night awakening (OR 4.81 95 % CI 2.98-7.78:p < 0.001), parasomnias (OR 1.86, 95 % CI 1.45-2.38:p < 0.001), and daytime sleepiness (OR1.89,95 % CI 1.52-2.36: p < 0.001). DM use 30 min before bedtime was significantly associated with a higher CSHQ score (OR 1.32, 95 % CI 1.20-1.45; p < 0.001). In bivariate regression analysis, DM use ≥2 h/day was associated with poor academic performance (OR 2.36 95 % CI 1.28-4.35; p 0.006).

Conclusion

This study has shown that the average sleep duration in children was shorter than the recommended duration. DM use was common in school children and it has a significant association with sleep habits especially with use of ≥2 h/day and 30 mints before bedtime. It was also associated with poor academic performance. Public awareness on effect of DM use in school children is the need of the hour.

Effectiveness of a program to lower unwanted media screens among 2-5-year-old children: a randomized controlled trial

Background

Limited interventions exist on reducing unwanted screen time (ST) among children from low- and middle-income countries (LMICs), so we developed and assessed the effectiveness of the program to lower unwanted media screen time (PLUMS) among children aged 2-5 years in Chandigarh, Union Territory, North India.

Methods

An open-label randomized control parallel group trial per CONSORT guidelines was conducted among randomly selected 340 families with children aged 2-5 (±3 months) years in Chandigarh, India. PLUMS was implemented at the family level with a focus on modifying the home media environment and targeted individual-level interventions using parent and child modules for 2 months. A post-intervention (immediately) and a follow-up assessment after 6 months was done. During the follow-up period, the interaction was done passively via WhatsApp groups. The control group received routine healthcare services. Validated and standardized tools, including a digital screen exposure questionnaire with a physical activity component, preschool child behavior checklist, and sleep disturbance scale for children, were used to collect data at baseline, post-intervention, and follow-up periods. The primary outcome was the mean difference in ST (minutes/day) among children in the intervention group versus the control group. Generalized estimating equation (GEE) analysis was performed to adjust for clustering.

Results

An equal number of families (n = 170) were randomly assigned to the intervention and control arms. In the post-intervention assessment, 161 and 166 families continued while, at the follow-up assessment, 154 and 147 were in the intervention and control arm, respectively. The mean difference in ST on a typical day [27.7 min, 95% Confidence Interval (CI) 5.1, 50.3] at the post-intervention assessment significantly (p < 0.05) decreased in the intervention (102.6 ± 98.5 min) arm as compared with the control (130.3 ± 112.8 min) arm. A significant reduction in ST (β = -35.81 min, CI -70.6, -1.04) from baseline (β = 123.1 min) to follow-up phase (β = 116 min) was observed in GEE analysis. The duration of physical activity increased both at post-intervention (β = 48.4 min, CI = +6.6, +90.3) and follow-up (β = 73.4 min, CI = 36.2, 110.5) assessments in the intervention arm.

Conclusion

The PLUMS intervention significantly reduced the children's mean ST on a typical day and increased the physical activity immediately post-intervention and during the 6-month follow-up period. These results might guide the policymakers to include strategies in the national child health programs in the Southeast Asia Region to reduce unwanted ST.Clinical trial registration: https://clinicaltrials.gov/, identifier CTRI/2017/09/009761.

Jordanian parental perception of screen time and its association with psychological distress: A cross-sectional design

BACKGROUND

The excessive use of electronic devices among children is a global concern because of its negative impact on behavior. This cross-sectional study aimed to assess parents' awareness of their children's electronic device use and their perspective on how screen time affects behavior for 4-10-year-olds in Jordan.

METHODS

A cross-sectional study was conducted to assess parents' awareness of their children's electronic device usage. The study included 807 mothers and fathers from Jordan with at least one child aged 4 to 10. The data collection instrument consisted of a self-administered survey with 43 questions, including sociodemographic characteristics and the Strength and Difficulties Questionnaire. Descriptive analysis, categorical Chi-square test, Independent t-test, and Mann-Whitney U test were used for statistical analysis. The study followed ethical standards and principles.

RESULTS

A survey of 807 parents in Jordan found that gaming and videos were the most common content watched by children, and 61.3% used devices alone. Only 37.1% of parents believed that device use could improve their children's psychological growth, while 72.7% and 65.9% believed it could impact negatively their children's mental and psychological growth, respectively. The Strengths and Difficulties Questionnaire showed that 51.4% of children were normal, while 25.3% were borderline and 23.3% were abnormal.

CONCLUSION

Children in the study used electronic devices excessively and this was linked to severe behavioral problems. Parents should follow AAP guidelines and spend more time with their children through non-electronic activities to improve their behavior.

Unsupervised Screen Exposure and Poor Language Development: A Scoping Review to Assess Current Evidence and Suggest Priorities for Research

Screen exposure has both negative and positive effects on the level of language skills a child acquires. The purpose of this review is to address current literature on the possible relationship between unsupervised screen exposure and language development in children and to provide recommendations to caregivers regarding screen exposure of children, taking into consideration the possible effects. A scoping review was conducted using the PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) database. A total of 590 articles were retrieved and considered for inclusion. Twenty-one articles were finally included and reviewed with an emphasis on language, communication, and executive skills as well as cognitive development. The negative effects of screen exposure for children outweigh the positive effects. The largest number of studies demonstrate that unsupervised screen exposure may negatively impact a child's language usage and cognitive and executive skills, disrupt playtime, and affect the quality of sleep. On the other hand, supervised screen use is associated with improved language skills. More evidence is needed on unsupervised exposure in children to new types of screens. As technology could play a significant role in schools in the future, additional research is required to create educational media for schoolchildren with specific guidelines.